Current Perspectives for Diabetes and Allostatic Load: The Role of Nutrition

Author(s): Melahat S. Macit, Nilüfer Acar-Tek*.

Journal Name: Current Nutrition & Food Science

Volume 15 , Issue 7 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Allostasis and allostatic load are new concepts explaining the changes in body stemming from chronic stress. These concepts are explained with the assessment of metabolic, cardiovascular, inflammatory, and neuroendocrine systems. Type 2 Diabetes Mellitus (DM) is a chronic disease with the fluctuations in fasting plasma glucose, and also in other various biomarkers and poses a risk forother chronic diseases. The course and duration of the disease, genetic factors, and environmental factors, including nutrition, aggravate these complications. Allostatic load is a multi-system assessment. Individuals’ compliance with the medical nutrition therapy in the short and long-term, changes in anthropometric and biochemical biomarkers that are used to measure the nutritional status. In the monitoring of patients with diabetes, it’s important to assess metabolic, cardiovascular, neuroendocrine, and immune system biomarkers as well as fasting blood glucose. There exist studies in the literature, investigating the relationship of the allostatic load with socio-economic status, chronic diseases such as diabetes and cardiovascular diseases, gender, and ethnicity. In these studies, chronic stress, nutritional status, stress, and allostasis are briefly described. In the present literature review, it was aimed to evaluate different aspects of the relationships among diabetes, nutrition, allostatic load, and stress.

Keywords: Allostasis, allostatic load, chronic stress, diabetes, HPA axis, nutrition.

Lazarus RS, Folkman S. Stress, Appraisal, and Coping. Springer Berlin, Germany 1984.
Frei R, Haile SR, Mutsch M, Rohrmann S. Relationship of serum vitamin D concentrations and allostatic load as a measure of cumulative biological risk among the US population: A cross-sectional study. PLOS One 2015; 10(10) e0139217
Maestripieri D, Hoffman CL. Chronic stress, allostatic load, and aging in nonhuman primates. Develop Psychopathol 2011; 23: 1187-95.
Seeman T, Epel E, Gruenewald T, Karlamangla A, McEwen BS. Socio-economic differentials in peripheral biology: cumulative allostatic load. Ann N Y Acad Sci 2010; 1186: 223-39.
Allsworth JE, Weitzen S, Boardman LA. Early age at menarche and allostatic load: data from the Third National Health and Nutrition Examination Survey. Ann Epidemiol 2005; 15(6): 438-44.
Lipowicz A, Szklarska A, Malina RM. Allostatic load and socioeconomic status in Polish adult men. J Biosoc Sci 2014; 46(2): 155-67.
Thayer Z, Barbosa-Leiker C, McDonell M, Nelson L, Buchwald D, Manson S. Early life trauma, post-traumatic stress disorder, and allostatic load in a sample of American Indian adults. Am J Hum Biol 2017; 29e22943
Gustafsson PE, Janlert U, Theorell T, Westerlund H, Hammarström A. Socioeconomic status over the life course and allostatic load in adulthood: Results from the Northern Swedish Cohort. J Epidemiol Commun Health 2011; 65(11): 986-92.
Rainisch BK, Upchurch DM. Sociodemographic correlates of allostatic load among a national sample of adolescents: findings from the National Health and Nutrition Examination Survey, 1999-2008. J Adolesc Health 2013; 53(4): 506-11.
Kim JY. Relationships between dietary habits and allostatic load index in metabolic syndrome patients. Korean J Fam Med 2013; 34(5): 334-46.
Sterlin P, Eyer J. Allostasis: a new paradigm to explain arousal pathology. In: Fisher S, Reason J, Eds. Handbook of life stress, cognition and health. John Wiley & Sons Oxford, England 1988; pp. 629-49.
Danese A, McEwen BS. Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav 2012; 106(1): 29-39.
Morrison S, Shenassa ED, Mendola P, Wu T, Schoendorf K. Allostatic load may not be associated with chronic stress in pregnant women, NHANES 1999-2006. Ann Epidemiol 2013; 23(5): 294-7.
McEwen BS, Karatsoreos IN. Sleep deprivation and circadian disruption. Sleep Med Clin 2015; 10(1): 1-10.
McEwen BS, Rasgon NL. The brain and body stress allostatic load and mechanisms for depression and dementia. In: Strain JJ, Blumenfield M, Eds. Depression as a systemic illness. Oxford University Press New York 2018; pp. 14-36.
Logan JG, Barksdale DJ. Allostasis and allostatic load: Expanding the discourse on stress and cardiovascular disease. J Clin Nurs 2008; 17(7B): 201-8.
McEwen B, Nasveld P, Palmer M, Anderson R. Allostatic load a review of the literature. Department of Veterans’ Affairs Canberra, Australia 2012.
Langelaan S, Bakker AB, Schaufeli WB, Van Rhenen W, Van Doornen LJP. Is burnout related to allostatic load? Int J Behav Med 2007; 14(4): 213-21.
Read S, Grundy E. Allostatic load - a challenge to measure multisystem physiological dysregulation. NCRM Working paper 2012; 4(12); Available at: ingpaper_0412.pdf
Brody GH, Lei MK, Chae DH, Yu T, Kogan SM. Beach SRH Perceived discrimination among African American adolescents and allostatic load: a longitudinal analysis with buffering effects. Child Dev 2014; 85(3): 989-1002.
Trovato GM, Catalano D, Martines GF, et al. Psychological stress measure in type 2 diabetes. Eur Rev Med Pharmacol Sci 2006; 10: 69-74.
Mitra A. Diabetes and stress: a review. Ethno-Med 2008; 2(2): 131-5.
Buyken AE, Mitchell P, Ceriello A, Brand-Miller J. Optimal dietary approaches for prevention of type 2 diabetes: A life-course perspective. Diabetologia 2010; 53(3): 406-18.
Surwit RS, van Tilburg MA, Zucker N, et al. Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care 2002; 25: 30-4.
Doan SN, Evans GW. Maternal responsiveness moderates the relationship between allostatic load and working memory. Dev Psychopathol 2011; 23(3): 873-80.
Hawkley LC, Lavelle LA, Berntson GG, Cacioppo JT. Mediators of the relationship between socioeconomic status and allostatic load in the Chicago Health, Aging, and Social Relations Study (CHASRS). Psychophysiology 2011; 48(8): 1134-45.
Hjempdahl P, Rosengren A, Steptoe E. Introduction to Cardiovascular Disease, Stress and Adaptation. In: Hjempdahl P, Rosengren A, Steptoe E, Eds. Stress and cardiovasculer disease. 2012; pp. 1-14.
Goldstein DS, Kopin IJ. Linking stress, catecholamine autotoxicity, and allostatic load with neurodegenerative diseases: a focused review in memory of Richard Kvetnansky. Cell Mol Neurobiol 2018; 38: 13-24.
Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link betweenstress, depression, and type 2 diabetes mellitus. Ann NY Acad Sci 2017; 1391(1): 20-34.
Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev 2010; 35(1): 2-16.
Vicennati V, Pasquali R. Abnormalities of the hypothalamic-pituitary-adrenal axis in nondepressed women with abdominal obesity and relations with insulin resistance: Evidence for a central and a peripheral alteration. J Clin Endocrinol Metab 2000; 85(11): 4093-8.
Wyillie J. Allostatic load and its role in insulin resistance Logan College od Chiropractic
Öztürk Y. Hipertansiyon ve lipid polikliniği’ne başvuran tip 2 diyabetik hipertansif hastaların tedavi hedefleri açısından retrospektif incelenmesi Master thesis 2006.
Chrousos G. The role of stress and the hypothalamic - pituitary - adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes. Int J Obes 2000; 2: 50-5.
Papadaki A, Hondros GA, Scott J, Kapsokefalou M. Eating habits of university students living at, or away from home in Greece. Appetite 2007; 49(1): 169-76.
Mahan LK, Escott-Stump S, Raymon J. Krause’s Food and Nutrition Process. Elsevier The Netherlands 2012.
Al-Rethaiaa AS, Fahmy AE, Al-Shwaiyat NM. Obesity and eating habits among college students in Saudi Arabia: a cross sectional study. Nutr J 2010; 9: 39.
Carlsson AC, Nixon Andreasson A, Wandel PE. Poor self-rated health is not associated with a high total allostatic load in type 2 diabetic patients-but high blood pressure is. Diabetes Metab 2011; 37(5): 446-51.
Center for Drug Evaluation and Research (CDER). Guidance for Industry Diabetes Mellitus: Developing Drugs and Therapeutic Biologics for Treatment and Prevention 2008.
Rosemberg MS, Li Y, Seng J. Allostatic load: a useful concept for advancing nursing research. J Clin Nurs 2017; 26(23-24): 5191-205.
Pi-Sunyer FX. Symposium on body weight regulation and obesity: Metabolic and clinical aspects: 1st plenary session: “obesity.” Obesity: criteria and classification. Proceedings of the Nutrition Society 2000. 59.
Dandona P, Aljada A, Bandyopadhyay A. Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol 2004; 25(1): 4-7.
Eckel RH, Kahn SE, Ferrannini E, et al. Obesity and type 2 diabetes: What can be unified and what needs to be individualized? J Clin Endocrinol Metab 2011; 96(6): 1654-63.
Tan M, Mamun A, Kitzman H, Mandapati SR, Dodgen L. Neighborhood disadvantage and allostatic load in African American women at risk for obesity-related diseases. Prev Chronic Dis 2017; 14 E119
Ottino-González J, Jurado MA, García-García I, et al. Allostatic load is linked to cortical thickness changes depending on body-weight status. Front Hum Neurosci 2017; 11: 639.
Cheung B, Li C. Diabetes and hypertension: Is there a common metabolic pathway? Curr Atheroscler Rep 2012; 14(2): 160-6.
Lukic L, Lalic NM, Rajkovic N, et al. Hypertension in obese type 2 diabetes patients is associated with increases in insulin resistance and IL-6 cytokine levels: potential targets for an efficient preventive intervention. Int J Environ Res Public Health 2014; 11(4): 3586-98.
Meshram A, Agrawal U, Dhok A, Adole P, Meshram K, Khare R. HbA1c, hs-CRP and anthropometric biomarkers evaluation in the patients of diabetes mellitus of Central Rural India. Int J Med Sci Public Health 2013; 2(2): 293-6.
Wang X, Bao W, Liu J, et al. Inflammatory markers and risk of type 2 diabetes: A systematic review and meta-analysis. Diabetes Care 2013; 36(1): 166-75.
Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001; 286(3): 327-34.
Maury E, Brichard S. Adipokine dysregulation, adipose tissue inflammation and metabolic syndrome. Mol Cell Endocrinol 2010; 314(1): 1-16.
Hotamısşlıgil GS. The role of TNFalpha and TNF receptors in obesity and insulin resistance. J Intern Med 1999; 245(6): 621-5.
Koçyıldız E. Postmenopozal Diyabetik Ve Nondiyabetik Kadinlarda Serum Dehidroepiandrosteron Sülfat Düzeyleri Ile Vücut Kitle Indeksi, Vücut Yağ Orani, Açlik Serum Insülin Düzeyi, Kemik Mineral Dansitesi Ve Koroner Arter Hastaliği Risk Faktörleri Arasindaki Ilişki. Master thesis, İstanbul 2006.
Kapoor D, Malkin CJ, Channer KS, Jones TH. Androgens, insulin resistance and vascular disease in men. Clin Endocrinol (Oxf) 2005; 63(3): 239-50.
Kanazawa I, Yamaguchi T, Yamamoto M, et al. Serum DHEA-S level is associated with the presence of atherosclerosis in postmenopausal women with type 2 diabetes mellitus. Endocr J 2005; 55(4): 667-75.
Yorek MA, Coppey LJ, Gel JS, et al. Effect of treatment of diabetic rats with dehydroepiandrosterone on vascular and neural function. Am J Physiol Endocrinol Metab 2003; 8(2): 128-33.
Ueshiba H, Shimizu Y, Hiroi N, et al. Decreased steroidogenic enzyme 17,20-lyase and increased 17-hydroxylase activities in type 2 diabetes mellitus. Eur J Endocrinol 2002; 146(3): 375-80.
Chiodini I, Adda G, Scillitani A, et al. Cortisol secretion in patients with type 2 diabetes: relationship with chronic complications. Diabetes Care 2007; 30(1): 83-8.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [646 - 652]
Pages: 7
DOI: 10.2174/1573401314666180620164859
Price: $58

Article Metrics

PDF: 21
PRC: 1