Introduction
weight loss, diabetes
INSULIN RESISTANCE, ZONA, PATHOGENESIS, CORTEX, DIABETES
Cortisol is the main glucocorticosteroid (GC) produced by the adrenal glands, specifically in the zona fasciculata of the adrenal cortex and is commonly known as a “stress hormone”. It is a key component of the body’s stress response system, which is regulated by the hypothalamic-pituitary-adrenal (HPA) axis. In addition, cortisol is involved in many physiological processes including metabolism, glycemic control, immune response, growth, cardiovascular function, mood, cognitive functions, reproduction, and development (Dysregulation of cortisol can lead to significant health implications, primarily by inducing insulin resistance and diabetes through its effects on key organs involved in the pathogenesis of insulin resistance, including the liver, skeletal muscle, adipose tissue, and pancreas (Studies of lifestyle interventions on changes in GCs levels have yielded mixed results. In a systematic review conducted by Chawla et al., it was observed that the timing of food consumption, particularly time-restricted eating (TRE), can impact the circadian cortisol fluctuations. Notably, during Ramadan practice of TRE, a reduced waking cortisol response was observed, and a statistically significant increase in cortisol levels in the evening compared to non-Ramadan periods. In non-Ramadan TRE studies, skipping dinner was associated with a decrease in evening cortisol levels and potentially an elevated morning level, although not all cases accounted for waking time (In this study, we aimed to investigate the impact of long-term dietary interventions on fasting morning cortisol (FMC) and its association with metabolic health, beyond the effects of weight loss.