Mediating-Moderating Effect of Allostatic Load on the Association between Dietary Approaches to Stop Hypertension Diet and All-Cause and Cause-Specific Mortality: 2001–2010 National Health and Nutrition Examination Surveys

Abstract

This secondary analysis of survey data examined mediating-moderating effects of allostatic load score (calculated using the Rodriquez method) on the association between nutrient-based Dietary Approaches to Stop Hypertension (DASH) diet score (Mellen Index) and the all-cause and cause-specific mortality risks among 11,630 adults ≥ 30 years of age from the 2001–2010 National Health and Nutrition Examination Surveys with no history of cardiovascular disease or cancer at baseline, and who were followed-up for ~9.35 years. Multivariable models were adjusted for demographic, socioeconomic, lifestyle, and health characteristics. All-cause, cardiovascular disease, and cancer-specific mortality rates were estimated at 6.5%, 1.1%, and 1.9%, respectively. The median DASH total score was 3.0 (range: 1–8) (with 78.3% scoring < 4.5), whereas the median allostatic load score was 3 (range: 0–9). The DASH diet, fiber, and magnesium were negatively correlated with allostatic load, whereas allostatic load predicted higher all-cause mortality, irrespective of the DASH diet. Whereas protein was protective, potassium increased all-cause mortality risk, irrespective of allostatic load. Potassium was protective against cardiovascular disease-specific mortality but was a risk factor for cancer-specific mortality. Although no moderating effects were observed, mediation by the allostatic load on cardiovascular disease-specific mortality was observed for DASH total score and selected component scores. Direct (but not indirect) effects of DASH through the allostatic load were observed for all-cause mortality, and no direct or indirect effects were observed for cancer-specific mortality. From a public health standpoint, the allostatic load may be a surrogate for the preventive effects of the DASH diet and its components on cardiovascular disease-specific mortality risk.

Allostatic Load and Its Impact on Health: A Systematic Review

“…A number of studies addressed the relationship be tween allostatic load and health status and outcomes [204][205][206][207][208], including chronic conditions [209], disabili ties [210], pain [211,212], and mortality [17,24,56,[213][214][215][216][217][218].…”

“…Physical activity was found to be associated with lower allostatic load [227][228][229], whereas poor sleep quality [230][231][232][233], unhealthy diet and overweight [52,218,228,[234][235][236][237][238][239], alcohol consumption [52,92,228,229,240] and smoking habits [241] were associated with high allo static load levels.…”

Allostatic Load in Cancer: A Systematic Review and Mini Meta-Analysis

“…The 12 articles selected for review were published between 2013 and 2020, from studies conducted in USA (Acheampong et al, 2020;Beydoun et al, 2019;Hughes Halbert et al, 2020;Levine & Crimmins, 2014;Mattei et al, 2010;Parente et al, 2013;Santacroce & Crandell, 2014;Xing et al, 2020), Taiwan (Hwang et al, 2014), Italy (Ruini et al, 2015), China (Ye et al, 2017), and Scotland (Robertson et al, 2017). As shown in Table 1, 6 studies used a cohort design (Acheampong et al, 2020;Beydoun et al, 2019;Hwang et al, 2014;Levine & Crimmins, 2014;Robertson et al, 2017;Xing et al, 2020), while 5 used a cross-sectional design (Hughes Halbert et al, 2020;Mattei et al, 2010;Parente et al, 2013;Ruini et al, 2015;Santacroce & Crandell, 2014). Only one study was a randomized controlled trial (Ye et al, 2017).…”

“…Table 2 describes the details of the study populations. Eight studies used data from large population databases (Acheampong et al, 2020;Beydoun et al, 2019;Hwang et al, 2014;Levine & Crimmins, 2014;Mattei et al, 2010;Parente et al, 2013;Robertson et al, 2017;Xing et al, 2020 A total of 47,520 participants were enrolled in these 12 studies. Among the studies using population databases, sample sizes ranged from 409 (Xing et al, 2020) to 13,628 (Acheampong et al, 2020), with an average of about 5,889 participants.…”

Gestational diabetes status and dietary intake modify maternal and cord blood allostatic load markers

“… 6 35 AL is also suggested as a mediator between nutrient-based Dietary Approaches to Stop Hypertension diet score and all cause mortality in the 2001–2010 National Health and Nutrition Examination Surveys. 36 Understanding whether calorie and nutrient intakes modify the AL index in both mothers and fetuses during GDM will provide insights into the strategies of medical nutrition therapy in modulating GDM pathophysiology.…”