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ORIGINAL ARTICLE
Year : 2019  |  Volume : 19  |  Issue : 1  |  Page : 6-12

Study of stress response to novel laboratory challenges in relation to body fat distribution in normal young adults and habituation to repeated stress challenges


Department of Physiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Date of Submission04-Nov-2017
Date of Acceptance14-Nov-2017
Date of Web Publication16-May-2020

Correspondence Address:
Dr. Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
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DOI: 10.4103/sjsm.sjsm_47_17

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  Abstract 


Background: Perceived stress negatively affects cardiovascular functions and body fat distribution.
Aims: The aim is to study whether participants with greater central fat have altered autonomic activity in response to novel laboratory stress challenges and whether they adapt less effectively to repeated stress challenges over time.
Materials and Methods: Two hundred and forty-four healthy adults within the age group 20–45 years were divided into eight groups consisting of 30–31 participants in each group on the basis of sex, body mass index, and waist–hip ratio (WHR). Resting pulse rate and blood pressure were measured. All participants had to go through two stress sessions. Stress sessions were arranged according to trier social stress test. Pulse, systolic blood pressure and diastolic blood pressure (DBP), heart rate variability (root mean square of successive differences), and capillary blood glucose were measured on three consecutive occasions, -at rest, immediately after stress session 1 (day 1), and immediately after stress session 2 (day 2).
Results: Among lean males and lean females, there was significant difference in blood glucose level between high WHR group and low WHR group after stress session 1 and after stress session 2. Among overweight participants, no significant difference in heart rate variability was observed between high WHR group and low WHR group after stress session 1 and after stress session 2. However, in lean participants, significant difference was observed between high WHR group and low WHR group after stress session 1 and after stress session 2. Significant difference in pulse rate and DBP was observed in lean participants between high- and low-WHR groups after stress session 1 and after stress session 2.
Conclusions: Central fat among lean participants may be an indicator of the allostatic load which contributes to physical damage resulting from lack of adaptation to stress. Thus, lean participants with high WHR may be at higher risk of disease.

Keywords: Cardiovascular disease, stress challenge, visceral fat


How to cite this article:
Goswami A, Chaudhuri A, Samanta A, Guha A, Nandi K, Nandy S. Study of stress response to novel laboratory challenges in relation to body fat distribution in normal young adults and habituation to repeated stress challenges. Saudi J Sports Med 2019;19:6-12

How to cite this URL:
Goswami A, Chaudhuri A, Samanta A, Guha A, Nandi K, Nandy S. Study of stress response to novel laboratory challenges in relation to body fat distribution in normal young adults and habituation to repeated stress challenges. Saudi J Sports Med [serial online] 2019 [cited 2020 Oct 22];19:6-12. Available from: https://www.sjosm.org/text.asp?2019/19/1/6/284306








  Introduction Top


Modern human no longer faces the epidemic of plague, but stress-related diseases are becoming number one killer. The previous studies have shown that perceived stress negatively affects cardiovascular functions by altering cardiovascular reactivity and increasing blood pressure. The autonomic dysfunction induced by chronic stress can explain at least in part the cause of this association.[1],[2],[3] Not only the men but also women are affected by stress, and the conventional thought that women are protected from cardiovascular diseases before menopause has come to change. Twenty-five percent of females in the United States die of heart diseases.[4],[5],[6],[7]

Epidemiological studies have found adverse psychological states such as depression, anxiety, and social difficulties such as unemployment and divorce are related to central body fat distribution.[8],[9] Stress causes increased cortisol secretion and increased sympathetic activity. However, it remains less clear whether there is any relation between stress-induced cortisol secretion, change in autonomic activity, and fat distribution among healthy nondepressed people.[4],[5],[6],[7],[8],[9],[10]

The present study was conducted to study whether participants with greater central fat have altered autonomic activity in response to novel laboratory stress challenges and whether they adopt less effectively to repeated stress challenges over time.


  Materials and Methods Top


This cross-sectional pilot project was conducted in a time span of 1 year. Two hundred and forty-four participants in the age group of 20–45 years were taken from a general educated population of Burdwan district.

Inclusion criteria

Participants were educated individual aged between 20 and 45 years who had given consent. They were minimum graduate. Their perceived stress level was <13 according to COHEN's perceived stress scale.[11]

Exclusion criteria

Current or past history of smoking; regular alcohol intake (>7 drinks per week); pregnancy; current or past history of endocrine disorder; eating disorder; depression or any psychiatric disorder; hypertension; medication including oral contraceptives; irregular menstrual cycle; more than three pregnancies; recent weight changes; past hospitalization for addictive disorder; heavy exercise (>2 h/day); congenital and ischemic heart diseases.

Approval from the ethics committee of Burdwan Medical College was taken before conduction of the study. Participants were recruited through advertisement on social network websites. Proper informed consent was taken first from the participating individuals. Detailed history was taken regarding any past or current illness, hospitalization, medication, smoking and alcoholism, and daily habits. On the day of the test, no cigarette, nicotine, coffee, or drugs were permitted. Participants were called for stress sessions on 2 consecutive days at same time (e.g., between 4 pm and 5 pm). Each session lasted for 15 min.

Baseline anthropometric measurements were done, and body mass index (BMI) and waist/hip ratios (WHR) were calculated.[12]

Participants were divided into following eight groups:

  1. Lean male


    • With high WHR
    • With low WHR.


  2. Lean female


    • With high WHR
    • With low WHR.


  3. Overweight male


    • With high WHR
    • With low WHR.


  4. Overweight female


    • With high WHR
    • With low WHR.


Participants were asked to take rest for 15 min. Resting pulse rate and blood pressure were measured. Heart rate was recorded in the supine position by conventional method during normal quiet breathing for 1 min followed by recording of blood pressure.

All participants had to go through two stress sessions. Each stress session was broken into three sections, and each section was for 5 min. First 5 min was for preparation of a presentation and participants were allowed to use a pen and paper for this preparation. Next 5 min was for the presentation itself, and last 5 min were for some arithmetic problem. Participants had to face all these sessions in front of three unknown interviewers. After stress session, 2 participants were explained about the study in detail. Stress sessions were arranged according to trier social stress test.[13] However, we did not use any video camera and audio recording device(s), and also, there was no audience as in conventional trier social stress test.

Pulse, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate variability (root mean square of successive differences [RMSSD]), and capillary blood glucose were measured on three consecutive occasions – at rest, immediately after stress session 1 (day 1), and immediately after stress session 2 (day 2) were recorded.

Statistical analysis

The computer software Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc., Released 2007, SPSS for Windows, Version 16.0., SPSS Inc., Chicago, IL, USA) was used for analysis of data. Values were recorded as mean and standard deviation. Unpaired t-test was used to determine statistically significant differences during an intragroup analysis of participants. For all analysis, the P < 0.05* was considered statistically significant and P < 0.01** as highly significant.


  Result and Analysis Top


In the present study, 244 healthy adults within age group 20–45 years without any gross systemic disease were selected. They were divided into eight groups consisting of 30–31 participants in each group on the basis of sex, BMI, and WHR.

The results of blood glucose measurement – among overweight males and females no significant difference in blood glucose level was observed between high WHR group and low WHR group after stress session 1 and after stress session 2. However, among lean males and lean females, there was a significant difference in blood glucose level between high WHR group and low WHR group after stress session 1 and after stress session 2 [Table 1], [Table 2], [Table 3], [Table 4].
Table 1: Comparison of blood glucose level, pulse rate, systolic blood pressure, diastolic blood pressure in lean males at rest, after stress session 1, and after stress session 2

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Table 2: Comparison of blood glucose, pulse rate, systolic blood pressure, diastolic blood pressure in lean female at rest, after stress session 1, and after stress session 2

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Table 3: Comparison of blood glucose level, pulse rate, systolic blood pressure, diastolic blood pressure in overweight males at rest, after stress session 1, and after stress session 2

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Table 4: Comparison of blood glucose level, pulse rate, systolic blood pressure, diastolic blood pressure in overweight females at rest, after stress session 1, and after stress session 2

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Results of HRV (root mean square of successive differences) measurement

Among overweight participants, no significant difference in HRV was observed between high WHR group and low WHR group after stress session 1 and after stress session 2. However, in lean participants, significant difference was observed between high WHR group and low WHR group after stress session 1 and after stress session 2 [Table 1], [Table 2], [Table 3], [Table 4].

Results of pulse rate

Among overweight participants, there was no significant difference in pulse rate between high and low WHR groups after stress session 1 and after stress session 2. Significant difference in pulse rate was observed in lean participants between high- and low-WHR groups after stress session 1 and after stress session 2 [Table 1], [Table 2], [Table 3], [Table 4].

The results of SBP showed no significant difference between high WHR and low WHR groups after stress session 1 and after stress session 2 among both lean and overweight participants [Table 1], [Table 2], [Table 3], [Table 4].

The results of DBP showed no significant difference between high- and low-WHR groups among overweight participants after stress session 1 and after stress session 2. However, significant difference in DBP was observed among lean participants after stress session 1 and after stress session 2 [Table 1], [Table 2], [Table 3], [Table 4].

Lean males

Comparison of blood glucose level, RMSDD, pulse rate, SBP, DBP in lean males at rest, after stress session 1, and after stress session 2 are shown in [Table 1].

Lean females

Comparison of blood glucose level, RMSDD, pulse rate, SBP, DBP in lean female at rest, after stress session 1, and after stress session 2 are shown in [Table 2].

Overweight males

Comparison of blood glucose level, RMSDD, pulse rate, SBP, and DBP in overweight males at rest, after stress session 1, and after stress session 2 are shown in [Table 3].

Overweight females

Comparison of blood glucose level, RMSDD, pulse rate, SBP, and DBP in overweight females at rest, after stress session 1, and after stress session 2 are shown in [Table 4].


  Discussion Top


The roles of stress and behavioral stress response in the development of disease are in heightened focus. Stress may be the direct cause in the production or exacerbation of disease or may indirectly contribute to the development of behaviors such as smoking, overeating, or drug abuse that increase the risk of disease.[4],[5],[6],[7],[8],[9],[10],[11] The manifestations of stress response are strongly neuroendocrine matter. Moreover, immune system both affects and is affected by the stress response. The ultimate effect is immune suppression and sympathetic system activation that ends in producing metabolic syndrome coronary artery disease, hypertension, etc.[4],[5],[6],[7],[8],[9],[10],[11] Jääskeläinen et al. in 2014 studied a population to observe the stress-related eating pattern. The results showed stress-related eating behavior was more common among girls (43%) than boys (15%). Compared with nonstress-driven eaters, stress-driven eaters had a higher prevalence of overweight, obesity, and abdominal obesity.[14] In the present study, participants with low BMI but with high WHR were significantly more stressed than the participants with low BMI and low WHR after a laboratory stress challenge. On the other hand, no significant difference in acute stress was observed among high BMI groups with high and low WHR, respectively.

At rest, high WHR group and low WHR group have the mean blood glucose level 83.37 ± 11.45 and 84.23 ± 8.70, respectively, and there is no significant difference. After stress session 1, high WHR group had 92.07 ± 10.10 and low WHR group had 84.03 ± 10.48 blood glucose level, respectively. After stress session 2, high WHR group and low WHR groups had 90.73 ± 9.01 and 83.97 ± 10.78 mean blood glucose level, respectively.

At rest, high WHR and low WHR group showed the mean blood glucose level of 77.07 ± 5.20 and 75.43 ± 4.99, respectively, without any significant difference. After stress session 1, high WHR group had the mean blood glucose level 99.73 ± 6.22, whereas low WHR group had 75.43 ± 4.99. After stress session 2, high WHR group had the mean blood glucose level 99.37 ± 6.13 and low WHR group had 75.03 ± 5.11, respectively. After both stress sessions, low WHR group had lesser values with very significant difference.

At rest, high WHR group and low WHR group had the mean blood glucose level 93.62 ± 9.96 and 90.77 ± 9.46, respectively. After stress session 1, they had the mean blood glucose level 97.43 ± 11.24 and 94.09 ± 9.53, respectively. After stress session 2, high WHR group had 95.41 ± 11.27, and low WHR group had 92.45 ± 9.39 mean blood glucose level. On all occasions, no significant difference observed.

At rest, high WHR group and low WHR group had the mean blood glucose level 88.67 ± 10.23 and 88.73 ± 9.81, respectively. After stress session 1, they had the mean blood glucose level 91.87 ± 9.77 and 92.86 ± 9.55, respectively. After stress session 2, high WHR group had 90.7 ± 10.31, and low WHR group had 91.53 ± 9.7 mean blood glucose level. On all occasions, no significant difference observed.

Lean participants with high WHR showed a lack of adaptation. They had more blood glucose level (probably due to more cortisol secretion) than lean participants with low WHR after the first stress exposure even though the two groups had similar blood glucose level at baseline. Moreover, on the 2nd day of challenge at stress session 2, when the stressor was familiar and predictable, the lean participants with high WHR continued to have more blood glucose level than the lean participants with low WHR.

Overweight participants showed no significant differences. They were with high WHR had similar blood glucose level at rest, after stress session 1, and after stress session 2 with the low WHR participants. Both the overweight groups habituate to stress with equal effectiveness.

Glucocorticoids, the hormonal end-product of the hypothalamic–pituitary–adrenal (HPA) axis, exert primarily catabolic effects to utilize every available energy resource against the challenge posed by intrinsic or extrinsic stressors. Glucocorticoids increase hepatic gluconeogenesis and plasma glucose concentration, induce lipolysis (although they favor abdominal and dorsocervical fat accumulation), and cause protein degradation at multiple tissues to provide amino acids that would be used as an additional substrate for oxidative pathways. In addition to their direct catabolic actions, glucocorticoids also antagonize the beneficial anabolic actions of growth hormone, insulin, and sex steroids on their target tissues.[15],[16],[17] Chronic activation of HPA axis, however, would be damaging as it is expected to increase visceral adiposity, decrease lean body (muscle and bone) mass, suppress osteoblastic activity, and cause insulin resistance. The integrity of metabolic homeostasis is also centrally affected by the neuroendocrine integration of the HPA axis, and the central stress pathways to the central nervous system centers that control appetite/satiety and energy expenditure.[18] In a recent study by Lawson et al.,[19] the high cortisol and neuropeptide Y levels found to be associated with disordered eating psychopathology independent of BMI. Recent data also support that insulin and leptin play important roles in the regulation of central pathways related to food reward.[20]

Another interpretation of our results is that lean participants with high WHR seem more vulnerable relative to our control group lean participants with low WHR. These lean participants with high WHR are hardy and resilient group because after exposure to novel stressors designed to elicit a high cortisol response (and thereby increase in blood glucose level); they had barely detectable increase in blood glucose. It may also be possible that if we had used the original Trier Social Stress Test in the presence of live audience, they could have shown a greater response. Nevertheless, these lean group participants with low WHR showed and scored highest in self-esteem and combating stress among all groups.

At rest, there is no significant difference in RMSSD between high and low WHR groups with the mean value 47.94 ± 6.55 and 50.23 ± 6.37, respectively. After stress session 1, they had mean RMSSD of 40.23 ± 3.99 and 44.36 ± 5.58, and after stress session 2, they had the mean RMSSD 39.15 ± 3.59 and 45.69 ± 5.34, respectively. Both stress sessions showed a significant difference between two groups.

At rest, high WHR group and low WHR group had the mean RMSSD 49.49 ± 6.60 and 46.89 ± 6.09, respectively, without any significant difference. After stress session 1, they had mean RMSSD 45.05 ± 6.5 and 41.48 ± 4.38, respectively. After stress session 2, high WHR group had 47.94 ± 6.41, and low WHR group had 40.14 ± 3.97 mean values of RMSSD. At stress session 1, there was significant difference, and after stress session 2, there was significant difference between two groups.

Vagal innervation is the mediator of HRV, and therefore, HRV is an indication of vagal tone. The higher the HRV, the stronger the vagal tone. In the present study, RMSSD is significantly less in lean high-WHR participants because of decrease in vagal tone.

At rest, high WHR and low WHR groups had 80.03 ± 7.97 and 82.16 ± 7.82 mean pulse rate values, respectively. After stress session 1, they had 89.29 ± 7.52 and 84.48 ± 8.06, and after stress session 2, they had 92.23 ± 6.82 and 83.81 ± 7.77 mean pulse rate, respectively. After stress session 1, there was a significant difference, and after stress session 2, there was significant difference in pulse rate between two groups.

At rest, high WHR and low WHR groups had 82 ± 8.64 and 80.68 ± 8.17 mean pulse rate values, respectively. After stress session 1, they had 89.19 ± 8.08 and 82.52 ± 7.08, and after stress session 2, they had 95.09 ± 6.83 and 82.77 ± 6.69 mean pulse rate values, respectively. After both stress sessions, there was a significant difference in mean pulse rate.

Pulse rate is the marker of both parasympathetic and sympathetic activity because of dual innervations of the heart. Increase in pulse rate in lean and high WHR participants may be due to:

  1. Tilt in the autonomic balance toward sympathetic dominance
  2. An increase in sympathetic discharge and decreased vagal tone.[21],[22]


At rest, high WHR and low WHR groups had 78.69 ± 6.19 and 79.37 ± 6.33 mean DBP, respectively. After stress session 1, they had 85.56 ± 5.24 and 80 ± 5.63, and after stress session 2, they had 89 ± 3.37 and 82.63 ± 5.14 mean DBP, respectively. After both stress sessions, high WHR groups had significantly higher DBP then low WHR group.

At rest, high WHR and low WHR groups had 77.81 ± 6.35 and 77.42 ± 6.31 mean DBP, respectively. After stress session 1, they had 84.26 ± 5.77 and 79.23 ± 5.84, and after stress session 2, they had 87.03 ± 4.53 and 79.29 ± 5.69 mean DBP, respectively. After both stress sessions, high WHR groups had significantly higher DBP then low WHR group.

DBP is a measure of peripheral resistance. Significant increase in DBP among lean high WHR groups in response to acute stress may be due to increase in sympathetic activity, and thereby increase in arterial tone and peripheral resistance.[23]

Reduced autonomic function predominantly parasympathetic nervous activity has been linked to visceral fat. Higher abdominal-to-peripheral body fat distributions measured by DXA have been found to be strongly correlated with lower sympathetic and parasympathetic function in young and old healthy men.[24] Other studies have also shown that body fat distribution is a major factor, particularly visceral fat carrying the greatest risk for cardiovascular morbidity and mortality.[25],[26],[27] In keeping with this, data from the current study demonstrated that heart rate, DBP increased and heart rate variability decreased in lean participants with high WHR. This suggests that one of the possible explanations for reduced cardiac parasympathetic activity could well be due to increased WHR which is an indicator of visceral fat.


  Conclusions Top


Central fat among lean participants may be an indicator of the allostatic load which contributes to physical damage resulting from lack of adaptation to stress. Thus, lean participants with high WHR may be at higher risk of disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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