Gluck Marci E, Geliebter Allan, Hung Jennifer, Yahav Eric
New York Obesity Research Center, Department of Medicine, St. Luke's/Roosevelt Hospital Center, New York, NY 10025, USA.
Psychosom Med. 2004 Nov-Dec;66(6):876-81. doi: 10.1097/01.psy.0000143637.63508.47.
Increased basal cortisol levels have been found in bulimia nervosa. After stress, increased cortisol levels have been associated with increased food intake in healthy women. Therefore, we assessed cortisol, hunger, and desire to binge eat after a cold pressor test (CPT) among women with binge eating disorder (BED).
Twenty-two obese (body mass index [BMI] = 36.7 +/- 6.5 SD) females (11 non-BED, 11 BED) completed the Zung depression scale and underwent the CPT, hand submerged in ice water for 2 minutes. Over 60 minutes, periodic ratings of hunger and desire to binge eat were obtained, just before blood draws for cortisol, as well as insulin. On a separate day, participants had a 1-mg oral dexamethasone suppression test (DST).
The BED group had higher depression scores than the non-BED (p = .04), but depression was not a significant covariate for the cortisol response or to DST. After controlling for contraceptive use (n = 3), the BED group had higher basal cortisol than the non-BED group (p = .03), but cortisol did not differ after DST (p = .40). The BED group had nearly significant greater cortisol AUC after the CPT (p = .057) after controlling for insulin AUC and contraceptive use (p = .057). The BED group also had greater AUC for hunger (p = .03) and desire to binge eat (p = .02) after the CPT.
These findings support our hypothesis of a hyperactive HPA-axis in BED, which may contribute to greater hunger and binge eating.
在神经性贪食症患者中发现基础皮质醇水平升高。应激后，健康女性体内皮质醇水平升高与食物摄入量增加有关。因此，我们评估了暴食症（BED）女性在冷加压试验（CPT）后皮质醇、饥饿感和暴饮暴食欲望的情况。
22名肥胖（体重指数[BMI]=36.7±6.5标准差）女性（11名非BED患者，11名BED患者）完成了zung抑郁量表，并接受了CPT，将手浸入冰水中2分钟。在60多分钟内，在抽取皮质醇以及胰岛素血样之前，定期获取饥饿感和暴饮暴食欲望的评分。在另一天，参与者进行了1毫克口服地塞米松抑制试验（DST）。
BED组的抑郁评分高于非BED组（p=0.04），但抑郁不是皮质醇反应或DST的显著协变量。在控制避孕药使用情况（n=3）后，BED组的基础皮质醇水平高于非BED组（p=0.03），但DST后皮质醇水平无差异（p=0.40）。在控制胰岛素AUC和避孕药使用情况后（p=0.057），BED组在CPT后的皮质醇AUC几乎显著更高（p=0.057）。BED组在CPT后的饥饿感AUC（p=0.）和暴饮暴食欲望AUC（p=0.02）也更高。
这些发现支持了我们关于BED中下丘脑-垂体-肾上腺（HPA）轴功能亢进的假设，这可能导致更强烈的饥饿感和暴饮暴食。
