Not the Root of the Problem—Hair Cortisol and Cortisone Do Not Mediate the Effect of Child Maltreatment on Body Mass Index

Katharina Pittner*, Renate S.M. Buisman, Lisa J.M. van den Berg, Laura H.C.G. Compier-de Block, Marieke S. Tollenaar, Marian J. Bakermans-Kranenburg, Marinus H. van IJzendoorn, Bernet M. Elzinga, Lenneke R.A. Alink

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Background: Experiencing maltreatment during childhood exerts substantial stress on the child and increases the risk for overweight and obesity later in life. The current study tests whether hair cortisol—a measure of chronic stress—and its metabolite cortisone mediate the relation between abuse and neglect on the one hand, and body mass index (BMI) on the other. Method: The sample consisted of 249 participants aged 8 to 87 years (M = 36.13, SD = 19.33). We collected data on child abuse and neglect using questionnaires, measured cortisol and cortisone concentrations in hair, and BMI. In a structural model, the effects of abuse and neglect on hair cortisol, hair cortisone, and BMI were tested, as well as the covariance between hair cortisol and BMI, and hair cortisone and BMI. Results: Within the sample, 23% were overweight but not obese and 14% were obese. Higher levels of experienced abuse were related to higher cortisone concentrations in hair (β = 0.24, p <.001) and higher BMI (β = 0.17, p =.04). Neglect was not related to hair cortisol, hair cortisone, or BMI. Hair cortisol and cortisone did not mediate the association between maltreatment, and BMI. Sensitivity analyses demonstrate the same pattern of results in a subsample of adult participants currently not living with their parents. However, in younger participants who were still living with their parents, the associations between abuse and cortisone (β = 0.14, p =.35) and abuse and BMI (β = 0.02, p =.92) were no longer significant. Conclusion: These findings confirm that experiencing abuse is related to higher BMI but suggest that hair cortisol and cortisone are not the mechanism underlying the association between child maltreatment and BMI. This is the first study to show abuse may be associated to elevated concentrations of hair cortisone—evidence of long-term alterations in chronic stress levels. Future research may benefit from exploring the effects of maltreatment on weight gain in longitudinal designs, including measures of other potential mediators such as eating as a coping mechanism, and more direct indicators of metabolic health.

Original languageEnglish
Article number387
Pages (from-to)1-13
Number of pages13
JournalFrontiers in Psychiatry
Publication statusPublished - 8 May 2020


The study was supported by the Netherlands Organization for Scientific Research (MB-K: VICI grant [no. 453-09-003]; LA: VIDI grant [no. 016.145.360]; MI: NWO SPINOZA prize) and grants of Leiden University to initiate and support the Research Profile Area Health, Prevention and the Human Life Cycle awarded to MI, P. Assendelft, and B. van Hemert.

FundersFunder number
Netherlands Organization for Scientific Research453-09-003, 016.145.360
Universiteit Leiden
Nederlandse Organisatie voor Wetenschappelijk Onderzoek


    • abuse
    • body mass index
    • child maltreatment
    • hair cortisol
    • hair cortisone
    • hypothalamic–pituitary–adrenal axis
    • neglect


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