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McQuitty EN, Black TA, Rousseau MA, Parvathaneni A, Gonna N, Farris DP, Nelson KC. Retrospective operationalization of allostatic load in patients with cancer: A systematic review. Psychoneuroendocrinology 2024; 167:107085. [PMID: 38833997 DOI: 10.1016/j.psyneuen.2024.107085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/05/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024]
Abstract
Allostatic load (AL) has been shown to impact cancer outcomes. At present, no gold standard exists surrounding AL computation. As such, a systematic review of the literature was performed to identify studies that retrospectively calculated AL in patients with cancer. The following variables were collected for each study: AL calculation method, including the biomarkers used and their cutoff values, number of biosystems represented, definition of high AL, and the use of proxy biomarkers. Thirteen articles were included for full-text review. The number of biomarkers used in the calculation of AL varied considerably, ranging from 6 to 16. Considerable variability was also observed in terms of utilized biomarkers and biosystem representation. This lack of standardization complicates retrospective AL calculation among patients with cancer. Nonetheless, determining AL in patients with cancer presents an important step in the optimization of patient care and outcomes.
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Affiliation(s)
- Emelie N McQuitty
- John P. and Kathrine G. McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - T Austin Black
- John P. and Kathrine G. McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Morgan A Rousseau
- John P. and Kathrine G. McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Aarthi Parvathaneni
- John P. and Kathrine G. McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Nadeen Gonna
- John P. and Kathrine G. McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - David P Farris
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Li Y, Chen C, Wen Y, Wang X, Zeng Z, Shi H, Chen X, Sun R, Xue Q. Impact of baseline and longitudinal allostatic load changes on incident cardiovascular disease and all-cause mortality: A 7-year population-based cohort study in China. J Affect Disord 2024; 355:487-494. [PMID: 38548202 DOI: 10.1016/j.jad.2024.03.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 02/17/2024] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND We aimed to prospectively examine the association of baseline allostatic load (AL) and longitudinal AL changes with incident cardiovascular disease (CVD) and all-cause mortality among middle-aged and elderly Chinese populations and evaluate the relative contributions of each physiological system of AL. METHODS Data from the China Health and Retirement Longitudinal Study (CHARLS) among adults aged 45 years or older were analyzed. Cox regression models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for the associations between baseline AL/longitudinal AL changes with incident CVD and all-cause mortality. RESULTS Compared with adults with AL 0-1, HRs of those with baseline AL 2-3 and AL ≥ 4 were 1.24 (95 % CI: 1.06, 1.45) and 1.51 (95 % CI: 1.27, 1.80) for incident CVD, and 1.39 (95 % CI: 1.11, 1.75) and 2.02 (95 % CI: 1.60, 2.54) for all-cause mortality. Similar results were found when we treated baseline AL as a continuous variable. We also found per AL score increase during 4 years of follow-up was related to a 11 % (HR, 1.11; 95 % CI: 1.03, 1.20) and 21 % (HR, 1.21; 95 % CI: 1.10, 1.34) increase in incident CVD and all-cause mortality, respectively. LIMITATIONS Self-reported physician-diagnosed CVD was used to assess the incident CVD. CONCLUSIONS Both baseline AL and longitudinal increases in AL were positively associated with incident CVD and all-cause mortality in middle-aged and elderly adults. Individuals with high AL need to be dynamically monitored for CVD and pre-mature mortality prevention.
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Affiliation(s)
- Yachao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Chu Chen
- School of Health Management, Fujian Medical University, Fujian, China
| | - Ying Wen
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China; School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiuli Wang
- Healthcare Evaluation and Organizational Analysis Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Ziqian Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Hongying Shi
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Wenzhou Medical University, Zhejiang, China; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Xiaofang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Ruichan Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Qingping Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China.
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Gordon REF, Kosty D, Khurana A. The mediating role of child delay of gratification in the link between early and prolonged poverty exposure and adolescent allostatic load. Psychoneuroendocrinology 2024; 163:106990. [PMID: 38412742 PMCID: PMC10954378 DOI: 10.1016/j.psyneuen.2024.106990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
Early and prolonged exposure to poverty disrupts biological processes associated with the body's stress response system, leading to long-term negative health outcomes, including obesity, autoimmune disorders, and cardiovascular disease. Allostatic load (AL), a composite measure of chronic stress on the body, is a robust predictor of subsequent health outcomes. However, developmental research examining the associations of early poverty exposure with AL in adolescence, as well as the underlying mechanisms of influence is limited. Early poverty exposure also impedes healthy development of child self-regulation, which may increase risk for high AL in adolescence, but this mechanistic pathway has not yet been tested. We used data from the national Study of Early Child Care and Youth Development (SECCYD) to examine the longitudinal associations between prolonged poverty exposure in early childhood (0-3 years) and AL in adolescence (age 15). We also tested the mediating role of child delay of gratification, a behavioral measure of self-regulation (at age 54 months), in the potential association between early poverty exposure and adolescent AL. Accounting for model covariates (i.e., child biological sex and race-ethnicity) and individual differences in child delay of gratification, early and prolonged poverty exposure was significantly associated with higher AL at age 15. The indirect effect through child delay of gratification was not significant, but the individual pathways of the indirect effect were significant, and the overall direct association of early poverty exposure with adolescent AL was significant. Our findings show that prolonged exposure to poverty in early childhood (0-3 years) can have significant negative associations with both child delay of gratification (at 54 months) and AL (at age 15). Given that the detrimental impacts of poverty exposure can be detected at an early age, targeted prevention efforts (e.g., anti-poverty programs such as cash assistance programs) may be able to offset some of the risks of early poverty exposure on self-regulation and AL.
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Affiliation(s)
- Rebecca E F Gordon
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA.
| | - Derek Kosty
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Atika Khurana
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA
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Holochwost SJ, Volpe VV, Collins AN, Propper CB, Mills-Koonce WR, Brown ED, Jaffee SR. Allostatic Load in Childhood, Adolescence, and Young Adulthood: Are Assumptions of Measurement Invariance Warranted? Psychosom Med 2024; 86:169-180. [PMID: 38588495 DOI: 10.1097/psy.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OVERVIEW Allostatic load represents the cumulative toll of chronic mobilization of the body's stress response systems, as indexed by biomarkers. Higher levels of stress and disadvantage predict higher levels of allostatic load, which, in turn, predict poorer physical and mental health outcomes. To maximize the efficacy of prevention efforts, screening for stress- and disadvantage-associated health conditions must occur before middle age-that is, during childhood, adolescence, and young adulthood. However, this requires that models of allostatic load display properties of measurement invariance across age groups. Because most research on allostatic load has featured older adults, it is unclear if these requirements can be met. METHODS To address this question, we fit a series of exploratory and confirmatory analytic models to data on eight biomarkers using a nationally representative sample of N = 4260 children, adolescents, and young adults drawn from the National Health and Nutrition Examination Survey dataset. RESULTS Exploratory and confirmatory models indicated that, consistent with allostatic load theory, a unidimensional model was a good fit to the data. However, this model did not display properties of measurement invariance; post-hoc analyses suggested that the biomarkers included in the final confirmatory model were most strongly intercorrelated among young adults and most weakly intercorrelated among adolescents. CONCLUSIONS These results underscore the importance of testing assumptions about measurement invariance in allostatic load before drawing substantive conclusions about stress, disadvantage, and health by directly comparing levels of allostatic load across different stages of development, while underscoring the need to expand investigations of measurement invariance to samples of longitudinal data.
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Affiliation(s)
- Steven J Holochwost
- From the Department of Psychology (Holochwost), Lehman College, The City University of New York, Bronx, New York; Department of Psychology (Volpe, Collins), North Carolina State University, Raleigh; School of Nursing (Propper) and School of Education (Mills-Koonce), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Psychology (Brown), West Chester University, West Chester; and Department of Psychology (Jaffee), University of Pennsylvania, Philadelphia, Pennsylvania
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Neufcourt L, Castagné R, Wilsgaard T, Grimsgaard S, Chadeau-Hyam M, Vuckovic D, Ugarteche-Perez A, Farbu EH, Sandanger TM, Delpierre C, Kelly-Irving M. Educational patterning in biological health seven years apart: Findings from the Tromsø Study. Psychoneuroendocrinology 2024; 160:106670. [PMID: 37992555 DOI: 10.1016/j.psyneuen.2023.106670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Social-to-biological processes is one set of mechanisms underlying the relationship between social position and health. However, very few studies have focused on the relationship between social factors and biology at multiple time points. This work investigates the relationship between education and the dynamic changes in a composite Biological Health Score (BHS) using two time points seven years apart in a Norwegian adult population. METHODS We used data from individuals aged 30 years and above who participated in Tromsø6 (2007-2008) and Tromsø7 (2015-2016) (n = 8117). BHS was defined using ten biomarkers measured from blood samples and representing three physiological systems (cardiovascular, metabolic, inflammatory). The higher the BHS, the poorer the health status. FINDINGS Linear regression models carried out on BHS revealed a strong educational gradient at two distinct time points but also over time. People with lower educational attainment were at higher risk of poor biological health at a given time point (βlow education Tromsø6=0.30 [95 %-CI=0.18-0.43] and βlow education Tromsø7=0.30 [95 %-CI=0.17-0.42]). They also presented higher longitudinal BHS compared to people with higher education (βlow education = 0.89 [95 %-CI=0.56-1.23]). Certain biomarkers related to the cardiovascular system and the metabolic system were strongly socially distributed, even after adjustment for sex, age, health behaviours and body mass index. CONCLUSION This longitudinal analysis highlights that participants with lower education had their biological health deteriorated to a greater extent over time compared to people with higher education. Our findings provide added evidence of the biological embodiment of social position, particularly with respect to dynamic aspects for which little evidence exists.
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Affiliation(s)
- Lola Neufcourt
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France.
| | - Raphaële Castagné
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Dragana Vuckovic
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Ainhoa Ugarteche-Perez
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Erlend Hoftun Farbu
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Cyrille Delpierre
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
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Hao B, Chen J, Cai Y, Li H, Zhu Z, Xu W, Liu H. Association between allostatic load and adverse outcomes among older patients with heart failure with preserved ejection fraction. BMC Geriatr 2023; 23:360. [PMID: 37296410 PMCID: PMC10257257 DOI: 10.1186/s12877-023-04091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The allostatic load (AL) refers to the cumulative weakening of multiple physiological systems caused by repeated adaptation of the body to stressors There are still no studies have focused on the association between AL and the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). The present study aimed to investigate the association between AL and adverse outcomes, including mortality and HF admission, among elderly male patients with HFpEF. METHODS We conducted a prospective cohort study of 1111 elderly male patients with HFpEF, diagnosed between 2015 and 2019 and followed up through 2021. We constructed an AL measure using a combination of 12 biomarkers. The diagnosis of HFpEF was made according to the 2021 European Society of Cardiology guidelines. A Cox proportional hazards model was used to determine the associations between AL and adverse outcomes. RESULTS In multivariate analysis, AL was significantly associated with increased risk of all-cause mortality (medium AL: adjusted hazard ratio [HR] = 2.53; 95% confidence interval [CI] 1.37-4.68; high AL: HR = 4.21; 95% CI 2.27-7.83; per-score increase: HR = 1.31; 95% CI 1.18-1.46), cardiovascular mortality (medium AL: HR = 2.67; 95% CI 1.07-6.68; high AL: HR = 3.13; 95% CI 1.23-7.97; per-score increase: HR = 1.20; 95% CI 1.03-1.40), non-cardiovascular mortality (medium AL: HR = 2.45; 95% CI 1.06-5.63; high AL: HR = 5.81; 95% CI 2.55-10.28; per-score increase: HR = 1.46; 95% CI 1.26-1.69), and HF admission (medium AL: HR = 2.68; 95% CI 1.43-5.01; high AL: HR = 3.24; 95% CI 1.69-6.23; per-score increase: HR = 1.24; 95% CI 1.11-1.39). Consistent results were found in multiple subgroup analyses. CONCLUSIONS A higher AL was associated with poor prognosis in elderly men with HFpEF. AL relies on information that is easily obtained in physical examinations and laboratory parameters and can be assessed in various care and clinical settings to help risk stratification of HFpEF patients.
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Affiliation(s)
- Benchuan Hao
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Jianqiao Chen
- Department of Geriatrics, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yulun Cai
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Huiying Li
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Zifan Zhu
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Weihao Xu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China.
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China.
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Carbone JT, Holzer KJ, Clift J, Fu Q. Latent profiles of biological dysregulation and risk of mortality: time-to-event analysis using the Midlife in the US longitudinal study. J Epidemiol Community Health 2023; 77:182-188. [PMID: 36627117 DOI: 10.1136/jech-2021-218073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is a well-established relationship between high allostatic load (AL) and increased risk of mortality. This study expands on the literature by combined latent profile analysis (LPA) with survival data analysis techniques to assess the degree to which AL status is associated with time to death. METHODS LPA was employed to identify underlying classes of biological dysregulation among a sample of 815 participants from the Midlife in the US study. Sex-stratified Cox proportional hazards regression models were used to estimate the association between class of biological dysregulation and time to death while controlling for sociodemographic covariates. RESULTS The LPA resulted in three classes: low dysregulation, immunometabolic dysregulation and parasympathetic reactivity. Women in the immunometabolic dysregulation group had more than three times the risk of death as compared with women in the low dysregulation group (HR=3.25, 95% CI: 1.47 to 7.07), but that there was not a statistically significant difference between the parasympathetic reactivity group and the low dysregulation group (HR=1.80, 95% CI: 0.62 to 5.23). For men, the risk of death for those in the immunometabolic dysregulation (HR=1.79, 95% CI: 0.88 to 3.65) and parasympathetic reactivity (HR=0.90, 95% CI: 0.34 to 3.65) groups did not differ from the low dysregulation group. CONCLUSION The findings are consistent with the previous research that demonstrates increased AL as a risk factor for mortality. Specifically, in women, that increased risk may be associated with immunometabolic dysregulation and not simply a generalised measure of cumulative risk as is typically employed in AL research.
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Affiliation(s)
- Jason T Carbone
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Katherine J Holzer
- St Louis School of Medicine, Washington University, St Louis, Missouri, USA
| | - Jennifer Clift
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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Joannès C, Colineaux H, Guernec G, Castagné R, Kelly-Irving M. Toward a conceptual framework of health and its operational definition: an application in the 1958 British birth cohort. BMC Public Health 2023; 23:100. [PMID: 36639784 PMCID: PMC9840257 DOI: 10.1186/s12889-022-14967-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Defining and measuring Health presents a challenge, partly due to its conceptual pluralism. To measure Health as an ability to adapt and self-manage, we developed an approach within the theoretical framework of resources and reserves over the life course, recently proposed in the literature. We aimed to (i) use the conceptual framework developed to identify indicators of deteriorating health reserves, (ii) construct an overall health measure from these indicators, (iii) evaluate the association between the overall health measure and subsequent health outcomes and (iv) assess the robustness of our method. METHODS We used data from 7,043 individuals born in 1958 in Great Britain included in the National Child Development Study. An overall health measure was constructed via the sum of three selected indicators of deteriorating health reserves in mid-life: chronic widespread pain (CWP), Clinical Interview Schedule - revised (CIS-r), and allostatic load (AL). A three-category variable was defined: impaired/medium/optimal overall health. We explored criterion validity by modelling the relationships between the overall health measure, or each reserve taken separately at 44-45 years, and self-rated health at 46 years and mortality up to 58 years, corresponding to 14 years of follow up, using Cox and logistic regressions respectively. We performed comparative analyses to assess the robustness of the method. RESULTS Having an impaired overall health measure was significantly associated with all-cause premature mortality (HRimpaired = 2.74 [1.86; 4.05]) and an increased risk of later fair/poor/very poor self-rated health (ORimpaired = 7.50 [6.29; 8.95]). The overall health measure had a greater effect on the self-rated health estimates than each indicator of deteriorating health reserves considered separately (ORAL medium = 1.82 [1.59; 2.09]; ORAL high = 2.74 [2.37; 3.16]; ORCIS-r = 5.20 [4.45; 6.08]; ORCWP = 2.85 [2.53; 3.21]). CIS-r and allostatic load were also associated with premature mortality contrary to chronic widespread pain (HRAL medium1.82 [1.27; 2.61]; HRAL high = 3.10 [2.19; 4.40]; HRCIS-r = 1.77 [1.22; 2.56]; HRCWP = 1.32 [0.98; 1.76]). The multiple comparative analyses conducted allowed us to assess the robustness of our method within this cohort. CONCLUSIONS We proposed a method for measuring Health in mid-life in line with the concept of Health as the ability to adapt and self-manage and the concept of health reserves. This method may be applied and further developed within the field of social and positive epidemiology.
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Affiliation(s)
- Camille Joannès
- grid.15781.3a0000 0001 0723 035XEquity Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Hélène Colineaux
- grid.15781.3a0000 0001 0723 035XEquity Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Gregory Guernec
- grid.15781.3a0000 0001 0723 035XEquity Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Raphaële Castagné
- grid.15781.3a0000 0001 0723 035XEquity Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- grid.15781.3a0000 0001 0723 035XEquity Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France ,grid.15781.3a0000 0001 0723 035XInterdisciplinary Federal Research Institute On Health & Society (IFERISS), Université Toulouse III Paul Sabatier, Toulouse, France
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Beese S, Postma J, Graves JM. Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192417006. [PMID: 36554888 PMCID: PMC9779615 DOI: 10.3390/ijerph192417006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods. METHODS This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews. RESULTS The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden. CONCLUSIONS The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.
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Affiliation(s)
- Shawna Beese
- College of Agricultural, Human, and Natural Resources Sciences, Washington State University, Pullman, WA 99164, USA
- College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - Julie Postma
- College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - Janessa M. Graves
- College of Nursing, Washington State University, Spokane, WA 99202, USA
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10
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Seeley KE, Proudfoot KL, Edes AN. The application of allostasis and allostatic load in animal species: A scoping review. PLoS One 2022; 17:e0273838. [PMID: 36040981 PMCID: PMC9426905 DOI: 10.1371/journal.pone.0273838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
Principles of allostasis and allostatic load have been widely applied in human research to assess the impacts of chronic stress on physiological dysregulation. Over the last few decades, researchers have also applied these concepts to non-human animals. However, there is a lack of uniformity in how the concept of allostasis is described and assessed in animals. The objectives of this review were to: 1) describe the extent to which the concepts of allostasis and allostatic load are applied theoretically to animals, with a focus on which taxa and species are represented; 2) identify when direct assessments of allostasis or allostatic load are made, which species and contexts are represented, what biomarkers are used, and if an allostatic load index was constructed; and 3) detect gaps in the literature and identify areas for future research. A search was conducted using CABI, PubMed, Agricola, and BIOSIS databases, in addition to a complementary hand-search of 14 peer-reviewed journals. Search results were screened, and articles that included non-human animals, as well as the terms “allostasis” or “allostatic” in the full text, were included. A total of 572 articles met the inclusion criteria (108 reviews and 464 peer-reviewed original research). Species were represented across all taxa. A subset of 63 publications made direct assessments of allostatic load. Glucocorticoids were the most commonly used biomarker, and were the only biomarker measured in 25 publications. Only six of 63 publications (9.5%) constructed an allostatic load index, which is the preferred methodology in human research. Although concepts of allostasis and allostatic load are being applied broadly across animal species, most publications use single biomarkers that are more likely indicative of short-term rather than chronic stress. Researchers are encouraged to adopt methodologies used in human research, including the construction of species-specific allostatic load indexes.
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Affiliation(s)
- Kathryn E. Seeley
- Department of Preventive Medicine, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, United States of America
- * E-mail:
| | - Kathryn L. Proudfoot
- Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Ashley N. Edes
- Department of Reproductive and Behavioral Sciences, Saint Louis Zoo, St. Louis, Missouri, United States of America
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Parker HW, Abreu AM, Sullivan MC, Vadiveloo MK. Allostatic Load and Mortality: A Systematic Review and Meta-Analysis. Am J Prev Med 2022; 63:131-140. [PMID: 35393143 DOI: 10.1016/j.amepre.2022.02.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Allostatic load, a measure of stress-related physiologic dysregulation, is associated with numerous mortality risk factors. This systematic review and meta-analysis examines the relationship between high allostatic load (i.e., increased dysregulation versus low dysregulation) and mortality (cardiovascular disease and all-cause mortality). METHODS Systematic searches of 2 databases conducted in May 2021 yielded 336 unique records; 17 eligible studies (2001-2020) were included. RESULTS High allostatic load was associated with increased risk of all-cause mortality across all the 17 individual studies (hazard ratio=1.08-2.75) and in 6 of 8 studies examining cardiovascular disease mortality (hazard ratio=1.19-3.06). Meta-analyses indicated that high allostatic load was associated with increased risk of all-cause mortality, overall (hazard ratio=1.22, 95% CI=1.14, 1.30, n=10) and across subgroups (hazard ratio=1.11-1.41), and similarly for cardiovascular disease mortality (hazard ratio=1.31, 95% CI=1.10, 1.57, n=6). Although studies were generally of good quality (n=13), heterogeneity was high in most pooled estimates (I2>90%). DISCUSSION In this review of relatively good-quality studies, high allostatic load was associated with an increased mortality risk of 22% for all-cause mortality and 31% for cardiovascular disease mortality. Thus, allostatic load is an emerging and potent modifiable risk factor for all-cause and cardiovascular disease mortality that shows promise as a prognostic indicator for mortality. The heterogeneity in allostatic load assessment across studies highlights the need for standardized measurement. The findings underscore the importance of allostatic load's dynamic nature, which may be especially relevant for mitigating mortality risk in younger adults. Because older adults are oversampled, future allostatic load research should prioritize younger adults and longitudinal monitoring and specific cardiovascular disease mortality risk associations and individualize behavioral and lifestyle targets for reducing allostatic load.
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Affiliation(s)
- Haley W Parker
- Department of Nutrition and Food Sciences, College of Health Sciences, The University of Rhode Island, Kingston, Rhode Island
| | - Alyssa M Abreu
- Department of Nutrition and Food Sciences, College of Health Sciences, The University of Rhode Island, Kingston, Rhode Island
| | - Mary C Sullivan
- College of Nursing, The University of Rhode Island, Providence, Rhode Island
| | - Maya K Vadiveloo
- Department of Nutrition and Food Sciences, College of Health Sciences, The University of Rhode Island, Kingston, Rhode Island.
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12
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Stacy M, Schulkin J. Suicide: Allostatic regulation and resilience. Psychoneuroendocrinology 2022; 139:105691. [PMID: 35218982 DOI: 10.1016/j.psyneuen.2022.105691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Suicide is a complex public health problem that is the result of a number of intertwined biopsychosocial factors. The diathesis-stress model suggests that suicide is the result of an interaction between genetic vulnerability and environmental stressors. Chronic stress and trauma contribute to biologic adaptations, including hypothalamus-pituitary-adrenal axis dysregulation, that contribute to the degradation of regulatory mechanisms and promote wear and tear the body, represented by allostatic load (AL). AL has been associated with a number of negative outcomes, including mental health problems and suicide. Fortunately, there are pharmacological and non-pharmacological interventions that are effective at reducing AL and reversing its effects. Thus, AL may provide a construct for supporting early risk identification, prevention, and treatment of suicide. AL biomarkers that are amenable to measurable change, effective treatments to reduce AL and perhaps help prevent suicide, and how to best tailor them to the individual and societal levels are important avenues of therapeutic inquiry.
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Affiliation(s)
- Meaghan Stacy
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA.
| | - Jay Schulkin
- School of Medicine, University of Washington, 1959 Pacific St NE, Seattle, WA 98105, USA.
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13
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Meng LC, Huang ST, Peng LN, Chen LK, Hsiao FY. Biological Features of the Outcome-Based Intrinsic Capacity Composite Scores From a Population-Based Cohort Study: Pas de Deux of Biological and Functional Aging. Front Med (Lausanne) 2022; 9:851882. [PMID: 35308493 PMCID: PMC8931213 DOI: 10.3389/fmed.2022.851882] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/07/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction This study aims to develop and validate an integrative intrinsic capacity (IC) scoring system, to investigate its associations with a wide spectrum of biomarkers and to explore the predictive value of the integrative IC score on 4-year mortality among community dwelling people aged 50 years and older. Methods We included 839 adults aged ≥50 years from the Social Environment and Biomarkers of Aging Study (SEBAS) and randomly divided them into derivation and validation cohorts to develop the IC scoring system. The multivariate logistic regression model was used to weight each subdomain (locomotion, sensory, vitality, psychological, and cognition) of IC according to its association with impairments in instrumental activities of daily living (IADL) and to construct the integrative IC score. Age-related biomarkers and genetic markers were compared between IC groups by ordinal logistic regression. A Cox proportional hazard model was used to examine the association between IC and mortality, and subgroup analysis was used to assess the robustness of the results among participants aged 60 years and older. Results A 12-score IC scoring system (AUROC = 0.83; Hosmer–Lemeshow goodness-of-fit test p = 0.17) was developed, and higher scores indicated better intrinsic capacity. High interleukin (IL)-6, high E-selectin, low serum albumin and low folate were significantly associated with low IC in the whole sample. However, high IL-6, low serum albumin, low folate, high allostatic load, and APOE ε4 genotype were significantly associated with low IC in those aged 60 years old and older. Compared to the high IC group, the low IC group was significantly associated with all-cause mortality (HR: 2.50, 95% CI: 1.22–5.11, p = 0.01 for all participants; HR 2.19, 95% CI 1.03–4.64, p = 0.04 for participants aged 60 years and older). Conclusions The conceptually proposed IC can be easily transformed into a scoring system considering different weights of individual subdomains, which not only predicts mortality but also suggests different pathophysiologies across the life course of aging (inflammation, nutrition, stress, and ApoE4 genotype). An intervention study is needed using the composite IC score to promote healthy aging and determine the underlying pathophysiology.
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Affiliation(s)
- Lin-Chieh Meng
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming Chiao Tung University Yangming Campus, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming Chiao Tung University Yangming Campus, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Fei-Yuan Hsiao
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Stephen G, Muldoon Orla T, Bennett Kate M. Multiple group membership, social network size, allostatic load and well-being: A mediation analysis. J Psychosom Res 2021; 151:110636. [PMID: 34638016 PMCID: PMC8660054 DOI: 10.1016/j.jpsychores.2021.110636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 10/29/2022]
Abstract
OBJECTIVES This study examined whether social network size and allostatic load (AL) mediated the association between multiple group membership (MGM) and future physical and psychological well-being. METHODS A longitudinal design was used and data from 1026 healthy participants on the relevant variables was extracted from Wave 2(2010-12), Wave 3 (2011-2013) (for baseline MGM, social network size and AL) and Wave 9 (2017-19) (for well-being at follow-up) of the Understanding Society UK population-based dataset. RESULTS MGM was not directly associated with future well-being, but both social network size, β = 0.06, t = 2.02, p = .04, and AL, β = -0.06, t = -2.05, p = .04, were associated with physical but not psychological well-being at follow-up. Those who had higher numbers of friends had better physical well-being, and those who had lower AL risk scores had better physical well-being at follow-up. However, MGM was indirectly associated with physical well-being through social network size, and AL such that those reporting higher MGM, reported a greater number of friends which was associated with a lower AL and then future physical well-being, β = 0.004, CI [0.001., 0.0129]. This was not evident for psychological well-being. This mediation withstood adjustment for confounding factors (e.g. age, gender, marital status lifestyle factors). CONCLUSION The present study extends findings on the existing social relationships and social cure literature and our findings are discussed in relation to the social cure hypothesis.
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Affiliation(s)
- Gallagher Stephen
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland.
| | - T. Muldoon Orla
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland
| | - M. Bennett Kate
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, UK
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15
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Sulfur mustard and biological ageing: A multisystem biological health score approach as an extension of the allostatic load in Sardasht chemical veterans. Int Immunopharmacol 2021; 101:108375. [PMID: 34810125 DOI: 10.1016/j.intimp.2021.108375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Mustard gas as a chemical weapon has been used in wars and its long-term side effects are substantial in the human body. This study was aimed to apply an extension of allostatic load, known as synthetic biological health score (BHS), including the wear-and-tear of four physiological systems (endocrine, inflammatory, cardiovascular and metabolic systems) and two organs (liver and kidney) to estimate biological aging caused by sulfur mustard (SM) gas poisoning. METHODS The plasma samples were prepared from two following groups of people; 1) 446 individuals exposed to SM gas in 1987. 2) 115 healthy members, at the same range of age and residence, as the non-exposed group. These people were chosen from the same patients' families and have not had any exposure to SM or pulmonary dysfunction. To estimate BHS, 18 blood-derived biomarkers of the mentioned systems and organs were measured and the relative contribution of many social and body parameters across the age groups was explored. RESULTS It was revealed, in BHS calculation, the cardiovascular system had the most effect. Also, in the SM group, BHS was significantly higher than in the control group. This feature has a positive correlation with physical parameter (BMI) and a negative correlation with social parameters (salary and educational levels). CONCLUSION The multisystem BHS could be useful in the evaluation of biological aging due to SM exposure. Social (education, good-paying job) and physical (BMI) parameters could influence BHS and the higher BHS indicates the progress of biological aging due to mustard gas.
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Guidi J, Lucente M, Sonino N, Fava GA. Allostatic Load and Its Impact on Health: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:11-27. [PMID: 32799204 DOI: 10.1159/000510696] [Citation(s) in RCA: 397] [Impact Index Per Article: 132.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria. OBJECTIVE To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature. METHODS PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations. RESULTS A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings. CONCLUSIONS The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
| | | | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy.,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
| | - Giovanni A Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
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Malik M, Javed S. Perceived stress among university students in Oman during COVID-19-induced e-learning. MIDDLE EAST CURRENT PSYCHIATRY 2021. [PMCID: PMC8331211 DOI: 10.1186/s43045-021-00131-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Higher education institutions across the world moved to e-learning in response to the disruptions caused by the pandemic. While e-learning has an advantage for students that they can attend to their courses from anywhere at their convenience, yet the sudden disruptive shift to e-learning during the pandemic saw students facing many challenges, which had strong ability to induce mental health issues among the students. This study aimed at examining the impact of COVID-19-induced e-learning on the university students’ stress perceptions in Oman. Results A total of 966 usable responses were received. The results showed that 96.9% (moderate stress = 82.5% and high stress = 14.4%) reported having experienced stress through e-learning during COVID-19. The results further indicated that there was a significant negative correlation between perceived stress and the students’ academic performance. The family support and institutional support were observed to have a significant effect on students’ stress perception. Conclusions Students are away from the physical campuses over a year now, continuing their courses and programs online. The numerous challenges they are facing through e-learning, together with the prevailing uncertainty, have intensified stress among them. The continued stress over time will not only affect their academic performance, but their mental and physical health as well, as the stress has proven to be one of the major causes of various physical and mental disorders. While e-learning seems to emerge as a new normal, the students require proper attention, help, and support from their families and institutions. The institutions should revisit their online courses and program delivery mechanisms, methods, and practices to ensure that students are not over stressed.
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18
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Zhang T, Yan LL, Chen HS, Jin HY, Wu C. Association between allostatic load and mortality among Chinese older adults: the Chinese Longitudinal Health and Longevity Study. BMJ Open 2021; 11:e045369. [PMID: 34344673 PMCID: PMC8336121 DOI: 10.1136/bmjopen-2020-045369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Allostatic load (AL) has shown that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest ageing population in the world. OBJECTIVE This study is to examine the association between AL and all-cause mortality among Chinese adults aged at least 60 years. DESIGN Population-based prospective cohort study. SETTING In 2011-2012, an ancillary study, in which a blood test was added, including a total of 2439 participants, was conducted in eight longevity areas in the Chinese Longitudinal Healthy Longevity Survey. PARTICIPANTS The final analytical sample consisted of 1519 participants (mean±SD age: men 80.5±11.3 years; women 90.2±11.8 years and 53% women). PRIMARY OUTCOME MEASURE Cox models were used to examine the association between AL and mortality among men and women, separately. Analyses were also adjusted for potential confounders including age, ethnicity, education and marital status, smoking and exercise. RESULTS Male with a medium AL burden (score: 2-4) and high AL burden (score: 5-9) had a 33% and 118% higher hazard of death, respectively, than those with a low AL burden (score: 0-1). We did not find significant difference between females with different levels of AL burden. CONCLUSION Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong association among women. In conclusion, Intervention programmes targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.
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Affiliation(s)
- Tianhang Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- School of Public Health, Imperial College London, London, UK
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Hua-Shuai Chen
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Hai-Yu Jin
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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19
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Yu EYT, Yeung CHN, Wan EYF, Tang EHM, Wong CKH, Cheung BMY, Lam CLK. Association between health behaviours and cardiometabolic dysregulation: a population-based survey among healthy adults in Hong Kong. BMJ Open 2021; 11:e043503. [PMID: 34244247 PMCID: PMC8273464 DOI: 10.1136/bmjopen-2020-043503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 06/02/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the association between cardiometabolic dysregulation, an integral component of allostatic load, and health risk behaviours (HRBs) of the Hong Kong healthy adult population. DESIGN Secondary analysis of cross-sectional anonymous data. SETTING Data on sociodemographics, self-reported health status, HRBs and biomarkers were extracted from the Hong Kong Population Health Survey 2014/2015. PARTICIPANTS One thousand five hundred and fifty-one participants aged 18-64 years without self-reported diagnoses of hypertension, diabetes mellitus, hyperlipidaemia, cardiovascular disease, cognitive impairment or cancer. PRIMARY OUTCOME MEASURES Cardiometabolic dysregulation index (CMDI), ranging from 0 to 6, was calculated by counting the number of biomarkers including systolic blood pressure, diastolic blood pressure, waist to hip ratio, glycated haemoglobin, total cholesterol to high-density lipoprotein cholesterol ratio, and triglycerides that were above the respective normal level suggested by international guidelines and literature. HRBs including smoking, dietary habits and sleeping hours were collected by self-report questionnaire. Alcohol consumption was assessed by the 10-item Alcohol Use Disorders Identification Test, while physical activity level was measured using the Global Physical Activity Questionnaire. A composite HRB score, ranging from 0 to 5, was calculated as the cumulative number of HRBs. The effect of HRB on CMDI was evaluated by negative binomial regression with adjustment for socioeconomic status, health awareness and comorbidities of the participants. RESULTS The mean CMDI of the studied population was 1.6; 29.5% had a CMDI of 0, whereas 1.5% had a CMDI of 6. Significant difference was observed in mean CMDI between gender and different age groups. Sleeping less than 6 hours (incidence rate ratio (IRR)=1.26, p<0.001), smoking (IRR=1.15, p=0.027), insufficient physical activity (IRR=1.12, p=0.007) and higher composite HRB score (IRR=1.12, 95% CI 1.06 to 1.18) were significantly associated with higher CMDI. CONCLUSION Smoking, physical inactivity and inadequate sleep-an essential yet often overlooked health behaviour-were associated with higher CMDI in the Hong Kong healthy adult population.
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Affiliation(s)
- Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | | | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Eric Ho Man Tang
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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20
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Mathew A, Doorenbos AZ, Li H, Jang MK, Park CG, Bronas UG. Allostatic Load in Cancer: A Systematic Review and Mini Meta-Analysis. Biol Res Nurs 2021; 23:341-361. [PMID: 33138637 PMCID: PMC8755951 DOI: 10.1177/1099800420969898] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Individuals with cancer experience stress throughout the cancer trajectory. Allostatic load (AL), a cumulative multi-system measure, may have a greater value in stress assessment and the associated biological burden than individual biomarkers. A better understanding of the use of AL and its operationalization in cancer could aid in early detection and prevention or alleviation of AL in this population. PURPOSE To consolidate findings on the operationalization, antecedents, and outcomes of AL in cancer. METHODS Seven databases (CINAHL, Ovid MEDLINE, Web of Science, APA PsycInfo, Scopus, Embase, and Cochrane CENTRAL) were searched for articles published through April 2020. The NIH tools were used to assess study quality. RESULTS Twelve studies met inclusion criteria for this review. Although variability existed in the estimation of AL, biomarkers of cardiovascular, metabolic, and immune systems were mostly used. Associations of AL with cancer-specific variables were examined mostly utilizing population-databases. Significant associations of AL with variables such as cancer-related stress, positive cancer history, post traumatic growth, resilience, tumor pathology, and cancer-specific mortality were found. Mini meta-analysis found that a one-unit increase in AL was associated with a 9% increased risk of cancer-specific mortality. CONCLUSION This review reveals heterogeneity in operationalization of AL in cancer research and lack of clarity regarding causal direction between AL and cancer. Nevertheless, AL holds a significant promise in cancer research and practice. AL could be included as a screening tool for high-risk individuals or a health outcome in cancer. Optimal standardized approaches to measure AL would improve its clinical utility.
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Affiliation(s)
- Asha Mathew
- College of Nursing, University of Illinois, Chicago, IL, USA
- College of Nursing, Christian Medical College, Vellore, India
| | - Ardith Z. Doorenbos
- College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Hongjin Li
- College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Min Kyeong Jang
- College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Chang Gi Park
- College of Nursing, University of Illinois, Chicago, IL, USA
- Department of Population Health Nursing Science, Office of Research Facilitation, Chicago, IL, USA
| | - Ulf G. Bronas
- College of Nursing, University of Illinois, Chicago, IL, USA
- Laboratory of Vascular and Cognitive Health, Chicago, IL, USA
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21
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Honkalampi K, Virtanen M, Hintsa T, Ruusunen A, Mäntyselkä P, Ali-Sisto T, Kärkkäinen O, Koivumaa-Honkanen H, Valkonen-Korhonen M, Panayiotou G, Lehto SM. Comparison of the level of allostatic load between patients with major depression and the general population. J Psychosom Res 2021; 143:110389. [PMID: 33609985 DOI: 10.1016/j.jpsychores.2021.110389] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We compared the level of allostatic load (AL) between patients with major depressive disorder (MDD) and non-depressed controls using two definitions of AL: continuous AL scores (AL index) and clinically significant high AL (≥4). We examined whether MDD was associated with AL independent of basic socioeconomic (age, sex, cohabiting status and level of education) and lifestyle factors (smoking and alcohol use). METHODS The MDD patient sample consisted of 177 psychiatric outpatients (mean age 33.7, SD 10.7 years), who were recruited from the Department of Psychiatry at Kuopio University Hospital, Finland, in 2016-19. The non-depressed controls (n = 228, mean age 49.8, SD 10.1 years) lived in the municipality of Lapinlahti, Finland. Ten biomarkers were used to construct the two AL variables. These indicators were systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, creatinine, waist circumference, body mass index (BMI) and C-reactive protein (CRP). RESULTS The mean AL scores did not significantly differ between MDD patients (2.97) and non-depressed controls (3.12), thus it was not associated with MDD in univariate analysis. In multivariate models a higher AL index was associated with a 1.42 to 1.82 times higher likelihood of belonging to the MDD group. Furthermore, we found that high AL (i.e. AL ≥ 4) was associated with MDD, with the likelihood ranging between 2.27 and 2.96 compared with the non-depressed controls in multivariate models. CONCLUSIONS Even young adult patients with MDD appear to display clinically significant, high AL compared with non-depressed controls. Thus, it is important to pay attention to the somatic health of depressed patients in addition to their mental health.
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Affiliation(s)
- Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Taina Hintsa
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Anu Ruusunen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Deakin University, iMPACT Institute/Food and Mood Centre, School of Medicine, Geelong, Australia
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Toni Ali-Sisto
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Olli Kärkkäinen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Minna Valkonen-Korhonen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Georgia Panayiotou
- Clinical Psychology and Psychophysiology lab, University of Cyprus, Nicosia, Cyprus
| | - Soili M Lehto
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Department of Psychiatry, University of Helsinki, Helsinki, Finland
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22
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Edes AN, Wolfe BA, Crews DE. Testing a method to improve predictions of disease and mortality risk in western lowland gorillas ( gorilla gorilla gorilla) using allostatic load. Stress 2021; 24:76-86. [PMID: 32228119 DOI: 10.1080/10253890.2020.1748003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Allostatic load is the wear-and-tear organisms accumulate due to senescence and stress; it is measured by combining biomarkers from multiple somatic systems into allostatic load indices (ALIs). Frequently used in human research, ALIs have shown consistent results across samples despite different biomarkers and methods. However, determining optimal models likely is necessary if ALIs are to be feasible research tools in other species. Herein, we build on prior research in western lowland gorillas to explore one potential method for determining which biomarkers may be best for estimating allostatic load. After narrowing down which biomarkers to include using a combination of forward stepwise regression and independent biomarker associations with project variables, we estimated allostatic load using both the traditional one-tailed quartile method as well as a multi-method approach. There was a significant positive association between allostatic load and triglycerides, but not cholesterol, both of which are commonly used as diagnostic markers of poor health. Using binomial generalized linear models, a one-unit increase in allostatic load was associated with increased risk of all-cause morbidity and mortality, but reduced risk of cardiac disease. Although conclusions were similar, compared to our original ALIs, these new ALIs had weaker effect sizes and poorer relative goodness of fit, suggesting this method for identifying the best possible list of biomarkers to include in an index was not effective. This report continues the development of ALIs as a clinical tool in wildlife while systematically testing one possible method for determining an optimal ALI for a particular species.
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Affiliation(s)
- Ashley N Edes
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
| | - Barbara A Wolfe
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Douglas E Crews
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
- College of Public Health, The Ohio State University, Columbus, OH, USA
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23
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McLoughlin S, Kenny RA, McCrory C. Does the choice of Allostatic Load scoring algorithm matter for predicting age-related health outcomes? Psychoneuroendocrinology 2020; 120:104789. [PMID: 32739647 DOI: 10.1016/j.psyneuen.2020.104789] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/27/2022]
Abstract
Allostatic Load (AL) is posited to provide a measure of cumulative physiological dysregulation across multiple biological systems and demonstrates promise as a sub-clinical marker of overall health. Despite the large heterogeneity of measures employed in the literature to represent AL, few studies have investigated the impact of different AL scoring systems in predicting health. This study uses data for 4477 participants aged 50+ years participating in the Irish Longitudinal Study on Ageing (TILDA) to compare the utility of 14 different scoring algorithms that have been used to operationalise AL (i.e. count-based high-risk quartiles, deciles, two-tailed cut-points, z-scores, system-weighted indices, clinical cut-points, sex-specific scores, and incorporating medication usage). Model fit was assessed using R2, Bayesian Information Criterion (BIC), and the area under the Receiver Operating Characteristic curve (AUC). The measure incorporating medications predicted walking speed and SRH marginally better than others. In general, AL was not predictive of grip strength. Overall, the results suggest that the choice of AL scoring algorithm exerts a relatively modest influence in predicting a number of important health outcomes.
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Affiliation(s)
- Sinead McLoughlin
- The Irish Longitudinal Study on Ageing (TILDA), Trinity Central, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland.
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity Central, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Cathal McCrory
- The Irish Longitudinal Study on Ageing (TILDA), Trinity Central, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
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24
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Egorov AI, Griffin SM, Converse RR, Styles JN, Klein E, Scott J, Sams EA, Hudgens EE, Wade TJ. Greater tree cover near residence is associated with reduced allostatic load in residents of central North Carolina. ENVIRONMENTAL RESEARCH 2020; 186:109435. [PMID: 32315826 PMCID: PMC7584403 DOI: 10.1016/j.envres.2020.109435] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Among urban residents, increased contacts with nature are associated with reduced morbidity and mortality. The concept of allostatic load, a biomarker-based composite measure of physiological dysregulation, can be applied to study subclinical benefits of exposure, and to elucidate pathways leading to improved health. OBJECTIVE This research explored associations between residential vegetated land cover and an allostatic load index calculated using the statistical distance measure known as Mahalanobis distance. METHODS This cross-sectional population-based study involved 186 adult residents of the Durham-Chapel Hill, North Carolina metropolitan area. Measures of tree and grass cover within 500 m of residence were derived from the U.S. Environmental Protection Agency's EnviroAtlas land cover database. Fifteen biomarkers of immune, neuroendocrine, and metabolic functions were analyzed in serum samples. Regression analysis was conducted using generalized additive models with thin-plate spline functions of geographic coordinates, adjusting for modelled traffic air pollution from local sources and sociodemographic covariates. RESULTS The second and third tertiles of distance-weighted tree cover were associated with 14% (95% Confidence Limits 20%; 8%) and 15% (21%; 8%) reduction in adjusted median allostatic load, respectively, compared to the first tertile. The same tertiles of tree cover were also associated with 0.16 (0.03; 0.76) and 0.04 (0.01; 0.35) adjusted odds ratios of having allostatic load index above the 90th percentile of the sample distribution. Grass cover was inversely correlated with tree cover and was not associated with reduced allostatic load. CONCLUSIONS Subclinical beneficial health effects of green spaces demonstrated in this study are consistent with reduced susceptibility to acute environmental and social stressors, and reduced risks of morbidity and mortality.
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Affiliation(s)
- Andrey I Egorov
- Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA.
| | - Shannon M Griffin
- Office of Research and Development, United States Environmental Protection Agency, Cincinnati, OH, USA
| | - Reagan R Converse
- Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Jennifer N Styles
- Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA; Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth Klein
- ORAU Student Services Contractor, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - James Scott
- Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Elizabeth A Sams
- Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Edward E Hudgens
- Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Timothy J Wade
- Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
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25
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Stress Measured by Allostatic Load Varies by Reason for Immigration, Age at Immigration, and Number of Children: The Africans in America Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124533. [PMID: 32599711 PMCID: PMC7345091 DOI: 10.3390/ijerph17124533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 12/18/2022]
Abstract
Stress leads to physiologic dysfunction and cardiometabolic disease. Allostatic load score (ALS) measures stress-induced cardiovascular, metabolic, and inflammatory biomarkers. We estimated the odds of high ALS by reason for and age at immigration, duration of American residence, number of children, and socioeconomic status in 193 African immigrants (male: 65%, age 41 ± 10 y (mean ± Standard Deviation (SD)), range 22–65 y). ALS was calculated with High-ALS defined as ALS ≥ 3.0 and Low-ALS defined as ALS < 3.0. Oral glucose tolerance tests (OGTT) were performed, the cardiovascular disease (CVD) risk estimated, and TNF-α, an inflammatory cytokine, measured. Logistic regression was used to estimate odds of High-ALS. In the High- and Low-ALS groups, ALS were 4.0 ± 1.2 vs. 1.3 ± 0.7, diabetes prevalence: 14% vs. 4%, CVD risk: 23% vs. 8%, TNF-α levels: 15 ± 9 vs. 11 ± 6 pg/mL, respectively (all p ≤ 0.01). Immigrants were more likely to be in the High-ALS group if their reason for immigration was work or asylum/refugee (OR 2.18, p = 0.013), their age at immigration was ≥30 y (OR 3.28, p < 0.001), their duration of residence in United States was ≥10 y (OR 3.16, p = 0.001), or their number of children was ≥3 (OR 2.67, p = 0.019). Education, income, health insurance, marital status, and gender did not affect High-ALS odds. Factors adversely influencing allostatic load and cardiometabolic health in African immigrants were age at and reason for immigration, duration of residence in America, and number of children.
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26
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Edes AN, Edwards KL, Wolfe BA, Brown JL, Crews DE. Allostatic Load Indices With Cholesterol and Triglycerides Predict Disease and Mortality Risk in Zoo-Housed Western Lowland Gorillas ( Gorilla gorilla gorilla). Biomark Insights 2020; 15:1177271920914585. [PMID: 32425494 PMCID: PMC7218307 DOI: 10.1177/1177271920914585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/25/2020] [Indexed: 11/17/2022] Open
Abstract
Allostatic load, or the physiological dysregulation accumulated due to senescence and stress, is an established predictor of human morbidity and mortality and has been proposed as a tool for monitoring health and welfare in captive wildlife. It is estimated by combining biomarkers from multiple somatic systems into allostatic load indices (ALIs), providing a score representing overall physiological dysregulation. Such ALIs have been shown to predict disease and mortality risk in western lowland gorillas. In these prior analyses, we were unable to include lipid markers, a potential limitation as they are key biomarkers in human models. Recently, we were able to assay serum cholesterol and triglycerides and add them to our previous ALI. We then re-examined associations with health outcomes using binomial generalized linear models. We constructed ALIs using 2 pooling strategies and 2 methods. By itself, a 1-unit increase in allostatic load was associated with higher odds of all-cause morbidity and mortality, but results were mixed for cardiac disease. However, the best fit models for all-cause morbidity and cardiac disease included only age and sex. Allostatic load was retained alongside age in the best fit models for mortality, with a 1-unit increase associated with 23% to 45% higher odds of death. Compared with previous results, ALIs containing cholesterol and triglycerides better predict disease risk in zoo-housed western lowland gorillas, as evidenced by larger effect sizes for some models and better goodness of fit for all ALIs. Based on these results, we address methodology for future allostatic load research on wildlife.
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Affiliation(s)
- Ashley N Edes
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
| | - Katie L Edwards
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| | - Barbara A Wolfe
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Janine L Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| | - Douglas E Crews
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
- College of Public Health, The Ohio State University, Columbus, OH, USA
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27
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Neighborhood perceptions and allostatic load: Evidence from Midlife in the United States study. Health Place 2020; 61:102263. [PMID: 32329729 DOI: 10.1016/j.healthplace.2019.102263] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/15/2019] [Accepted: 11/28/2019] [Indexed: 12/31/2022]
Abstract
Allostatic load, which represents the cumulative wear and tear on physiological systems resulting from long-term exposure to stress, provides a theoretical framework that can be applied to understand the association between neighborhood conditions and health outcomes. Within allostatic load theory perception plays a key role, as the cognitive appraisal process associated with one's perceptions determines whether external stimuli-such as neighborhood conditions-are deemed threatening or benign. With data from the Midlife Development in the United States, this study employed structural equation modeling to assess the association between neighborhood perceptions and cumulative, systems-level allostatic load scores. The findings demonstrate that neighborhood perception, as operationalized as a combination of perceived trust in neighbors, perceived neighborhood safety, and perceived neighborhood conditions, was inversely associated with allostatic load even when controlling for objective neighborhood conditions.
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28
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Borrell LN, Rodríguez-Álvarez E, Dallo FJ. Racial/ethnic inequities in the associations of allostatic load with all-cause and cardiovascular-specific mortality risk in U.S. adults. PLoS One 2020; 15:e0228336. [PMID: 32053626 PMCID: PMC7018050 DOI: 10.1371/journal.pone.0228336] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 11/19/2022] Open
Abstract
Non-Hispanic blacks have higher mortality rates than non-Hispanic whites whereas Hispanics have similar or lower mortality rates than non-Hispanic blacks and whites despite Hispanics' lower education and access to health insurance coverage. This study examines whether allostatic load, a proxy for cumulative biological risk, is associated with all-cause and cardiovascular (CVD)-specific mortality risks in US adults; and whether these associations vary with race/ethnicity and further with age, sex and education across racial/ethnic groups. Data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File were used for adults 25 years or older (n = 13,673 with 6,026 deaths). Cox proportional hazards regression was used to estimate the associations of allostatic load scores (2 and ≥3 relative to ≤1) with a) all-cause and b) CVD-specific mortality risk among NHANES III participants before and after controlling for selected characteristics. Allostatic load scores are associated with higher all-cause and CVD-specific mortality rates among U.S. adults aged 25 years or older, with stronger rates observed for CVD-specific mortality. All-cause mortality rates for each racial/ethnic group differed with age and education whereas for CVD-specific mortality rates, this difference was observed for sex. Our findings of high allostatic load scores associated with all-cause and CVD-specific mortality among US adults call attention to monitor conditions associated with the allostatic load's biomarkers to identify high-risk groups to help monitor social inequities in mortality risk, especially premature mortality.
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Affiliation(s)
- Luisa N. Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, New York, United States of America
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), Bizkaia, Spain
- Department of Surgery, Medical and Social Science, University of Alcalá, Madrid, Spain
| | - Elena Rodríguez-Álvarez
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), Bizkaia, Spain
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Bizkaia, Spain
| | - Florence J. Dallo
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, Michigan, United States of America
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Charles ST, Mogle J, Piazza J, Karlamangla A, Almeida DM. Going the distance: The diurnal range of cortisol and its association with cognitive and physiological functioning. Psychoneuroendocrinology 2020; 112:104516. [PMID: 31805455 PMCID: PMC6948931 DOI: 10.1016/j.psyneuen.2019.104516] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/18/2019] [Accepted: 11/12/2019] [Indexed: 12/21/2022]
Abstract
Cortisol features prominently in theories describing how chronic stress wears away at physical and cognitive health. The current study examines composite measures of physiological and cognitive functioning in relation to two aspects of daily cortisol: total daily output and change in levels throughout the day. Participants (N = 1001; aged 28-84 years-old) from the Midlife Development in the United States (MIDUS) study provided 4 daily saliva samples across four consecutive days and underwent a physical exam that provided information about six inter-related physiological systems that were combined into a measure of allostatic load. They also completed a phone-based battery of cognitive tasks, which provided a composite score combining memory, reasoning, and speed of processing performance. Total daily cortisol output was captured using area under the curve with respect to ground (AUCg). Change in cortisol levels was assessed using two methods: slope, calculated through piecewise spline models, and dynamic range, calculated by the difference between the day's highest and lowest log-cortisol levels. Findings indicate that, when examined together, overall cortisol output was not associated with either outcome, but a greater range in cortisol throughout the day was associated with both lower allostatic load and higher cognitive functioning. Results emphasize the importance of dynamic daily processes, assessed either using slopes or dynamic range, to both physiological and cognitive functioning.
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Affiliation(s)
- Susan T. Charles
- Department of Psychological Science, 4568 Social & Behavioral Sciences Gateway, University of California, Irvine, CA 92697-7085 USA
| | - Jacqueline Mogle
- Prevention Research Center, The Pennsylvania State University, v320D Biobehavioral Health Building, University Park, PA 16802, USA.
| | - Jennifer Piazza
- Department of Public Health, KHS 243, California State University, Fullerton Fullerton, CA 92831 USA
| | - Arun Karlamangla
- Department of Medicine, David Geffen School of Medicine, 200 UCLA Medical Plaza Suite 365, Los Angeles, CA 90095, USA.
| | - David M. Almeida
- Department of Human Development and Family Studies, 403 Biobehavioral Health Building, University Park, PA 16802 USA
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Mao F, Astell-Burt T, Feng X, Liu Y, Dong J, Liu S, Wang L, Jiang Y, Dong W, Zhou M, Wang L. Social and spatial inequalities in allostatic load among adults in China: a multilevel longitudinal study. BMJ Open 2019; 9:e031366. [PMID: 31784439 PMCID: PMC6924714 DOI: 10.1136/bmjopen-2019-031366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate potential geographical and socioeconomic patterning of allostatic load (AL) in China. DESIGN Multilevel longitudinal study of the 2010 Chronic Disease Risk Factor Surveillance linked to the National Death Surveillance up to 31 December 2015. SETTING All 31 provinces in China, not including Hong Kong, Macao or Taiwan. PARTICIPANTS 96 466 ≥ 18 years old (women=54.3%). EXPOSURES Person-level educational attainment and mean years of education in counties. OUTCOME AL was measured using clinical guidelines for nine biomarkers: body mass index; waist circumference; systolic blood pressure; diastolic blood pressure; fasting blood glucose; total cholesterol; triglycerides; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol. RESULTS Multilevel logistic regressions adjusted for sex, age, marital status, person-level education, county mean years of education and urban/rural reported ORs of 1.22 (95% CI 1.08 to 1.38) for 5-year all-cause mortality (n=3284) and 1.20 (1.04-1.37) for deaths from non-communicable diseases (n=2891) among people in AL quintile 5 (high) compared with quintile 1 (low). The median rate ratio estimated from unadjusted multilevel negative binomial regression showed AL clustered geographically (province=1.14; county=1.12; town=1.11; village=1.14). After adjusting for aforementioned confounders, AL remained higher with age (rate ratio 1.02, 95% CI 1.02 to 1.02), higher in women compared with men (1.17, 1.15 to 1.19), lower among singletons (0.83, 0.81 to 0.85) and widowers (0.96, 0.94 to 0.98). AL was lower among people with university-level compared with no education (0.92, 0.89 to 0.96), but higher in counties with higher mean education years (1.03, 1.01 to 1.05). A two-way interaction suggested AL was higher (1.04, 1.02 to 1.06) among those with university-level compared with no education within counties with higher mean years of education. Similar results were observed for alternative constructions of AL using 75th and 80th percentile cut-points. CONCLUSIONS AL in China is patterned geographically. The degree of association between AL and person-level education seems to be dependent on area-level education, which may be a proxy for other contextual factors that warrant investigation.
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Affiliation(s)
- Fan Mao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yunning Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianqun Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yingying Jiang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenlan Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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31
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Chiu CJ, Lin YC. Spousal health and older adults' biomarker change over six years: Investigation of gender differences. Arch Gerontol Geriatr 2019; 83:44-49. [PMID: 30947066 DOI: 10.1016/j.archger.2019.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Relationship of spousal health and biomarkers over six years were examined. METHODS AND MATERIALS Nationally representative sample of 483 adults aged 54+ in Taiwan were followed for six years. Four classes of spousal health changes and three categories of biomarker indexes were examined. Biomarkers were assessed by counting the adverse progression on items of allostatic load (AL), cardiovascular disease biomarkers (CVD), and metabolic syndromes, respectively. RESULTS When the health status of an individual's spouse became worse, women increased their AL by 0.48 (P < 0.05), CVD by 0.56 (P < .001), and metabolic syndrome by 0.43 (P < 0.05). If the health status of a woman's spouse remained poor, it increased her allostatic load by 0.60 (P < 0.05). These effects were only observed in women. In addition, when the health status of a men's spouse became better, man's biomarker profile on AL significantly improved by 0.80 (P < 0.05). No significant moderating effect of education was observed in this sample. CONCLUSIONS Married couples display concordance in both physical and mental health-related biomarkers, specifically, allostatic load. Women were more likely than men to experience adverse biomarker progress on all the biomarkers examined in this study when the status of their spouse became worse based on their subjective judgment, and men were more sensitive to positive health changes in their spouse than women.
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Affiliation(s)
- Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Taiwan.
| | - Yu-Cheng Lin
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Taiwan
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32
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Edwards KL, Edes AN, Brown JL. Stress, Well-Being and Reproductive Success. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1200:91-162. [DOI: 10.1007/978-3-030-23633-5_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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EVALUATING ALLOSTATIC LOAD: A NEW APPROACH TO MEASURING LONG-TERM STRESS IN WILDLIFE. J Zoo Wildl Med 2018; 49:272-282. [DOI: 10.1638/2016-0070.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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34
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Castagné R, Garès V, Karimi M, Chadeau-Hyam M, Vineis P, Delpierre C, Kelly-Irving M. Allostatic load and subsequent all-cause mortality: which biological markers drive the relationship? Findings from a UK birth cohort. Eur J Epidemiol 2018; 33:441-458. [PMID: 29476357 PMCID: PMC5968064 DOI: 10.1007/s10654-018-0364-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/08/2018] [Indexed: 12/23/2022]
Abstract
The concept of allostatic load (AL) refers to the idea of a global physiological 'wear and tear' resulting from the adaptation to the environment through the stress response systems over the life span. The link between socioeconomic position (SEP) and mortality has now been established, and there is evidence that AL may capture the link between SEP and mortality. In order to quantitatively assess the role of AL on mortality, we use data from the 1958 British birth cohort including eleven year mortality in 8,113 adults. Specifically, we interrogate the hypothesis of a cumulative biological risk (allostatic load) reflecting 4 physiological systems potentially predicting future risk of death (N = 132). AL was defined using 14 biomarkers assayed in blood from a biosample collected at 44 years of age. Cox proportional hazard regression analysis revealed that higher allostatic load at 44 years old was a significant predictor of mortality 11 years later [HR = 3.56 (2.3 to 5.53)]. We found that this relationship was not solely related to early-life SEP, adverse childhood experiences and young adulthood health status, behaviours and SEP [HR = 2.57 (1.59 to 4.15)]. Regarding the ability of each physiological system and biomarkers to predict future death, our results suggest that the cumulative measure was advantageous compared to evaluating each physiological system sub-score and biomarker separately. Our findings add some evidence of a biological embodiment in response to stress which ultimately affects mortality.
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Affiliation(s)
- Raphaële Castagné
- Faculty of Medicine Purpan, LEASP UMR 1027, Inserm-Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France.
| | - Valérie Garès
- Faculty of Medicine Purpan, LEASP UMR 1027, Inserm-Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Maryam Karimi
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College, Norfolk Place, London, W2 1PG, UK
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College, Norfolk Place, London, W2 1PG, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College, Norfolk Place, London, W2 1PG, UK
- Molecular and Genetic Epidemiology Unit, Italian Institute for Genomic Medicine (IIGM), Via Nizza 52, 10126, Turin, Italy
| | - Cyrille Delpierre
- Faculty of Medicine Purpan, LEASP UMR 1027, Inserm-Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Michelle Kelly-Irving
- Faculty of Medicine Purpan, LEASP UMR 1027, Inserm-Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France
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Allostatic load as a predictor of grey matter volume and white matter integrity in old age: The Whitehall II MRI study. Sci Rep 2018; 8:6411. [PMID: 29686319 PMCID: PMC5913085 DOI: 10.1038/s41598-018-24398-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/26/2018] [Indexed: 11/21/2022] Open
Abstract
The allostatic load index quantifies the cumulative multisystem physiological response to chronic everyday stress, and includes cardiovascular, metabolic and inflammatory measures. Despite its central role in the stress response, research of the effect of allostatic load on the ageing brain has been limited. We investigated the relation of mid-life allostatic load index and multifactorial predictors of stroke (Framingham stroke risk) and diabetes (metabolic syndrome) with voxelwise structural grey and white matter brain integrity measures in the ageing Whitehall II cohort (N = 349, mean age = 69.6 (SD 5.2) years, N (male) = 281 (80.5%), mean follow-up before scan = 21.4 (SD 0.82) years). Higher levels of all three markers were significantly associated with lower grey matter density. Only higher Framingham stroke risk was significantly associated with lower white matter integrity (low fractional anisotropy and high mean diffusivity). Our findings provide some empirical support for the concept of allostatic load, linking the effect of everyday stress on the body with features of the ageing human brain.
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More than a feeling: A unified view of stress measurement for population science. Front Neuroendocrinol 2018; 49:146-169. [PMID: 29551356 PMCID: PMC6345505 DOI: 10.1016/j.yfrne.2018.03.001] [Citation(s) in RCA: 425] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 12/16/2022]
Abstract
Stress can influence health throughout the lifespan, yet there is little agreement about what types and aspects of stress matter most for human health and disease. This is in part because "stress" is not a monolithic concept but rather, an emergent process that involves interactions between individual and environmental factors, historical and current events, allostatic states, and psychological and physiological reactivity. Many of these processes alone have been labeled as "stress." Stress science would be further advanced if researchers adopted a common conceptual model that incorporates epidemiological, affective, and psychophysiological perspectives, with more precise language for describing stress measures. We articulate an integrative working model, highlighting how stressor exposures across the life course influence habitual responding and stress reactivity, and how health behaviors interact with stress. We offer a Stress Typology articulating timescales for stress measurement - acute, event-based, daily, and chronic - and more precise language for dimensions of stress measurement.
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O'Connor DB, Green JA, Ferguson E, O'Carroll RE, O'Connor RC. Effects of childhood trauma on cortisol levels in suicide attempters and ideators. Psychoneuroendocrinology 2018; 88:9-16. [PMID: 29144990 DOI: 10.1016/j.psyneuen.2017.11.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as one potential risk factor for suicide. Recent evidence has indicated that blunted cortisol reactivity to stress is associated with suicidal behavior. The current study investigated whether childhood trauma was associated with blunted cortisol reactivity to a laboratory stressor and resting cortisol levels in suicide attempters and ideators. METHODS 160 Participants were recruited and grouped according to history of previous suicidal attempt, suicidal ideation or as control participants. Participants completed background questionnaires, including the Childhood Trauma Questionnaire, before completing a laboratory stress task. Cortisol levels were assessed at rest and during the stress task. RESULTS The highest levels of childhood trauma were reported in those who had attempted suicide (78.7%), followed by those who thought about suicide (37.7%) and then those with no suicidal history (17.8%). Moreover, regression analyses showed that childhood trauma was a significant predictor of blunted cortisol reactivity to stress and resting cortisol levels, such that higher levels of trauma were associated with lower cortisol levels in those with a suicidal history. Family history of suicide did not interact with the effects of childhood trauma on cortisol levels. CONCLUSIONS These results indicate that childhood trauma is associated with blunted HPA axis activity in vulnerable populations in adulthood. The challenge for researchers is to elucidate the precise causal mechanisms linking trauma, cortisol and suicide risk and to investigate whether the effects of childhood trauma on cortisol levels are amendable to psychological intervention.
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Affiliation(s)
| | | | - Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, UK
| | | | - Rory C O'Connor
- Suicidal Behavior Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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YANG Y, SUN L, ZHANG H, HUANG S, ZHU X. Allosatic load and its relationship with socioeconomic health disparities. ACTA ACUST UNITED AC 2018. [DOI: 10.3724/sp.j.1042.2018.01475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Graves KY, Nowakowski ACH. Childhood Socioeconomic Status and Stress in Late Adulthood: A Longitudinal Approach to Measuring Allostatic Load. Glob Pediatr Health 2017; 4:2333794X17744950. [PMID: 29226194 PMCID: PMC5714076 DOI: 10.1177/2333794x17744950] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 01/31/2023] Open
Abstract
Objectives: This study examines how the effects of childhood socioeconomic status (SES) may carry on into late adulthood. Methods: We examine how childhood SES affects both perceived stress and allostatic load, which is a cumulative measure of the body’s biologic response to chronic stress. We use the National Social Life, Health, and Aging Project, Waves 1 and 2, and suggest a novel method of incorporating a longitudinal allostatic load measure. Results: Individuals who grew up in low SES households have higher allostatic load scores in late adulthood, and this association is mediated mostly by educational attainment. Discussion: The longitudinal allostatic load measure shows similar results to the singular measures and allows us to include 2 time points into one outcome measure. Incorporating 2 separate time points into one measure is important because allostatic load is a measure of cumulative physiological dysregulation, and longitudinal data provide a more comprehensive measure.
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Affiliation(s)
- Katelyn Y Graves
- School of Physician Assistant Practice/Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Alexandra C H Nowakowski
- Department of Geriatrics/Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Orlando Regional Campus, Orlando, FL, USA
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Egorov AI, Griffin SM, Converse RR, Styles JN, Sams EA, Wilson A, Jackson LE, Wade TJ. Vegetated land cover near residence is associated with reduced allostatic load and improved biomarkers of neuroendocrine, metabolic and immune functions. ENVIRONMENTAL RESEARCH 2017; 158:508-521. [PMID: 28709033 PMCID: PMC5941947 DOI: 10.1016/j.envres.2017.07.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Greater exposure to urban green spaces has been linked to reduced risks of depression, cardiovascular disease, diabetes and premature death. Alleviation of chronic stress is a hypothesized pathway to improved health. Previous studies linked chronic stress with a biomarker-based composite measure of physiological dysregulation known as allostatic load. OBJECTIVE This study's objective was to assess the relationship between vegetated land cover near residences and allostatic load. METHODS This cross-sectional population-based study involved 206 adult residents of the Durham-Chapel Hill, North Carolina metropolitan area. Exposure was quantified using high-resolution metrics of trees and herbaceous vegetation within 500m of each residence derived from the U.S. Environmental Protection Agency's EnviroAtlas land cover dataset. Eighteen biomarkers of immune, neuroendocrine, and metabolic functions were measured in serum or saliva samples. Allostatic load was defined as a sum of potentially unhealthy biomarker values dichotomized at 10th or 90th percentile of sample distribution. Regression analysis was conducted using generalized additive models with two-dimensional spline smoothing function of geographic coordinates, weighted measures of vegetated land cover allowing decay of effects with distance, and geographic and demographic covariates. RESULTS An inter-quartile range increase in distance-weighted vegetated land cover was associated with 37% (95% Confidence Limits 46%; 27%) reduced allostatic load; significantly reduced adjusted odds of having low level of norepinephrine, dopamine, and dehydroepiandrosterone, and high level of epinephrine, fibrinogen, vascular cell adhesion molecule-1, and interleukin-8 in serum, and α-amylase in saliva; and reduced odds of previously diagnosed depression. CONCLUSIONS The observed effects of vegetated land cover on allostatic load and individual biomarkers are consistent with prevention of depression, cardiovascular disease and premature mortality.
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Affiliation(s)
- Andrey I Egorov
- National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC, USA.
| | - Shannon M Griffin
- National Exposure Research Laboratory, United States Environmental Protection Agency, Cincinnati, OH, USA
| | - Reagan R Converse
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer N Styles
- National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC, USA; National Exposure Research Laboratory, United States Environmental Protection Agency, Cincinnati, OH, USA
| | - Elizabeth A Sams
- National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Anthony Wilson
- Association of Schools and Programs of Public Health fellow at the United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Laura E Jackson
- National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Timothy J Wade
- National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC, USA
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Robertson T, Beveridge G, Bromley C. Allostatic load as a predictor of all-cause and cause-specific mortality in the general population: Evidence from the Scottish Health Survey. PLoS One 2017; 12:e0183297. [PMID: 28813505 PMCID: PMC5559080 DOI: 10.1371/journal.pone.0183297] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/02/2017] [Indexed: 11/18/2022] Open
Abstract
Allostatic load is a multiple biomarker measure of physiological ‘wear and tear’ that has shown some promise as marker of overall physiological health, but its power as a risk predictor for mortality and morbidity is less well known. This study has used data from the 2003 Scottish Health Survey (SHeS) (nationally representative sample of Scottish population) linked to mortality records to assess how well allostatic load predicts all-cause and cause-specific mortality. From the sample, data from 4,488 men and women were available with mortality status at 5 and 9.5 (rounded to 10) years after sampling in 2003. Cox proportional hazard models estimated the risk of death (all-cause and the five major causes of death in the population) according to allostatic load score. Multiple imputation was used to address missing values in the dataset. Analyses were also adjusted for potential confounders (sex, age and deprivation). There were 258 and 618 deaths over the 5-year and 10-year follow-up period, respectively. In the fully-adjusted model, higher allostatic load (poorer physiological ‘health’) was not associated with an increased risk of all-cause mortality after 5 years (HR = 1.07, 95% CI 0.94 to 1.22; p = 0.269), but it was after 10 years (HR = 1.08, 95% CI 1.01 to 1.16; p = 0.026). Allostatic load was not associated with specific causes of death over the same follow-up period. In conclusions, greater physiological wear and tear across multiple physiological systems, as measured by allostatic load, is associated with an increased risk of death, but may not be as useful as a predictor for specific causes of death.
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Affiliation(s)
- Tony Robertson
- Centre for Public Health and Population Health Research, Faculty of Health Sciences & Sport, University of Stirling, Stirling, Scotland
- * E-mail:
| | - Gayle Beveridge
- Scottish Collaboration for Public Health Research & Policy, University of Edinburgh, Edinburgh, Scotland
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Utumatwishima JN, Baker RL, Bingham BA, Chung ST, Berrigan D, Sumner AE. Stress Measured by Allostatic Load Score Varies by Reason for Immigration: The Africans in America Study. J Racial Ethn Health Disparities 2017; 5:279-286. [PMID: 28444629 DOI: 10.1007/s40615-017-0368-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/14/2017] [Accepted: 04/03/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Reason for immigration as a biological stress has not been studied in Africans. Our goal was to determine in African immigrants, if biological stress measured by allostatic load score (ALS) varies by reason for immigration. METHODS Using an ALS which had been previously developed with the National Health and Nutrition Examination Survey (NHANES) data to assess stress due to racism and nativity, ALS was calculated in 85 African immigrants (67% male, age 42 ± 10 years). For confirmation, we tested five additional ALS also built from NHANES. RESULTS The two reasons for immigration which consistently had the lowest ALS were family reunification and lottery winner for self and immediate family. The other reasons for immigration such as study, asylum/refugee, and work had higher ALS. As reasons for immigration with the lowest ALS promoted family unity, they were combined (group 1) and the Africans who came for other reasons were combined (group 2). ALS in group 1 vs. group 2 was 1.96 ± 1.40 vs. 2.94 ± 1.87, P = 0.03. CONCLUSIONS Biological stress varies by reason for immigration and appears to be mitigated by maintaining family unity. Overall, reason for immigration is an important biographical data likely to influence health.
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Affiliation(s)
- Jean N Utumatwishima
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), Bld 10-CRC, Rm 6-5940, MSC 1612, 9000 Rockville Pike, Bethesda, MD, 20892-1612, USA
| | - Rafeal L Baker
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), Bld 10-CRC, Rm 6-5940, MSC 1612, 9000 Rockville Pike, Bethesda, MD, 20892-1612, USA
| | - Brianna A Bingham
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), Bld 10-CRC, Rm 6-5940, MSC 1612, 9000 Rockville Pike, Bethesda, MD, 20892-1612, USA
| | - Stephanie T Chung
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), Bld 10-CRC, Rm 6-5940, MSC 1612, 9000 Rockville Pike, Bethesda, MD, 20892-1612, USA
| | - David Berrigan
- Health Behavior Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), Bld 10-CRC, Rm 6-5940, MSC 1612, 9000 Rockville Pike, Bethesda, MD, 20892-1612, USA.
- National Institute of Minority Health and Health Disparities, NIH, Bethesda, MD, USA.
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O'Campo P, Schetter CD, Guardino CM, Vance MR, Hobel CJ, Ramey SL, Shalowitz MU. Explaining racial and ethnic inequalities in postpartum allostatic load: Results from a multisite study of low to middle income woment. SSM Popul Health 2016; 2:850-858. [PMID: 29082305 PMCID: PMC5659269 DOI: 10.1016/j.ssmph.2016.10.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Racial and ethnic inequalities in women's health are widely documented, but not for the postpartum period, and few studies examine whether neighborhood, psychosocial, and biological factors explain these gaps in women's health. METHODS Using prospective longitudinal data collected from 1766 low to middle income women between 2008 and 2012 by the Community Child Health Network (CCHN), we tested the extent to which adjustment for neighborhood, economic, psychological, and medical conditions following a birth explained differences between African American, Latina, and White women in an indicator of physiological dysregulation allostatic load (AL), at one year postpartum as measured by 10 biomarkers: Body Mass Index, Waist Hip Ratio, systolic and diastolic blood pressure, high sensitivity C-reactive protein, Hemoglobin A1c, high-density lipoprotein and cholesterol ratio, and diurnal cortisol. RESULTS Mean postpartum AL scores were 4.65 for African American, 4.57 for Latina and 3.86 for White women. Unadjusted regression estimates for high AL for African American women (with White as the reference) were 0.80 (SD = 0.11) and 0.53 (SD = 0.15) for Latina women. Adjustment for household poverty, neighborhood, stress, and resilience variables resulted in a reduction of 36% of the excess risk in high AL for African Americans versus Whites and 42% of the excess risk for Latinas compared to Whites. CONCLUSIONS Racial and ethnic inequalities in AL were accounted for largely by household poverty with additional contributions by psychological, economic, neighbourhood and medical variables. There remained a significant inequality between African American, and Latina women as compared to Whites even after adjustment for this set of variables. Future research into health inequalities among women should include a fuller consideration of the social determinants of health including employment, housing and prepregnancy medical conditions.
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Affiliation(s)
- Patricia O'Campo
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Christine M Guardino
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Calvin J Hobel
- UCLA and Cedar Sinai Health System, Los Angeles, CA, USA
| | - Sharon Landesman Ramey
- Virginia Tech Carilion Research Institute, Virginia Tech, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Madeleine U Shalowitz
- NorthShore University Health System and University of Chicago Pritzker School of Medicine, Evanston, IL, USA
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Arbeev KG, Ukraintseva SV, Yashin AI. Dynamics of biomarkers in relation to aging and mortality. Mech Ageing Dev 2016; 156:42-54. [PMID: 27138087 PMCID: PMC4899173 DOI: 10.1016/j.mad.2016.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/08/2016] [Accepted: 04/26/2016] [Indexed: 02/06/2023]
Abstract
Contemporary longitudinal studies collect repeated measurements of biomarkers allowing one to analyze their dynamics in relation to mortality, morbidity, or other health-related outcomes. Rich and diverse data collected in such studies provide opportunities to investigate how various socio-economic, demographic, behavioral and other variables can interact with biological and genetic factors to produce differential rates of aging in individuals. In this paper, we review some recent publications investigating dynamics of biomarkers in relation to mortality, which use single biomarkers as well as cumulative measures combining information from multiple biomarkers. We also discuss the analytical approach, the stochastic process models, which conceptualizes several aging-related mechanisms in the structure of the model and allows evaluating "hidden" characteristics of aging-related changes indirectly from available longitudinal data on biomarkers and follow-up on mortality or onset of diseases taking into account other relevant factors (both genetic and non-genetic). We also discuss an extension of the approach, which considers ranges of "optimal values" of biomarkers rather than a single optimal value as in the original model. We discuss practical applications of the approach to single biomarkers and cumulative measures highlighting that the potential of applications to cumulative measures is still largely underused.
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Affiliation(s)
- Konstantin G Arbeev
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, 2024 W. Main St., Room A102F, Box 90420, Durham, NC 27705, USA.
| | - Svetlana V Ukraintseva
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, 2024 W. Main St., Room A102F, Box 90420, Durham, NC 27705, USA
| | - Anatoliy I Yashin
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, 2024 W. Main St., Room A102F, Box 90420, Durham, NC 27705, USA
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Howard JT, Sparks PJ. Does allostatic load calculation method matter? Evaluation of different methods and individual biomarkers functioning by race/ethnicity and educational level. Am J Hum Biol 2016; 28:627-35. [DOI: 10.1002/ajhb.22843] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/22/2015] [Accepted: 01/09/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Jeffrey T. Howard
- US Army Institute of Surgical Research; San Antonio Texas
- Epidemiology and Biostatistics Department; US Army Institute of Surgical Research, JBSA San Antonio; Texas
| | - P. Johnelle Sparks
- Department of Demography; University of Texas at San Antonio; San Antonio Texas
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O'Connor DB, Ferguson E, Green JA, O'Carroll RE, O'Connor RC. Cortisol levels and suicidal behavior: A meta-analysis. Psychoneuroendocrinology 2016; 63:370-9. [PMID: 26555430 DOI: 10.1016/j.psyneuen.2015.10.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/03/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
Suicide is a major cause of death worldwide, responsible for 1.5% of all mortality. The causes of suicidal behavior are not fully understood. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, is one potential risk factor. This meta-analytic review aimed (i) to estimate the strength and variability of the association between naturally fluctuating cortisol levels and suicidal behavior and (ii) to identify moderators of this relationship. A systematic literature search identified 27 studies (N=2226; 779 suicide attempters and 1447 non-attempters) that met the study eligibility criteria from a total of 417 unique records initially examined. Estimates of effect sizes (r) obtained from these studies were analysed using Comprehensive Meta-Analysis. In these analyses, we compared participants identified as having a past history of suicide attempt(s) to those with no such history. Study quality, mean age of sample and percentage of male participants were examined as potential moderators. Overall, there was no significant effect of suicide group on cortisol. However, significant associations between cortisol and suicide attempts were observed as a function of age. In studies where the mean age of the sample was below 40 years the association was positive (i.e., higher cortisol was associated with suicide attempts; r=.234, p<.001), and where the mean age was 40 or above the association was negative (i.e., lower cortisol was associated with suicide attempts; r=-.129, p<.001). These findings confirm that HPA axis activity, as indicated by age-dependent variations in cortisol levels, is associated with suicidal behavior. The challenge for theory and clinical practice is to explain the complete reversal of the association with age and to identify its clinical implications.
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Affiliation(s)
| | - Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, UK
| | | | | | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
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Frei R, Haile SR, Mutsch M, Rohrmann S. Relationship of Serum Vitamin D Concentrations and Allostatic Load as a Measure of Cumulative Biological Risk among the US Population: A Cross-Sectional Study. PLoS One 2015; 10:e0139217. [PMID: 26451600 PMCID: PMC4599851 DOI: 10.1371/journal.pone.0139217] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 09/10/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The allostatic load (AL) index is a multi-systemic measure of physiologic dysregulation known to be associated with chronic exposure to stress and adverse health outcomes. We examined the relationship between AL and serum 25-hydroxyvitamin D (25(OH)D) concentration in non-institutionalized US adults. METHODS Data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94) were used to calculate two versions of AL including 9 biomarkers and another two with 14 biomarkers (systolic and diastolic blood pressure, pulse rate, serum cholesterol, serum HDL-cholesterol, glycated hemoglobin, sex-specific waist-to-hip ratio, serum albumin, and serum C-reactive protein for AL1, and, additionally body mass index, serum triglyceride, serum creatinine, and serum herpes I & II antibodies for AL2), each set defined by predefined cut-offs or by quartiles. Serum vitamin D concentration was ranked into quartiles. Logistic regression, Poisson regression and linear regression were used to examine the association of serum 25(OH)D concentrations on AL, after adjusting for biological, physiological, socioeconomic, lifestyle, and health variables. RESULTS Odds Ratios (OR) for high AL of the lowest 25(OH)D serum quartile were between 1.45 (95% CI: 1.28, 1.67) and 1.79 (95% CI: 1.39, 2.32) for the fully adjusted model, depending on AL version. Inverse relationships between vitamin D serum concentrations were observed for all AL versions and every adjustment. This relationship was consistent after stratification by sex, age or ethnic background. Sensitivity to low 25(OH)D concentrations was highest among the youngest group (20-39 years) with an OR of 2.11 (95% CI: 1.63, 2.73) for the lowest vitamin D quartile Q1. CONCLUSIONS Vitamin D had a consistent and statistically significant inverse association with all tested models of high AL, which remained consistent after adjusting for biological, socioeconomic, lifestyle and health variables. Our study adds evidence linking low 25(OH)D concentrations with poorer health, further-reaching than bone health.
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Affiliation(s)
- Regina Frei
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Sarah R. Haile
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Margot Mutsch
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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Jiménez MP, Osypuk TL, Arevalo S, Tucker KL, Falcon LM. Neighborhood socioeconomic context and change in allostatic load among older Puerto Ricans: The Boston Puerto Rican health study. Health Place 2015; 33:1-8. [PMID: 25706323 DOI: 10.1016/j.healthplace.2015.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/27/2015] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Abstract
Neighborhood context may influence health and health disparities. However, most studies have been constrained by cross-sectional designs that limit causal inference due to failing to establish temporal order of exposure and disease. We tested the impact of baseline neighborhood context (neighborhood socioeconomic status factor at the block-group level, and relative income of individuals compared to their neighbors) on allostatic load two years later. We leveraged data from the Boston Puerto Rican Health Study, a prospective cohort of aging Puerto Rican adults (aged 45-75 at baseline), with change in AL modeled between baseline and the 2nd wave of follow-up using two-level hierarchical linear regression models. Puerto Rican adults with higher income, relative to their neighbors, exhibited lower AL after two years, after adjusting for NSES, age, gender, individual-level SES, length of residence, and city. After additional control for baseline AL, this association was attenuated to marginal significance. We found no significant association of NSES with AL. Longitudinal designs are an important tool to understand how neighborhood contexts influence health and health disparities.
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Affiliation(s)
- Marcia P Jiménez
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA
| | - Theresa L Osypuk
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, West Bank Office Building, Suite 435, 1300 S. Second Street, Minneapolis, MN 55454, USA
| | - Sandra Arevalo
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, 3 Solomont Way, Suite 4, Lowell, MA 01854, USA; Center for Population Health and Health Disparities, University of Massachusetts at Lowell, Weed Hall 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, 3 Solomont Way, Suite 4, Lowell, MA 01854, USA; Center for Population Health and Health Disparities, University of Massachusetts at Lowell, Weed Hall 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
| | - Luis M Falcon
- College of Fine Arts, Humanities, & Social Sciences, University of Massachusetts at Lowell, 150 Wilder St., Lowell, MA 01854, USA; Center for Population Health and Health Disparities, University of Massachusetts at Lowell, Weed Hall 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
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Allostatic load and the assessment of cumulative biological risk in biobehavioral medicine: challenges and opportunities. Psychosom Med 2014; 76:478-80. [PMID: 25141272 PMCID: PMC4163075 DOI: 10.1097/psy.0000000000000095] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Allostatic load provides a useful framework for conceptualizing the multisystem physiological impact of sustained stress and its effects on health and well-being. Research across two decades shows that allostatic load indices predict health outcomes including all-cause mortality and vary with stress and related psychosocial constructs. The study by Slopen and colleagues in this issue provides an example both of the utility of the allostatic load framework and of limitations in related literature, such as inconsistencies in conceptualization and measurement across studies, and the frequent application of cross-sectional designs. The current article describes these limitations and provides suggestions for further research to enhance the value and utility of the allostatic load framework in biobehavioral medicine research.
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