The relation between childhood adversity and adult obesity in a population-based study in women and men

Childhood trauma associations with changes in body mass index over 12 months of treatment in first-episode schizophrenia spectrum disorders

BACKGROUND

Childhood trauma (CT) is a risk factor for the development of adulthood obesity, both in the general population, and in patients with schizophrenia.

AIM

We examined the associations between CT exposure and visit-wise changes in body mass index (BMI) over 12 months of treatment in patents with first-episode schizophrenia spectrum disorders (FES) (n = 77) compared to matched controls (n = 55). We also examined the moderating effects of socio-demographic, clinical, and treatment-related factors on the relationships between CT exposure and weight gain in patients.

METHODS

CT was assessed using the Childhood Trauma Questionnaire. BMI was assessed at baseline in patients and controls and again at regular 3-month intervals in patients. Linear mixed effect models for continuous repeated measures (MMRM) were constructed to examine the effects of CT exposure on visit-wise changes in BMI over time.

RESULTS

Patients had a lower baseline BMI than controls, but were balanced for CT exposure. In patients, but not in controls, more severe childhood emotional abuse (EA) correlated with a higher baseline BMI. Initial MMRM indicated that higher childhood EA was associated with more pronounced weight gain over 12 months in patients. Explorative MMRM indicated that this effect was limited to cannabis non-users, and no longer significant in cannabis users.

DISCUSSION

Cannabis use moderated the association between childhood EA and more pronounced weight gain in FES. Future studies would do well to examine the effects of other risk and resilience factors on the relationships between CT exposure and metabolic syndrome changes in schizophrenia.

Child Maltreatment Characteristics and Adult Physical Multimorbidity in Germany

Importance

Associations between child maltreatment (CM) and health have been studied broadly, but most studies focus on multiplicity (number of experienced subtypes of CM). Studies assessing multiple CM characteristics are scarce, partly due to methodological challenges, and were mostly conducted in patient samples.

Objective

To determine the importance of CM characteristics in association with physical multimorbidity in adulthood for women and men in a German representative sample.

Design, Setting, and Participants

This survey study used data from a representative sample of the German population between July and October 2021. Households were randomly selected within regional areas by a German demographic consultation company, and the Kish-Grid method was applied to ensure random participation. Reasons for nonparticipation were refusal of the selected household or target person to participate and failure to contact a household after 4 visits. Analyses took place between June 2023 and July 2024.

Exposure

Characteristics of CM, including subtypes of CM, multiplicity, age at time of maltreatment (timing), number of years of experienced maltreatment (duration), frequency, and subjective severity (measured with the ISPCAN Child Abuse Screening Tools Retrospective version questionnaire).

Main Outcomes and Measures

The main outcome was physical multimorbidity, defined as the sum score of lifetime leading morbidity and mortality causes in Western countries (obesity, diabetes, cancer, hypertension, myocardial infarction, chronic obstructive pulmonary disease, and incident stroke). Conditioned random forest regression analyses (a machine learning regression technique) were conducted to examine what characteristics of CM were most importantly associated with physical multimorbidity in adulthood while considering all other variables in the model.

Results

Of 5908 individuals invited, the study sample included 2514 participants (response rate, 42.6%), with 1297 (51.6%) women (mean [SD] age, 50.6 [17.9] years) and 1217 (48.4%) men (mean [SD] age, 49.5 [18.2] years). Duration of CM was the most important factor for physical multimorbidity in adulthood for both women (importance = 0.595; 95% CI, 0.599-0.601) and men (importance = 1.389; 95% CI, 1.386-1.394). Duration and timing variables were more importantly associated with outcomes than multiplicity in women and men. For women, severity and experiencing CM at age 4 years was significantly associated with physical multimorbidity in adulthood. For men, experiencing CM at age 11 years was most importantly associated with physical multimorbidity in adulthood.

Conclusions and Relevance

In this survey study, conditioned random forest regression analyses were applied to provide insights in the importance of duration and timing of CM for physical health in addition to the frequently studied multiplicity. These findings suggest that CM assessments should be considered in diagnostics of individuals with physical health conditions and may also inform strategies to mitigate the risk.

More Than What You Eat: A Review on the Association Between Childhood Maltreatment and Elevated Adult BMI

PURPOSE OF REVIEW

Obesity is an overwhelmingly common medical entity seen in the adult population. A growing body of research demonstrates that there is a significant relationship between child maltreatment and adult obesity.

RECENT FINDINGS

Emerging research demonstrates a potential dose-response relationship between various types of child abuse and adulthood BMI. Recent work also explores the potential role of the hypothalamic-pituitary-adrenal (HPA) axis, and other hormonal mediators such as sex-hormone binding globulin and leptin. There are also studies that suggest factors such as depression and socioeconomic and environmental influences mediate this relationship. Comorbidities that have been reported include cardiovascular and metabolic disease, diabetes, and insulin resistance. Preliminary work also demonstrates potential gender and racial disparities in the effect of abuse on adulthood obesity. In this narrative review, we summarize the existing work describing the different child maltreatment types (physical, sexual, emotional, verbal, and child neglect) and their relation to adult obesity, what is known about a potential dose-response relationship, potential mediators and pathophysiology, comorbidities, and preliminary work on gender and racial/ethnic disparities. We review the limited data on interventions that have been studied, and close with a discussion of implications and suggestions for clinicians who treat adult obesity, as well as potential future research directions.

Examining the association between the FTO gene and neuroticism reveals indirect effects on subjective well-being and problematic alcohol use

Associations between the fat mass and obesity-associated (FTO) gene and obesity are well-established. However, recent studies have linked FTO to addiction phenotypes and dopaminergic signaling, thus suggesting broader psychiatric implications. We explored this assumption by conducting a phenome-wide association study across 4756 genome-wide association studies, identifying 23-26 psychiatric traits associated with FTO at the multiple-corrected significance level. These traits clustered into four categories: substance use, chronotype/sleep, well-being, and neuroticism. To validate these findings, we analyzed a functionally suggestive FTO variant (rs1421085) in a separate cohort, examining its impact on (i) alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT), (ii) subjective well-being based on the WHO (Ten) Well-Being Index, and (iii) neuroticism based on Schafer's Five Factor Model or the Karolinska Scales of Personality. Our results confirmed a direct association between rs1421085 and neuroticism that was independent of age, sex, alcohol use, body mass index (BMI), and childhood adversities. Interestingly, while no direct association with alcohol intake was observed, both cross-sectional and lagged longitudinal mediation analyses uncovered indirect relationships between rs1421085 and problematic alcohol use (AUDIT-P), with increased neuroticism acting as the intermediary. Mediation analyses also supported an indirect effect of rs1421085 on lower well-being through the pathways of increased neuroticism and BMI. Our study is the first to validate a direct association between FTO and neuroticism. However, additional studies are warranted to affirm the causal pathways linking FTO to well-being and alcohol use through neuroticism.

Childhood Racism and Cardiometabolic Risk in Latina Mothers Across the First Postpartum Year

OBJECTIVE

Immigrant Latinas, particularly of Mexican descent, initially achieve healthy perinatal outcomes. Although this advantage wears off across generations in the United States (US), the early life psychosocial mechanisms that may initiate a cascade of biological vulnerabilities remain elusive. The current investigation aimed to understand the extent to which childhood experiences of racism may contribute to elevated levels of C-reactive protein (CRP), an early indicator of cardiometabolic risk, during the first postpartum year.

METHODS

Latinas from the Community and Child Health Network ( N = 457) retrospectively reported experiences of childhood racism and childhood country of residence via structured questionnaires. Interviewers collected CRP bloodspots and height and weight measurements for body mass index at 6 months and 1 year postpartum.

RESULTS

Latinas who grew up in the US experienced a steeper increase of CRP levels across the first postpartum year ( β = 0.131, p = .009) and had higher CRP levels 1 year postpartum than Latinas who grew up in Latin America. Based on Bayesian path analyses, Latinas who grew up in the US reported higher levels of childhood racism than Latinas who immigrated after childhood ( β = 0.27; 95% credible interval = 0.16-0.37). In turn, childhood racism mediated the relationship between country of childhood residence and elevated CRP at 6 months and 1 year postpartum, even after adjusting for sociodemographic and behavioral covariates. After adjusting for body mass index, mediational relationships became nonsignificant.

CONCLUSIONS

This study is an important first step toward understanding how childhood racism may contribute to postmigratory health patterns among Latinas, particularly cardiometabolic risk 1 year after childbirth.

Traumatic Life Events, Violence, and Obesity: A Cross-Sectional Study from 408 Patients Enrolled in a Bariatric Surgery Program

INTRODUCTION

Obesity is a chronic disease that increases cardiovascular and metabolic morbidity and mortality, decreases quality of life, and increases health care costs. While the role of lifestyle behavioral factors in the development of obesity is well established, the role of traumatic life events, including violence, is unclear. The purpose of this study was to describe situations of traumatic life events reported by patients undergoing a bariatric surgery program, with a particular focus on sexual violence and its clinical correlates.

METHODS

In this cross-sectional study, patients with grade II or III obesity, admitted to our digestive surgery department for bariatric surgery from August 01, 2019, to December 31, 2020, underwent a structured interview by a trained psychologist to describe the history of traumatic life events self-reported by the patients. The primary endpoint was the presence of a history of sexual violence (SV). Multivariate logistic regressions were applied to identify independent risk factors for SV.

RESULTS

Of the 408 patients interviewed, 87.1% reported at least one traumatic life event and 33.1% reported having had an SV in the past. Female gender (aOR = 7.44, 95% confidence interval: 3.85-15.73; p < 0.001) and higher body mass index (1.05, 1.02-1.08; p = 0.002) were associated with an increased risk of SV. Male gender was associated with a higher risk of difficulties including sports cessation, depression, and work-related distress.

CONCLUSION

In the context of obesity, psychosocial trauma is characterized by a high frequency and several gender specificities that must be taken into account in the management of these patients.

Sex-specific associations of childhood maltreatment with obesity-related traits - The Study of Health in Pomerania (SHIP)

BACKGROUND

Child maltreatment (CM) is linked to obesity in adulthood. However, sex-differences and direct measurements of body fat have previously been insufficiently considered in this context.

OBJECTIVE

To assess sex-specific associations of CM with anthropometric markers of overweight/obesity and direct measures of body fat.

PARTICIPANTS AND SETTING

Analyses were conducted in 4006 adults from a population-based cohort in Northeastern Germany (SHIP-TREND-0).

METHODS

CM was assessed using the Childhood Trauma Questionnaire (CTQ). Obesity-related traits included anthropometric indicators (i.e., height, weight, body mass index [BMI], waist [WC] and hip circumference [HC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR]), fat mass (FM) and fat-free mass (FFM) derived from bioelectrical impedance analysis (BIA), and subcutaneous (SAT) and visceral adipose tissue (VAT) ascertained using magnetic resonance imaging (MRI). Sex-stratified linear regression models predicting obesity-related traits from total CTQ scores were adjusted for age and education. Exploratory analyses investigated effects of CTQ subscales on obesity-related traits.

RESULTS

In men, CM was positively associated with WHtR (β = 0.04; p = .030) and VAT (β = 0.02; p = .031) and inversely with body height (β = -0.05; p = .010). In women, CM-exposure was positively associated with body weight (β = 0.07; p = .018), BMI (β = 0.03; p = .013), WC (β = 0.07; p = .005), HC (β = 0.05; p = .046), WHR (β = 0.03; p = .015), WHtR (β = 0.04; p = .006), FM (β = 0.04; p = .006), and SAT (β = 0.06; p = .041). In both sexes, effects were mainly driven by exposure to emotional and physical abuse.

CONCLUSIONS

Results suggest that associations between CM-exposure and obesity-related traits in adulthood are primarily present in women. This may have implications for sex-specific obesity-related cardiometabolic risk after CM.

The contribution of childhood maltreatment to the incidence of heavy cannabis use in Iran (IRNS-CCI): A multicenter, matched-pairs, nested, case-control study

BACKGROUND

Previous studies have shown the role of the interaction between the endocannabinoid system (ECS) and life's adversities in the formation of addiction, including alcohol abuse.

OBJECTIVE

Our objective was to identify childhood maltreatment (CM) patterns with the strongest impact on the probability of heavy cannabis use (THCCOOH concentrations ≥150 ng/mL) in Iran.

PARTICIPANTS AND SETTING

Using survivor sampling, 350 adult participants were selected, and they were then allocated to three categories based on an optimal algorithm: 1) Sexual abuse, 2) Physical abuse, and 3) Physical neglect.

METHODS

From 1 September 2019 to 1 May 2023, we implemented a multicenter, matched-pairs, nested, case-control study based on the wave 3-wave 6 data of a longitudinal, multicenter, cohort study. The cases and controls (n = 350 men) were defined according to the severity of CM. The THC potency was evaluated with the delta-9 carboxy tetrahydrocannabinol (THC-COOH) levels in urine using gas chromatography/mass spectrometry (GC/MS). We calculated the population attributable fractions (PAFs) to identify the patterns of maltreatment associated with the highest odds of high-potency cannabis use.

RESULTS

Accumulating CM, including sexual abuse, physical abuse, and physical neglect, carried more than three times the risk of heavy cannabis use (OR 3.4 95 % CI 2.9-4.1), and the combination of the three indicators of maltreatment and a high BMI (25-29.9) carried more than four times the risk of heavy cannabis use (OR 4.7 95 % CI 2.7-4.1) compared to the controls. We estimated that in the case of zero CM for each of the three indicators, over 20 % of new cases of heavy cannabis use can be prevented.

CONCLUSIONS

The findings show the significance of CM as a predicator of heavy cannabis use in adulthood and in the abstinence phase.

Prenatal exposure to social adversity and infant cortisol in the first year of life

Exposure to social adversity has been associated with cortisol dysregulation during pregnancy and in later childhood; less is known about how prenatal exposure to social stressors affects postnatal cortisol of infants. In a secondary analysis of data from a longitudinal study, we tested whether a pregnant woman's reports of social adversity during the third trimester were associated with their infant's resting cortisol at 1, 6, and 12 months postnatal. Our hypothesis was that prenatal exposure to social adversity would be associated with elevation of infants' cortisol. Measures included prenatal survey reports of social stressors and economic hardship, and resting cortisol levels determined from infant saliva samples acquired at each postnatal timepoint. Data were analyzed using linear mixed effects models. The final sample included 189 women and their infants (46.56% assigned female sex at birth). Prenatal economic hardship was significantly associated with infant cortisol at 6 months postnatal; reports of social stressors were not significantly associated with cortisol at any time point. Factors associated with hardship, such as psychological distress or nutritional deficiencies, may alter fetal HPA axis development, resulting in elevated infant cortisol levels. Developmental changes unique to 6 months of age may explain effects at this timepoint. More work is needed to better comprehend the complex pre- and post-natal physiologic and behavioral factors that affect infant HPA axis development and function, and the modifying role of environmental exposures.

Current Weight Status of Sexually Assaulted Pediatric Female Patients in an Emergency Department Setting

Background: The relationship between childhood sexual abuse (CSA) and childhood obesity (CO) is unclear with studies reporting conflicting results in female populations. This study aims to assess the association between suspected CSA and current emergency department (ED) weight status when compared with trauma patients. Methods: This is a single-center retrospective case-control study that utilized pediatric ED data (2016-2018) from identified female patients (6-17 years old) with a chief complaint of sexual assault and trauma registry patients. Focus was on female patients for literary comparisons. Two weight measurements were calculated based on available height data: BMI-for-age and weight-for-age. Nonparametric testing and binary logistic regression were utilized. Results: There were 2044 study participants: 1454 (71.1%) cases and 590 (28.9%) controls. Cases were older, underrepresented minorities (URMs), and carried public insurance (all p-values <0.001). Using BMI-for-age, patients with a sexual assault complaint had a 67% increased odds for CO after adjusting for age, URM status, and insurance type [adjusted odds ratio (aOR) = 1.67 (95% confidence intervals [CIs] 1.07-2.62); p-value = 0.03], whereas the weight-for-age metric increased the aOR odds by 58% [aOR = 1.58 (95% CI 1.14-2.17); p-value = 0.01] when compared with pediatric trauma patients. Similar results were found in a sensitivity analysis using patients matched on age and URM. Conclusion: Our data demonstrated an association between suspected CSA and CO. More research is needed to identify the biopsychosocial implications for this relationship and the potential to augment clinical care.

Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial

BACKGROUND

Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity.

OBJECTIVE

This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ≥25 kg/m2) to improve health outcomes.

METHODS

The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews.

RESULTS

We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language.

CONCLUSIONS

This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women.

Association of Early Parent-Child Separation With Multidomain Implications in Adolescence and Emerging Adulthood: A Prospective Cohort Study in China

PURPOSE

The aim of the study was to explore the long-term impacts of parent-child separation on a broad set of health and well-being indicators during adolescence and emerging adulthood.

METHODS

Participants were from the China Family Panel Studies, a national representative prospective cohort, and 2710 adolescents aged 7-15 years recruited from 25 provinces after an 8-year follow-up were eventually included in this study. We examined the association of prolonged parent-child separation with educational, social, emotional, and health-related outcomes by comparing participants with experience of prolonged parent-child separation and their counterparts staying with parents.

RESULTS

Participants who experienced prolonged parent-child separation in childhood were more likely to have lower educational attainment (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.03, 2.76; p = .04), depression (OR: 2.63, 95% CI: 1.28, 5.41; p = .008), marriage or cohabitation (OR: 2.79, 95% CI: 1.40, 5.57; p = .004), and ever-smoke (OR: 3.39, 95% CI: 1.95, 5.91; p < .001). Prolonged parent-child separation was also associated with a 0.64-year loss in educational attainment, 2.99- and 2.39-unit decreases in math and word test score, as well as 2.08 kg/m2 decreases in body mass index.

DISCUSSION

This nationally representative study indicates that prevention efforts that reduce exposure to parent-child separation in childhood could substantially reduce the lifetime prevalence of educational, emotional, behavioral, and cognitive problems in the general population.

Dimensions of childhood adversity differentially affect biological aging in major depression

Adverse childhood experiences have been consistently linked with physical and mental health disorders in adulthood that may be mediated, in part, via the effects of such exposures on biological aging. Using recently developed "epigenetic clocks", which provide an estimate of biological age, several studies have demonstrated a link between the cumulative exposure to childhood adversities and accelerated epigenetic aging. However, not all childhood adversities are equivalent and less is known about how distinct dimensions of childhood adversity relate to epigenetic aging metrics. Using two measures of childhood adversity exposure, we assess how the dimensions of Maltreatment and Household Dysfunction relate to epigenetic aging using two "second-generation" clocks, GrimAge and PhenoAge, in a cohort of unmedicated somatically healthy adults with moderate to severe major depression (n = 82). Our results demonstrate that the dimension of Maltreatment is associated with epigenetic age acceleration (EAA) using the PhenoAge but not the GrimAge clock. This association was observed using both the Childhood Trauma questionnaire (CTQ; β = 0.272, p = 0.013) and the Adverse Childhood Experiences (ACEs) questionnaire (β = 0.307, p = 0.005) and remained significant when adjusting for exposure to the dimension of Household Dysfunction (β = 0.322, p = 0.009). In contrast, the dimension of Household Dysfunction is associated with epigenetic age deceleration (β = -0.194, p = 0.083) which achieved significance after adjusting for exposure to the dimension of Maltreatment (β = -0.304, p = 0.022). This study is the first to investigate these effects among individuals with Major Depressive Disorder and suggests that these dimensions of adversity may be associated with disease via distinct biological mechanisms.

The association between childhood sexual abuse and historical intimate partner violence with body mass index and diabetes: Evidence from the Australian Longitudinal Study on Women's Health

The purpose of this study was to investigate the associations of childhood sexual abuse and historical intimate partner violence with body mass index and diabetes among mid-age women. Data from 5782 participants in the 1946-51 cohort of the Australian Longitudinal Study on Women's Health were used. The association of abuse reported to have occurred before 1996 with body mass index and incident diabetes during 20 years of follow-up were examined using longitudinal logistic regression. Women who experienced childhood sexual abuse only, historical intimate partner violence only, or both forms of abuse had higher risk of obesity compared to women who did not experience either form of abuse. The associations between experiencing childhood sexual abuse only, historical intimate partner violence only, or both forms of abuse and incident diabetes (adjusted odds ratios, AOR = 1.28, 95%CI = 1.00, 1.65, AOR = 1.27 (1.02, 1.58) and AOR = 1.74 (1.27, 2.38) respectively) were attenuated by adding body mass index and other variables in the model (AOR = 1.16, 95%CI = 0.90, AOR = 1.49, 1.17 (0.94, 1.46) and AOR = 1.41 (1.03, 1.95) respectively) compared with women who did not experience abuse. The clinical implication is that awareness of a woman's early life experience of abuse may provide insight into managing her weight and risk of diabetes.

Childhood Emotional Neglect and Cardiovascular Disease: A Narrative Review

Psychosocial factors predict the incidence and progression of cardiovascular disease (CVD). There is accumulating evidence for the importance of childhood maltreatment for the development and progression of both CVD-related risk factors and CVD. However, past research has predominantly focused on active forms of childhood maltreatment such as emotional abuse, physical abuse, and sexual abuse. At the same time, childhood neglect as a relatively silent form of childhood maltreatment received less attention. Childhood emotional neglect is the most common form of neglect. This narrative review summarizes findings on the association between childhood emotional neglect and CVD and potential underlying mechanisms. These mechanisms may involve biological factors (i.e., elevated inflammation, autonomic dysregulation, dysregulated HPA axis, and altered brain development), psychological variables and mental health (i.e., depression and anxiety), and health behaviors (i.e., eating behavior, smoking, drug use, physical activity) and interpersonal aspects. Evidence suggests that emotional neglect is associated with CVD and CVD risk factors such as obesity, diabetes, inflammation, a dysregulated stress system, altered brain development, depression and other psychological abnormalities (i.e., emotion-regulation difficulties), interpersonal difficulties, and lack of health behaviors. Specific subtypes of childhood maltreatment may be associated with CVD via different mechanisms. This review further encompasses clinical suggestions, identifies research gaps, and has implications for future studies. However, more research with better study designs is desperately needed to identify the exact underlying mechanisms and opportunities for mitigating the negative health consequences of emotional neglect to reduce the prevalence and progression of CVD.

Association between Self-Reported Childhood Difficulties and Obesity and Health-Related Behaviors in Adulthood-A Cross-Sectional Study among 28,047 Adults from the General Population

The aim of the present study was to examine the associations between self-reported childhood difficulties, weight status, and lifestyle behaviors among a representative sample of Norwegian adults. This cross-sectional study included 28,047 adults (>18 years old) living in southern Norway. A self-report questionnaire was used to assess information about the overall quality of the respondents’ childhood retrospectively in addition to current weight status and current lifestyle behaviors. Multivariable logistic regression models adjusted for gender, age, and educational level showed that evaluating childhood as difficult was associated with increased odds of obesity (OR: 1.29; 95% CI; 1.16–1.44) in adulthood. Moreover, a difficult childhood was associated with increased odds of unhealthy lifestyle behaviors in adulthood, including low consumption of fruit and berries (1.21; 1.09–1.34) and fish (1.43; 1.30–1.57), high consumption of sugar-sweetened beverages (1.30; 1.14–1.48), low level of physical activity (1.10; 1.01–1.21), smoking cigarettes (1.78; 1.61–1.97), and using smokeless tobacco (1.20; 1.07–1.36). Overall, results from the present study suggest that experiencing childhood as difficult is associated with an increased risk of obesity and a range of unhealthy lifestyle behaviors in adulthood. Thus, our findings highlight the importance of identifying and providing support to children in difficult life circumstances in addition to customized and targeted public health efforts in adulthood.

Depression Mediates the Association Between Childhood Emotional Abuse and the Onset of Type 2 Diabetes: Findings From German Multi-Cohort Prospective Studies

BACKGROUND

The dysregulation of glucose homeostasis via mental health stress is increasingly acknowledged, whereby depression independently increases the risk of the onset of type 2 diabetes by up to 60%. Contributing mental health factors starting in early life have further been considered, indicating that exposure to childhood emotional abuse is associated with both depression and an increased onset of type 2 diabetes in adulthood. However, the potential role of depression within the emotional abuse and type 2 diabetes link remains unknown.

METHODS

Data were derived from community-dwelling participants in southern and northeastern Germany who participated in the longitudinal KORA-F4 and SHIP-3 studies. Multivariable logistic regression analyses adjusted for lifestyle, somatic, and psychological risk factors were used to investigate the association between childhood emotional abuse, assessed retrospectively by the Childhood Trauma Screener, and newly diagnosed type 2 diabetes cases, which were confirmed using a standard oral glucose tolerance test. The mediating role of depressive symptoms between childhood emotional abuse and type 2 diabetes was assessed by the Patient Health Questionnaire-9 and calculated by using the Sobel test for mediation.

RESULTS

A total of 2,973 (53.2% women, 46.8% men) participants with a mean age of 49.7 were included in the analyses, of whom 5.9% (7.1% women, 4.5% men) reported emotional abuse in childhood. Participants exposed to childhood emotional abuse had a 1.70 (1.12-2.56; p = 0.02) times higher odds of depression in the fully adjusted model than unexposed participants. During the 6.5-year follow-up period, 104 (3.5%) participants developed type 2 diabetes. Participants who were exposed to childhood emotional abuse had a 2.56 (1.31-4.98, p = 0.005) times higher odds of developing type 2 diabetes than unexposed participants. This association was significantly mediated by the increased odds of depression in participants with childhood emotional abuse (Sobel Test, 1.84, p = 0.06; Goodman Test, 1.91, p = 0.05).

CONCLUSION

The current results indicate that the increased likelihood of type 2 diabetes onset in participants who were exposed to childhood emotional abuse is significantly attributed to increased depression in adulthood.