title: Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study. Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study. Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults Comfort food is comforting to those most stressed: Evidence of the chronic stress response network in high stress women Dietary Patterns and Risk of Mortality From Cardiovascular Disease, Cancer, and All Causes in a Prospective Cohort of Women Childhood cumulative risk and later allostatic load: mediating role of substance use. Serum electrolyte, serum protein, serum fat and renal responses to a dietary sodium challenge: Allostasis and allostatic load Diabetes mellitus, fasting glucose, and risk of cause-specific death.
abstract: OBJECTIVE Only a few prospect i ve studies have examined the relationship between the frequency of cigarette smoking and the incidence of diabetes mellitus .  The purpose of this study was to determine whether greater frequency of cigarette smoking accelerated the development of diabetes mellitus , and whether quitting reversed the effect . METHODS Data were collected in the Cancer Prevention Study I , a prospect i ve cohort study conducted from 1959 through 1972 by the American Cancer Society where volunteers recruited more than one million acquaintances in 25 US states . From these over one million original participants , 275,190 men and 434,637 women aged > or = 30 years were selected for the primary analysis using predetermined criteria . RESULTS As smoking increased , the rate of diabetes increased for both men and women . Among those who smoked > or = 2 packs per day at baseline , men had a 45 % higher diabetes rate than men who had never smoked ; the comparable increase for women was 74 % . Quitting smoking reduced the rate of diabetes to that of non-smokers after 5 years in women and after 10 years in men . CONCLUSIONS A dose-response relationship seems likely between smoking and incidence of diabetes . Smokers who quit may derive substantial benefit from doing so . Confirmation of these observations is needed through additional epidemiological and biological research Puerto Ricans living in the United States mainl and present multiple disparities in prevalence of chronic diseases , relative to other racial and ethnic groups . Allostatic load ( AL ) , or the cumulative wear and tear of physiological responses to stressors such as major life events , social and environmental burden , has been proposed as a possible mechanism for the inequalities observed in minority groups , but has not been studied in Puerto Ricans . The aim of this study was to determine the association of AL to six chronic diseases ( abdominal obesity , hypertension , diabetes , and self-reported cardiovascular disease ( CVD ) , arthritis and cancer ) in Puerto Ricans , and to contrast AL to metabolic syndrome ( MetS ) . Participants of the Boston Puerto Rican Health Study ( n=1116 , ages 45 - 75 years ) underwent a  home-based interview  , where question naires were completed and biological sample s collected . A summary definition of AL was constructed using clinical ly-defined cutoffs and medication use for 10 physiological parameters in different body systems . Logistic regression models were run to determine associations between AL score and disease status , controlling for age , sex , smoking , alcohol use , physical activity , total fat intake and energy intake . Parallel models were also run with MetS score replacing AL . We found that increasing categories of AL score were significantly associated with abdominal obesity , hypertension , diabetes and self-reported cardiovascular disease ( CVD ) and arthritis , but not with self-reported cancer . The strength of associations of AL with all conditions , except diabetes and cancer , was similar to or larger than those of MetS score . In conclusion , Puerto Rican older adults experienced physiological dysregulation that was associated with increased odds of chronic conditions . AL was more strongly associated with most conditions , compared to MetS , suggesting that this cumulative measure may be a better predictor of disease . These results have prospect i ve research implication s for Puerto Ricans and other ethnic groups Background Discrimination promotes multisystem physiological dysregulation termed allostatic load , which predicts morbidity and mortality . It remains unclear whether weight-related discrimination influences allostatic load . Purpose The aim of this study was to prospect ively examine 10-year associations between weight discrimination , allostatic load , and its components among adults 25–75 years in the Midlife Development in the US Biomarker Sub study . Methods Participants with information on weight discrimination were analyzed ( n=986 ) . At both timepoints , participants self-reported the frequency of perceived weight discrimination across nine scenarios as “ never/rarely ” ( scored as 0 ) , “ sometimes ” ( 1 ) , or “ often ” ( 2 ) . The two scores were averaged and then dichotomized as “ experienced ” versus “ not experienced ” discrimination . High allostatic load was defined as having ≥3 out of 7 dysregulated systems ( cardiovascular , sympathetic/parasympathetic nervous systems , hypothalamic pituitary axis , inflammatory , lipid/metabolic , and glucose metabolism ) , which collectively included 24 biomarkers . Relative risks ( RR ) were estimated from multivariate models adjusted for sociodemographic and health characteristics , other forms of discrimination , and BMI . Results Over 41 % of the sample had obesity , and 6 % reported weight discrimination at follow-up . In multivariable-adjusted analyses , individuals who experienced ( versus did not experience ) weight discrimination had twice the risk of high allostatic load ( RR , 2.07 ; 95 % CI , 1.21 ; 3.55 for baseline discrimination ; 2.16 , 95 % CI , 1.39 ; 3.36 for long-term discrimination ) . Weight discrimination was associated with lipid/metabolic dysregulation ( 1.56 ; 95 % CI 1.02 , 2.40 ) , glucose metabolism ( 1.99 ; 95 % CI 1.34 , 2.95 ) , and inflammation ( 1.76 ; 95 % CI 1.22 , 2.54 ) , but no other systems . Conclusions Perceived weight discrimination doubles the 10-year risk of high allostatic load . Eliminating weight stigma may reduce physiological dysregulation , improving obesity-related morbidity and mortality Chronically stressed rodents who are allowed to eat calorie-dense " comfort " food develop greater mesenteric fat , which in turn dampens hypothalamic-pituitary-adrenocortical ( HPA ) axis activity . We tested whether similar relations exist in humans , at least cross-sectionally . Fifty-nine healthy premenopausal women were exposed to a st and ard laboratory stressor to examine HPA response to acute stress and underwent diurnal saliva sampling for basal cortisol and response to dexamethasone administration . Based on perceived stress scores , women were divided into extreme quartiles of low versus high stress categories . We found as hypothesized that the high stress group had significantly greater BMI and sagittal diameter , and reported greater emotional eating . In response to acute lab stressor , the high stress group showed a blunted cortisol response , lower diurnal cortisol levels , and greater suppression in response to dexamethasone . These cross-sectional findings support the animal model , which suggests that long-term adaptation to chronic stress in the face of dense calories result in greater visceral fat accumulation ( via ingestion of calorie-dense food ) , which in turn modulates HPA axis response , result ing in lower cortisol levels Background — The impact of overall dietary patterns that reflect actual eating behaviors on mortality caused by cardiovascular or other chronic diseases is largely unknown . Methods and Results — We prospect ively evaluated the relation between dietary patterns and risk of cardiovascular , cancer , and all-cause mortality among 72 113 women who were free of myocardial infa rct ion , angina , coronary artery surgery , stroke , diabetes mellitus , or cancer and were followed up from 1984 to 2002 . Dietary patterns were derived by factor analysis based on vali date d food frequency question naires administered every 2 to 4 years . Two major dietary patterns were identified : High prudent pattern scores represented high intakes of vegetables , fruit , legumes , fish , poultry , and whole grains , whereas high Western pattern scores reflected high intakes of red meat , processed meat , refined grains , french fries , and sweets/desserts . During 18 years of follow-up , 6011 deaths occurred , including 1154 cardiovascular deaths and 3139 cancer deaths . After multivariable adjustment , the prudent diet was associated with a 28 % lower risk of cardiovascular mortality ( 95 % confidence interval [ CI ] , 13 to 40 ) and a 17 % lower risk of all-cause mortality ( 95 % CI , 10 to 24 ) when the highest quintile was compared with the lowest quintile . In contrast , the Western pattern was associated with a higher risk of mortality from cardiovascular disease ( 22 % ; 95 % CI , 1 to 48 ) , cancer ( 16 % ; 95 % CI , 3 to 30 ) , and all causes ( 21 % ; 95 % CI , 12 to 32 ) . Conclusion — Greater adherence to the prudent pattern may reduce the risk of cardiovascular and total mortality , whereas greater adherence to the Western pattern may increase the risk among initially healthy women OBJECTIVE The present study investigated the long-term impact of exposure to  poverty-related stressors during childhood on allostatic load , an index of physiological dysregulation , and the potential mediating role of substance use . METHOD Participants ( n = 162 ) were rural children from New York State , followed for 8 years ( between the ages 9 and 17 ) .  Poverty- related stress was computed using the cumulative risk approach , assessing stressors across 9 domains , including environmental , psychosocial , and demographic factors . Allostatic load captured a range of physiological responses , including cardiovascular , hypothalamic pituitary adrenal axis , sympathetic adrenal medullary system , and metabolic activity . Smoking and alcohol/drug use were tested as mediators of the hypothesized childhood risk-adolescent allostatic load relationship . RESULTS Cumulative risk exposure at age 9 predicted increases in allostatic load 8 years later . Smoking , but not alcohol and drug use , was a significant mediator of the prospect i ve , longitudinal relationship between childhood cumulative risk and adolescent allostatic load . CONCLUSIONS The present paper contributes to the underst and ing of the role of early life stress in health across the life span and of the mechanisms by which adverse childhood environments impact health as children emerge into early adulthood . This knowledge will have implication s for early intervention efforts Objective : The purpose of this study was to assess , in borderline hypertensive subjects , the homeostatic and allostatic responses of serum electrolytes , proteins , lipids , hematocrit and renal function to an extreme dietary sodium challenge , and to evaluate whether the responses in these clinical parameters were associated with a concomitant response in blood pressure . Subjects and methods : Data from middle-aged adults with a diagnosis of mild , uncomplicated borderline hypertension were collected at the end of 1-month r and omized trials of low ( 24 ± 13 mmol/day ) and high ( 309 ± 88 mmol/day ) dietary sodium intake . A total of 48 subjects ( 38 men and 10 women ) were examined . Results : Serum sodium increased ( p<0.001 ) , while all other serum electrolytes , except chloride , decreased ( p<0.01 ) from the low to high sodium diets . Serum proteins ( p<0.05 ) and hematocit ( p<0.001 ) also declined among subjects on a high sodium diet . However , creatinine clearance ( an indicator of glomerular filtration ) increased with sodium intake ( p = 0.004 ) . None of these biochemical or renal functional responses was associated with a change in blood pressure . Conclusion : There are modest yet significant changes in serum electrolytes associated with changes in dietary sodium intake , suggesting that these ions are under an allostatic control mechanism . Serum proteins also appear to function as allostatic compensatory mechanisms , off setting the net effect of increased serum salinity . It is speculated that the adaptive allostatic renal response to a high sodium diet ( an increase in GFR ) may result in loss of the ability to appropriately vary renal filtration if that diet is chronically maintained BACKGROUND The extent to which diabetes mellitus or hyperglycemia is related to risk of death from cancer or other nonvascular conditions is uncertain . METHODS We calculated hazard ratios for cause-specific death , according to baseline diabetes status or fasting glucose level , from  individual-participant data  on 123,205 deaths among 820,900 people in 97 prospect i ve studies . RESULTS After adjustment for age , sex , smoking status , and body-mass index , hazard ratios among persons with diabetes as compared with persons without diabetes were as follows : 1.80 ( 95 % confidence interval [ CI ] , 1.71 to 1.90 ) for death from any cause , 1.25 ( 95 % CI , 1.19 to 1.31 ) for death from cancer , 2.32 ( 95 % CI , 2.11 to 2.56 ) for death from vascular causes , and 1.73 ( 95 % CI , 1.62 to 1.85 ) for death from other causes . Diabetes ( vs. no diabetes ) was moderately associated with death from cancers of the liver , pancreas , ovary , colorectum , lung , bladder , and breast . Aside from cancer and vascular disease , diabetes ( vs. no diabetes ) was also associated with death from renal disease , liver disease , pneumonia and other infectious diseases , mental disorders , nonhepatic digestive diseases , external causes , intentional self-harm , nervous-system disorders , and chronic obstructive pulmonary disease . Hazard ratios were appreciably reduced after further adjustment for glycemia measures , but not after adjustment for systolic blood pressure , lipid levels , inflammation or renal markers . Fasting glucose levels exceeding 100 mg per deciliter ( 5.6 mmol per liter ) , but not levels of 70 to 100 mg per deciliter ( 3.9 to 5.6 mmol per liter ) , were associated with death . A 50-year-old with diabetes died , on average , 6 years earlier than a counterpart without diabetes , with about 40 % of the difference in survival attributable to excess nonvascular deaths . CONCLUSIONS In addition to vascular disease , diabetes is associated with substantial premature death from several cancers , infectious diseases , external causes , intentional self-harm , and degenerative disorders , independent of several major risk factors . ( Funded by the British Heart Foundation and others . )
target: Lifestyle coping behaviours therefore have a significant contribution to AL .
  This study is among the first to explore multiple domains of HRB in relation to AL .
background: Health risk behaviours ( HRB ) across the lifespan have been associated with higher cumulative physiological burden as measured by allostatic load ( AL ) .
  This study examines the contribution of HRB and their effects on multisystem biological risk associated with morbidity and early mortality .