Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study

Abstract

Puerto Ricans living in the United States mainland present multiple disparities in prevalence of chronic diseases, relative to other racial and ethnic groups. Allostatic load (AL), or the cumulative wear and tear of physiological responses to stressors such as major life events, social and environmental burden, has been proposed as a possible mechanism for the inequalities observed in minority groups, but has not been studied in Puerto Ricans. The aim of this study was to determine the association of AL to six chronic diseases (abdominal obesity, hypertension, diabetes, and selfreported cardiovascular disease (CVD), arthritis and cancer) in Puerto Ricans, and to contrast AL to metabolic syndrome (MetS). Participants of the Boston Puerto Rican Health Study (n=1,116, ages 45-75 years) underwent a home-based interview, where questionnaires were completed and biological samples collected. A summary definition of AL was constructed using clinicallydefined cutoffs and medication use for 10 physiological parameters in different body systems. Logistic regression models were run to determine associations between AL score and disease status, controlling for age, sex, smoking, alcohol use, physical activity, total fat intake and energy intake. Parallel models were also run with MetS score replacing AL. We found that increasing categories of AL score were significantly associated with abdominal obesity, hypertension, diabetes and self-reported cardiovascular disease (CVD) and arthritis, but not with self-reported cancer. The strength of associations of AL with all conditions, except diabetes and cancer, was similar to or larger than those of MetS score. In conclusion, Puerto Rican older adults experienced physiological dysregulation that was associated with increased odds of chronic conditions. AL was more strongly associated with most conditions, compared to MetS, suggesting that this cumulative measure may be a better predictor of disease. These results have prospective research implications for Puerto Ricans and other ethnic groups.

Allostatic load and biological anthropology

“…In other research, medications were accounted for by adjusting the construction of the reported ALI. For example, some researchers add a point for every biomarker directly affected by a medication to the ALI regardless of the biomarker's current level, although specific adjustments vary by study (Ar evalo, Tucker, & Falc on, 2014;Doamekpor & Dinwiddie, 2015;Gale, Booth, Starr, & Deary, 2015;Hampson et al, 2009;Mattei et al, 2010;Robertson et al, 2014;Robertson & Watts, 2016 Clinically based constructs directly counteract the usefulness of ALIs to determine individuals in a group at greatest underlying risk for future health issues and early mortality. However, within medical settings, applying ALIs using clinical cut-points may be more practical, particularly as sample distributions are not usually available when working with individual patients (Mauss et al, 2016).…”

“…In general, higher allostatic load is associated with poorer physical performance and increased risk for physical decline (Seeman et al, 1997). Across research settings, higher allostatic load also is associated significantly with cardiovascular diseases (CVD; Karlamangla et al, 2002;Mattei et al, 2010;Seeman et al, 2002), abdominal obesity (Mattei et al, 2010), hypertension (Mattei et al, 2010), diabetes (Mattei et al, 2010), and arthritis (Mattei et al, 2010).…”

“…Over time, such damage accumulates, producing allostatic load (McEwen & Stellar, 1993). As dysregulation continues, allostasis theory suggests cardiovascular and metabolic diseases follow, leading to stress-related tertiary outcomes such as cardiovascular disease, hypertension, and diabetes (Karlamangla, Singer, McEwen, Rowe, & Seeman, 2002;Mattei, Demissie, Falcon, Ordovas, & Tucker, 2010;Seeman, Singer, Ryff, Love, & Levy-Storms, 2002) and mortality (Glei, Goldman, Rodríguez, & Weinstein, 2014;Gruenewald, Seeman, Ryff, Karlamangla, & Singer, 2006;Hwang et al, 2014;Levine & Crimmins, 2014;Seeman, Crimmins, et al, 2004;Seeman, McEwen, Rowe, & Singer, 2001;Seeman et al, 1997). We illustrate this process in Figure 2.…”

Racial and Ethnic Patterns of Allostatic Load Among Adult Women in the United States: Findings from the National Health and Nutrition Examination Survey 1999–2004

“…11 Prior research has shown higher AL to be associated with mortality, cardiovascular disease, and decreased physical and cognitive functioning. 8,9,[15][16][17][18][19] The formulation of AL by McEwen and Seeman 13 and Seeman et al 10 included primary mediators and secondary markers involved in physiological stress responses. Primary mediators are circulating hormonal agents that mediate the body's response to stressors through their effects on tissues and organs (e.g., cortisol, epinephrine, C-reactive protein [CRP] and dehydroepiandrosterone-sulfate [DHEA-S]).…”

Disruption of multisystem responses to stress in type 2 diabetes: Investigating the dynamics of allostatic load

“…Allostatic load is frequently quantified by measuring a range of biomarkers (e.g., blood pressure, cortisol, catecholamines, glycated hemoglobin, waist circumference, cholesterol, inflammatory markers), and allocating individuals scores based on the number of variables on which values are elevated compared with the sample distribution (9,10). Studies relating allostatic load measures with type 2 diabetes have been inconsistent to date (11,12). However, another aspect of allostasis is that it is manifest in modifications of dynamic responses to challenge, not only in basal measures.…”