Abstract
OBJECTIVE: Pediatric obesity commonly co-exists with emotional and behavioral disorders, while disturbed Cortisol concentrations have been reported in both obese and chronically stressed individuals with anxiety and/or depression. We investigated the prevalence of internalizing and externalizing problems, reported by both parents and children, in a clinical population of obese children (OC) compared to normal-weight children. We examined the role of Cortisol as a potential mediator between obesity and such problems. DESIGN: We compared 110 obese with 31 normal-weight children. The Greek version of the child behavior checklist (CBCL) and the youth self-report (YSR) were used and salivary Cortisol was determined serially five times a day. RESULTS: T-scores of internalizing problems (anxiety/depression, social withdrawal, somatic complains) reported by both children (49.3±12.3 vs. 43.2±9.1) and mothers (60.6±11.3 vs. 50.6±10.4) were significantly higher (p=0.03 and p<0.001, respectively) in the obese than in the lean children. Externalizing problems (delinquency, rule-breaking behaviors) reported only by mothers were significantly higher in the OC (57.2±10.5 vs. 48.2±13.3, p=0.003). The Cortisol area under the curve (AUC) was significantly smaller (p=0.03) in the OC than in the controls; however, a Cortisol correlation with internalizing/externalizing symptoms was not observed. CONCLUSIONS: There is a high prevalence of internalizing and externalizing problems in a clinical population of OC. A mediation effect of Cortisol in the relation between internalizing/externalizing problems and obesity could not be supported.
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World Health Organization (2012) Global strategy on diet, physical activity and health. 2012. Available at: http://www.who.
Weiss R, Dziura J, Burgert TS, 2004 Obesity and Metabolic Syndrome in Children and Adolescents. N Engl J Med 350: 2362–2374.
Kassi E, Pervanidou P, Kaltsas G, Chrousos G, 2011 Metabolic syndrome: definitions and controversies. BMC Med 9: 48.
Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ, 2003 Obesity and psychiatric disorder: developmental trajectories. Pediatrics 111: 851–859.
Anderson S, He X, Schoppe-Sullivan S, et al, 2010 Externalizing behavior in early childhood and body mass index from age 2 to 12 years: longitudinal analyses of a prospective cohort study. BMC Pediatr 10: 49.
Sanderson K, Patton GC, McKercher C, Dwyer T, Venn AJ, 2011 Overweight and obesity in childhood and risk of mental disorder: a 20-year cohort study. Aust N Z J Psychiatry 45: 84–92.
Onyike CU, Crum RM, Lee HB, Lyketsos CG, Eaton WW, 2003 Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 158: 1139–1147.
Anderson SE, Cohen P, Naumova EN, Must A, 2006 Association of depression and anxiety disorders with weight change in a prospective community-based study of children followed up into adulthood. Arch Pediatr Adolesc Med 160: 285–291.
Pettit JW, Lewinsohn PM, Joiner TE Jr, 2006 Propagation of major depressive disorder: relationship between first episode symptoms and recurrence. Psychiatry Res 141: 271–227.
Puder JJ, Munsch S, 2010 Psychological correlates of childhood obesity. Int J Obes (Lond) 34: Suppl 2: 37–43.
Pauli-Pott U, Neidhard J, Heinzel-Gutenbrunner M, Becker K, 2014 On the link between attention deficit/hyperactivity disorder and obesity: do comorbid oppositional defiant and conduct disorder matter? Eur Child Adolesc Psychiatry 23: 531–537.
Sawyer MG, Miller-Lewis L, Guy S, Wake M, Canterford L, Carlin JB, 2006 Is there a relationship between overweight and obesity and mental health problems in 4- to 5-year-old Australian children? Ambul Pediatr 6: 306–311.
Lawlor DA, Mamun AA, O’Callaghan MJ, Bor W, Williams GM, Najman JM, 2005 Is being overweight associated with behavioural problems in childhood and adolescence? Findings from the Mater-University study of pregnancy and its outcomes. Arch Dis Child 90: 692–697.
Nederkoorn C, Jansen E, Mulkens S, et al, 2007 Impulsivity predicts treatment outcome in obese children. Behav Res Ther 45: 1071–1075.
Brotman LM, Dawson-McClure S, Huang KY, et al, 2012 Early childhood family intervention and long-term obesity prevention among high-risk minority youth. Pediatrics 129: e621–e628.
Pervanidou P, Chrousos GP, 2011 Stress and obesity/metabolic syndrome in childhood and adolescence. Int J Pediatr Obes 6: Suppl 1: 21–28.
Pervanidou P, Chrousos GP, 2012 Metabolic consequences of stress during childhood and adolescence. Metabolism 61: 611–619.
Chrousos GP, 2009 Stress and disorders of the stress system. Nat Rev Endocrinol 5: 374–381.
Williams JR, 2008 The Declaration of Helsinki and public health. Bulletin of the World Health Organization 86: 650–651.
Pervanidou P, Bastaki D, Chouliaras G, et al, 2013 Circadian Cortisol profiles, anxiety and depressive symptomatology, and body mass index in a clinical population of obese children. Stress 16: 34–43.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH, 2000 Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320: 1240–1243.
Chiotis D, Krikos X, Tsiftis G, Hatzisymeaon M, Maniati-Christidi M, Dacou-Voutetakis C, 2004 Body mass index and prevalence of obesity in subjects of Hellenic origin aged 0–18 years, living in the Athens area. Ann Clin Paediatr Univ Atheniensis 51: 139–154.
Tanner JM, 1962 Growth at adolescence. Blackwell Scientific Publications, Oxford.
Roussos A, Karantanos G, Richardson C, et al, 1999 Achenbach’s Child Behavior Checklist and Teachers’ Report Form in a normative sample of Greek children 6–12 years old. Eur Child Adolesc Psychiatry 8: 165–172.
Roussos A, Francis K, Zoubou V, Kiprianos S, Prokopiou A, Richardson C, 2001 The standardization of Achenbach’s Youth Self-Report in Greece in a national sample of high school students. Eur Child Adolesc Psychiatry 10: 47–53.
Achenbach TM, 1991 Manual for Child Behavior Checklist/4–18 and 1991 Profile. Burlington, VT: University of Vermont.
Achenbach TM, 2009 The Achenbach System of Empirically Based Assessment (ASEBA): Development, Findings, Theory, and Applications. Burlington, VT. University of Vermont Research Center for Children, Youth and Families.
Goldbacher EM, Matthews KA, 2007 Are Psychological Characteristics Related to Risk of the Metabolic Syndrome? A Review of the Literature. Annals of Behavioral Medicine 34: 240–252.
Goossens L, Braet C, Van Vlierberghe L, et al, 2009 Loss of control over eating in overweight youngsters: the role of anxiety, depression and emotional eating. Eur Eat Disord Rev 17: 68–78.
Harrist AW, Hubbs-Tait L, Topham GL, Shriver LH, Page MC, 2013 Emotion regulation is related to children’s emotional and external eating. J Dev Behav Pediatr 34: 557–565.
Sjöberg RL, Nilsson KW, Leppert J, 2005 Obesity, shame, and depression in school-aged children: a population-based study. Pediatrics 116: e389–392.
Mond J, van den Berg P, Boutelle K, Hannan P, Neumark-Sztainer D, 2011 Obesity, body dissatisfaction, and emotional well-being in early and late adolescence: findings from the project EAT study. J Adolesc Health 48: 373–378.
Hart CN, Carskadon MA, Considine RV, et al, 2013 Changes in children’s sleep duration on food intake, weight, and leptin. Pediatrics 132: e1473–1480.
Fliers EA, Buitelaar JK, Maras A, et al, 2013 ADHD is a risk factor for overweight and obesity in children. J Dev Behav Pediatr 34: 566–574.
Erhart M, Herpertz-Dahlmann B, Wille N, Sawitzky-Rose B, Hölling H, Ravens-Sieberer U, 2012 Examining the relationship between attention-deficit/hyperactivity disorder and overweight in children and adolescents. Eur Child Adolesc Psychiatry 21: 39–49.
Cortese S, Morcillo Peöalver C, 2010 Comorbidity between ADHD and obesity: exploring shared mechanisms and clinical implications. Postgrad Med 122: 88–96.
Graziano PA, Bagner DM, Waxmonsky JG, Reid A, McNamara JP, Geffken GR, 2012 Co-occurring weight problems among children with attention deficit/hyperactivity disorder: the role of executive functioning. Int J Obes (Lond) 36: 567–572.
Luman M, van Meel CS, Oosterlaan J, et al, 2012 Reward and punishment sensitivity in children with ADHD: validating the sensitivity to punishment and sensitivity to reward questionnaire for children (SPSRQ-C). J Abnorm Child Psychol 40: 145–157.
Cortese S, Comencini E, Vincenzi B, Speranza M, Angriman M, 2013 Attention-deficit/hyperactivity disorder and impairment in executive functions: a barrier to weight loss in individuals with obesity? BMC Psychiatry 13: 286.
Cortese S, Vincenzi B, 2012 Obesity and ADHD: Clinical and Neurobiological Implications. Curr Top Behav Neurosci 9: 199–218.
Pervanidou P, 2008 Biology of Posttraumatic Stress Disorder in childhood and adolescence J Neuroendocrinol 20: 632–638.
Pervanidou P, Chrousos GP, 2010 Neuroendocrinology of Posttraumatic Stress Disorder. Prog Brain Res 182: 149–160.
Nelemans SA, Hale WW3rd, Branje SJ, et al, 2014 Persistent Heightened Cortisol Awakening Response and Adolescent Internalizing Symptoms: A 3-year Longitudinal Community Study. J Abnorm Child Psychol 42: 767–777
Ulrike S, Reinhold L, Dirk H, 2013 Major depression in young girls is related to altered Cortisol awakening response. Eur Child Adolesc Psychiatry 22: 379–384.
Hillman JB, Dorn LD, Bin Huang, 2010 Association of anxiety and depressive symptoms and adiposity among adolescent females, using dual energy X-ray absorptiometry. Clin Pediatr (Phila) 49: 671–677.
Hillman JB, Dorn LD, Loucks TL, Berga SL, 2012 Obesity and the hypothalamic-pituitary-adrenal axis in adolescent girls. Metabolism 61: 341–348.
Dockray S, Susman EJ, Dorn LD, 2009. Depression, Cortisol reactivity, and obesity in childhood and adolescence. J Adolesc Health 45: 344–350.
Psychountaki M, Zervas Y, Karteroliotis K, Spielberger C, 2003 Reliability and Validity of the Greek Version of the STAIC. Eur J Psychol Assess 19: 124–130.
Giannakopoulos G, Kazantzi M, Dimitrakaki C, Tsiantis J, Kolaitis G, Tountas Y, 2009 Screening for children’s depression symptoms in Greece: the use of the Children’s Depression Inventory in a nation-wide school-based sample. Eur Child Adolesc Psychiatry 18: 485–492.
Isaksson J, Nilsson KW, Lindblad F, 2013 Early psychosocial adversity and Cortisol levels in children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 22: 425–432.
von Polier GG, Herpertz-Dahlmann B, Konrad K, et al, 2013 Reduced Cortisol in boys with early-onset conduct disorder and callous-unemotional traits. Biomed Res Int 2013: 349530.
Isaksson J, Nilsson KW, Nyberg F, Hogmark A, Lindblad F, 2012 Cortisol levels in children with attention-deficit/hyperactivity disorder. J Psychiatr Res 46: 1398–1405.
Yang SJ, Shin DW, Noh KS, Stein MA, 2007 Cortisol is inversely correlated with aggression for those boys with attention deficit hyperactivity disorder who retain their reactivity to stress. Psychiatry Res 153: 55–60.
Fairchild G, 2012 Hypothalamic-pituitary-adrenocortical axis function in attention-deficit hyperactivity disorder. Curr Top Behav Neurosci 9: 93–111.
Feilhauer J, Cima M, Korebrits A, Nicolson NA, 2013 Salivary Cortisol and psychopathy dimensions in detained antisocial adolescents. Psychoneuroendocrinology 38: 1586–1595.
Stadler C, Kroeger A, Weyers P, et al, 2011 Cortisol reactivity in boys with attention-deficit/hyperactivity disorder and disruptive behavior problems: the impact of callous unemotional traits. Psychiatry Res 187: 204–209.
Platje E, Vermeiren RR, Raine A, et al, 2013 A longitudinal biosocial study of Cortisol and peer influence on the development of adolescent antisocial behavior. Psychoneuroendocrinology 38: 2770–2779.
Platje E, Jansen LM, Raine A, et al, 2013 Longitudinal associations in adolescence between Cortisol and persistent aggressive or rule-breaking behavior. Biol Psychol 93: 132–137.
Haitigan JD, Roisman GI, Susman EJ, Barnett-Walker K, Monahan KC, 2011 Elevated trajectories of externalizing problems are associated with lower awakening Cortisol levels in midadolescence. Dev Psychol 47: 472–478.
Fairchild G, van Goozen SH, Stollery SJ, et al, 2008 Cortisol diurnal rhythm and stress reactivity in male adolescents with early-onset or adolescence-onset conduct disorder. Biol Psychiatry 64: 599–606.
Kjölhede EA, Gustafsson P, Gustafsson P, Nelson N, 2014 Overweight and obese children have lower Cortisol levels than normal weight children. Acta Paediatr 103: 295–299.
Lumeng JC, Miller A, Peterson KE, et al, 2014 Diurnal Cortisol pattern, eating behaviors and overweight in low-income preschool-aged children. Appetite 73: 65–72.
Miller AL, Clifford C, Sturza J, et al, 2013 Blunted Cortisol response to stress is associated with higher body mass index in low-income preschool-aged children. Psychoneuroendocrinology 38: 2611–2617.
Ruttle PL, Javaras KN, Klein MH, et al, 2013 Concurrent and longitudinal associations between diurnal Cortisol and body mass index across adolescence. J Adolesc Health 52: 731–737.
Abraham SB, Rubino D, Sinaii N, Ramsey S, Nieman LK, 2013 Cortisol, obesity, and the metabolic syndrome: a cross-sectional study of obese subjects and review of the literature. Obesity (Silver Spring) 21: E105–117.
Veldhorst MA, Noppe G, Jongejan MH, et al, 2014 Increased scalp hair Cortisol concentrations in obese children. J Clin Endocrinol Metab 99: 285–290.
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Pervanidou, P., Bastaki, D., Chouliaras, G. et al. Internalizing and externalizing problems in obese children and adolescents: associations with daily salivary Cortisol concentrations. Hormones 14, 623–631 (2015). https://doi.org/10.14310/horm.2002.1602
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DOI: https://doi.org/10.14310/horm.2002.1602