Original ResearchEvaluation of Nutritional Status and Allostatic Load in Adult Patients With Type 2 Diabetes
Introduction
Type 2 diabetes mellitus (T2DM) has a complex pathophysiology, with complications such as beta-cell damage and insulin resistance (1). Stress-related factors may play a role in the etiology of T2DM and can affect the inflammatory, metabolic and cardiovascular systems. Lifestyle factors may also be involved in the relationship between stress and diabetes, as well as the psychobiological factors. Allostatic load, which evaluates the dysregulation of several systems, is a model that incorporates all parameters of the inflammatory, metabolic and cardiovascular systems that are important in terms of T2DM complications. Allostatic load assessment also clarifies the effects of chronic stress on health through a comprehensive approach 2, 3.
Chronic stress emerges with the release of corticotrophin hormone from the hypothalamus and causes physiological changes, which result in negative health outcomes (4). If there is long-term chronic activity or inactivity in the metabolism, allostasis and allostatic load occurs, with high blood pressure, high blood lipids, high catecholamine levels, low glycemic control, increased waist circumference and abnormal levels of cortisol. This may lead to chronic diseases, such as obesity, atherosclerosis and diabetes, and may worsen the progression of current diseases 5, 6. Fasting blood glucose, glycated hemoglobin (HbA1C), total cholesterol, body mass index (BMI), waist/hip ratio, body fat percentage and blood pressure are the metabolic and cardiovascular system parameters involved in the evaluation of allostatic load (7).
Diabetes is a major public health problem and higher levels of blood glucose pose a long-term risk for patients. In these patients, it is useful to assess all parameters as well as blood glucose to prevent development of diabetes complications. It is necessary to monitor cardiovascular, metabolic and allostatic load-related parameters in patients with diabetes. High blood pressure may cause hypertension and unregulated blood glucose may cause microvascular complications of diabetes. Therefore, a holistic approach that includes all metabolic criteria represents a useful tool in clinical assessment. All parameters of the allostatic load are closely associated with diabetes. Accordingly, evaluation of allostatic load in patients with diabetes provides comprehensive follow up for patients in the clinic (5). Allostatic load index may provide more accurate information on mortality and physical condition as compared with evaluating the parameters separately. This model ensures assessment of primary and secondary mediators in conjunction and reveals tertiary outcomes for patients at risk (8).
Nutrition is an important factor as it has major effects on allostatic load parameters. Effects of eating habits, body composition and tertiary outcomes of allostatic load are summarized in Figure 1. Environmental factors, including diet, also have effects on allostatic load. The allostatic load may occur in response to food preferences and eating habits, and high-allostatic-load scores may be associated with abdominal obesity, cardiovascular disease, hypertension and T2DM (9).
Based on this background, we conducted a study to evaluate the relationship between nutritional status and allostatic load in patients with diabetes.
Our hypotheses were as follows:
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Nutrition has several effects on body composition and biochemical parameters, and also on allostatic load.
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Consumption of food groups may affect allostatic load scores independently.
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Unregulated blood glucose may be a determinant for high allostatic load.
Section snippets
Methods
This study was planned and conducted between May 2015 and December 2015 with a total of 103 patients, including 30 males and 73 females (20 to 55 years old) with diabetes at the Endocrinology and Metabolism Outpatient Clinic of Ondokuz Mayıs University Hospital. Pregnant/breastfeeding women, those with a different endocrine disease, those using drugs that affect cortisol level (etomidate, ketoconazole, estrogens) and those doing a sport that requires intense physical activity were excluded from
Results
A total of 79.6% of individuals had high-allostatic-load scores (73.3% of males and 82.2% of females, respectively; data not shown). In the low-allostatic-load group (allostatic load score, 0 to 4), the mean value of allostatic load was 3.4±0.68 for the total group, 3.6±0.74 for males and 3.3±0.63 for females. There was no statistically difference according to gender (p=0.268). In the high-allostatic-load group (allostatic load score, ≥4), the mean value of allostatic load was 6.5±1.22 for the
Discussion
Allostatic load is a multisystem assessment that includes metabolic, anthropometric, cardiovascular, inflammatory and neuroendocrine parameters. Diabetes is a major chronic disease with a number of complications, which includes the parameters above. Nutritional status may affect allostatic load and disease duration due to their influences on these parameters (21).
According to the present findings, 79.6% of participants had high-allostatic-load scores and 20.4% had low-allostatic-load scores,
Conclusions
To our knowledge, there has been no previous study evaluating the relationships between nutrition, T2DM and allostatic load.
Our recommendations include:
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In T2DM patients with unregulated blood glucose, there are fluctuations in several parameters as well as HbA1C. Allostatic load provides an assessment that incorporates all these parameters. This measure may help to prevent or delay complications.
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In T2DM patients, vegetable and total fruit‒vegetable consumption have positive effects. Consumption
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