title: Allostatic load and spinal cord injury: review of existing research and preliminary data.
abstract: OBJECTIVE
  To introduce allostatic load (AL) as a framework for measuring stress-related outcomes after spinal cord injury (SCI) by identifying the number and nature of biomarkers investigated in existing studies and by generating preliminary data on AL in 30 persons with traumatic SCI.
  
  
  METHODS
  This systematic review and pilot study were conducted at a medical university in the southeastern United States. A review of literature published between 1993 and 2012 identified studies using 2 or more of 5 classes of AL biomarkers. We then collected data on 11 biomarkers (n = 30) from self-selected participants using physical exams and blood and urine specimen collection. These included waist to hip ratio, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, dihydroepiandrosterone, glycosylated hemoglobin, C-reactive protein, interleukin-6, and cortisol, norepinephrine, and epinephrine normalized by 12-hour creatinine.
  
  
  RESULTS
  We were unable to identify any studies investigating AL biomarkers from each of the 5 areas or any studies specifically proposing to investigate AL. AL scores were relatively low, with metabolic indicators being the most elevated and neuroendocrine the least elevated.
  
  
  CONCLUSIONS
  AL is a promising, yet underutilized, construct that may be feasibly assessed after SCI.
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: James S
authors.initials: JS
authors.lastname: Krause
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Nicole D
authors.initials: ND
authors.lastname: DiPiro
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Lee L
authors.initials: LL
authors.lastname: Saunders
authors.affiliation: Department of Nursing, College of Nursing, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Newman
authors.affiliation: Department of Neurosciences, College of Medicine, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Narendra L
authors.initials: NL
authors.lastname: Banik
authors.affiliation: Department of Neurosciences, College of Medicine, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Sookyoung
authors.initials: S
authors.lastname: Park
keywords: allostasis; allostatic load; spinal cord injury; stress