최영근,오한진, 주일우

관동대학교 의과대학 제일병원 가정의학과

Background The key pathophysiology of metabolic syndrome (MS) is insulin resistance. Chronic stress may induce increased insulin resistance, high blood glucose, visceral obesity, and high blood pressure via increased cortisol levels from chronic activation of the hypothalamus-pituitary-adrenal axis (HPA axis). However, the relationships between cortisol, dehydroepiandrosterone sulfate (DHEA-S), and cortisol)/DHEA-S and each of the components of MS have not yet been thoroughly investigated. In our study, we evaluated the relationships between cortisol, DHEA-S, and cortisol/DHEA-S as biologic stress markers and components of MS in postmenopausal Korean women.
Methods This study was a cross-sectional analysis of 223 postmenopausal women who visited our climacteric clinic at a university hospital in Seoul with stressful events. These women were seen between January 2001 and March 2008. Metabolic syndrome was diagnosed according to the NCEP-ATP III criteria using body mass index (BMI) instead of waist circumference. We evaluated the relationships between each biological stress marker and the components of MS. Independent t-tests were conducted on each cut-off point of the MS components. The study population was classified as normal subjects (no MS components) or MS subjects (>3 MS components). Mean differences in biologic stress markers between normal and MS subjects were evaluated by independent t-tests.
Results Cortisol levels were positively associated with FPG (p=0.01), and DHEA-S levels were negatively associated with TG (p=0.019), but not with the other components of MS. DHEA-S levels showed statistically significant mean differences from BMI, FPG, TG, and HDL-C (p=0.022; p=0.004; p=0.012; p=0.010) by independent t-tests. Significant mean differences in DHEA-S and cortisol/DHEA-S between normal subjects and MS subjects were also observed (p=0.0002, p=0.039), but the mean difference in cortisol was not significant.
Conclusions It has been hypothesized that persistent chronic psychosocial stress may be a causative factor of MS. Unfortunately, we were unable to look into this hypothesis because of the limitations of the cross-sectional design. However, this study suggests that DHEA-S levels and MS might be meaningfully correlated.

Key words metabolic syndrome, stress, cortisol, DHEA-S