Björntorp P
University of Göteborg, Sahlgrenska Hospital, Sweden.
Metabolism. 1995 Sep;44(9 Suppl 3):21-3. doi: 10.1016/0026-0495(95)90315-1.
Studies have shown that patients with central obesity have increased cortisol secretion, probably because they have increased activity of the hypothalamic-pituitary-adrenal (HPA) axis. A high waist-to-hip ratio (WHR) is associated with low production of sex steroids, such as testosterone in men, and a low rate of secretion of growth hormone. High levels of cortisol and insulin combined with low levels of growth hormone and sex steroid can cause lipid accumulation. These hormonal changes probably produce more deposition of visceral than subcutaneous fat. Patients who are deficient in either testosterone or growth hormone show a reduction in visceral adiposity when their hormone levels are normalized. Stress has been shown to activate the HPA axis and may cause the hormonal changes associated with obesity. Individuals with elevated WHR have indications of high levels of stress and anxiety. Monkeys that were stressed by social disruption were found to have increased cortisol levels and low sex steroid levels. Many of these animals had insulin resistance and visceral adiposity. Stimulants, such as alcohol and smoking, also increase the activity of the HPA axis.
研究表明，中心性肥胖患者的皮质醇分泌增加，这可能是因为他们下丘脑 - 垂体 - 肾上腺（HPA）轴的活性增强。高腰臀比（WHR）与性类固醇分泌减少有关，如男性体内睾酮水平降低，以及生长激素分泌率降低。高水平的皮质醇和胰岛素，再加上低水平的生长激素和性类固醇，会导致脂质堆积。这些激素变化可能会使内脏脂肪比皮下脂肪更多地沉积。睾酮或生长激素缺乏的患者，当他们的激素水平恢复正常时，内脏肥胖会有所减轻。压力已被证明会激活HPA轴，并可能导致与肥胖相关的激素变化。WHR升高的个体有高压力和焦虑的迹象。发现因社会扰乱而受到压力的猴子，其皮质醇水平升高，性类固醇水平降低。这些动物中有许多存在胰岛素抵抗和内脏肥胖。酒精和吸烟等兴奋剂也会增加HPA轴的活性。
