Impact of a Randomized Church-based, Lifestyle Intervention on Allostatic Load in African American Women in Dallas

Purpose: African American women have higher rates of cardiovascular risk factors and greater than 50% higher mortality from cardiovascular disease than White women. This disparity may be explained by the uniquely higher allostatic load found in African American women. Allostatic load represents the physiologic cost to adapting to chronic and significant stressors throughout the life-course. Though poor nutrition and physical inactivity have shown inconsistent correlations with allostatic load in African American women, there have been no studies testing the effect of lifestyle interventions on allostatic load in this group. Our objectives are to (1) assess the change in allostatic load following a lifestyle intervention, (2) explore the role of health behavior changes and allostatic load, (3) evaluate how socioeconomic (SES) variables including neighborhood SES influence these relationships. Methods: Study participants were non-diabetic (48.8±11.2y) AA women (n=221) randomized to a church-based, standard diabetes prevention program (DPP) or a faith-enhanced DPP. Allostatic Load (AL) score was calculated at baseline and 4-month follow-up using the high-risk quartile method of 9 biomarkers: systolic and diastolic blood pressure, total cholesterol to high-density lipoprotein (HDL) ratio, HDL, triglycerides, hemoglobin A1c, body mass index, salivary cortisol, and waist circumference. We assessed perceived stress, neighborhood disadvantage, individual SES, physical activity, and other lifestyle variables. Multinomial logistic regression model was used to estimate the effect of lifestyle factors, perceived stress, and neighborhood disadvantage on change in AL. Results: AL was reduced (-0.12±0.99, p=0.04) from baseline to 4-month. 39% of participants had lower AL and 19.5% had increased AL. After adjusting for age and intervention effects, low level of education (high school degree or less) (OR:0.037, CI:0.004–0.379) and alcohol consumption (OR:0.091, CI:0.020–0.421) contributed to increased AL. Other variables were positively, but not statistically associated, with decreased AL. Conclusions: More research is necessary to determine the roles of perceived stress, physical activity, and weight loss in reducing AL. Lower education levels and alcohol consumption may dampen the effect of positive lifestyle behaviors in reducing AL.