Frailty confers a high risk for institutionalization and increased risk of mortality and is characterized by unintentional weight loss, feelings of exhaustion and fatigue, physical inactivity, slow gait speed and low grip strength. Neuroendocrine function, including cortisol secretion, is thought to be involved in the etiology of frailty, but until now the underlying biological mechanisms have not been well understood. Cortisol is a major stress hormone which allows for optimal bodily adaptation to changing demands or challenges from the environment.
Hamimatunnisa Johar and colleagues from the Mental Health Research Unit, Institute of Epidemiology II at the Helmholtz Zentrum München in collaboration with scientists from the Medizinische Klinik, Ludwig-Maximilians University, Munich examined the dysregulation in cortisol secretion (DCS) in the etiology of frailty. “Cortisol typically follows a distinct daily pattern with the highest level in the morning and the lowest basal level at night,” said Prof. Dr. Karl-Heinz Ladwig, head of the Mental Health working group at Helmholtz Zentrum München. “Our findings showed dysregulated cortisol secretion, as featured by a smaller morning to late in the evening cortisol level ratio (lower morning and higher evening levels), was significantly associated with frailty status.”
The data are derived from the KORA-Age Study, which examines the association between lifestyle factors and health status in people aged 65 years or older in the area of Augsburg, Germany. In this study, researchers conducted a cross-sectional analysis of 745 participants between the ages of 65 and 90 years. Cortisol levels were measured using saliva samples at three points: awakening, 30 minutes after awakening and in the late evening. Participants were classified as frail if three or more of the following criteria were met: exhaustion, physical inactivity, low walking speed, weakness (measured by grip strength) or weight loss (loss of more than 5 kilograms in the past six months).
“Our results suggest a link between disrupted cortisol regulation and loss of muscle mass and strength, as the underlying pathophysiology of frailty,” said Hamimatunnisa Johar, a PhD student at Helmholtz Zentrum München and first author of the study. “In a clinical setting assessment of frailty can be time-consuming, and our findings show measurements of cortisol may offer a feasible alternative.”
The aim of the Helmholtz Zentrum München is to develop new approaches for the diagnosis, therapy and prevention of common diseases.
Johar, H. et al. (2014), Blunted Diurnal Cortisol Pattern is Associated with Frailty: A Cross-Sectional Study of 745 Participants Aged 65 to 90 Years, JCEM, doi: 10.1210/jc.2013
Helmholtz Zentrum München, as German Research Center for Environmental Health, pursues the goal of developing personalized medical approaches for the diagnosis, treatment and prevention of major widespread diseases such as diabetes mellitus and lung diseases. To achieve this, it investigates the interaction of genetics, environmental factors and lifestyle. The head office of the Center is located in Neuherberg in the north of Munich. Helmholtz Zentrum München has a staff of about 2,200 people and is a member of the Helmholtz Association, a community of 18 scientific-technical and medical-biological research centers with a total of about 34,000 staff members.
The Institute of Epidemiology II (EPI II) focuses on the assessment of environmental and lifestyle risk factors which jointly affect major chronic diseases such as diabetes, heart disease and mental health. Research builds on the unique resources of the KORA cohort, the KORA myocardial infarction registry, and the KORA aerosol measurement station. Aging-related phenotypes have been added to the KORA research portfolio within the frame of the Research Consortium KORA-Age. The institute’s contributions are specifically relevant for the population as modifiable personal risk factors are being researched that could be influenced by the individual or by improving legislation for the protection of public health.
For more than 20 years, the research platform Cooperative Health Research in the Augsburg Region (KORA) has been collecting and analyzing data on the health of thousands of people living in the Augsburg region. The objective is to elucidate the effects of environmental factors, behavior and genes. KORA focuses on the development and course of chronic diseases, in particular myocardial infarction and diabetes mellitus. Risk factors are analyzed with regard to individual health behavior (e.g. smoking, diet, exercise), environmental factors (e.g. air pollution, noise) and genetics. From the perspective of health care research, questions regarding the utilization of health care resources and the cost of health care are also studied.
Prof. Karl-Heinz Ladwig, Helmholtz Zentrum München – Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany – Phone: +49-89-3187-3623 – E-Mail