Urinary steroid metabolites and the overgrowth of lean and fat tissues in obese girls

The Impact of Obesity on the Excretion of Steroid Metabolites in Boys and Girls: A Comparison with Normal-Weight Children

Obesity in childhood is associated with several steroid changes, which result from excess body mass. The aim of this study was to evaluate steroid metabolism in children with obesity compared with those with normal weight, especially in relation to sex and puberty progress. We analyzed the clinical data of 191 children, aged between 5 and 18 years, with 115 affected (64 girls and 51 boys) and 76 unaffected (35 girls and 41 boys) by obesity. Routine clinical assessment and pubertal stage evaluation based upon Tanner's scale were performed. In addition, to evaluate the impact of puberty, children with pre-adolescence and advanced puberty were divided into separate subgroups. Then, 24 h urine steroid excretion profiles were analyzed by gas chromatography/mass spectrometry. Significant differences in the excretion of steroid metabolites were found between normal weight children and children with obesity, especially in the prepubertal cohort. In this group, we observed enhanced activity in all the pathways of adrenal steroidogenesis. Raised excretion of mineralocorticoid derivatives such as tetrahydro-11-deoxycorticosterone, tetrahydrocorticosterone, and 5α-tetrahydrocorticosterone supported increased activity of this track. No significant differences were detected in the excreted free forms of cortisol and cortisone, while the excretion of their characteristic tetrahydro-derivatives was different. In pre-adolescent children with obesity, α-cortol and especially α-cortolone appeared to be excreted more abundantly than β-cortol or β-cortolone. Furthermore, in children with obesity, we observed elevated androgen excretion with an enhanced backdoor pathway. As puberty progressed, remarkable reduction in the differences between adolescents with and without obesity was demonstrated.

The physical activity, stress and metabolic syndrome triangle: a guide to unfamiliar territory for the obesity researcher

Research aimed at deciphering the aetiology of obesity and the metabolic syndrome remains focused on two behavioural factors, namely diet and physical activity, even though epidemiologic research suggests that these two cornerstones of treatment and prevention account for only a small-to-moderate portion of the variance in these phenotypes. In recent years, this observation has prompted the intensified investigation of the pathogenic potential of factors that extend beyond the traditional concept of energy imbalance and examine the putative causes of this imbalance. Psychosocial stress has emerged as one such factor, raising the need for researchers to be informed about this expansive and complex literature. The purpose of this review is twofold (i) To introduce obesity researchers to fundamental concepts and historically important theoretical developments in the stress field and (ii) To outline the dyadic and triadic interactions between stress, physical activity and the metabolic syndrome. Although the expansion of the research focus to multiple, diverse and interacting putative causal agents will certainly increase the complexity of the research enterprise, this step seems essential for the comprehension and effective response to the continuing rise in the prevalence of obesity and the metabolic syndrome.

Adrenocortical activity in healthy children is associated with fat mass

BACKGROUND

Excess endogenous or exogenous cortisol is a potent stimulus for fat gain.

OBJECTIVE

We examined whether physiologic variations in endogenous cortisol secretion may be associated with changes in body composition during growth.

DESIGN

Anthropometric measurements and 24-h excretion rates of urinary free cortisol (UFF) and cortisone (UFE) and the sum of 3 major glucocorticoid metabolites (GC), which reflects overall daily cortisol secretion, were determined cross-sectionally in healthy preschool (50 boys and 50 girls aged 4-5 y), late prepubertal (50 boys and 50 girls aged 8-9 y), and pubertal (50 males aged 13-14 y and 50 females aged 12-13 y) subjects.

RESULTS

Significant positive associations (P < 0.001) were found between GC excretion and fat mass, percentage body fat, and body mass index by using covariance analysis adjusted for the grouping factors sex and age. The relations between GC and indexes of body fat remained significant (P < 0.05) even after GC was corrected for individual body surface area and the effect of maternal body mass index on fatness was considered. No consistent associations with fat indexes were seen for UFF, UFE, or the ratio of major urinary cortisol to cortisone metabolites, which reflects 11 beta-hydroxysteroid dehydrogenase type 1 activity.

CONCLUSIONS

Although direct effects of UFF and UFE on body composition were not shown, our findings strongly suggest that a higher adrenocortical activity is one endocrine-metabolic feature of healthy children with higher body fat. Whether urinary GC is a long-term predictor of fat gain during childhood should be analyzed in future studies.

Obesity and cortisol

Cortisol in obesity is a much-studied problem. Previous information indicates that cortisol secretion is elevated but that circulatory concentrations are normal or low, suggesting that peripheral disappearance rate is elevated. These studies have usually not taken into account the difference between central and peripheral types of obesity. Recent studies using saliva cortisol have indicated that the problem is complex with both high and low secretion of cortisol, perhaps depending on the status of the function of the hypothalamic-pituitary-adrenal gland axis. A significant background factor seems to be environmental stress. The results also suggest that the pattern of cortisol secretion may be important. Other neuroendocrine pathways are also involved, including the central sympathetic nervous system, the gonadal and growth hormone axes, and the leptin system. In concert, these abnormalities seem to be responsible for the abnormal metabolism often seen in central obesity. Several associated polymorphisms of candidate genes may provide a genetic background. Cortisol conversion to inactive metabolites may be a factor increasing central signals to secretion and may add to the increased secretion of cortisol induced by centrally acting factors. Perinatal factors have been found to be involved in the pathogenesis of obesity and its complications. The mechanism involved is not known, but available information suggests that programming of the hypothalamic-pituitary-adrenal axis may be responsible.

Neuroendocrine perturbations as a cause of insulin resistance

Insulin resistance is followed by several prevalent diseases. The most common condition with insulin resistance is obesity, particularly when localized to abdominal, visceral regions. A summary of recent reviews on the pathogenesis of systemic insulin resistance indicates that major factors are decreased insulin effects on muscular glycogen synthase or preceding steps in the insulin signalling cascade, on endogenous glucose production and on circulating free fatty acids (FFA) from adipose tissue lipolysis. Contributions of morphologic changes in muscle and other factors are considered more uncertain. Newly developed methodology has made it possible to determine more precisely the neuroendocrine abnormalities in abdominal obesity including increased cortisol and adrenal androgen secretions. This is probably due to a hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, amplified by inefficient feedback inhibition by central glucocorticoid receptors, associated with molecular genetic defects. Secondly, secretion of gender-specific sex steroid hormones becomes inhibited and the sympathetic nervous system activated. At this stage the HPA axis shows signs of a 'burned-out' condition, and cortisol secretion is no longer elevated. Cortisol counteracts the insulin activation of glycogen synthase in muscle, the insulin inhibition of hepatic glucose production and the insulin inhibition of lipolysis in adipose tissue, leading to the well-established systemic insulin resistance caused by excess cortisol. This is exaggerated by increased free fatty acid mobilization, particularly with a concomitant elevation of the activity of the sympathetic nervous system. Furthermore, capillarization and fiber composition in muscle are changed. These are the identical perturbations responsible for insulin resistance in recent reviews. The diminished sex steroid secretion in abdominal obesity has the same consequences. It is thus clear that insulin resistance may be induced by neuroendocrine abnormalities, such as those seen in abdominal obesity. These endocrine perturbations also direct excess fat to visceral fat depots via mechanisms that are largely known, indicating why abdominal obesity is commonly associated with insulin resistance. This possible background to the most prevalent condition of insulin resistance has been revealed by development of methodology that allows sufficiently sensitive measurements of HPA axis activity. These findings demonstrate the power of neuroendocrine regulations for somatic health.

The hypothalamic-pituitary-adrenal axis in obesity

The hypothalamic-pituitary-adrenal (HPA) axis normally maintains the concentration of cortisol within a narrow range with a diurnal variation characterized by higher cortisol concentrations in the morning and reduced levels in the evening. Excessive or deficient secretion of cortisol is associated with pathologic changes. Obesity has been linked with age, sex and racial alterations in the functioning of the HPA axis which are reviewed. The possible relationship of altered HPA axis activity with the long-term complications of obesity are considered.

The control of cell mass and replication. The DNA unit--a personal 20-year study

The deoxyribonucleic acid (DNA) is constant per cell in diploid tissues and in polyploid tissues the DNA content and the cytoplasm increase commensurately. In muscle the DNA unit (protein/DNA) was described on the assumption that each nucleus has jurisdiction over a certain volume of cytoplasm. Such an approach allows a sensible interpretation of metabolic data. Since 66-70% of nuclei are within myofibres muscle represents a reasonably homogeneous tissue. A brief historical review is made concerning the use of DNA as a cell constant. The application of this knowledge to normal human somatic growth and to disease states is considered as well as reduced nutrition and overnutrition. The consequences of reduced nutrition as it related to brain growth are briefly mentioned as is our 7 year study on the fetal primate (Macaca mulatta). Attention is focussed on our work in the early 1960's concerning the role of insulin and growth hormone on the DNA unit. In the last decade this work culminated in the close study of the Little Mouse with isolated growth hormone deficiency--thus exposing the panhypopituitary model (the human pituitary dwarf, Snell Smith mouse or hypophysectomised rat) as non-optimal models. The findings indicate that growth hormone is indeed related to cell replication and insulin to cytoplasmic growth in the postnatal period but the role of other hormones is clearly important, augmenting or opposing these hormones. The concept of constant change of the DNA unit not only applies to major tissues such as muscle but to the study of kidney growth when the contralateral kidney is removed (renal compensatory growth). Species differences are noted in the pattern of cell growth in muscle, but emphasis is placed on cell replication rather than on cytoplasmic growth in the primate. Restriction of protein energy metabolism mainly affects cytoplasmic growth of muscle but restoration of growth to expected levels is the rule. Overnutrition and obesity relate to excessive growth of DNA units in number rather than size. Attention is drawn to factors other than calories, proteins and hormones that influence hormonal actions viz. trace metals such as zinc, chromium and vanadium. The cell mass of the body can readily be reached by relatively non-invasive methods and by monitoring the intracellular water. Muscle mass can be precisely measured by creatinine excretion. The cell mass of muscle constitutes 70% of the entire cell mass.(ABSTRACT TRUNCATED AT 400 WORDS)

Estimation of total water and fatness from weight and height: inaccurate for lean women

Mellits and Cheek have provided a regression equation which predicts total water, and by extension, fat, from weight and height of women. The equation has been used by many researchers as a convenient means to estimate fat when more complicated body composition estimation techniques are not possible. It is an essential component of evidence provide by Frisch for the critical fat hypothesis. The equation has not been validated on another sample, however, and has a large standard error. I test the Mellits and Cheek equation on five samples of young women, two of which show a normal range of heights and weights. The other three are athletic samples composed of lean women. In the normal samples mean fat percent determined by density (from underwater weighing) is closely approximated by the weight and height equation but not in the lean samples. When measured fat is regressed on estimated fat, correlations are low, and standard errors are high, suggesting that the Mellits and Cheek equation predicts poorly the body fat percentage of individual females. In summary, the Mellits and Cheek equation is moderately useful for the prediction of group means for body composition on samples with normal ranges of height and weight. It does not produce acceptable results on groups selected for extreme leanness or obesity. It is not recommended for fat prediction of individuals.