Elsevier

Neuroscience & Biobehavioral Reviews

Volume 83, December 2017, Pages 657-677
Neuroscience & Biobehavioral Reviews

Review
Simultaneous measurement of salivary cortisol and alpha-amylase: Application and recommendations

https://doi.org/10.1016/j.neubiorev.2017.08.015Get rights and content

Highlights

  • sCort and sAA reflect the activity of the two most prominent stress response systems.

  • Similar and unique potential determinants of sCort and sAA may act as confounders.

  • Physiological confounders are age, sex, health, medication.

  • Behavioral confounders are smoking, food, caffeine, alcohol, physical activity, sleep.

  • Potential confounders should be considered in the study design and data analysis.

Abstract

Salivary cortisol (sCort) and salivary alpha-amylase (sAA) constitute proxy measures of the two major stress response systems, i.e. the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, respectively. Potentially confounding determinants of sCort and sAA may limit a reliable concurrent measurement of both biomarkers, if not adequately considered. We reviewed the most important determinants of sCort and sAA and provide recommendations for handling these potential confounders. We focused on a selection of confounders, resulting in an in-depth consideration of age, sex steroid-related factors, somatic health, acute medication, smoking, consumption of food and drinks, alcohol consumption, physical activity/fitness, and sleep. Our review further highlights the importance of the consideration of potential confounders for a reliable and valid simultaneous measurement of sCort and sAA. We further provide recommendations about which and how to handle relevant confounders in the study design or data analysis.

Section snippets

Introduction and aims

Researchers from different areas are increasingly including salivary stress measures in a variety of research paradigms. While it is laudable that stress research is embracing new ways of assessing stress-related parameters, researchers need guidance in deciding on the optimal method. With these recommendations, we try to meet the need for such guidance and provide advice on the concurrent collection and application of two of the most frequently used salivary stress markers: cortisol and

Method section

For this narrative review, we identified relevant peer-reviewed English-language publications using PubMed search (publications up to July 2016), hand searching or checking references in full texts. Abstracts and full texts were screened with respect to the following general inclusion criteria: a) sCort or/and sAA as outcome measure, b) between-subjects comparison of ≥2 groups based on covariate of interest (simple correlation analyses between determinant and sCort/sAA were excluded) or

Age

Overall, 67 studies (summarized in Supplementary Table S1) fulfilled our inclusion criteria, with 9 studies measuring both sCort and sAA. The studies summarized in this chapter provide an overview of age-related changes in sCort and sAA and cover a wide age range, from early infancy to older-old adulthood.

Cautionary note on collection method, storage and salivary flow rate

Before concluding this review with a summary and recommendations on how to handle confounding determinants of sCort and sAA, this section provides a brief discussion of methodological questions which researchers are advised to consider. Since there are well-conducted studies on the issue of collection devices influencing saliva-based analytes, we kindly refer the reader to this literature (Beltzer et al., 2010, Harmon et al., 2007, Granger et al., 2007c). In short, each collection device has

Summary and outlook

Saliva is a valuable medium due to its easy collection and possibility for the simultaneous assessment of multiple salivary analytes. This simultaneous assessment, however, presents researchers with the challenge of considering similar as well as unique potential confounders of each salivary analyte in order to warrant reliable and valid assessment. The current review aimed to provide researchers with recommendations for the concurrent measurement of the two most important stress measures,

Conflict of interest

The authors have nothing to disclose; this includes any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work.

Role of the funding source

The sponsor had no role in the course of literature research and selection; in the writing of the report; and in the decision to submit the article for publication.

Acknowledgement

This work was funded by the Volkswagen Foundation (AZ: II/84905).

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