Hair Cortisone Levels and the Metabolic Syndrome: Stronger Links in Younger Compared to Older Adults

Susanne Kuckuck; Robin Lengton; Julius März; Nina Van Gerwen; Dimitris Rizopoulos; Manon H.J. Hillegers; Maryam Kavousi; Sjoerd A.A. Van den Berg; Erik J. Giltay; Brenda W.J.H. Penninx; Mariëtte R. Boon; Elisabeth F.C. Van Rossum

doi:10.1210/clinem/dgaf322

Hair Cortisone Levels and the Metabolic Syndrome: Stronger Links in Younger Compared to Older Adults

Susanne Kuckuck
, Robin Lengton
, Julius März
, Nina Van Gerwen
, Dimitris Rizopoulos
, Manon H.J. Hillegers
, Maryam Kavousi
, Sjoerd A.A. Van den Berg
, Erik J. Giltay
, Brenda W.J.H. Penninx
, Mariëtte R. Boon
, Elisabeth F.C. Van Rossum^*

^*Corresponding author for this work

Obesity Centre CGG
Erasmus University Rotterdam
Leiden University
Vrije Universiteit Amsterdam

Research output: Contribution to journal › Article › Academic › peer-review

2 Citations (Scopus)

15 Downloads (Pure)

Abstract

Background:

The striking link between Cushing syndrome, the metabolic syndrome (MetS), and cardiovascular disease suggests that long-term exposure to high glucocorticoid levels catalyzes cardiometabolic deterioration. However, the relation of subtle variations in long-term glucocorticoid levels with MetS remains poorly understood. Specifically, little is known about potential moderating roles of age, sex, and mental health status in this association. Design: We investigated the association of long-term glucocorticoid levels with MetS using data of 1405 participants (73.4% women) of the Netherlands Study of Depression and Anxiety. Predictors included hair cortisol and cortisone levels. Outcomes were MetS presence, number of MetS components, and individual component (ie, diastolic blood pressure, waist circumference, and fasting glucose, high-density lipoprotein cholesterol, and triglycerides). We investigated potential interactions with age, sex, and mental health status.

Results:

Hair glucocorticoid levels were positively associated with MetS presence (OR = 1.27; 95% CI = 1.11-1.44, and OR = 1.32; 95% CI = 1.14-1.52 for hair cortisol and cortisone, respectively), number of MetS components, waist circumference, and triglyceride levels. Hair cortisol, but not cortisone, was in trend associated with diastolic blood pressure and high-density lipoprotein cholesterol levels. No associations were seen with blood glucose. Of note, the relationship of hair cortisone with MetS was stronger among younger compared to older individuals (OR = 1.95; 95% CI = 1.50-2.54 vs OR = 1.14; 95% CI = .96-1.35 in younger vs older participants).

Conclusion:

Long-term biological stress, measured through hair glucocorticoid levels, is associated with MetS presence, especially among younger individuals. Prospective studies need to evaluate the extent to which hair cortisol and cortisone add to standard risk factors when predicting future cardiometabolic diseases.

Original language	English
Pages (from-to)	e116-e124
Journal	Journal of Clinical Endocrinology and Metabolism
Volume	111
Issue number	1
DOIs	https://doi.org/10.1210/clinem/dgaf322
Publication status	Published - 1 Jan 2026

Bibliographical note

Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society.

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Cite this

Kuckuck, S., Lengton, R., März, J., Van Gerwen, N., Rizopoulos, D., Hillegers, M. H. J., Kavousi, M., Van den Berg, S. A. A., Giltay, E. J., Penninx, B. W. J. H., Boon, M. R., & Van Rossum, E. F. C. (2026). Hair Cortisone Levels and the Metabolic Syndrome: Stronger Links in Younger Compared to Older Adults. Journal of Clinical Endocrinology and Metabolism, 111(1), e116-e124. https://doi.org/10.1210/clinem/dgaf322

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title = "Hair Cortisone Levels and the Metabolic Syndrome: Stronger Links in Younger Compared to Older Adults",

abstract = "Background: The striking link between Cushing syndrome, the metabolic syndrome (MetS), and cardiovascular disease suggests that long-term exposure to high glucocorticoid levels catalyzes cardiometabolic deterioration. However, the relation of subtle variations in long-term glucocorticoid levels with MetS remains poorly understood. Specifically, little is known about potential moderating roles of age, sex, and mental health status in this association. Design: We investigated the association of long-term glucocorticoid levels with MetS using data of 1405 participants (73.4\% women) of the Netherlands Study of Depression and Anxiety. Predictors included hair cortisol and cortisone levels. Outcomes were MetS presence, number of MetS components, and individual component (ie, diastolic blood pressure, waist circumference, and fasting glucose, high-density lipoprotein cholesterol, and triglycerides). We investigated potential interactions with age, sex, and mental health status.Results: Hair glucocorticoid levels were positively associated with MetS presence (OR = 1.27; 95\% CI = 1.11-1.44, and OR = 1.32; 95\% CI = 1.14-1.52 for hair cortisol and cortisone, respectively), number of MetS components, waist circumference, and triglyceride levels. Hair cortisol, but not cortisone, was in trend associated with diastolic blood pressure and high-density lipoprotein cholesterol levels. No associations were seen with blood glucose. Of note, the relationship of hair cortisone with MetS was stronger among younger compared to older individuals (OR = 1.95; 95\% CI = 1.50-2.54 vs OR = 1.14; 95\% CI = .96-1.35 in younger vs older participants). Conclusion: Long-term biological stress, measured through hair glucocorticoid levels, is associated with MetS presence, especially among younger individuals. Prospective studies need to evaluate the extent to which hair cortisol and cortisone add to standard risk factors when predicting future cardiometabolic diseases.",

author = "Susanne Kuckuck and Robin Lengton and Julius M{\"a}rz and \{Van Gerwen\}, Nina and Dimitris Rizopoulos and Hillegers, \{Manon H.J.\} and Maryam Kavousi and \{Van den Berg\}, \{Sjoerd A.A.\} and Giltay, \{Erik J.\} and Penninx, \{Brenda W.J.H.\} and Boon, \{Mari{\"e}tte R.\} and \{Van Rossum\}, \{Elisabeth F.C.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society.",

year = "2026",

month = jan,

day = "1",

doi = "10.1210/clinem/dgaf322",

language = "English",

volume = "111",

pages = "e116--e124",

journal = "Journal of Clinical Endocrinology and Metabolism",

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Kuckuck, S, Lengton, R, März, J, Van Gerwen, N, Rizopoulos, D , Hillegers, MHJ , Kavousi, M , Van den Berg, SAA, Giltay, EJ, Penninx, BWJH, Boon, MR & Van Rossum, EFC 2026, 'Hair Cortisone Levels and the Metabolic Syndrome: Stronger Links in Younger Compared to Older Adults', Journal of Clinical Endocrinology and Metabolism, vol. 111, no. 1, pp. e116-e124. https://doi.org/10.1210/clinem/dgaf322

TY - JOUR

T1 - Hair Cortisone Levels and the Metabolic Syndrome

T2 - Stronger Links in Younger Compared to Older Adults

AU - Kuckuck, Susanne

AU - Lengton, Robin

AU - März, Julius

AU - Van Gerwen, Nina

AU - Rizopoulos, Dimitris

AU - Hillegers, Manon H.J.

AU - Kavousi, Maryam

AU - Van den Berg, Sjoerd A.A.

AU - Giltay, Erik J.

AU - Penninx, Brenda W.J.H.

AU - Boon, Mariëtte R.

AU - Van Rossum, Elisabeth F.C.

PY - 2026/1/1

Y1 - 2026/1/1

N2 - Background: The striking link between Cushing syndrome, the metabolic syndrome (MetS), and cardiovascular disease suggests that long-term exposure to high glucocorticoid levels catalyzes cardiometabolic deterioration. However, the relation of subtle variations in long-term glucocorticoid levels with MetS remains poorly understood. Specifically, little is known about potential moderating roles of age, sex, and mental health status in this association. Design: We investigated the association of long-term glucocorticoid levels with MetS using data of 1405 participants (73.4% women) of the Netherlands Study of Depression and Anxiety. Predictors included hair cortisol and cortisone levels. Outcomes were MetS presence, number of MetS components, and individual component (ie, diastolic blood pressure, waist circumference, and fasting glucose, high-density lipoprotein cholesterol, and triglycerides). We investigated potential interactions with age, sex, and mental health status.Results: Hair glucocorticoid levels were positively associated with MetS presence (OR = 1.27; 95% CI = 1.11-1.44, and OR = 1.32; 95% CI = 1.14-1.52 for hair cortisol and cortisone, respectively), number of MetS components, waist circumference, and triglyceride levels. Hair cortisol, but not cortisone, was in trend associated with diastolic blood pressure and high-density lipoprotein cholesterol levels. No associations were seen with blood glucose. Of note, the relationship of hair cortisone with MetS was stronger among younger compared to older individuals (OR = 1.95; 95% CI = 1.50-2.54 vs OR = 1.14; 95% CI = .96-1.35 in younger vs older participants). Conclusion: Long-term biological stress, measured through hair glucocorticoid levels, is associated with MetS presence, especially among younger individuals. Prospective studies need to evaluate the extent to which hair cortisol and cortisone add to standard risk factors when predicting future cardiometabolic diseases.

AB - Background: The striking link between Cushing syndrome, the metabolic syndrome (MetS), and cardiovascular disease suggests that long-term exposure to high glucocorticoid levels catalyzes cardiometabolic deterioration. However, the relation of subtle variations in long-term glucocorticoid levels with MetS remains poorly understood. Specifically, little is known about potential moderating roles of age, sex, and mental health status in this association. Design: We investigated the association of long-term glucocorticoid levels with MetS using data of 1405 participants (73.4% women) of the Netherlands Study of Depression and Anxiety. Predictors included hair cortisol and cortisone levels. Outcomes were MetS presence, number of MetS components, and individual component (ie, diastolic blood pressure, waist circumference, and fasting glucose, high-density lipoprotein cholesterol, and triglycerides). We investigated potential interactions with age, sex, and mental health status.Results: Hair glucocorticoid levels were positively associated with MetS presence (OR = 1.27; 95% CI = 1.11-1.44, and OR = 1.32; 95% CI = 1.14-1.52 for hair cortisol and cortisone, respectively), number of MetS components, waist circumference, and triglyceride levels. Hair cortisol, but not cortisone, was in trend associated with diastolic blood pressure and high-density lipoprotein cholesterol levels. No associations were seen with blood glucose. Of note, the relationship of hair cortisone with MetS was stronger among younger compared to older individuals (OR = 1.95; 95% CI = 1.50-2.54 vs OR = 1.14; 95% CI = .96-1.35 in younger vs older participants). Conclusion: Long-term biological stress, measured through hair glucocorticoid levels, is associated with MetS presence, especially among younger individuals. Prospective studies need to evaluate the extent to which hair cortisol and cortisone add to standard risk factors when predicting future cardiometabolic diseases.

UR - https://www.scopus.com/pages/publications/105025235726

U2 - 10.1210/clinem/dgaf322

DO - 10.1210/clinem/dgaf322

M3 - Article

C2 - 40458043

AN - SCOPUS:105025235726

SN - 0021-972X

VL - 111

SP - e116-e124

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

IS - 1

ER -

Hair Cortisone Levels and the Metabolic Syndrome: Stronger Links in Younger Compared to Older Adults

Abstract

Bibliographical note

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