High allostatic load score identifies African immigrants at increased risk for diabetes and cardiovascular disease: the Africans in America Study
Pan African Medical Journal - Conference Proceedings. 2017:2(3).23
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Keywords: Stress, ALS, diabetes, African
High allostatic load score identifies african immigrants at increased risk for diabetes and cardiovascular disease: the Africans in America Study
Jean Nepo Utumatwishima1,&, Rafeal Baker1, Brianna Bingham1, Madia Ricks1, Lilian Mabundo1, Mirella Galvan-Delacruz1, Anthony Onuzuruike1, David Sacks1, Stephanie Chung1, Anne Sumner1
1National Institutes of Health, Bethesda, Maryland, USA
Jean Nepo Utumatwishima, National Institutes of Health, Bethesda, Maryland, USA
Introduction: allostatic load score (ALS) is a measure of the biologic response to stress. The degree to which high ALS is associated with risk for diabetes and cardiovascular disease in African immigrants to the United States is unknown.
Methods: ALS was calculated in 252 self-identified healthy African immigrants (age: 40±10, (mean±SD), range 21-64y), BMI 27.8±4.5, range 18.2-42.4 kg/m2, 69% male) using 11 variables from 3 domains: cardiac (SBP, DBP, cholesterol, triglyceride, homocysteine), metabolic (BMI, A1C, glycated albumin, eGFR) and immunological (hsCRP, albumin). High-risk was defined by the highest quartile for each variable, except for albumin and eGFR, which used the lowest quartile. One point was assigned if the variable was in the high-risk range and 0 if not. High ALS was defined by the cut-off for the highest ALS quartile (=4.0). Risk factors for diabetes and cardiovascular disease were defined by newly diagnosed prediabetes or diabetes during an OGTT, low insulin sensitivity calculated by the Matsuda Index and high visceral adipose tissue (VAT) mass measured by computerized tomographic (CT) scan.
Results: African immigrants with high ALS had higher fasting glucose (97±19 vs. 89±7 mg/dL, P < 0.001) and 2h glucose levels (151±55 vs. 124±31 mg/dL, P < 0.001) than African immigrants with low ALS. The prevalence of newly detected diabetes (16% vs. 3%, P < 0.001) and prediabetes (41% vs. 24%, P < 0.001) was also higher in the high ALS group. In addition, compared to African immigrants with a low ALS, African immigrants with high ALS had less insulin sensitivity (5.6±4.1 vs. 7.2±4.9, P = 0.009) and more VAT (148±74 vs. 85±64 cm3, P < 0.001).
Conclusion: high ALS detects risk for diabetes and cardiovascular disease in African immigrants. Measuring ALS may prove to be a valid cost-effective way to detect risk for diabetes and cardiovascular disease in low resource areas of Africa.