Evaluation of Nutritional Status and Allostatic Load in Adult Patients With Type 2 Diabetes

Abstract

Objective

Diabetes is a chronic disease, affected by nutritional status, and characterized by dysregulations in several systems. Allostatic load is an index that evaluates the dysregulation of all physiological and metabolic systems. This study was conducted to determine the relationship between nutritional status and allostatic load in patients with type 2 diabetes mellitus (T2DM).

Methods

The study sample consisted of 30 males and 73 females between 20 and 55 years of age. Individuals had T2DM for 7.9±6.17 (mean ± standard deviation) years. World Health Organization criteria cutoffs were used to calculate allostatic load scores. Twelve parameters were questioned and an allostatic load score between 0 and 12 was obtained; values above the cutoff levels were assigned a value of 1, and values in the normal range were assigned a value of 0.

Results

Individuals with high allostatic load comprised a significant portion of the sample (79.6%) for both males and females (73.3% and 82.2%, respectively). Longer diabetes duration was associated with high allostatic load score (p<0.05). There was lower vegetable consumption and higher fruit consumption in the high-allostatic-load group compared with the low-allostatic-load group (p<0.05). However, fruit consumption was still lower than recommended levels in both groups.

Conclusions

A significant number of individuals had high allostatic load scores in our study. A healthy diet plan in line with the recommendations may help to decrease the allostatic load scores by reducing body weight, waist/hip ratio, blood pressure and fasting blood glucose, and may prevent the negative effects of stress on metabolic processes in the long-term malnutrition in T2DM.

Résumé

Objectif

Le diabète est une maladie chronique, influencée par l’état nutritionnel et caractérisée par des dysrégulations de nombreux systèmes. La charge allostatique est un indice qui permet d’évaluer la dysrégulation de tous les systèmes physiologiques et métaboliques. Nous avons mené la présente étude pour déterminer la relation entre l’état nutritionnel et la charge allostatique des patients atteints du diabète sucré de type 2 (DST2).

Méthodes

L’échantillon de la population étudiée était composé de 30 hommes et de 73 femmes entre 20 et 55 ans. Les individus avaient le DST2 depuis 7,9 ± 6,17 (moyenne ± écart type) ans. Nous avons utilisé les seuils de l’Organisation mondiale de la santé pour calculer les scores de l'indice de charge allostatique. Pour les 12 paramètres pris en compte, un score de l'indice de charge allostatique entre 0 et 12 a été obtenu; les valeurs supérieures aux seuils se sont vu attribuer une valeur de 1, et les valeurs dans la fourchette normale se sont vu attribuer une valeur de 0.

Résultats

Les individus qui avaient une charge allostatique élevée comptaient pour une part importante de l’échantillon (79,6 %) d'hommes et de femmes (73,3 % et 82,2 %, respectivement). Une durée plus longue du diabète a été associée à un score élevé de l'indice de charge allostatique (p < 0,05). Le groupe qui avait une charge allostatique élevée consommait moins de légumes et plus de fruits que le groupe qui avait une faible charge allostatique (p < 0,05). Toutefois, dans les 2 groupes, la consommation de fruits était toujours inférieure aux portions recommandées.

Conclusions

Dans notre étude, un nombre important d'individus avaient des scores élevés de l'indice de charge allostatique. Un régime alimentaire sain conforme aux recommandations peut aider à diminuer les scores de l'indice de charge allostatique du fait de la réduction du poids corporel, du rapport taille/hanches, de la pression artérielle et de la glycémie à jeun, et peut prévenir les effets négatifs du stress sur les processus métaboliques de la malnutrition à long terme lors de DST2.

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:

• Nutrition has several effects on body composition and biochemical parameters, and also on allostatic load.

• Consumption of food groups may affect allostatic load scores independently.

• Unregulated blood glucose may be a determinant for high allostatic load.