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Early stress, cortisol in hair and health among children in different psychosocial environments
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Psychosocial circumstances during early life are increasingly recognized as crucial, not only for the growing individual but also for health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker that allows assessment of long-term activity of the hypothalamic-pituitary-adrenal axis.

The objective of this thesis was to investigate the relationship between early stress, levels of cortisol in hair and health among children in different psycho-social environments.

The ABIS-study is a prospective population-based cohort study of every child born in southeast Sweden between Oct 1 1997 and Oct 1 1999 (N=21,700) in which approximately 17,000 families (79%) participated. The studies presented in Papers I, III and IV were based on ABIS data on children aged 1, 3, 5 and 8 years concerning stress related psychosocial variables as well as hair samples and diabetes related autoantibodies. Papers I and IV compared a subsample (n=2,448) from two different social environments. Paper III consisted of a subsample of 100 children as well as their mothers. Paper II covered 99 university students.

Paper I showed that the risk for diabetes-related autoantibodies, both against GADA and IAG2A (>95% cut off), was significantly higher (p<0.0001) among children from the blue-collar than from the white-collar city. This difference persisted still after adjustment for other previously documented risk factors. In paper II the method of measuring cortisol concentrations in hair was developed and mean cortisol levels were significantly related to serious life events (p=0.045) among the students. Paper III demonstrated that, in children from one to eight years of age, cortisol levels in hair decreased over time and correlated to each succeeding age, between years 1 and 3 (r=0.30,p=0.002), 3 and 5 (r=0.39, p=0.001), and 5 and 8 (r=0.44, p=0.001). Repeated measures gave a significant linear association over time (p=0.001). Maternal hair cortisol levels during the second and third trimester and child hair cortisol at year 1 and 3 was also significantly associated. Paper IV showed that children with prenatal psychosocial exposures had higher infant cortisol levels in hair (B=0.40, p<0.0001, adjusted for gender and size for gestational age) in a dose-response manner and were more often (p≤0.05) affected by 12 of the 14 most common childhood diagnoses with a general pattern of rising ORs.

In conclusion, the findings in this thesis showed that children born into an environment fraught with adverse psychosocial exposures seem to have an increased hypothalamic-pituitary-adrenal axis activity. It appears to be persistent throughout early childhood and affect health negatively, as evidenced through common childhood diseases and levels of autoantibodies. A widespread and dose response-like effect of adverse psychosocial circumstances was seen on the different outcomes studied throughout this thesis. This supports the model of physiologic dysregulation as a plausible pathway in how the duration and number of early detrimental exposures act as a trajectory to health disparities. Knowledge of these relationships could be valuable in selecting preventive measures, not least in primary care. Moreover, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair appears to be a useful aid in studies on how long-term stress affects health and may be particularly relevant when applied to research on children.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. , 83 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1419
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-111096DOI: 10.3384/diss.diva-111096ISBN: 978-91-7519-243-7 (print)OAI: oai:DiVA.org:liu-111096DiVA: diva2:753316
Public defence
2014-10-24, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-10-07 Created: 2014-10-07 Last updated: 2014-10-14Bibliographically approved
List of papers
1. Could the social environment trigger the induction of diabetes related autoantibodies in young children?
Open this publication in new window or tab >>Could the social environment trigger the induction of diabetes related autoantibodies in young children?
2012 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 2, 177-182 p.Article in journal (Refereed) Published
Abstract [en]

Aims: The onset and progression of the autoimmune process leading to type 1 diabetes is partly dependent on genetic predisposition and partly on environmental factors. We have implemented a study design where 1-year-old children, from two equally sized, neighbouring but socioeconomically different cities, were compared for the induction of beta-cell autoantibodies. Methods: This study comprises 2448 newborn infants, all living in the urban parts of the twin cities, followed prospectively with regular biological samples and questionnaires in a major population-based study. Of these, a random sample of 1497 children were tested for tyrosine phosphatase (IA-2A) and 1409 children for glutamic acid decarboxylase (GADA). Other documented risk factors of beta-cell autoimmunity and type 1 diabetes, such as family characteristics, dietary factors, and psychosocial factors were also included in the analysis. Results: The risk for diabetes-related autoantibodies, both against GADA and IA-2A (andgt; 95% cut off), was significantly higher (p andlt; 0.0001) among children from the blue-collar than from the white-collar city. This difference persisted still after adjustment for other previously documented risk factors. Some of these previously known risk factors remained significant in the multivariate analysis as independent explanatory factors, in addition to living in a blue-collar city. Conclusions:Factors in the social environment could trigger the induction of diabetes-related autoantibodies in 1-year-old children. These results point out that our present knowledge of factors influencing the autoimmune process might be widen to also include factors in the social environment of the community.

Place, publisher, year, edition, pages
SAGE Publications (UK and US), 2012
Keyword
Autoantibodies, children, diabetes, glutamic acid decarboxylase, tyrosine phosphatase, public health, social environment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76189 (URN)10.1177/1403494811435491 (DOI)000301192100010 ()
Available from: 2012-03-31 Created: 2012-03-30 Last updated: 2017-12-07
2. Cortisol in hair measured in young adults - a biomarker of major life stressors?
Open this publication in new window or tab >>Cortisol in hair measured in young adults - a biomarker of major life stressors?
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2011 (English)In: BMC Clinical Pathology, ISSN 1472-6890, E-ISSN 1472-6890, Vol. 11, no 1, 12- p.Article in journal (Refereed) Published
Abstract [en]

Background Stress as a cause of illness has been firmly established. In public health and stress research a retrospective biomarker of extended stress would be an indispensible aid. The objective of this pilot study was to investigate whether concentrations of cortisol in hair correlate with perceived stress, experiences of serious life events, and perceived health in young adults. Methods Hair samples were cut from the posterior vertex area of (n = 99) university students who also answered a questionnaire covering experiences of serious life events, perceived Stress Scale and perceived health during the last three months. Cortisol was measured using a competitive radioimmunoassay in methanol extracts of hair samples frozen in liquid nitrogen and mechanically pulverised. Results Mean cortisol levels were significantly related to serious life events (p = 0.045), weakly negatively correlated to perceived stress (p = 0.025, r = -0.061) but nor affected by sex, coloured/permed hair, intake of pharmaceuticals or self-reported health. In a multiple regression model, only the indicator of serious life events had an independent (p = 0.041) explanation of increased levels of cortisol in hair. Out of four outliers with extremely high cortisol levels two could be contacted, both reported serious psychological problems. Conclusions These findings suggest that measurement of cortisol in hair could serve as a retrospective biomarker of increased cortisol production reflecting exposure to major life stressors and possibly extended psychological illness with important implications for research, clinical practice and public health. Experience of serious life events seems to be more important in raising cortisol levels in hair than perceived stress.

Place, publisher, year, edition, pages
BioMed Central, 2011
Keyword
Biomarker; Coping; Cortisol; Hair; Serious life events; Stress
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-74866 (URN)10.1186/1472-6890-11-12 (DOI)22026917 (PubMedID)
Available from: 2012-02-10 Created: 2012-02-10 Last updated: 2017-12-07Bibliographically approved
3. Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair
Open this publication in new window or tab >>Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair
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2013 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 132, no 5, E1333-E1340 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate cortisol concentrations in hair as biomarker of prolonged stress in young children and their mothers and the relation to perinatal and sociodemographic factors. less thanbrgreater than less thanbrgreater thanMETHODS: Prospective cohort study of 100 All Babies In Southeast Sweden study participants with repeated measures at 1, 3, 5, and 8 years and their mothers during pregnancy. Prolonged stress levels were assessed through cortisol in hair. A questionnaire covered perinatal and sociodemographic factors during the childs first year of life. less thanbrgreater than less thanbrgreater thanRESULTS: Maternal hair cortisol during the second and third trimester and child hair cortisol at year 1 and 3 correlated. Child cortisol in hair levels decreased over time and correlated to each succeeding age, between years 1 and 3 (r = 0.30, P = .002), 3 and 5 (r = 0.39, P andlt; .001), and 5 and 8 (r = 0.44, P andlt; .001). Repeated measures gave a significant linear association over time (P andlt; .001). There was an association between high levels of hair cortisol and birth weight (beta = .224, P = .020), nonappropriate size for gestational age (beta = .231, P = .017), and living in an apartment compared with a house (beta = .200, P = .049). In addition, we found high levels of cortisol in hair related to other factors associated with psychosocial stress exposure. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Correlation between hair cortisol levels in mothers and their children suggests a heritable trait or maternal calibration of the childs hypothalamic-pituitary-adrenocortical axis. Cortisol output gradually stabilizes and seems to have a stable trait. Cortisol concentration in hair has the potential to become a biomarker of prolonged stress, especially applicable as a noninvasive method when studying how stress influences childrens health.

Place, publisher, year, edition, pages
American Academy of Pediatrics, 2013
Keyword
stress, children, mother, cortisol, hair, health disparities
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102501 (URN)10.1542/peds.2013-1178 (DOI)000326475000026 ()
Note

Funding Agencies|Swedish Child Diabetes Foundation (Barndiabetesfonden)||Research Council of Southeast Sweden|FORSS-87771FORSS-36321|Swedish Medical Research Council (MRF)|VR: K99-72X-11242-05A|JDRF Wallenberg Foundation|K 98-99D-12813-01A|County Council of Ostergotland, ALF project grant, Linkoping, Sweden||

Available from: 2013-12-12 Created: 2013-12-12 Last updated: 2017-12-06Bibliographically approved
4. Impact of prenatal psychosocial exposures on hair cortisol levels and child health: cohort study
Open this publication in new window or tab >>Impact of prenatal psychosocial exposures on hair cortisol levels and child health: cohort study
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2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background Early psychosocial exposures are increasingly recognized as crucial for health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker, assessing long-term HPA axis activity. The objective was to investigate whether prenatal adverse psychosocial circumstances influence infant cortisol levels in hair and health outcome in children prospectively until age 10.

Methods True prospective cohort study in the general community with a questionnaire covering 11 psychosocial items in the family during pregnancy formed a composite scale of prenatal psychosocial vulnerability, and cumulative incidence of diseases through diagnoses until age 10 in n=1876 children. At age 1, cortisol levels in hair were measured using a competitive radioimmunoassay on a subsample of n=209.

Results Children with added prenatal psychosocial exposures had higher infant cortisol levels in hair (B=0.40, p<0.0001, adjusted for gender and size for gestational age) in a cumulative manner and were more often (p≤0.05) affected by 12 of the 14 most common childhood diagnoses with a general pattern of rising ORs.

Conclusions These findings support the model of physiologic dysregulation as a plausible mechanism in how the duration and number of early detrimental psychosocial exposures determine health outcome. It indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.

Keyword
Psychosocial stress, antenatal programming, child health and development, cortisol in hair, health disparities
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-111093 (URN)
Available from: 2014-10-07 Created: 2014-10-07 Last updated: 2015-06-11Bibliographically approved

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