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Allostasis in Nonalcoholic Fatty Liver Disease: Implications for Risk Assessment

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Abstract

Allostasis, a concept of anticipatory physiological regulation in response to external and internal challenges, was originally developed in the context of neuroendocrinology and behavioral medicine. Allostasis preserves function under changing conditions by abandoning physiological set points and developing new ones. Allostatic load refers to the aggregate effect of adaptation throughout life, and corresponds to the wear and tear associated with this process. In response to chronic stress, allostatic load may accumulate faster than expected if sustained activation of regulatory systems exceeds optimum operating ranges; this results in increased risk of disease. Used in a broader sense, the allostatic model of adaptive responses, trade-offs, feed-forward cycles, and collateral damage provides a framework for assessing the involvement of environmental–genetic interactions and co-morbidities in the course of chronic disease and developing a comprehensive score for personalized risk prediction. The utility of this approach is illustrated for nonalcoholic fatty liver disease, a prevalent condition with common and less common outcomes.

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Acknowledgments

This work received no grants or other financial support. The author would like to acknowledge the useful discussions on this work with Dr. Joseph Loscalzo.

Conflict of interest

The author discloses no financial interest.

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Authors and Affiliations

  1. Department of Medicine, VA Boston Healthcare System and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    György Baffy

  2. Section of Gastroenterology, VA Boston Healthcare System, 150 S. Huntington Ave., Room 6A-46, Boston, MA, 02130, USA

    György Baffy

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  1. György Baffy
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Correspondence to György Baffy.

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Baffy, G. Allostasis in Nonalcoholic Fatty Liver Disease: Implications for Risk Assessment. Dig Dis Sci 58, 302–308 (2013). https://doi.org/10.1007/s10620-012-2344-8

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