Do Not Exclude Your Observations: Negative Cortisol Awakening Responses (car) May Be Biologically Relevant
Social Science Research Network(2022)
摘要
The Cortisol Awakening Response (CAR) is one of the main stress biomarkers. Although positive CAR values are expected, negative values could be associated to health status, reflected in hematological parameters, or to environmental exposures. For example, exposure to lead (Pb) has shown neuroendocrine effects, including altering cortisol diurnal rhythms. The aim of this study was to analyze the prevalence of negative CAR values and their association with hematological parameters and blood Pb (BPb) levels in women participating in a birth cohort. Cortisol was measured by luminescence immunoassay in two-day saliva samples from n= 900 pregnant women from the PROGRESS cohort in Mexico. CAR was estimated as the difference between the first (time of awakening) and second (45 min after) cortisol concentrations for each collection day. CAR was categorized as: both days positive (CAR-PP), either day with a negative CAR (CAR-NP/PN), and both negative (CAR-NN). A complete blood count was done using a coulter hematology analyzer. BPb was analyzed by inductively coupled plasma-mass spectrometry. Associations and estimated probabilities analyses were carried out to determine the variation in hematological variables and BPb concentrations for each CAR group. The median (25th, 75th) CAR for the first collection day was -1.0 ng/ml (-6.0, 5.3) and -1.5 ng/ml (-6.4, 4.8) for the second day; 23% of the women were CAR-PP, 40% CAR-NP/PN, and 37% CAR-NN. Women with higher concentrations of leukocytes, eosinophils, basophils, and BPb were more likely to belong to CAR-NN or CAR-NP/PN groups. Compared to women with CAR-PP, those with CAR-NP/PN and CAR-NN had inverse associations for leukocyte levels and higher BPb concentrations. In this study 77% of women had at least one negative CAR value that could be an indicator of an underlying health condition or associated with lead exposure. Researchers should consider not excluding negative CAR values from their analyses.
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