1. Allostasis refers to the body's ability to adapt to environmental demands through physiological responses, while allostatic load describes the wear and tear on the body from chronic stress. 2. The study aims to measure the primary, secondary, and tertiary effects of allostasis using biomarkers, physical measurements, and clinical indices, and correlate levels of stress exposure with health outcomes. 3. The methodology involves collecting data from parents on socioeconomic factors and child's environment and performance via questionnaire, taking biological samples and physical readings from children to assess stress response, and optionally distinguishing data by race to compare groups.

1. ALLOSTATIC LOAD
STUDY DESIGN

2. Few points to note:
1. Allostasis refers to the body's ability to adapt and adjust to environmental demands by
matching the demands of the environment with physiological responses.
2. Given the costs of physiological arousal, organisms undergoing chronic stress and
chronic arousal may experience depleted physiological resources. McEwen and Stellar
defined this physiologically compromised state as "allostatic load.“
3. In summary, allostasis allows an organism to adapt to chronic stress by supporting a
prolonged state of physiological arousal, but such prolonged strain on the system can
result in physical and psychological damage.
4. Stimuli from internal inputs from the body and external sensory sources are
interpreted and processed in the brain. This parallel processing enables the brain to
control and coordinate behavioural and physiological adjustments engendered by
internal or external challenges to homeostasis (McEwen & Gianaros, 2010).
5. However, how the brain responds to stimuli may be influenced by or depend upon a
number of variables, including genetic make-up, developmental history (i.e., early
childhood experiences), current behavioural and psychological states of the
individual, and psychosocial factors (McEwen & Gianaros, 2010).

3. 6. The biological systems that promote adaptation include the hypothalamus-
pituitary-adrenal (HPA) axis, the autonomic nervous system, the metabolic
system, the gastrointestinal tract, the kidneys, and the immune system. The chief
bio-mediators of these systems are cortisol, cytokines, and metabolic hormones
(McEwen, 2006).
7. Also, Allostasis has 3 basic effects:
PRIMARY EFFECTS OF ALLOSTASIS: The primary effects of allostatic load are typically
not measured; however early in the allostatic load literature, McEwen and
Seeman (1999) noted that it would be desirable to study primary effects, because
they are the basis for the secondary and tertiary outcomes, which represent the
biological progression along the allostasis (normal) to allostatic overload
(dysregulated) continuum.
SECONDARY EFFECTS OF ALLOSTASIS: Secondary outcomes are integrated processes
that reflect the cumulative outcome of the primary effects in a tissue/organ
specific manner in response to the primary mediators.
TERTIARY EFFECTS OF ALLOSTASIS: Tertiary outcomes refer to the actual diseases or
disorders that are the result of allostatic load, which can be predicted from the
extreme values of the secondary outcomes and of the primary mediators.

4. AIM & OBJECTIVE OF THE ATUDY:
Corelation various stress factors with these effects of allostasis.
Measure primary effects of allostasis: S. DHEA& cortisol ratio, etc.
Measure secondary effects of allostasis: Physical measurements + HDL:LDL ratio
CO-RELATE with tertiary effects of allostasis (Quantifiable): Caries Index & OHIS Index

5. METHODOLOGY
We require three sets of data. The third set is optional, i.e., if Dr. Gomez wants you to do it
or not.
FIRST SET OF DATA: Data from parents (Questionnaire based survey)
Here parents shall be given a questionnaire based on-
1. Socioeconomic status
2. Single parent or not
3. Separated parent
4. No. of siblings
5. No. of days of absence from school
6. Any persistent illness s/a any kind of respiratory, cardiovascular or hematologic
distress, etc.
7. Type of housing: Single room, double room, spacious or congested appartments, etc.
8. Child’s overall performance in school.
9. Neighborhood violence, etc.
Numerous such questions can be framed.
This will give us an insight into the degree of allostatic load on the child.

6. SECOND SET OF DATA: Data from Children (During an interview in school)
First the child is calmed down in a separate room with the interviewers by making
the child watch cartoons etc but with a pulse oximeter attached to the child.
BIOMARKERS PHYSICAL MARKERS CLINICAL
-HbA1c -BP -Dental Caries
-CRP -PR Index, WHO
-S. cortisol -O2 Saturation, etc. -OHIS Index
-S. Adr/Nor Adr
-HDL:LDL ratio
Co-relate with
amount of dental
caries n periodontal
health: see whether
they co-relate or not.
These 2 parameters will give us an idea of the degree
of stress the child is under

7. THIRD SET OF DATA (OPTIONAL): Racial Distinction
The same set of data can be evaluated in various races & comparatively evaluated .