Stress Measured by Allostatic Load in Neurologically Impaired Children: The Importance of Nutritional Status

Abstract

Background: Allostatic load (AL) is the cumulative physiological wear and tear that results from repeated efforts to adapt to stressors over time. The life stress response is modified by nutritional status. Aim: We estimated AL scores among neurologically impaired (NI) children; the association with malnutrition was also evaluated. Methods: Forty-one patients with severe disabilities were included. Data based on 15 biomarkers were used to create the AL score. A dichotomous outcome of high AL was defined for those who had ≥6 dysregulated components. Body mass index (BMI)-standard deviation score (SDS) <–2 or SDS ≥2 and biochemical markers (≥4) defined malnutrition. Results: High AL was noted in 17/41 of the whole sample (41.47%). Malnutrition occurred in 36.6% of the subjects. A significant correlation between high AL and malnutrition was observed (p = 0.01; ar ea under the receiver operating characteristic curve, 0.7457). High AL subjects had a significantly higher BMI (p = 0.009) and lower BMI-SDS (p = 0.003) than low AL subjects. AL score correlated with fat mass (p ≤ 0.01) and negatively correlated with fat-free mass (p ≤ 0.02). Conclusion: In NI children, high AL was associated with malnutrition. Body composition is a better indicator than BMI of allostatic adjustments. AL estimation should be considered a measure of health risk and be used to promote quality of life in at-risk disabled populations.

The association between allostatic load and anthropometric measurements among a multiethnic cohort of children

“…As such, our preliminary analyses evaluated the potential contributions of energy intake (kcal) and physical activity to our main outcome in response to previously published data supporting associations of these parameters with body composition and with stress response. 3,9 However, when energy-intake variables and physical activity variables (obtained from 24-h dietary recalls and questionnaires, respectively, as described elsewhere 24 ) were added as covariates in the models no statistical contributions were observed from these measures (data not shown). Consequently, these variables were not included in our statistical models.…”

“…The use of ALoad as measure of chronic stress and its association with health outcomes has been highly described in the literature. 6,[8][9][10]18,19 While there are variations in how ALoad is calculated, it has been suggested that ALoad calculations in adults should include biomarkers from three systems (cardiovascular, metabolic, and immune/ inflammatory). 7 In children, to measure the association with paediatric obesity, ALoad index typically includes markers such as homeostasis model assessment-insulin resistance (HOMA-IR), total cholesterol, triglycerides, blood pressure (systolic and diastolic), C-reactive protein (CRP), and others.…”

“…7 However, research on ALoad index calculations in children is limited, and prior studies have utilized different combinations of bio-markers. 8,9 While there is no consensus on how to measure ALoad, the use of a previously published scoring system or developing a new definition tailored to a specific question is preferred. 7 Despite the variability in ALoad indexes, its use in predicting health risk associated with stress has been well documented, and it has been shown that the ALoad index improves the prediction of mortality and health outcomes compared with the use of metabolic syndrome components alone.…”

Malnutrition and Associated Risk Factors Among Disabled Children. Special Considerations in the Pediatric Surgical “Fragile” Patients

“…In individuals exposed to repeated or chronic stress, such as disability, the glucocorticoid (GC)-dependent stress-response negative feedback mechanism is impaired, leading to GC receptor resistance, and high systemic levels of molecular stress mediators, affecting the immune system and damaging multiple organs and tissues over time (13). A high cumulative physiological wear and tear, referred to allostatic load (AL) and considered a marker of chronic stress, has already been described in disabled children (14). AL is a preclinical marker of pathophysiological processes that can be considered a key mediator of adversity and negative health outcomes able to predict cardiovascular disease progression and mortality (14).…”

“…A high cumulative physiological wear and tear, referred to allostatic load (AL) and considered a marker of chronic stress, has already been described in disabled children (14). AL is a preclinical marker of pathophysiological processes that can be considered a key mediator of adversity and negative health outcomes able to predict cardiovascular disease progression and mortality (14). More than 40% of the NI subjects showed high AL, significantly correlated with malnutrition (13) and potentially influencing outcome.…”