A population-based study of children suggests blunted morning cortisol rhythms are associated with alterations of the systemic inflammatory state
PSYCHONEUROENDOCRINOLOGY(2024)
摘要
Background: In children, digital media, lifestyle, and the COVID pandemic have impacted sunlight exposure, exercise, and diet patterns - cues that entrain the circadian clock. We hypothesized that low morning cortisol reflects a weak circadian clock, impacting the pro-inflammatory state. The primary objective was to test relationships between diurnal cortisol fluctuations and the inflammatory state in children as a means of providing indirect support for this hypothesis.Methods: The Cardiovascular Health Intervention Program (CHIP) was a population-based cross-sectional and longitudinal study of circadian health in public elementary school children in Southern Maine, USA (recruitment period 2012-2017). Participants were 689 students in 4th grade (baseline; age=9.2 +/- 0.4 years), and 647 students in 5th grade (age=10.5 +/- 0.5 years). Nine salivary cortisol measures per child (2 awakening and 1 prior to bed for 3 sequential days) (n = 1336 child phenotype days; n = 7987 cortisol assays), 10 cytokines measured in morning and evening saliva samples (n = 202 child phenotype days), and lipids were measured. Clinical outcomes were blood pressure, weight and height (body mass index [BMI]; BMI = kg/m(2)), among others.Findings: Upon-waking cortisol levels were 0.28 +/- 0.13 mu g/dL, 30-minute post-waking 0.33 +/- 0.15 mu g/dL, and evening 0.08 +/- 0.10 mu g/dL. Salivary cytokine levels (n = 202) showed interleukins (IL) IL-1 beta and IL-8 were highest in early morning (upon awakening; AM), and IL-6 and tumor necrosis factor (TNF) TNF-alpha highest before bed (PM) (IL-1 beta AM > PM [-4.02 fold; p < 0.001]; IL-8 AM > PM [-1.36 fold; p < 0.001]; IL-6 AM < PM [+1.49 fold; p < 0.001]; TNF-alpha AM < PM [+1.73 fold; p = 0.03]. Regression modeling showed high morning cortisol was associated with high morning IL-1 beta (p = 3.82 x10(-6)), but low evening IL-1 beta (p = 6.27 x10(-4)). Regression modeling of BMI z-score as the response variable showed the expected significant relationships to high density lipoprotein (HDL) (negative; p < 0.001), mean arterial pressure (positive; p < 0.001), and morning cortisol (negative; p = 0.01) but only weak relationships to either evening cortisol (p = 0.1) or cytokine (positive; p = 0.02; from the model with smallest Rsquared) levels.Interpretation: We provide preliminary data on diurnal fluctuations of inflammatory cytokines in saliva in a population-based cohort of children. Correlation of morning and evening cortisol levels with inflammatory cytokines in the same saliva samples showed that high morning cortisol was associated with high morning IL-1 beta and low evening IL-1 beta. Future studies may test the hypothesis that strong diurnal cycling of IL-1 beta may serve as a homeostatic mechanism keeping the immune system in check, and that low morning cortisol (possible circadian misalignment) may lead to less stringent control of inflammatory networks.
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关键词
Cortisol,Circadian rhythm,Cytokines,Inflammation,Saliva
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