Variation in the Calculation of Allostatic Load Score: 21 Examples from NHANES

Abstract

After decades of resistance there is now a genuine consensus that disease cannot be prevented or even successfully treated unless the role of stress is addressed alongside traditionally recognized factors such as genes and the environment. Measurement of allostatic load, which is quantified by the allostatic load score (ALS), is one of the most frequently used methods to assess the physiologic response to stress. Even though there is universal agreement that in the calculation of ALS, biomarkers from three categories should be included (cardiovascular, metabolic and immune), enormous variation exists in how ALS is calculated. Specifically, there is no consensus on which biomarkers to include or the method which should be used to determine whether the value of a biomarker represents high risk. In this Perspective, we outline the approach taken in 21 different NHANES studies.

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

“…For example, around 18 different ALoad calculations and 26 different biomarkers have been used in various studies using data from the National Health and Nutrition Examination Survey (NHANES). 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.…”

“…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. 6 …”

“…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. 6 Although the perception of stress and activation of the allostatic mechanism are influenced by individual differences, 10 the long-term effects of ALoad from adverse circumstances such as social and economic stressors have been observed in different races/ethnicities, countries, and ages.…”

The Association between Stress Measured by Allostatic Load Score and Physiologic Dysregulation in African Immigrants: The Africans in America Study

“…Even though the concept of measuring biologic stress by an allostatic load score (ALS) is decades old (1, 2), no consensus exists on which biomarkers to include in calculating ALS (12, 13). After reviewing the literature, we felt that studies of ALS, which focused on African-Americans and/or Hispanic immigrant populations, may have the most relevance to the African immigrant experience (12).…”

“…After reviewing the literature, we felt that studies of ALS, which focused on African-Americans and/or Hispanic immigrant populations, may have the most relevance to the African immigrant experience (12). Therefore, we chose the ALS formulation used by both Geronimus et al and Kaestner et al (4, 8).…”