# Appetite Regulation and Allostatic Load Across Prediabetes Phenotypes

## TL;DR

This study explores how stress and appetite regulation differ in people with prediabetes, finding that a specific prediabetes type is linked to higher stress and altered hunger hormones.

## Contribution

The study is the first to show that allostatic load and appetite regulation differ across prediabetes phenotypes, particularly in those with combined impaired fasting glucose and glucose tolerance.

## Key findings

- Participants with IFG + IGT had higher allostatic load, obesity, and insulin resistance compared to those with only IFG or IGT.
- IFG + IGT participants had lower fasting ghrelin levels and a tendency toward higher desire for fatty foods.
- Allostatic load was associated with altered ghrelin levels and increased body weight in IFG + IGT individuals.

## Abstract

Allostatic load is a physiological measure of chronic stress, and stress is implicated in disrupting appetite regulation. Individuals with obesity and type 2 diabetes have higher allostatic load compared to lean counterparts. However, whether allostatic load differs across prediabetes phenotypes and relates to appetite is unknown. Purpose: Test whether prediabetes phenotypes differ in allostatic load in relation to altered appetite regulation. Methods: Individuals with obesity were recruited, and prediabetes was determined using American Diabetes Association (ADA) criteria (75 g OGTT) for this cross-sectional study. After an overnight fast, appetite hormones (ghrelin and PYY), insulin, and glucose were measured every 30 min up to 120 min of the OGTT. Perception of hunger and fullness as well as desire for sweet and fatty foods were assessed using a visual analog scale. Allostatic load was calculated from physiologic markers. Aerobic fitness (VO2max), body composition (DXA), clinical labs, and quality-of-life questionnaires were also collected. Results: Participants with impaired fasting glucose (IFG) + impaired glucose tolerance (IGT) had a higher allostatic load, obesity, and insulin resistance compared with IFG or IGT (all p < 0.05), independent of fitness. IFG + IGT also had lower fasting ghrelin (p < 0.05) and no difference in fasting PYY. Hunger, fullness, and sweet ratings were comparable across groups, but fatty food ratings tended to be higher in IFG + IGT than NGT. Conclusions: Allostatic load was associated with altered fasting ghrelin levels in individuals with IFG + IGT, along with elevated body weight and insulin resistance. These findings suggest stress is a potential mechanism underlying appetite dysregulation in different forms of prediabetes.