New Horizons in Health An Integrative Approach (2001) / Chapter Skim
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Predisease Pathways
Predisease Pathways
Pages 25-44
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From page 25... ...
Wider time horizons are required to understand early antecedents to later risk factors as well as the long-term etiological processes involved in multiple disease outcomes. Predisease pathways thus include a broad array of factors that affect the individual from conception (or before)
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From page 26... ...
Such overexposure comes about either because there are many challenges or because the turning on and turning off of the physiological responses is inefficient. This exacts a wear and tear termed "allostatic load." Factors that may increase allostatic load include genetic predispositions, adverse experiences from early development, poor health behaviors (e.g., diet, exercise, and substance abuse)
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From page 27... ...
We underscore the provisional nature of the operationalization of allostatic load, and in Chapter 10 we discuss in detail the future research program needed to refine assessment of cumulative physiological risk. In Chapter 3 we also discuss the optimal functioning of these multiple physiological systems via the concept of allostasis.
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From page 28... ...
Prenatal and Early Life Risk Factors Prenatal experience plays a critical role in interacting with the genome to shape brain development, and these epigenetic influences in intrauterine life confer a set of predispositions that act across the life span to affect vulnerability for many chronic diseases (see Chapter 4~. Optimal prenatal environments produce beneficial effects and adverse environments produce deleterious effects on the developing brain.
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From page 29... ...
Here genetic risk factors play a role. For example, the short form of the S-HTT allele, a gene related to serotonin transporter efficiency, confers low serotonin reuptake efficiency in monkeys, whereas the long form of the allele is associated with normal serotonin reuptake efficiency (Suomi, 1997~.
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From page 30... ...
Highly reactive infants cross-fostered to normal mothers exhibited deficits in early exploration and exaggerated behavioral and physiological responses to minor environmental perturbations. In adulthood they tended to drop and remain low in the dominance hierarchy (Suomi, 1991~.
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From page 31... ...
Comparable effects are seen in animal studies of caregiving under conditions of scarcity and exposure to other chronic stressors. A compelling example are the investigations of macaque mother-infant dyads maintained under one of three foraging conditions: low foraging demand (LED)
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From page 32... ...
These states include a sense of personal control or self-efficacy; the ability to regulate emotional experience; the development of social competence; temperamental states, such as optimism and neuroticism; cognitive states, such as positive or negative expectations regarding health; emotional states, such as depression and anxiety; and coping strategies, such as active versus avoidant coping. We highlight here some specific examples of the importance of these states in predisease processes.
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From page 33... ...
. The fact that hostility can be significantly modified in interventions for people diagnosed with coronary heart disease and the subsequent effects these interventions have on risk factors (Blumenthal et al., 1988)
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From page 34... ...
Among already diagnosed patients, those who became depressed in response to their diagnosed coronary artery disease were more likely to have a more debilitating course of illness and a repeat cardiac event, after controlling for other risk factors (Frasure-Smith et al., 1995~. The broad base of empirical evidence demonstrating the significance of these and related psychological states in pathways to many acute and chronic disease outcomes underscores the importance of continuing to exnlore their role in initiating, exacerbating, and moderating these predisease processes.
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From page 35... ...
A lesson learned from secondary prevention concerns modification of multiple behavioral risk factors simultaneously (such as diet, exercise, and stress management)
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From page 36... ...
Environmental Stressors The social environment is critically important in influencing when disease processes will be initiated and what their course will be across the life span. Over 100 investigations of social ties and social support are testimony to the vital role these processes play in predisease pathways, as well as for disease course and recovery processes (Seeman, 1996~.
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From page 37... ...
Research on populations affected by Hurricane Andrew ties stress exposure to alterations in immune functioning, including reductions in natural killer cell cytotoxicity and numbers of CD-4 and CD-8 T cells (Ironson et al., 1997~. There is, as yet, no clear evidence that these perturbations are linked to downstream health outcomes.
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From page 38... ...
For example, the ability to develop social ties at work, including ties with supervisors, act as protective factors against adverse health and mental health effects of work stress (Buunk and Verhoeven, 1991~. Changing patterns of combining work and family roles have been understudied for their effects on health, especially their roles in predisease pathways.
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From page 39... ...
Using such naturally occurring conditions and events as laboratories for investigating predisease pathways and identifying who is most at risk for adverse health effects can lead to substantial progress in understanding the parameters of predisease states, the mechanisms by which they develop, and subsequent progression to disease. CONNECTING PREDISEASE PATHWAYS TO CUMULATIVE PHYSIOLOGICAL RISK The preceding discussions of prenatal and early life risk factors, psychological states, behavioral factors, and environmental stressors address a wide array of precursors to illness and disease, focused largely on early life.
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From page 40... ...
It should include the following topics: · identification of early markers of predisease states; · examination of their genetic and environmental origins through animal and human studies; · identification of behavioral risk factors in the exacerbation or amelioration of predisease pathways; · prioritization of experimental and longitudinal research to chart these trajectories across the life span; · focus on the mechanisms by which genetic influences, early life experiences, and behavioral and psychosocial risk factors across the life span interact, leading to accumulating physiological risk for a broad range of disease outcomes. REFERENCES Abrams B
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From page 41... ...
1999 "Ambulatory blood pressure, heart rate, and neuroendocrine responses in women nurses during work and off work days" Psychosomatic Medicine 61:387-396. Gross JJ, Levenson RW.
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From page 42... ...
1999 "Socioeconomic status, hostility, and risk factor clustering in the normative aging study: Any help from the concept of allostatic load? " Annals of Bel7avioral Medicine 21/4:330-338.
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From page 43... ...
Peterson C, Seligman MEP, Vaillant GE. 1988 "Pessimistic explanatory style is a risk factor for physical illness: A thirty-five-year longitudinal study" Journal of Personality and Social Psychology 55:23-27.
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From page 44... ...
Rowe JW, McEwen BS. Unpublished manuscript "Allostatic load as a measure of cumulative physiological risk: Is it more than syndrome X?
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