Cardiovascular health of Finnish war evacuees 60 years later

The Intersectionality of Sex and Race in the Relationship Between Posttraumatic Stress Disorder and Cardiovascular Disease: A Scoping Review

Objectives: Posttraumatic stress disorder (PTSD) has been linked with cardiovascular disease (CVD), suggesting a risk for negative health outcomes among individuals with PTSD. This review synthesizes the temporal relationship between PTSD and CVD and highlights the intersection of sex and race. Methods: Covidence was used to systematically review the literature published between 1980 and 2020. Results: 176 studies were extracted. 68 (38.64%) of the studies were a predominantly male sample. 31 studies (17.61%) were a predominantly female sample. Most reported participants of both sexes (n = 72; 40.91%) and only 5 (2.84%) did not report respondent sex. No studies reported transgender participants. 110 (62.5%) studies reported racial and ethnic diversity in their study population, 18 (10.22%) described a completely or predominantly white sample, and 48 (27.27%) did not report race or ethnicity of their study population. Conclusion: A compelling number of studies did not identify sex differences in the link between PTSD and CVD or failed to report race and ethnicity. Investigating sex, race, ethnicity, and the temporal relationship between PTSD and CVD are promising avenues for future research.

Parent-child separation and cardiometabolic outcomes and risk factors in adulthood: A systematic review

BACKGROUND

Parent-child separation has been associated with negative mental health across childhood and adulthood, yet little is known about the long-term impacts for cardiovascular health. This systematic review synthesized and evaluated the quality of the literature examining the association between exposures to parent-child separation and cardiometabolic outcomes in adulthood.

METHODS

Following a registered protocol, online databases (Pubmed, PsycInfo, and Web of Science) were searched for relevant studies. Studies were included if they (a) defined the exposure before age 18 as institutionalization, foster care placement, parental incarceration, separation due to parents migrating for economic reasons, or asylum and war; and (b) quantified the association between parent-child separation and cardiometabolic events and diagnoses (e.g., coronary heart disease, diabetes) and risk factors (e.g., body mass index, fat distribution, serum-based metabolic markers, inflammatory markers in adulthood (≥ age 18). Studies lacking an unexposed comparison group were excluded. The risk for bias in each study was assessed with a modified Newcastle-Ottawa Scale.

RESULTS

Of the 1938 studies identified, 13 met our inclusion criteria. Two of the four studies examining associations between parent-child separation and cardiometabolic events and diagnoses found positive associations with coronary heart disease and diabetes. Amongst the 13 studies examining associations with any type of adult cardiometabolic risk factors, eight studies reported at least one positive association. Sub-analyses considering separate reasons for parent-child separation provided clearer insights: War evacuation was associated with hypertension and high blood pressure across four studies from the same cohort; out-of home care experiences largely evidenced null results across five different studies, and two studies on parental incarceration suggested positive associations with elevated inflammation, BMI and blood pressure.

CONCLUSIONS

The connections between parent-child separation and adult cardiometabolic outcomes and risk factors are currently inconsistent. The results may depend on the reason for separation, age of assessment, analytic differences and other psychosocial variables that are often unmeasured in this literature.

Perceived Chronic Stress Is Associated With the German Diabetes Risk Score Among Adults Without Known Diabetes in Germany

OBJECTIVE

There is evidence that psychological distress increases the risk of type 2 diabetes (T2D), but implications for prevention remain elusive. We examined the association between chronic stress and the German Diabetes Risk Score (GDRS) among adults without diabetes in Germany.

METHODS

The study population consisted of 4654 persons aged 18 to 64 years without known diabetes drawn from the German Health Interview and Examination Survey for Adults (2008-2011). The predicted 5-year T2D risk (in percent) was estimated using the GDRS. Perceived chronic stress was assessed by the Screening Scale of the Trier Inventory for the Assessment of Chronic Stress and categorized into "up to average," "above average," and "high." The cross-sectional association of chronic stress with log-transformed GDRS (expressed as geometric mean ratio [GMR]) was analyzed in multivariable linear regression models. Covariables included age, sex, community size, region, educational level, living alone, social support, depression, and alcohol use.

RESULTS

The mean predicted 5-year T2D risk rates were 2.7%, 2.9%, and 3.0% for chronic stress up to average, above average, and high chronic stress, respectively. Adjusted mean predicted 5-year risk was significantly higher among persons with chronic stress above average (GMR = 1.10, 95% confidence interval = 1.02-1.19) and high stress (GMR = 1.21, 95% CI = 1.06-1.39) compared with persons with chronic stress up to average. No interactions with sex or other covariables were found.

CONCLUSIONS

Perceived chronic stress is independently associated with an increased predicted T2D risk in cross-sectional analysis and should be considered as T2D risk factor in longitudinal studies.

Educational inequalities in heart failure mortality and the cycles of the internal armed conflict in Colombia: An observational panel study of ecological data, 1999-2017

Heart failure (HF) is a significant clinical problem and an important public health issue due to the morbidity and mortality that it causes, especially in a population that is aging and affected by social stressors such as armed conflict. We aim to describe the inequalities and trends of HF mortality by educational level in Colombia between 1999 and 2017 compared with the cycles of the internal armed conflict during the same period. An observational study of ecological data panels, with aggregates at the national level, was conducted. Information from death certificates with HF as the basic cause of death (COD) was used. Variables of the year of death, sex, age, department of residence, and educational level were considered. Mortality rates adjusted for age were calculated. A joinpoint regression was used to model the trend of rates by educational level. We found that both men and women with primary education had the highest adjusted mortality rates: among men, RR_primary = 19.06 deaths/100,000 inhabitants, SE = 0.13 vs. RR_tertiary = 4.85, SE = 0.17, and similar differences among women. Mortality rates tended to decrease at all educational levels, with a greater reduction in people with higher educational levels. In both sexes, the behavior of the relative index of inequality showed significant inequality, albeit with a strong reduction during the last decade. Mortality due to HF in Colombia shows inequalities by educational level. In the prevention of HF, education should be considered a structural social determinant. In addition, we analyzed the potential role of the Colombian long-term armed conflict in the observed trends. We highlighted the role of the health sector, together with other sectors (education, work, and housing), in developing intersectoral public policies that contribute to the reduction of cardiovascular mortality disparities.

Adverse childhood experiences and risk of diabetes: A systematic review and meta-analysis

Background

The association between adverse childhood experiences (ACEs) and diabetes is unclear. This systematic review and meta-analysis aims to quantify the association between the number and types of ACEs and diabetes during adulthood based on available observational studies.

Methods

A comprehensive literature search of studies exploring the association between ACEs and diabetes was conducted in PubMed, Medline, and Embase databases until 15 April 2022. A random-effects model was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) for the number and types of ACEs with diabetes. Regarding the association between the number of ACEs and diabetes, we used funnel plots to examine publication bias, subgroup analysis to explore sources of heterogeneity, and sensitivity analysis to explore the robustness of the pooled results.

Results

A total of 49 studies were included. Individuals with higher continuous ACEs (per each additional ACE: OR = 1.06, 95% CI = 1.02-1.10), any ACE (OR = 1.22, 95% CI = 1.16-1.28), or ≥4 ACEs (OR = 1.44, 95% CI = 1.27-1.63) were at an increased risk of diabetes in adulthood when compared with individuals without ACEs. Across specific ACE types, childhood economic adversity (OR = 1.11, 95% CI = 1.04-1.19), physical abuse (OR = 1.14, 95% CI = 1.07-1.21), sexual abuse (OR = 1.25, 95% CI = 1.12-1.39), verbal abuse (OR = 1.11, 95% CI = 1.03-1.20), and incarceration (OR = 1.22, 95% CI = 1.03-1.45) were associated with diabetes. However, neglect, emotional abuse, domestic violence, parental divorce or separation, parental death, and living with a family member with substance abuse or mental disorders were not significantly associated with diabetes.

Conclusions

Individuals with ACEs may have a cumulative risk for diabetes in adulthood. It is critical to prevent ACEs and build resilience in individuals affected by ACEs.

Childhood exposure to war and adult onset of cardiometabolic disorders among older Europeans

Childhood exposure to contexts of war is a common occurrence among current and recent cohorts of children in various parts of the world. It was also common among older cohorts across Europe. Utilizing the Survey of Health, Ageing, and Retirement in Europe (SHARE) the present study links early life course residential histories with detailed information on the timing and location of hostilities during WWII to address three questions: 1) is childhood exposure to war associated with earlier onset of cardiometabolic disease (cardiovascular disease, hypertension, high cholesterol, and diabetes)? 2) did this additional risk vary depending on the timing of first exposure? 3) did this additional risk manifest via different life course pathways depending on exposure timing? Results demonstrate that exposure to war is associated with increased lifetime risk of cardiovascular disease, diabetes, high cholesterol, and hypertension and that this association is strongly concentrated among cohorts exposed in utero or during early childhood (e.g., before age 8). The results also suggest that the impact of war exposure on cardiometabolic disorders are likely to be direct, operating through latent biological processes rather than through childhood hardship, stunting of adult socioeconomic attainment, or elevated risk-taking behaviors.

Lessons learned from 25 Years of Research into Long term Consequences of Prenatal Exposure to the Dutch famine 1944-45: The Dutch famine Birth Cohort

This paper describes the findings of a historical cohort study of men and women born around the time of the Dutch famine 1944-45. It provided the first direct evidence in humans of the lasting consequences of prenatal undernutrition. The effects of undernutrition depended on its timing during gestation, and the organs and tissues undergoing periods of rapid development at that time. Early gestation appeared to be particularly critical, with the effects of undernutrition being most apparent, even without reductions in size at birth. Undernutrition during gestation affected the structure and function of organs and tissues, altered behaviour and increased risks of chronic degenerative diseases. This demonstrates the fundamental importance of maternal nutrition during gestation as the building blocks for future health.

Association between exposure to earthquake in early life and diabetes mellitus incidence in adulthood with the modification of lifestyles: Results from the Kailuan study

BACKGROUND

Exposure to disasters in early life may induce lifetime health risk, but investigation on earthquake exposure and DM in later life is still limited. The aim of the current study is to evaluate the association between exposure to the Tangshan Earthquake in early life and diabetes mellitus (DM) incidence in adulthood, and explore the modification of lifestyles on DM development.

METHODS

Participants who were free of DM at baseline from the Kailuan Study were included in this study. All participants were divided into fetal-exposed, infant-exposed, early childhood-exposed and nonexposed group. The effect of earthquake exposure on DM and modification of lifestyles were examined by multivariable-adjusted Cox proportional hazard model.

RESULTS

The exposed group had a higher risk of DM than nonexposed group, especially in infant-exposed and early childhood-exposed group, with hazard ratio (HR) of 1.62 [95% confidence intervals (CI), 1.21-2.17] and 1.46 (95% CI, 1.06-1.99), respectively. After stratifying by lifestyles, a significant modification was observed in alcohol consumption.

CONCLUSION

Exposing to earthquake in early life could increase DM incidence in later life, and alcohol consumption might modify the effect of earthquake exposure on DM development. More attention should be paid on the preventions of DM among adults who exposed to earthquake in their early life.

THE FEATURES OF POSTTRAUMATIC STRESS DISORDER DEVELOPMENT IN PATIENTS WITH DIABETES MELLITUS 2 TYPE

OBJECTIVE

The aim: The revealing of the development of stress-related disorders in patients with type 2 diabetes mellitus (DM 2) to: identify the prevalence of stress-related disorders, particularly, posttraumatic stress disorder (PTSD); study the influence of psychosocial factors on the occurrence and course of stress-related disorders and increase the effectiveness of treatment in DM 2.

PATIENTS AND METHODS

Materials and methods: Research papers have been found by searching the PubMed database using the keywords ``ptsd and diabetes 2 type" with the result of 74 studies. Totally 25 of selected publications were analysed based on our criteria about the mechanisms through which the influence of psychosocial factors, permanent stressful or traumatic events on the probable risk of PTSD development and their analysis and relationships for the improvement of treatment effectiveness in DM 2 patients who have not been the veterans.

CONCLUSION

Conclusions: Given the complex neurophysiological relationships between the long-term stress and pathophysiological mechanisms of DM 2 - this group of patients has the higher risk of developing stress-related disorders, including PTSD.

Early-Life War Exposure and Later-Life Frailty Among Older Adults in Vietnam: Does War Hasten Aging?

OBJECTIVES

To assess the nature and degree of association between exposure to potentially-traumatic wartime experiences in early life, such as living in a heavily bombed region or witnessing death first-hand, and later-life frailty.

METHODS

The Vietnam Health and Aging Study included war survivors in Vietnam, 60+, who completed a survey and health exam between May and August 2018. Latent Class Analysis is used to construct classes exposed to similar numbers and types of wartime experiences. Frailty is measured using a deficit accumulation approach that proxies biological aging. Fractional logit regression associates latent classes with frailty scores. Coefficients are used to calculate predicted frailty scores and expected age at which specific levels of frailty are reached across wartime exposure classes.

RESULTS

LCA yields nine unique wartime exposure classes, ranging from extreme exposure to non-exposed. Higher frailty is found among those with more heavy/severe exposures with a combination of certain types of experiences, including intense bombing, witnessing death first-hand, having experienced sleep disruptions during wartime, and having feared for one's life during war. The difference in frailty-associated aging between the most and least affected individuals is more than 18 years.

DISCUSSION

War trauma hastens aging and warrants greater attention toward long-term implications of war on health among vast post-conflict populations across the globe.

Extracellular Vesicles in Premature Aging and Diseases in Adulthood Due to Developmental Exposures

The developmental origins of health and disease (DOHaD) is a paradigm that links prenatal and early life exposures that occur during crucial periods of development to health outcome and risk of disease later in life. Maternal exposures to stress, some psychoactive drugs and alcohol, and environmental chemicals, among others, may result in functional changes in developing fetal tissues, creating a predisposition for disease in the individual as they age. Extracellular vesicles (EVs) may be mediators of both the immediate effects of exposure during development and early childhood as well as the long-term consequences of exposure that lead to increased risk and disease severity later in life. Given the prevalence of diseases with developmental origins, such as cardiovascular disease, neurodegenerative disorders, osteoporosis, metabolic dysfunction, and cancer, it is important to identify persistent mediators of disease risk. In this review, we take this approach, viewing diseases typically associated with aging in light of early life exposures and discuss the potential role of EVs as mediators of lasting consequences.

Maternal separation in childhood and hair cortisol concentrations in late adulthood

BACKGROUND

Parent-child separation has been shown to increase the risk of a range of mental and physical health conditions later in life. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation may help to explain this association. However, few studies have examined the effect of maternal separation on cortisol in late adulthood.

METHODS

We examined the relationship between maternal separation in childhood and hair cortisol concentrations in late adulthood, using data from the Whitehall II study (n = 3969, mean age: 70 y, range: 60-83 y). Additionally, the role of childhood (adverse childhood experiences (ACEs), material disadvantage, and parenting), adult (marital status and social position), and health (health behaviors, cardiovascular health and medication, and depression) measures in this association were examined. Finally, we examined age of separation and reason for separation. Analysis was carried out using linear regression.

RESULTS

Hair cortisol concentrations (pg/mg) among participants who reported maternal separation during childhood were higher (B=0.179, 95% CI 0.041-0.317, p = 0.01) compared to their non-separated counterparts. This effect was robust to adjustment by childhood, adult, and health measures. Among participants who reported separation, age at onset and reason for separation were not significantly associated with hair cortisol concentrations.

CONCLUSION

In older age individuals, hair cortisol concentrations were higher in those who reported maternal separation during childhood. This effect was independent of a wide variety of factors suggesting that there are lifelong pathways between early life separation and HPA functioning in old age.

The Long Arm of Conflict: How Timing Shapes the Impact of Childhood Exposure to War

This paper examines how the timing of childhood exposure to armed conflict influences both the magnitude of the impact it has on later-life health and the pathways through which those impacts manifest. Utilizing the Survey of Health and Retirement in Europe, we examine cohorts of children during World War II. We find that cohorts born during the war show the largest negative effects of exposure on health in later life. The pathways also vary the timing of exposure. Consistent with a latent critical period process, children born during the war experienced increased risk of poor health and illness in childhood, as well as adult cardiometabolic conditions and poor functional health. Conversely, cohorts born before the war experienced more indirect pathways consistent with cumulative disadvantage processes and institutional breakdown. These pathways include stunted socioeconomic attainment, increased risk behaviors, and poorer mental health. Overall, this study emphasizes that the timing of exposure is critical to understanding the long-term health effects of war.

Early Life Exposure to Food Contaminants and Social Stress as Risk Factor for Metabolic Disorders Occurrence?-An Overview

The global prevalence of obesity has been increasing in recent years and is now the major public health challenge worldwide. While the risks of developing metabolic disorders (MD) including obesity and type 2 diabetes (T2D) have been historically thought to be essentially driven by increased caloric intake and lack of exercise, this is insufficient to account for the observed changes in disease trends. Based on human epidemiological and pre-clinical experimental studies, this overview questioned the role of non-nutritional components as contributors to the epidemic of MD with a special emphasis on food contaminants and social stress. This overview examines the impact of early life adverse events (ELAE) focusing on exposures to food contaminants or social stress on weight gain and T2D occurrence in the offspring and explores potential mechanisms leading to MD in adulthood. Indeed, summing up data on both ELAE models in parallel allowed us to identify common patterns that appear worthwhile to study in MD etiology. This overview provides some evidence of a link between ELAE-induced intestinal barrier disruption, inflammation, epigenetic modifications, and the occurrence of MD. This overview sums up evidence that MD could have developmental origins and that ELAE are risk factors for MD at adulthood independently of nutritional status.

The Prevalence of Frailty Using Three Different Frailty Measurements in Two Finnish Cohorts Born Before and After the Second World War

OBJECTIVES

To study the prevalence of frailty and its relationship to mortality in cohorts born before and after the Second World War using three different frailty measures.

METHODS

Cross-sectional data from two cohorts born in 1935 (n=593) and 1945 (n=714) were studied for frailty at the mean age of 70.7 (SD 1.8) years. Frailty was measured using the Frailty Phenotype (FP), the Frail Scale (FS) and the 74-item Frailty Index (FI>0.21 denoted frailty). Information on socioeconomic factors was obtained via a study questionnaire and the data on mortality were obtained from the Population Information System.

RESULTS

The prevalence of frailty by FI was more common in the older 1935 cohort than in the 1945 cohort (p<0.001). The percentage of robust subjects was higher in both sexes in the 1945 cohort using both FI and FS. After adjusting for sociodemographic factors, the difference in the prevalence of frailty between the cohorts remained significant in women only (OR 1.9 (95% CI 1.3-2.9), p=0.001). The FI classified people as frail more often (30.2% in the 1935 cohort and 17.5% in the 1945 cohort) than the FS (13.1% and 8.8%) or FP (1.8% and 1.6%). Low financial satisfaction was associated significantly with frailty in both sexes. Low level of education was associated with frailty in women and being unmarried or divorced in men. Frailty was associated to increased mortality using all frailty definitions in the 1935 cohort with a longer follow-up time.

CONCLUSIONS

Improved living conditions and health care may have resulted in the lower prevalence of frailty in the 1945 cohort. The present study further strengthens the association between frailty and mortality and poor economic status and frailty. Frailty definitions are in need of further study.

Does maternal separation accelerate maturation of perineuronal nets and parvalbumin-containing inhibitory interneurons in male and female rats?

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Maternal separation did not accelerate maturation of PNNs in amygdala or PFC.

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Maternal separation did not affect PV density in infant and juveniles.

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No sex differences were observed in effects of maternal separation on PNNs or PV.

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Impact of early adversity may be more easily seen with functional neural measures.

Early life adversity impacts on a range of emotional, cognitive, and psychological processes. A recent theoretical model suggests that at least some of these effects are due to accelerated maturation of specific physiological systems and/or neural circuits. For example, maternal separation (MS), a model of early life adversity in rodents, accelerates maturation of memory systems, and here we examined its impact on maturation of perineuronal nets (PNNs) and parvalbumin (PV)-containing inhibitory interneurons. PNNs are specialized extracellular matrix structures suggested to be involved in stabilizing long-term memories and in the closure of a sensitive period in memory development. PV-containing inhibitory interneurons are the type of cell that PNNs preferentially surround, and are also thought to be involved in memory. In Experiment 1, with male rats, there was an increase in PNNs in both the amygdala and prefrontal cortex with age from infancy to juvenility. Contrary to prediction, MS had no impact on either PNN or PV expression. The same pattern was observed in female rats in Experiment 2. Taken together, these data show that the early maturation of memory in MS infants is not due to an accelerated maturation of PNNs or PV-containing cells in either the amygdala or prefrontal cortex.

The Embodiment of War: Growth, Development, and Armed Conflict

Armed conflict regularly presents extremely adverse circumstances not only for combatants, but also for civilians. In fact, estimates from various wars over the past 70 years suggest that noncombatants comprise the majority of casualties. For survivors, war's effects are often embodied, leaving long-term effects on health and biology. Some of these effects, such as injuries and psychological trauma, are well known. Yet other effects may be subtle and may be elucidated by a developmental biological perspective. In early life, when growth rates are highest, conditions of war may have their greatest impact. Depending on local circumstances, a developing embryo, infant, or child growing in a place embroiled in armed conflict is likely to face—directly or indirectly—various stressors, including malnutrition, infectious disease, and/or psychological stress. Thus, the conditions of war and forced displacement may become embodied, getting under the skin for fundamental biological reasons.

Association of famine exposure with the risk of type 2 diabetes: A meta-analysis

PURPOSE

The association between famine exposure and type 2 diabetes (T2DM) remains controversial. A meta-analysis was performed to clarify the relation of famine exposure to T2DM risk in detail.

METHODS

A systematic literature search was performed in PubMed, Cochrane library, Web of Science, China National Knowledge Infrastructure (CNKI), Sinomed (CBM), Wanfang Data Knowledge Service Platform and China Science and Technology Journal VIP Database. The articles were limited to be available in English or Chinese before 10 April 2019. The pooled relative risk (RR) with 95% confidence interval (CI) was used to estimate the effect of famine exposure on T2DM. The I square value (I²) was used to assess heterogeneity, and the random effects model (REM) was adopted as the pooling method.

RESULTS

This meta-analysis included 24 published articles with 1,660,385 subjects. A significant association of famine exposure with increased risk of T2DM was observed (RR = 1.433, 95% CI: 1.101-1.865). The pooled RRs were different in terms of publication year, location, study design, sample size, famine duration and definition of diabetes (criteria). Longer the famine exposure experienced, greater the effect of famine exposure on T2DM would be. Compared to WHO criteria, studies of which diabetes diagnosed by ADA criteria and other criteria might more likely to find this association. Compared to moderate famine exposure, the pooled RR in severe famine was statistically significant. Furthermore, the pooled RR adjusted for the most confounders in females was 1.517 (95% CI: 1.018-2.261). In terms of period of famine exposure, compared to adult exposure, people who exposure famine in fetal, childhood, and adolescent were likely to be diabetes.

CONCLUSION

Famine exposure may increase the risk of T2DM. The risk may vary with famine duration, definition of diabetes, gender and period of famine exposure.

Familial Childhood Adversity is Associated with Chronic Disease Among Women: Data from the Geographic Research on Wellbeing (GROW) Study

Objectives Few population-based studies on the relationship between childhood adversity and health in adulthood for women exist. Little is known about whether some social groups are more vulnerable to childhood adversity than other groups. Methods Using data from the Geographic Research on Wellbeing survey (GROW) conducted in California during 2012-2013, we examine associations between familial childhood adversities (FCAs) and a set of important chronic diseases and related conditions among women with young children, employing logistic regression models (N = 2409). Specifically, we test two measures of FCAs on the odds of reporting one or more chronic diseases or related-conditions (diabetes, hypertension, high cholesterol, heart disease). We also examine whether the associations between the two measures and the dependent variables vary by social factors (race/ethnicity, marital status, education, income). Results Both FCA measures were associated with reporting one or more chronic diseases after controlling for a set of important sociodemographic factors. Each unit increase in the number of FCAs corresponded to about a 10% increase in the odds of reporting one or more chronic disease(s). Moderating effects were also observed, with greater impacts among more socially vulnerable groups. Furthermore, ancillary analyses demonstrated that diabetes and high cholesterol were the drivers of the relationship between FCAs and chronic disease. Conclusions for Practice The social ecological model framework suggests that childhood adversity can be considered at multiple levels; that is, a sustainable reduction in the adverse health impacts of childhood adversity requires a concerted effort among policymakers and practitioners that includes both "upstream" and "downstream" approaches.

Childhood adversity and mechanistic links to hypertension risk in adulthood

Adverse childhood experiences (ACEs), defined as traumatic events in childhood that range from various forms of abuse to household challenges and dysfunction, have devastating consequences on adult health. Epidemiological studies in humans and animal models of early life stress (ELS) have revealed a strong association and insight into the mechanistic link between ACEs and increased risk of cardiovascular disease (CVD). This review focuses on the mechanistic links of ACEs in humans and ELS in mice and rats to vasoactive factors and immune mediators associated with CVD and hypertension risk, as well as sex differences in these phenomena. Major topics of discussion in this review are as follows: (a) epidemiological associations between ACEs and CVD risk focusing on hypertension, (b) evidence for association of ACE exposures to immune-mediated and/or vasoactive pathways, (c) rodent models of ELS-induced hypertension risk, (d) proinflammatory mediators and vasoactive factors as mechanisms of ELS-induced hypertension risk. We also provide some overall conclusions and directions of further research. LINKED ARTICLES: This article is part of a themed section on Immune Targets in Hypertension. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.12/issuetoc.

Work careers in adults separated temporarily from their parents in childhood during World War II

INTRODUCTION

Traumatic experiences, such as separation from parents in childhood causing early life stress (ELS) may increase the risk of adverse long-term health outcomes and biological age-related changes. This may have an impact on work career. Our aim was to examine long term consequences of ELS due to temporary separation from parents during World War II (WWII) in relation to work career.

MATERIAL AND METHODS

The Helsinki Birth Cohort Study comprises 13,345 individuals born in Helsinki, Finland, between the years 1934-1944. From the original cohort, 1781 individuals were identified as being separated temporarily from their parents due to World War II. Information on date and type of pension was provided by the Finnish Centre for Pensions and the Social Insurance Institution of Finland. The cohort members either transitioned into old age pension at the statutory retirement age or retired earlier and transitioned into disability, unemployment, part-time pension or died before retirement.

RESULTS

Those who were separated were more likely to have transitioned into disability pension (RRR: 1.26: 95% CI: 1.06-1.48), especially due to diseases of the musculoskeletal system (OR: 1.57; 95% CI: 1.20-2.07), or into unemployment pension (RRR: 1.25; 95% CI: 1.02-1.53) compared with those not separated from their parents. Longer duration of separation was associated with early exit from the workforce compared with non-separation.

CONCLUSIONS

Exposure to ELS may have an impact upon lifetime work career. Early interventions preventing exposure to ELS or mitigating its negative effects may prolong future work careers along with healthier aging across the life-span.

Fetal and childhood malnutrition during the Korean War and metabolic syndrome in adulthood

OBJECTIVES

Koreans experienced unexpected shortages of food and refugee life during the Korean War (1950-1953). In the present study, we used the Korean War as a natural experiment for early life malnutrition with the aim of evaluating the risk for metabolic syndrome in adulthood according to participant exposure status during the Korean War.

METHODS

We used data from 25 708 participants from the fourth through seventh Korean National Health and Nutrition Examination Survey, a nationally representative database of Korea. By years of birth, we divided the study participants into non-exposed (1959-1963 and 1954-1958), fetal-exposed (1951-1953), early childhood-exposed (1946-1950), late-childhood-exposed (1941-1945), and adolescent-exposed (1936-1940) groups according to participants' ages during the Korean War. We calculated the risk for metabolic syndrome in adult life using logistic regression analysis.

RESULTS

Compared with the non-exposed group, women exposed to the Korean War while in utero and during early childhood were associated with increased risk for abdominal obesity and elevated triacylglycerol levels, whereas men showed low high-density lipoprotein cholesterol levels. Fetal and early childhood exposure increased the risk for metabolic syndrome in adults compared with the non-exposed group (fetal-exposed men: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.93-1.76; fetal-exposed women: OR, 1.35; 95% CI, 1.01-1.80; early-childhood-exposed men OR, 1.25; 95% CI, 0.82-1.90; and early-childhood-exposed women OR, 1.41; 95% CI, 0.97-2.06).

CONCLUSIONS

Fetal and early childhood experiences during the Korean War were associated with increased risk for some components of metabolic syndrome. The present study suggested that early life malnutrition due to the Korean War may be associated with metabolic syndrome in later life.

Psychosocial Stress Over the Lifespan, Psychological Factors, and Cardiometabolic Risk in the Community

OBJECTIVE

The complex relationship between psychosocial stress over the lifetime, psychological factors, and cardiometabolic risk is still poorly understood. Accordingly, our aims were (1) to independently assess the associations between childhood adversity, life-event stress in remote (earlier than the last 5 years), and recent adulthood and cardiometabolic risk, and (2) to determine the role of psychological factors including personality, coping, and depression in these associations.

METHODS

The sample included 2674 adults, aged 35 to 66 years, randomly selected from urban area. Participants underwent a physical examination including the assessment of obesity markers, blood pressure, and blood lipid and glucose levels. Stress during adulthood was determined using the severity scores of 52 stressful life events. Information on adverse childhood experiences and major depressive disorders was collected using semistructured interviews, whereas personality traits and coping mechanisms were evaluated through questionnaires.

RESULTS

Both childhood adversity and stress in remote adulthood were associated with elevated body mass index (β [95% confidence interval {CI}] = 0.249 [0.029 to 0.468]; 0.020 [0.006 to 0.034]), waist circumference (β [95% CI] = 0.061 [0.024 to 0.099]; 0.08 [0.04 to 0.11]), and the global cardiometabolic risk score (β [95% CI] = 0.278 [0.017 to 0.540]; 0.017 [0.001 to 0.033]) after adjustment for sociodemographic, lifestyle, and psychological factors. In addition, childhood adversity was associated with low high density lipoprotein levels (β [95% CI] = -0.021 [-0.042 to 0.000]), as well as increased fat mass and systolic blood pressure levels (β [95% CI] = 0.506 [0.165 to 0.846]; 0.952 [0.165 to 1.740]) and stress in remote adulthood with apolipoprotein B levels (β [95% CI] = 0.607 [0.312 to 0.901]). Psychological factors did not account for these associations and were not effect modifiers.

CONCLUSIONS

Our data demonstrate that psychosocial stress during childhood and remote adulthood favor adiposity and abnormal lipid metabolism.

Fetal undernutrition, placental insufficiency, and pancreatic β-cell development programming in utero

The prevalence of obesity and type 2 (T2D) diabetes is a major health concern in the United States and around the world. T2D is a complex disease characterized by pancreatic β-cell failure in association with obesity and insulin resistance in peripheral tissues. Although several genes associated with T2D have been identified, it is speculated that genetic variants account for only <10% of the risk for this disease. A strong body of data from both human epidemiological and animal studies shows that fetal nutrient factors in utero confer significant susceptibility to T2D. Numerous studies done in animals have shown that suboptimal maternal environment or placental insufficiency causes intrauterine growth restriction (IUGR) in the fetus, a critical factor known to predispose offspring to obesity and T2D, in part by causing permanent consequences in total functional β-cell mass. This review will focus on the potential contribution of the placenta in fetal programming of obesity and TD and its likely impact on pancreatic β-cell development and growth.

Early life stress and frailty in old age: the Helsinki birth cohort study

BACKGROUND

Evidence suggests that early life stress (ELS) may extend its effect into adulthood and predispose an individual to adverse health outcomes. We investigated whether wartime parental separation, an indicator of severe ELS, would be associated with frailty in old age.

METHODS

Of the 972 participants belonging to the present sub-study of the Helsinki Birth Cohort Study, 117 (12.0%) had been evacuated abroad unaccompanied by their parents in childhood during World War II. Frailty was assessed at a mean age of 71 years according to Fried's criteria.

RESULTS

Thirteen frail men (4 separated and 9 non-separated) and 20 frail women (2 separated and 18 non-separated) were identified. Compared to the non-separated men, men who had been separated had an increased relative risk ratio (RRR) of frailty (age-adjusted RRR 3.93, 95% CI 1.02, 15.11) that persisted after adjusting for several confounders. No associations were observed among women (RRR 0.62; 95% CI 0.13, 2.94).

CONCLUSIONS

These preliminary results suggest that ELS might extend its effects not just into adulthood but also into old age, and secondly, that men may be more vulnerable to the long-term effects of ELS.

Cumulative childhood adversity and adult cardiometabolic disease: A meta-analysis

OBJECTIVE

Adverse childhood experiences may be associated with cardiometabolic morbidity and mortality in adulthood. There is heterogeneity in this literature regarding the type of items in cumulative adversity indices, sample sizes, demographics, and covariates. The present review used quantitative meta-analysis to examine this association and potential moderators.

METHOD

Included studies had a measure of cumulative adversity (an index of at least 2 adverse childhood experiences from age 0 to 18) and a measure of cardiometabolic disease: cardiovascular disease (CVD) clinical outcomes (hypertension, coronary heart disease, ischemic heart disease, myocardial infarction, stroke, cerebrovascular disease) and metabolic outcomes (diabetes, metabolic syndrome) at age 18 or older. Given different interpretations of odds ratios (OR) versus hazard ratios (HR), effects were pooled separately. Overall, 9 HR studies (15 effects) based on 179,612 participants and 29 OR studies (62 effects) based on 247,393 participants were included.

RESULTS

On the basis of retrospectively assessed adversity, combined studies showed a significant estimated effect of cumulative childhood adversity on adult cardiometabolic disease (HR = 1.42, 95% CI [1.20, 1.67]; OR = 1.36 [1.27, 1.46]). Results varied somewhat by type of cardiometabolic disease, analytic strategy, and number and type of covariates.

CONCLUSIONS

The literature suggests that cumulative childhood adversity is modestly related to adult cardiometabolic disease, with effects somewhat stronger for CVD clinical outcomes. The absence of a consistent operational and conceptual definition of adversity and paucity of prospective designs temper the conclusions. It is time for further evaluation of the types and timing of childhood events that have maximal impact on adult cardiometabolic disease. (PsycINFO Database Record

Investigating the Early Life Determinants of Type-II Diabetes Using a Project Talent-Medicare Linked Data-set

The increasing prevalence of Type II Diabetes (T2D) presents a serious health and financial public crisis. Our study examines the hypothesis that adolescents' perceptions of economic insecurity, along with absolute and relative socioeconomic status (SES), can contribute to T2D prevalence later in life. Project Talent (PT) Survey data, collected on high school students in 1960, have been linked to Medicare records from 2012, presenting a unique opportunity to examine measures gathered in adolescence and T2D prevalence later-in-life among a large, national, and diverse sample (n=88,849). Our results provide compelling evidence that real, perceived, and relative SES in adolescence have persistent impacts on later-in-life diabetes risk, even when controlling for possible confounders such as cognitive ability, conscientiousness, and early-adulthood educational attainment.

Are adverse childhood experiences and depression associated with impaired glucose tolerance in females? An experimental study

Adverse childhood experiences (ACE) enhance the risk for mental disorders, e.g. major depressive disorder (MDD). Increasing evidence suggests an association between ACE and impaired physical health, e.g. metabolic syndrome. The aim of this study was to assess several metabolic risk markers in healthy individuals with and without ACE and depressed patients with and without ACE. We examined glucose and insulin release in the oGTT in 33 women with MDD and ACE, 47 women with MDD without ACE, 21 women with ACE but no current or lifetime MDD and 36 healthy women without either MDD or ACE. Several metabolic markers such as triglycerides, cholesterol, LDL, HDL, HbA1c, BMI and waist to hip ratio were assessed. The four groups did neither differ in insulin release and glucose concentrations in the oGTT nor with respect to other metabolic variables. Depressed patients with and without psychotropic medication did not differ in any outcome variable, but there was a trend towards higher glucose concentrations in the oGTT in patients with current psychotropic medication. In this physically healthy sample neither ACE nor MDD were associated with metabolic risk factors. Thus, metabolic alterations might not directly be linked to ACE and depression.

Early life stress induces immune priming in kidneys of adult male rats

Early life stress (ELS) in humans is associated with elevated proinflammatory markers. We hypothesized that ELS induces activation of the immune response in a rat model of ELS, maternal separation (MatSep), in adulthood. MatSep involves separating pups from the dam from postnatal day 2 to postnatal day 14 for 3 h/day. Control rats are nonseparated littermates. We determined circulating and renal immune cell numbers, renal immune cell activation markers, renal cytokine levels, and the renal inflammatory gene expression response to low-dose lipopolysaccharide (LPS) in male MatSep and control rats. We observed that MatSep did not change the percentage of gated events for circulating CD3⁺, CD4⁺, CD8⁺, and CD4⁺/Foxp3⁺ cells or absolute numbers of mononuclear and T cells in the circulation and kidneys; however, MatSep led to an increase in activation of renal neutrophils as well as CD44⁺ cells. Renal toll-like receptor 4 (TLR4) and interleukin 1 beta (IL-1β) was significantly increased in MatSep rats, specifically in the outer and inner medulla and distal nephron, respectively. Evaluation of renal inflammatory genes showed that in response to a low-dose LPS challenge (2 mg/kg iv) a total of 20 genes were significantly altered in kidneys from MatSep rats (17 genes were upregulated and 3 were downregulated), as opposed to no significant differences in gene expression in control vs. control + LPS groups. Taken together, these findings indicate that MatSep induces priming of the immune response in the kidney.

Timeline of Intergenerational Child Maltreatment: the Mind-Brain-Body Interplay

PURPOSE OF REVIEW

Still obscure mechanisms of intergenerational child maltreatment (ITCM) have been investigated partially, from various psychological and biological perspectives and from various time perspectives. This review is aimed at integrating the findings on different temporal ITCM pathways, emphasizing the mind-brain-body interplay.

RECENT FINDINGS

Psychological mediators of ITCM involve attachment, mentalization, dissociation, social information processing, personality traits, and psychiatric disorders. Neurobiological findings mostly refer to the neural correlates of caregiving and attachment behaviors, affected by several physiological systems (stress-response, immune, oxytocin), which also affect physical health. The latest research clusters around the epigenetic pathways of ITCM, suggesting the additional, prenatal, and preconception forms of transmission. Data suggest that ITCM needs to be conceptualized as a longitudinal process, with various interrelated psychological, neurodevelopmental, and somatic paths. Future research and prevention should take into account both, each path and each phase of ITCM, in an integrative way.

Early Life Stress, FKBP5 Polymorphisms, and Quantitative Glycemic Traits

OBJECTIVE

Early life stress (ELS) has been shown to influence health later in life. Functioning of the hypothalamic-pituitary-adrenal axis, regulated partly by FKBP5 gene, may moderate these effects. We examined whether FKBP5 single-nucleotide polymorphisms (SNPs) interact with ELS on Type 2 diabetes, cardiovascular disease, and quantitative glycemic traits.

METHODS

A total of 1728 Helsinki Birth Cohort Study participants born from 1934 to 1944 were genotyped for FKBP5 SNPs (rs1360780, rs9394309, rs9470080) and were administered a 2-hour (75 g) oral glucose tolerance test and a questionnaire on physician-diagnosed and medication use for chronic diseases at a mean age of 61.5 years. Of the participants, 273 had been exposed to ELS, operationalized as separation from their parents, at a mean age of 4.7 years due to evacuations during World War II.

RESULTS

ELS interacted with FKBP5 SNPs in the analyses of fasting (rs1360780, p = .015), 30-minute (rs1360780, p = .031; rs9394309, p = .041) and incremental insulin (rs1360780, p = .032; rs9394309, p = .028; rs9470080, p = .043), insulin area under the curve (rs1360780, p = .044), and impaired fasting glucose (rs9470080, p = .049); among carriers of at least one copy of minor allele, but not among major allele homozygotes, insulin values were higher, as were the odds for impaired fasting glucose if they had been separated compared with if they had not. Corresponding associations were found with a haplotype formed by minor alleles in all three SNPs for fasting, 30-minute, and incremental insulin (p < .05).

CONCLUSIONS

FKBP5 polymorphisms in combination with ELS exposure predict higher insulin and glucose values in midlife. Our findings support the role for hypothalamic-pituitary-adrenal axis dysregulation in health-related metabolic outcomes.

Placental Origins of Chronic Disease

Epidemiological evidence links an individual's susceptibility to chronic disease in adult life to events during their intrauterine phase of development. Biologically this should not be unexpected, for organ systems are at their most plastic when progenitor cells are proliferating and differentiating. Influences operating at this time can permanently affect their structure and functional capacity, and the activity of enzyme systems and endocrine axes. It is now appreciated that such effects lay the foundations for a diverse array of diseases that become manifest many years later, often in response to secondary environmental stressors. Fetal development is underpinned by the placenta, the organ that forms the interface between the fetus and its mother. All nutrients and oxygen reaching the fetus must pass through this organ. The placenta also has major endocrine functions, orchestrating maternal adaptations to pregnancy and mobilizing resources for fetal use. In addition, it acts as a selective barrier, creating a protective milieu by minimizing exposure of the fetus to maternal hormones, such as glucocorticoids, xenobiotics, pathogens, and parasites. The placenta shows a remarkable capacity to adapt to adverse environmental cues and lessen their impact on the fetus. However, if placental function is impaired, or its capacity to adapt is exceeded, then fetal development may be compromised. Here, we explore the complex relationships between the placental phenotype and developmental programming of chronic disease in the offspring. Ensuring optimal placentation offers a new approach to the prevention of disorders such as cardiovascular disease, diabetes, and obesity, which are reaching epidemic proportions.

Early Life Stress Increases Metabolic Risk, HPA Axis Reactivity, and Depressive-Like Behavior When Combined with Postweaning Social Isolation in Rats

Early-life stress is associated with depression and metabolic abnormalities that increase the risk of cardiovascular disease and diabetes. Such associations could be due to increased glucocorticoid levels. Periodic maternal separation in the neonate and rearing in social isolation are potent stressors that increase hypothalamus-pituitary-adrenal axis activity. Moreover, social isolation promotes feed intake and body weight gain in rats subjected to periodic maternal separation; however, its effects on metabolic risks have not been described. In the present study, we evaluated whether periodic maternal separation, social isolation rearing, and a combination of these two stressors (periodic maternal separation + social isolation rearing) impair glucose homeostasis and its relation to the hypothalamus-pituitary-adrenal axis and depressive-like behavior. Periodic maternal separation increased basal corticosterone levels, induced a passive coping strategy in the forced swimming test, and was associated with a mild (24%) increase in fasting glucose, insulin resistance, and dyslipidemia. Rearing in social isolation increased stress reactivity in comparison to both controls and in combination with periodic maternal separation, without affecting the coping strategy associated with the forced swimming test. However, social isolation also increased body weight gain, fasting glucose (120%), and insulin levels in rats subjected to periodic maternal separation. Correlation analyses showed that stress-induced effects on coping strategy on the forced swimming test (but not on metabolic risk markers) are associated with basal corticosterone levels. These findings suggest that maternal separation and postweaning social isolation affect stress and metabolic vulnerability differentially and that early-life stress-related effects on metabolism are not directly dependent on glucocorticoid levels. In conclusion, our study supports the cumulative stress hypothesis, which suggests that metabolic risk markers arise when vulnerable individuals are exposed to social challenges later in life.

The lifelong socioeconomic disadvantage of single-mother background - the Helsinki Birth Cohort study 1934-1944

BACKGROUND

Growing up with one parent is associated with economic hardship and health disadvantages, but there is limited evidence of its lifetime consequences. We examined whether being born to an unmarried mother is associated with socioeconomic position and marital history over the lifespan.

METHODS

We analysed data from the Helsinki Birth Cohort Study including birth, child welfare clinic and school healthcare records from people born in Helsinki, Finland, between 1934 and 1944. Using a unique personal identification number, we linked these data to information on adult socioeconomic position from census data at 5-year intervals between 1970 and 2000, obtained from Statistics Finland.

RESULTS

Compared to children of married mothers, children of unmarried mothers were more likely to have lower educational attainment and occupational status (odds ratio for basic vs. tertiary education 3.40; 95 % confidence interval 2.17 to 5.20; for lowest vs. highest occupational category 2.75; 1.92 to 3.95). They were also less likely to reach the highest income third in adulthood and more likely to stay unmarried themselves. The associations were also present when adjusted for childhood socioeconomic position.

CONCLUSION

Being born to an unmarried mother, in a society where marriage is the norm, is associated with socioeconomic disadvantage throughout life, over and above the disadvantage associated with childhood family occupational status. This disadvantage may in part mediate the association between low childhood socioeconomic position and health in later life.

Linking systemic arterial stiffness among adolescents to adverse childhood experiences

Adverse childhood experiences (ACEs) have been linked with cardiovascular disease and early mortality among adults. Most research examines this relationship retrospectively. Examining the association between ACEs and children's cardiovascular health is required to understand the time course of this association. We examined the relationship between ACEs exposure and ECG-to-toe pulse wave velocity (PWV), a measure of systemic arterial stiffness that is strongly related to cardiovascular mortality among adults. PWV (distance/transit time; m/s) was calculated using transit times from the ECG R-wave to the pulse wave contour at the toe. Transit times were collected over 15 heartbeats and the distance from the sternal notch to the left middle toe was used. A total of 221 children (119 females) aged 10-14 years participated in data collection of PWV, hemodynamic and anthropometric variables. Parents of these children completed a modified inventory of ACEs taken from the Childhood Trust Events Survey. Multivariable regression assessed the relationship between ACEs group (<4 ACEs versus ≥4 ACEs) and PWV. Analyses yielded an ACEs group by sex interaction, with males who experienced four or more ACEs having higher PWV (p<0.01). This association was independent of hemodynamic, anthropometric and sociodemographic variables (R(2)=0.346; p<0.01). Four or more ACEs is associated with greater arterial stiffness in male children aged 10-14 years. Addressing stress and trauma exposure in childhood is an important target for public health interventions to reduce early cardiovascular risk.

Comorbid mental and physical health and health access in Cambodian refugees in the US

Little research has been conducted on the prevalence of physical health problems in Cambodian refugees and the relationship between their mental and physical health. We identified the relationship between mental and physical health problems and barriers to healthcare access in Cambodian refugee adults. We used a cross-sectional survey design with a snowball sample of 136 Cambodian refugee adult residents of Connecticut and Western Massachusetts. 61% reported being diagnosed with three or more physical conditions and 73% with depression, posttraumatic stress disorder (PTSD) or both. Language and transportation problems were the primary barriers to accessing care. Participants with probable comorbid PTSD and depression had 1.850 times more physical health problems than those without either condition (p > .001; CI 1.334-2.566). Age moderated this relationship. Participants who had been diagnosed with both depression and PTSD reported a consistent number of health conditions across the age span while those who had no mental health conditions or only one of the two reported fewer health conditions when they were younger and more when they were older. These two groups were significantly different from the group reporting both. There is a significant relationship between chronic comorbid mental and physical health diseases affecting Cambodian refugees resettled in the US Having comorbid depression and PTSD puts Cambodian refugees at risk for physical health problems no matter their age. It is vital that those treating Cambodian genocide survivors identify and treat their prevalent comorbid health conditions. Language and transportation barriers must be addressed to improve access to mental and physical health care in this population.

Early life stress in male mice induces superoxide production and endothelial dysfunction in adulthood

Early life stress (ELS) is a risk for cardiovascular disease in adulthood although very little mechanistic insight is available. Because oxidative stress and endothelial dysfunction are major contributors to cardiovascular risk, we hypothesized that ELS induces endothelial dysfunction in adult male mice via increased superoxide production. Studies employed a mouse model of ELS, maternal separation with early weaning (MSEW), in which litters were separated from the dam for 4 h/day [postnatal days (PD) 2-5] and 8 h/day (PD6-16), and weaned at PD17. Control litters remained undisturbed until weaning at PD21. When compared with control mice, thoracic aortic rings from adult male MSEW mice displayed significant endothelial dysfunction that was reversed by the superoxide scavenger, polyethylene glycol-superoxide dismutase (PEG-SOD). PEG-SOD-inhibitable superoxide production by aortae from MSEW mice was significantly greater than observed in control aortae, although unaffected by nitric oxide synthase inhibition, suggesting that uncoupled nitric oxide synthase was not responsible for the accelerated superoxide production. Aortic SOD expression, plasma SOD activity, and total antioxidant activity were similar in MSEW and control mice, indicating unaltered antioxidant capacity in MSEW mice. Increased expression of the NADPH oxidase subunits, NOX2 and NOX4, was evident in the aortae of MSEW mice. Moreover, endothelial dysfunction and superoxide production in MSEW mice was reversed with the NADPH oxidase inhibitor, apocynin, indicating increased NADPH oxidase-dependent superoxide production and endothelial dysfunction. The finding that MSEW induces superoxide production and endothelial dysfunction in adult mice may provide a mechanistic link between ELS and adult cardiovascular disease risk.

Prenatal Undernutrition and Autonomic Function in Adulthood

OBJECTIVES

Early-life adversity has been shown to be associated with cardiovascular disease and mortality in later life, but little is known about the mechanisms that underlie this association. Prenatal undernutrition, a severe early-life stressor, is associated with double the risk of coronary heart disease and increased blood pressure responses to psychological stress. In the present study, we tested the hypothesis that prenatal undernutrition induces alterations in the autonomic nervous system, which may increase the risk of developing heart disease.

METHODS

We studied autonomic function in 740 men and women (mean [SD] age, 58 [0.9] years) who were members of the Dutch famine birth cohort. We compared those exposed to famine during early (n = 64), mid (n = 107), or late gestation (n = 127) to those unexposed to famine in utero (n = 442). Participants underwent a series of 3 psychological stressors (Stroop, mirror tracing, and speech) while their blood pressure and heart rate were recorded continuously.

RESULTS

Data had sufficient quality in 602 participants for derivation of autonomic function indices by spectral analysis. The stress protocol led to significant sample-level changes in systolic blood pressure, heart rate, and all cardiovascular control measures (all p values < .001). None of the autonomic function parameters, at rest or in response to stress, differed significantly (all p values > .050) according to prenatal famine exposure.

CONCLUSIONS

Prenatal undernutrition was not associated with autonomic function in late adulthood. We conclude that altered autonomic function does not seem to explain our previous findings of increased coronary heart disease risk among those exposed to famine prenatally.

Adverse childhood experiences and risk of type 2 diabetes: A systematic review and meta-analysis

AIMS

It is evident that adverse childhood experiences (ACEs) can influence health status of adult life, but few large-scale studies have assessed the relation of ACEs with type 2 diabetes. This meta-analysis aimed to summarize existing evidence on the link between ACEs and type 2 diabetes in adults.

MATERIALS AND METHOD

We searched all published studies from PubMed and EMBASE before Aug 2015 using keywords like adverse childhood experiences and diabetes, and scanned references of relevant original articles. We included studies that reported risk estimates for diabetes by ACEs and matched our inclusion criteria. We examined the overall relationship between ACEs and diabetes, and stratified the analyses by type of childhood adversities, study design and outcome measures, respectively.

RESULTS

Seven articles fulfilled the inclusion criteria for this Meta-analysis, comprising 4 cohort and 3 cross-section studies. A total of 87,251 participants and 5879 incident cases of type 2 diabetes were reported in these studies. The exposure of ACEs was positively associated with the risk of diabetes with a combined odds ratio of 1.32 (95% confidence interval 1.16 to 1.51) in the total participants. The influence of neglect was most prominent (pooled odds ratio 1.92, 95% confidence interval 1.43 to 2.57) while the effect of physical abuse was least strong (pooled odds ratio 1.30, 95% confidence interval 1.19 to 1.42). The pooled odds ratio associated with sexual abuse was 1.39 with the 95% confidence intervals from 1.28 to 1.52.

CONCLUSIONS

The results support a significant association of adverse childhood experiences with an elevated risk of type 2 diabetes in adulthood.

Accumulation of Major Life Events in Childhood and Adult Life and Risk of Type 2 Diabetes Mellitus

Background

The aim of the study was to estimate the effect of the accumulation of major life events (MLE) in childhood and adulthood, in both the private and working domains, on risk of type 2 diabetes mellitus (T2DM). Furthermore, we aimed to test the possible interaction between childhood and adult MLE and to investigate modification of these associations by educational attainment.

Methods

The study was based on 4,761 participants from the Copenhagen City Heart Study free of diabetes at baseline and followed for 10 years. MLE were categorized as 0, 1, 2, 3 or more events. Multivariate logistic regression models adjusted for age, sex, education and family history of diabetes were used to estimate the association between MLE and T2DM.

Results

In childhood, experiencing 3 or more MLE was associated with a 69% higher risk of developing T2DM (Odds Ratio (OR) 1.69; 95% Confidence Interval (CI) 1.60, 3.27). The accumulation of MLE in adult private (p-trend = 0.016) and work life (p-trend = 0.049) was associated with risk of T2DM in a dose response manner. There was no evidence that experiencing MLE in both childhood and adult life was more strongly associated with T2DM than experiencing events at only one time point. There was some evidence that being simultaneously exposed to childhood MLE and short education (OR 2.28; 95% C.I. 1.45, 3.59) and work MLE and short education (OR 2.86; 95% C.I. 1.62, 5.03) was associated with higher risk of T2DM, as the joint effects were greater than the sum of their individual effects.

Conclusions

Findings from this study suggest that the accumulation of MLE in childhood, private adult life and work life, respectively, are risk factors for developing T2DM.

Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes

Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.

Comorbidity between Type 2 Diabetes and Depression in the Adult Population: Directions of the Association and Its Possible Pathophysiological Mechanisms

Type 2 diabetes and depression are regarded as comorbid conditions, and three possible directions of the association between the diseases can underlie this observation of comorbidity. First, common etiology can increase a person's risk of both diseases; second, persons with type 2 diabetes have increased prevalence or risk of future development of depression; or third, persons with depression have increased prevalence or risk of development of type 2 diabetes. This review gives an overview over possible pathophysiological mechanisms for each of the directions of the association between type 2 diabetes and depression and further discusses epigenetics as an additional, direction independent approach. We argue that unspecific pathophysiological mechanisms involved in the stress response might, at least to some extent, explain each of the directions of the association between type 2 diabetes and depression, while changes in brain structure and function among persons with diabetes and possible increased risk of development of type 2 diabetes after use of antidepressant agents could represent more disease specific mechanisms underlying the comorbidity.

Birth order and physical fitness in early adulthood: evidence from Swedish military conscription data

Physical fitness at young adult ages is an important determinant of physical health, cognitive ability, and mortality. However, few studies have addressed the relationship between early life conditions and physical fitness in adulthood. An important potential factor influencing physical fitness is birth order, which prior studies associate with several early- and later-life outcomes such as height and mortality. This is the first study to analyse the association between birth order and physical fitness in late adolescence. We use military conscription data on 218,873 Swedish males born between 1965 and 1977. Physical fitness is measured by a test of maximal working capacity, a measure of cardiovascular fitness closely related to V02max. We use linear regression with sibling fixed effects, meaning a within-family comparison, to eliminate the confounding influence of unobserved factors that vary between siblings. To understand the mechanism we further analyse whether the association between birth order and physical fitness varies by sibship size, parental socioeconomic status, birth cohort or length of the birth interval. We find a strong, negative and monotonic relationship between birth order and physical fitness. For example, third-born children have a maximal working capacity approximately 0.1 (p < 0.000) standard deviations lower than first-born children. The association exists both in small (3 or less children) and large families (4 or more children), in high and low socioeconomic status families, and amongst cohorts born in the 1960s and the 1970s. While in the whole population the birth order effect does not depend on the length of the birth intervals, in two-child families a longer birth interval strengthens the advantage of the first-born. Our results illustrate the importance of birth order for physical fitness, and suggest that the first-born advantage already arises in late adolescence.

7(th) Annual Symposium on Self-Monitoring of Blood Glucose (SMBG), May 8-10, 2014, Helsinki, Finland

International experts in the fields of diabetes, diabetes technology, endocrinology, mobile health, sport science, and regulatory issues gathered for the 7(th) Annual Symposium on Self-Monitoring of Blood Glucose (SMBG). The aim of this meeting was to facilitate new collaborations and research projects to improve the lives of people with diabetes. The 2014 meeting comprised a comprehensive scientific program, parallel interactive workshops, and two keynote lectures.

Epigenomic profiling of men exposed to early-life stress reveals DNA methylation differences in association with current mental state

Early-life stress (ELS) is known to be associated with an increased risk of neuropsychiatric and cardiometabolic disease in later life. One of the potential mechanisms underpinning this is through effects on the epigenome, particularly changes in DNA methylation. Using a well-phenotyped cohort of 83 men from the Helsinki Birth Cohort Study, who experienced ELS in the form of separation from their parents during childhood, and a group of 83 matched controls, we performed a genome-wide analysis of DNA methylation in peripheral blood. We found no differences in DNA methylation between men who were separated from their families and non-separated men; however, we did identify differences in DNA methylation in association with the development of at least mild depressive symptoms over the subsequent 5-10 years. Notably, hypomethylation was identified at a number of genes with roles in brain development and/or function in association with depressive symptoms. Pathway analysis revealed an enrichment of DNA methylation changes in pathways associated with development and morphogenesis, DNA and transcription factor binding and programmed cell death. Our results support the concept that DNA methylation differences may be important in the pathogenesis of psychiatric disease.

Unaccompanied evacuation and adult mortality: evaluating the finnish policy of evacuating children to foster care during World War II

OBJECTIVES

I examined associations between evacuation of Finnish children to temporary foster care in Sweden during World War II and all-cause mortality between ages 38 and 78 years.

METHODS

I used a Cox proportional hazards model to estimate mortality risk according to whether the individual was evacuated during childhood or not. I used within-sibling analysis to control for all unobserved socioeconomic and genetic characteristics shared among siblings. Individual-level data for Finnish cohorts born in 1933 to 1944 were derived from wartime government records, Finnish census data from 1950 and 1970, and death cause registry from 1971 to 2011.

RESULTS

I found no statistically significant association between evacuation and all-cause mortality when all exposed individuals were included in the analysis. However, subgroup analysis showed that men evacuated before age 4 years had a 1.31 higher mortality risk (95% confidence interval = 1.01, 1.69) than their nonevacuated counterparts.

CONCLUSIONS

In the aggregate, individuals do not have elevated mortality risk as a consequence of foster care during early childhood owing to the onset of sudden external shocks (e.g., wars).

Mental and somatic health and pre- and post-migration factors among older Somali refugees in Finland

Mental and somatic health was compared between older Somali refugees and their pair-matched Finnish natives, and the role of pre-migration trauma and post-migration stressors among the refugees. One hundred and twenty-eight Somalis between 50-80 years of age were selected from the Somali older adult population living in the Helsinki area (N = 307). Participants were matched with native Finns by gender, age, education, and civic status. The BDI-21 was used for depressive symptoms, the GHQ-12 for psychological distress, and the HRQoL was used for health-related quality of life. Standard instruments were used for sleeping difficulties, somatic symptoms and somatization, hypochondria, and self-rated health. Clinically significant differences in psychological distress, depressive symptoms, sleeping difficulties, self-rated health status, subjective quality of life, and functional capacity were found between the Somali and Finnish groups. In each case, the Somalis fared worse than the Finns. No significant differences in somatization were found between the two groups. Exposure to traumatic events prior to immigrating to Finland was associated with higher levels of mental distress, as well as poorer health status, health-related quality of life, and subjective quality of life among Somalis. Refugee-related traumatic experiences may constitute a long lasting mental health burden among older adults. Health care professionals in host countries must take into account these realities while planning for the care of refugee populations.