Testing allostatic load factor structures among adolescents: A structural equation modeling approach

Amanda L. King*, Mauricio Garnier-Villarreal, Amanda M. Simanek, Norah L. Johnson

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Objectives: Allostatic load (AL) represents cumulative biological “wear and tear” that results from chronic stress exposure over time, ultimately increasing risk for chronic disease. A consensus is lacking regarding the best operationalization of AL, particularly for younger, less studied populations. The purpose of this study was to test multiple hypothesized factor structures for AL to determine the best measurement approach for adolescents. Methods: We analyzed biologic data for 1900 adolescents aged 12-18 from four waves (2003-2010) of the National Health and Nutrition Examination Survey. AL indicator variables included cardiovascular (systolic BP, creatinine), metabolic (HDL, LDL, triglycerides, insulin, fasting glucose, HA1C, body mass index [BMI], waist circumference), and immune (albumin, CRP, WBC, EBV) biomarkers. Structural equation modeling was used to test the fit of five hypothesized AL factor structures. Results: The data best supported a unidimensional factor structure, where the AL construct directly influenced each of the indicator variables. All but two of the indicators (HDL and albumin) had positive factor loadings, thus, as AL increases the values for those indicators also increase. The best indicators for AL were those measuring metabolic dysregulation, with BMI and waist circumference having the highest factor loadings (0.95 and 0.982, respectively). Conclusions: BMI and waist circumference may be some of the earliest clinical signs of elevated AL that manifest among adolescents. Future research should aim to include neuroendocrine biomarkers in their AL measures to have a more robust estimation of AL in younger populations.

Original languageEnglish
Article numbere23242
JournalAmerican Journal of Human Biology
Issue number4
Publication statusPublished - 1 Jul 2019
Externally publishedYes


This study was supported by the Robert Wood Johnson Foundation, the Wisconsin Chapter of the National Association of Pediatric Nurse Practitioners, and the Delta Gamma At-Large Chapter of Sigma Theta Tau International. Its contents are solely the responsibility of the authors and do not represent the official views of these organizations.

FundersFunder number
National Association of Pediatric Nurse Practitioners
Robert Wood Johnson Foundation
American Association of Nurse Practitioners
Sigma Theta Tau International


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