Clinical ScienceDetailed assessments of childhood adversity enhance prediction of central obesity independent of gender, race, adult psychosocial risk and health behaviors
Introduction
Obesity, especially central adiposity, and metabolic syndrome (MetS) place adults at high risk for other physical health problems, especially diabetes mellitus (DM), cardiovascular disease (CVD), and hypertension [1], [2], [3], [4], [5], [6], [7], [8], [9]. Central obesity has been associated with early stressful environments and events [10], [11], [12], [13], including intra-uterine stresses and early illnesses [14], [15], poverty [16], and specific and cumulative stresses such as physical and sexual abuse in childhood or death of a close family member [17], [18], [19], [20], in both animal models and human studies [14], [21], [22], [23]. Psychosocial factors including socioeconomic status (SES), education, and functional status (adjustment or functioning in the domains of mental health, work, leisure/interests, and close relationships) provide a mediated link between early life stressors and later health [12], [16], [24], [25], [26], [27]. Impaired psychosocial functioning is associated with health risk factors [28], [29], such as smoking, drinking, poor diet, and sedentary lifestyle that set the stage for poor health outcomes in general.
Many psychosocial factors and health risk factors are considered modifiable, with the potential to decrease obesity rates and costs [30], and are the focus of many prevention/intervention programs. However, it is rare for such programs to assess childhood adversity and its potential direct, non-mediated impact on metabolic functioning, central obesity versus overall obesity, and outcomes [12], [23], [31], [32].
Examining childhood adversity. The growing literature examining associations between early adversity and adult physical health typically uses cumulative adversity scores to assess the number of adversities an individual has experienced [10], [11], [12], [19]. This work addresses the concepts of severity and chronicity of stress [11], [12], but severity and chronicity of experiences are often inferred from the nature of the childhood adversity (e.g., maltreatment is considered to be severe and low SES chronic), rather than assessed and incorporated into measurements of adversity. The large sample sizes of many investigations preclude more in-depth assessments of these dimensions. Nevertheless, specific information on severity and chronicity could address issues of resilience and also allow for more personalized treatment plans and outcome expectations [33], [34], [35]. Unlike a large scale study, samples in which detailed, interview-based, childhood adversity histories are obtained allow for assessments of severity and chronicity. They also provide an opportunity to compare the predictive power of a cumulative score with a potentially more clinically relevant adversity score that incorporates number of adversities with severity and chronicity information.
The current study examines the impact of childhood adversity on midlife obesity in a racially and socioeconomically diverse, moderate-risk, but non-clinical sample. We explore a novel assessment of childhood adversity (number of adversities × severity × chronicity) as a direct predictor of central obesity compared with overall obesity. Additionally, we examine the contributions of current psychosocial (education, employment, social functioning) and health risk factors (smoking, drinking, diet and exercise). We hypothesize that the enhanced, interview-based overall childhood adversity score is a better predictor of central obesity than the cumulative adversity score, and will contribute to the prediction of central obesity beyond the more proximal midlife psychosocial and health risk factors.
Section snippets
Sample
Participants were 210 adults (mean age = 45.8; ± 3.3; range 35–55 years), of diverse SES backgrounds who were part of a study examining psychosocial influences on physical and mental health in midlife. The sample was generally representative of the population of Boston, MA with regard to proportion of men and women, European Americans, and those with a Bachelor's degree or higher, although it included a greater proportion of Black/African Americans [36]. The sample had an approximately equal
Results
Table 1 shows descriptive information for the entire sample. Anthropometric assessments are consistent with those described in the Third National Health and Nutrition Examination Survey [51].
Zero-order correlations are presented in Table 2. The psychosocial risk factor score was significantly associated with both WHR and BMI, but the health risk factor score was associated only with BMI.
Table 3 shows the results of two linear regression analyses predicting WHR, first with the overall adversity
Discussion
Results indicate that overall childhood adversity is an important predictor of central obesity, over and above the more proximal contributions of adult psychosocial and health risk factors. This underscores the impact of childhood adversity, taking into account its severity and chronicity, on metabolic functioning well into adulthood. We do not see the same effect of overall adversity in models predicting BMI, suggesting that overall childhood adversity is more specific to central, rather than
Conclusion
A number of large epidemiological investigations indicate that childhood adversity presents a considerable public health issue in midlife. Many studies and social policies highlight modifiable factors such as current health behaviors and social support as important contributors to physical health [61]. However, clinicians, policy makers, and researchers focusing on intervention should also take into consideration those in moderate to high-risk populations who are likely to have past experiences
Author contributions
Cynthia R. Davis: Manuscript writing, data analysis, data interpretation, data collection, data coding. Eric Dearing: Manuscript writing, data analysis, data interpretation. Nicole Usher: data collection, data coding. Sarah Trifiletti: data collection, data coding. Lesya Zaichenko: data collection. Elizabeth R. Weber: data collection, data coding. Mary T. Brinkoetter: data collection. Cindy Crowell-Doom: data coding. Kyoung Joung: Manuscript writing, data interpretation, data coding. Kyung Hee
Funding
Grant Support: This study was supported by the National Institute of Aging, grant AG032030, and National Institute of Diabetes and Digestive and Kidney Diseases grant 81913. The project described was supported by Grant Number UL1 RR025758 Harvard Clinical and Translational Science Center, from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or
Conflict of interest
Disclosure statement: The authors have nothing to disclose.
References (61)
Obesity and the hypothalamic–pituitary–adrenal axis in adolescent girls
Metabolism
(2012)Metabolically obese status with normal weight is associated with both the prevalence and severity of angiographic coronary artery disease
Metabolism
(2013)The complex interaction between obesity, metabolic syndrome and reproductive axis: a narrative review
Metabolism
(2013)Influence of obesity indices, metabolic parameters and age on cardiac autonomic function in abdominally obese men
Metabolism
(2012)- et al.
Adverse childhood experiences, allostasis, allostatic load, and age-related disease
Physiol Behav
(2012) - et al.
Metabolic consequences of stress during childhood and adolescence
Metabolism
(2012) Effects of gestational stress: 1. Evaluation of maternal and juvenile offspring behavior
Brain Res
(2008)Life course socioeconomic conditions and metabolic syndrome: the Atherosclerosis Risk in Communities (ARIC) Study
Ann Epidemiol
(2009)Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study
Am J Prev Med
(1998)Early trauma and adult obesity: is psychological dysfunction the mediating mechanism?
Physiol Behav
(2009)
Effects of maternal immobilization stress on birth weight and glucose homeostasis in the offspring
Psychoneuroendocrinology
Socioeconomic position and the metabolic syndrome in early, middle, and late life: evidence from NHANES 1999–2002
Ann Epidemiol
Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance
Am J Clin Nutr
Research electronic data capture (REDCap) — a metadata-driven methodology and workflow process for providing translational research informatics support
J Biomed Inform
The effects of glucocorticoids on adipose tissue lipid metabolism
Metabolism
Validity of retrospective measures of early maltreatment and depressive episodes using the Childhood Experiences of Care and Abuse (CECA) instrument — a life course study of adult chronic depression
J Affect Disord
“Portal" adipose tissue as a generator of risk factors for cardiovascular disease
Arterioscler Thromb Vasc Biol
Fat depots, free fatty acid, and dyslipidemia
Nutrients
Cause-specific excess deaths associated with underweight, overweight, and obesity
JAMA
Health risks associated with overweight and obesity
Obesity
Stress, visceral obesity and metabolic complications
Ann N Y Acad Sci
Psychological stress in childhood and susceptibility to the chronic issues of aging: moving toward a model of behavioral and biological mechanisms
Psychol Bull
A life course study of risk for hyperinsulinaemia, dyslipidaemia and obesity (the central metabolic syndrome) at age 49–51 years
Diabet Med
A 30-year follow-up of the effects of child abuse and neglect on obesity in adulthood
Obesity
Childhood sexual abuse, depression and family function in adult obese patients: a case control study
South Med J
Stress-related development of obesity and cortisol in women
Obesity
The glucocorticoid contribution to obesity
Stress
Social circumstances and education: life course origins of social inequalities in metabolic risk in a prospective national birth cohort
Am J Public Health
Social and biological pathways linking early life and adult disease
Br Med Bull
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