1
|
Zhou Y, Sun Y, Pan Y, Dai Y, Xiao Y, Yu Y. Association between adverse childhood experiences and obesity, and sex differences: A systematic review and meta-analysis. J Psychiatr Res 2024; 180:56-67. [PMID: 39378571 DOI: 10.1016/j.jpsychires.2024.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/20/2024] [Accepted: 09/29/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND Obesity is one of the most common health problems worldwide. Although studies have reported associations between adverse childhood experiences (ACEs) and obesity, specific subtype associations and sex differences are unclear. OBJECTIVE To systematically evaluate the association between ACEs and adult obesity risk and sex differences. METHODS Five databases, PubMed, Web of Science, Cochrane Library, Embase, and PsycINFO, were searched with a June 10, 2024 deadline. Included studies investigated the association between at least one ACE and obesity. Two researchers independently assessed the risk of bias using the Newcastle-Ottawa Scale (NOS) and its adaptations and extracted relevant characteristics and outcomes. Statistical analyses were performed using STATA 17.0, including random effects models, heterogeneity tests, sensitivity analyses, publication bias assessments, Meta-regression analyses, and subgroup analyses. Dose-response analyses revealed potential trends between different levels of abuse and risk of obesity. RESULTS The meta-analysis included 46 studies and showed a notable increased risk of obesity in adults experiencing ACEs (OR: 1.48, 95% CI: 1.38-1.59). Subgroup analyses showed significantly increased risk in Europe and North America, with significant increases observed in both developed and developing countries. Prospective, retrospective, and cross-sectional studies showed strong associations. Different types of ACEs (physical, sexual, psychological, and non-physical, psychological, or sexual abuse) were linked to a higher obesity risk. Sex difference analyses showed that females faced a greater risk when experiencing physical (OR: 1.606), sexual (OR: 1.581), and non-physical, psychological, or sexual (OR: 1.319) abuse; males exhibited increased risk only with non-physical, psychological, or sexual abuse (OR: 1.240). Dose-response analyses indicated that a higher number of ACEs was associated with an increased risk of obesity in adults. CONCLUSIONS ACEs significantly increase the risk of adult obesity, with consistent findings across geographic regions, levels of economic development, and types of study design. Sex difference analysis indicates that females are particularly affected. Future research should prioritize including studies from underrepresented geographic areas to enhance understanding of the global impact of ACEs on obesity risk. Additionally, strengthening child protection and intervention efforts is crucial to mitigate the adverse effects of ACEs on adult health.
Collapse
Affiliation(s)
- Yue Zhou
- Chengdu University of Traditional Chinese Medicine, China
| | - Yujian Sun
- Chengdu University of Traditional Chinese Medicine, China
| | - Yufan Pan
- Chengdu University of Traditional Chinese Medicine, China
| | - Yu Dai
- Chengdu University of Traditional Chinese Medicine, China
| | - Yi Xiao
- Chengdu University of Traditional Chinese Medicine, China
| | - Yufeng Yu
- Chengdu University of Traditional Chinese Medicine, China.
| |
Collapse
|
2
|
Wallace C, Krugman R. More Than What You Eat: A Review on the Association Between Childhood Maltreatment and Elevated Adult BMI. Curr Nutr Rep 2024; 13:377-381. [PMID: 38922364 PMCID: PMC11327177 DOI: 10.1007/s13668-024-00558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
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.
Collapse
Affiliation(s)
- Carmelle Wallace
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Richard Krugman
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
3
|
Amiri S, Mahmood N, Yusuf R, Ghenimi N, Javaid SF, Khan MAB. Adverse Childhood Experiences and Risk of Abnormal Body Mass Index: A Global Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1015. [PMID: 39201949 PMCID: PMC11352292 DOI: 10.3390/children11081015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/23/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024]
Abstract
(1) Objectives: The impact of abnormal body mass index (BMI) on health is extensive, and various risk factors contribute to its effects. This study aimed to examine the association between adverse childhood experiences (ACEs) and BMI categories, including underweight, overweight, obesity, severe obesity, and morbid obesity; (2) Methods: Three databases were searched: Web of Science, PubMed, and Scopus. Manual searches were conducted using Google Scholar and ResearchGate. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the association between ACEs and BMI. A random-effects model was used to combine the ORs and CIs across studies; (3) Results: This meta-analysis included 71 studies. The pooled ORs for the relationship between ACEs and obesity was 1.42 (95% CI: 1.24-1.63, Z = 4.96, p < 0.001), indicating a significant association. ACEs showed a positive association with overweight (OR = 1.16, 95% CI: 1.06-1.27, Z = 3.24, p = 0.001). Specifically, ACEs ≥ 4 were strongly associated with obesity (OR = 2.06, 95% CI: 1.27-3.36, Z = 2.90, p = 0.004). Sexual abuse was also found to be significantly associated with obesity (OR = 1.46, 95% CI: 1.29-1.65, Z = 5.98, p < 0.001); (4) Conclusion: This study finds that individuals who have experienced ACEs are more likely to have a higher BMI in adulthood. Therefore, ACEs should be considered a factor associated with abnormal BMI.
Collapse
Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran 17166, Iran;
| | - Nailah Mahmood
- Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK;
| | - Rahemeen Yusuf
- Emirates Center for Happiness Research, United Arab Emirates University, Al-Ain 15551, United Arab Emirates;
| | - Nadirah Ghenimi
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates;
| | - Syed Fahad Javaid
- Health and Wellness Research Group, Department of Psychiatry and Behavioral Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| | - Moien AB Khan
- Health and Wellness Research Group, Department of Psychiatry and Behavioral Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| |
Collapse
|
4
|
The long-term impact of early adverse experience on adaptive functioning: a pilot study integrating measures of mental status, nonverbal communication, and heart rate variability. Eur J Psychotraumatol 2023; 14:2181766. [PMID: 37052107 PMCID: PMC9980016 DOI: 10.1080/20008066.2023.2181766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Background: Childhood maltreatment (CM) can disrupt the development of behavioural and physiological systems, increasing the risk of physical and psychological adverse outcomes across the lifespan. CM may cause interpersonal dysfunctions that impair social communication and lead to dysfunctional activation of the autonomic nervous system. The present exploratory study analyzed the long-term impact of CM from an integrated perspective through the simultaneous assessment of psychological symptoms, social and behavioural communication, and physiological regulation. Methods: Participants were 55 healthy university students (9 males and 46 females; mean age ± SD = 25.26 ± 2.83 years), who filled out a battery of questionnaires to assess the presence of CM (Childhood Trauma Questionnaire) and psychopathological symptoms (Symptom Check-List-90 Item Revised). Participants were then subjected to a videotaped interview for the assessment of non-verbal behaviour (Ethological Coding System for Interviews) and measurement of tonic heart rate variability (HRV), a measure of physiological adaptability to the environment. We performed Pearson's correlation analysis to evaluate the associations between non-verbal behaviour, HRV, and CM variables. Multiple regression analysis was used to evaluate the independent associations between CM variables on HRV and nonverbal behaviour. Results: We found an association between more severe CM, increased symptoms-related distress (ps < .001), less submissive behaviour (ps < .018), and decreased tonic HRV (ps < .028). As a result of multiple regression analysis, participants with a history of emotional abuse (R² = .18, p = .002) and neglect (R² = .10, p = .03) were more likely to display decreased submissive behaviour during the dyadic interview. Moreover, early experience of emotional (R² = .21, p = .005) and sexual abuse (R² = .14, p = .04) was associated with decreased tonic HRV. Conclusion: Our preliminary findings show the utility of analyzing the long-term effects of adverse early experiences at different levels of ‘adaptive functioning’ (the capabilities needed to respond effectively to environmental demands). Substantial traumatic experiences during childhood, such as emotional abuse, emotional neglect, and sexual abuse were associated with lower heart rate variability levels in a sample of young adults. Young adults with a history of emotional abuse and neglect were more likely to display decreased submissive behaviour (ethological behaviour) during the dyadic interview. Severe childhood maltreatment was associated with increased symptoms-related distress, less submissive behaviour (ethological behaviour), and decreased tonic heart rate variability in young adults.
Collapse
|
5
|
Spencer CN, Khalil M, Herbert M, Aravkin AY, Arrieta A, Baeza MJ, Bustreo F, Cagney J, Calderon-Anyosa RJC, Carr S, Chandan JK, Coll CVN, de Andrade FMD, de Andrade GN, Debure AN, Flor LS, Hammond B, Hay SI, Knaul FN, Lim RQH, McLaughlin SA, Minhas S, Mohr JK, Mullany EC, Murray CJL, O'Connell EM, Patwardhan V, Reinach S, Scott D, Sorenson RJD, Stein C, Stöckl H, Twalibu A, Vasconcelos N, Zheng P, Metheny N, Chandan JS, Gakidou E. Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study. Nat Med 2023; 29:3243-3258. [PMID: 38081957 PMCID: PMC10719101 DOI: 10.1038/s41591-023-02629-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/04/2023] [Indexed: 12/17/2023]
Abstract
The health impacts of intimate partner violence against women and childhood sexual abuse are not fully understood. Here we conducted a systematic review by comprehensively searching seven electronic databases for literature on intimate partner violence-associated and childhood sexual abuse-associated health effects. Following the burden of proof methodology, we evaluated the evidence strength linking intimate partner violence and/or childhood sexual abuse to health outcomes supported by at least three studies. Results indicated a moderate association of intimate partner violence with major depressive disorder and with maternal abortion and miscarriage (63% and 35% increased risk, respectively). HIV/AIDS, anxiety disorders and self-harm exhibited weak associations with intimate partner violence. Fifteen outcomes were evaluated for their relationship to childhood sexual abuse, which was shown to be moderately associated with alcohol use disorders and with self-harm (45% and 35% increased risk, respectively). Associations between childhood sexual abuse and 11 additional health outcomes, such as asthma and type 2 diabetes mellitus, were found to be weak. Although our understanding remains limited by data scarcity, these health impacts are larger in magnitude and more extensive than previously reported. Renewed efforts on violence prevention and evidence-based approaches that promote healing and ensure access to care are necessary.
Collapse
Affiliation(s)
- Cory N Spencer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mariam Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly Herbert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Alejandra Arrieta
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - María Jose Baeza
- School of Medicine, The Pontifical Catholic University of Chile, Santiago, Chile
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Flavia Bustreo
- Fondation Botnar, Basel, Switzerland
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - Jack Cagney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jaidev Kaur Chandan
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carolina V N Coll
- Department of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Human Development and Violence Research Center, Federal University of Pelotas, Pelotas, Brazil
| | | | | | - Alexandra N Debure
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ben Hammond
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Felicia N Knaul
- Institute for the Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA
| | - Rachel Q H Lim
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sonica Minhas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jasleen K Mohr
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vedavati Patwardhan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Center on Gender Equity and Health, UC San Diego School of Medicine, San Diego, CA, USA
| | | | - Dalton Scott
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Reed J D Sorenson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caroline Stein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Heidi Stöckl
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Aisha Twalibu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| |
Collapse
|
6
|
Ziobrowski HN, Buka SL, Austin SB, Duncan AE, Sullivan AJ, Horton NJ, Field AE. Child and Adolescent Abuse Patterns and Incident Obesity Risk in Young Adulthood. Am J Prev Med 2022; 63:809-817. [PMID: 35941047 DOI: 10.1016/j.amepre.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Child abuse is associated with adult obesity. Yet, it is unknown how the developmental timing and combination of abuse types affect this risk. This report examined how distinct child and adolescent abuse patterns were associated with incident obesity in young adulthood. METHODS Data came from 7,273 participants in the Growing Up Today Study, a prospective cohort study in the U.S. with 14 waves from 1996 to 2016 (data were analyzed during 2020-2021). An abuse group variable was empirically derived using latent class analysis with indicators for child (before age 11 years) and adolescent (ages 11-17 years) physical, sexual, and emotional abuse. Risk ratios for obesity developing during ages 18-30 years were estimated using modified Poisson models. Associations of abuse groups with BMI across ages 18-30 years were then examined using mixed-effects models. All models were stratified by sex. RESULTS Among women, groups characterized by abuse had higher BMIs entering young adulthood and greater changes in BMI per year across young adulthood. Groups characterized by multiple abuse types and abuse sustained across childhood and adolescence had approximately twice the risk of obesity as that of women in a no/low abuse group. Associations were substantially weaker among men, and only a group characterized by physical and emotional abuse in childhood and adolescence had an elevated obesity risk (risk ratio=1.38; 95% CI=1.04, 1.83). CONCLUSIONS Obesity risk in young adulthood varied by distinct abuse groups for women and less strongly for men. Women who experience complex abuse patterns have the greatest risk of developing obesity in young adulthood.
Collapse
Affiliation(s)
- Hannah N Ziobrowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
| | - Stephen L Buka
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexis E Duncan
- Brown School, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Nicholas J Horton
- Department of Mathematics & Statistics, Amherst College, Amherst, Massachusetts
| | - Alison E Field
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
7
|
Bödicker C, Reinckens J, Höfler M, Hoyer J. Is Childhood Maltreatment Associated with Body Image Disturbances in Adulthood? A Systematic Review and Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:523-538. [PMID: 35958701 PMCID: PMC9360384 DOI: 10.1007/s40653-021-00379-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE We aimed to synthesize the evidence for an association between childhood maltreatment and body image disturbances in adulthood. Information on maltreatment subtypes and mediator variables was included to gain further insights into the mechanisms of the association. In addition, we aimed to examine the role of body image disturbances in the development of negative mental health outcomes associated with childhood maltreatment. METHODS Based on a comprehensive search strategy, eligible studies were identified in PubMed, Scopus, and Web of Science. The eligibility assessment was performed by two reviewers, and 132 articles were studied full-text. To reduce heterogeneity, only non-clinical samples were included in the meta-analysis. A meta-regression was computed to examine the influence of maltreatment subtype on body image disturbances. RESULTS Our results provide evidence for a robust association between childhood maltreatment and cognitive-affective body image, both in clinical and community samples. Included studies (N = 40) indicate that body image disturbances are especially pronounced in individuals suffering from Posttraumatic Stress Disorder (PTSD) after childhood maltreatment. The meta-analysis included 12 studies with a total of 15.481 participants, and indicates a small overall effect size (r = 0.21, 95% CI = [0.16, 0.26], p < .001). Meta-regression revealed no significant impact of maltreatment subtype in non-clinical samples. CONCLUSION Childhood maltreatment should be considered as a distal risk factor for the development of a negative cognitive-affective body image. We argue for future longitudinal studies which allow a better understanding of the pathways linking childhood maltreatment, body image disturbances and associated psychopathology. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00379-5.
Collapse
Affiliation(s)
- Christine Bödicker
- Institute for Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Jonas Reinckens
- Institute for Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Michael Höfler
- Institute for Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Jürgen Hoyer
- Institute for Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| |
Collapse
|
8
|
Huang YT, Liang Z, Emery C. Sexual Minority Stress, Adverse Childhood Experiences, and Obesity Among Gay Men in Taiwan: Findings from a Panel Study. LGBT Health 2022; 9:169-176. [PMID: 35255225 DOI: 10.1089/lgbt.2021.0110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Obesity is linked to personal behaviors and external stressors. Despite emerging evidence that sexual minority stress (SMS) and adverse childhood experiences (ACEs) are associated with the risk of obesity, little is known about their independent and interactive effects on sexual minority men. This study investigated these relationships using panel data. Methods: Self-identified gay and bisexual adult men in Taiwan were recruited through Facebook advertisements to complete an online questionnaire. This study reports only on data from the gay subsample (n = 731, mean age = 28.05 years, standard deviation = 5.75 years) as the bisexual subsample (n = 132) was insufficient for comparative statistical analysis. Over two time points, respondents reported their body weight and height, experiences with SMS, and ACEs on an online survey platform. Data analysis was conducted using multiple logistic regression to determine the individual and interactive effects of the ACE score, ACE components, and SMS on the odds for obesity. Results: Almost 16% of the respondents met the criterion for obesity (body-mass index ≥27). In the adjusted models, neither SMS nor ACEs had significant associations with the likelihood of obesity. Only the interaction term of SMS and childhood sexual abuse was significant, indicating that victims of sexual abuse have an increased likelihood of obesity that SMS may intensify. Conclusions: This study shows that gay men who experience childhood sexual abuse and SMS accumulatively faced an increased risk of obesity. Healthy weight promotion for these men should address these stressors.
Collapse
Affiliation(s)
- Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Zurong Liang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Clifton Emery
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
9
|
Muniz Carvalho C, Wendt FR, Pathak GA, Maihofer AX, Stein DJ, Sumner JA, Hemmings SM, Nievergelt CM, Koenen KC, Gelernter J, Belangero SI, Polimanti R. Disentangling sex differences in the shared genetic architecture of posttraumatic stress disorder, traumatic experiences, and social support with body size and composition. Neurobiol Stress 2021; 15:100400. [PMID: 34611531 PMCID: PMC8477211 DOI: 10.1016/j.ynstr.2021.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/04/2021] [Accepted: 09/14/2021] [Indexed: 11/03/2022] Open
Abstract
There is a well-known association of traumatic experiences and posttraumatic stress disorder (PTSD) with body size and composition, including consistent differences between sexes. However, the biology underlying these associations is unclear. To understand the genetic underpinnings of this complex relationship, we investigated genome-wide datasets informative of African and European ancestries from the Psychiatric Genomic Consortium, the UK Biobank, the GIANT Consortium, and the Million Veteran Program. We used genome-wide association statistics to estimate sex-specific genetic correlations (r g ) of traumatic experiences, social support, and PTSD with multiple anthropometric traits. After multiple testing corrections (false discovery rate, FDR q < 0.05), we observed 58 significant r g relationships in females (e.g., childhood physical abuse and body mass index, BMI r g = 0.245, p = 3.88 × 10-10) and 21 significant r g relationships in males (e.g., been involved in combat or exposed to warzone and leg fat percentage; r g = 0.405, p = 4.42 × 10-10). We performed causal inference analyses of these genetic overlaps using Mendelian randomization and latent causal variable approaches. Multiple female-specific putative causal relationships were observed linking body composition/size with PTSD (e.g., leg fat percentage→PTSD; beta = 0.319, p = 3.13 × 10-9), traumatic experiences (e.g., childhood physical abuse→waist circumference; beta = 0.055, p = 5.07 × 10-4), and childhood neglect (e.g., "someone to take you to doctor when needed as a child"→BMI; beta = -0.594, p = 1.09 × 10-5). In males, we observed putative causal effects linking anthropometric-trait genetic liabilities to traumatic experiences (e.g., BMI→childhood physical abuse; beta = 0.028, p = 8.19 × 10-3). Some of these findings were replicated in individuals of African descent although the limited sample size available did not permit us to conduct a sex-stratified analysis in this ancestry group. In conclusion, our findings provide insights regarding sex-specific causal networks linking anthropometric traits to PTSD, traumatic experiences, and social support.
Collapse
Affiliation(s)
- Carolina Muniz Carvalho
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT, 06516, USA
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Frank R. Wendt
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT, 06516, USA
| | - Gita A. Pathak
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT, 06516, USA
| | - Adam X. Maihofer
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Dan J. Stein
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Sian M.J. Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Caroline M. Nievergelt
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT, 06516, USA
- Departments of Genetics and Neuroscience, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Sintia I. Belangero
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Genetics Division, Department of Morphology and Genetics, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT, 06516, USA
| |
Collapse
|
10
|
Ziobrowski HN, Buka SL, Austin SB, Sullivan AJ, Horton NJ, Simone M, Field AE. Using latent class analysis to empirically classify maltreatment according to the developmental timing, duration, and co-occurrence of abuse types. CHILD ABUSE & NEGLECT 2020; 107:104574. [PMID: 32531618 PMCID: PMC7494521 DOI: 10.1016/j.chiabu.2020.104574] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/18/2020] [Accepted: 05/29/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Individuals can have vastly different maltreatment experiences depending on the types, developmental timing, and duration of abuse. Women and men may be differentially affected by distinct abuse patterns. OBJECTIVE To examine whether maltreatment subgroups could be identified based on the types, developmental timing, and duration of abuse, and to determine their prevalence among a large, community-based sample. We also examined sex differences in associations of maltreatment subgroups with adverse health outcomes. PARTICIPANTS AND SETTING Data came from 9310 women and men (95 % White) in the United States who responded to the Growing Up Today Study questionnaire in 2007 (aged 19-27 years). METHODS Participants reported on physical, sexual, and emotional abuse occurring in childhood (before age 11 years) and adolescence (ages 11-17 years). We conducted latent class (LC) analyses using indicators for child and adolescent abuse. We examined associations of LCs with health outcomes using sex-stratified log-binomial models with generalized estimated equations. RESULTS We identified five LCs characterized by: 1) no/low abuse (59 %), 2) child physical abuse (16 %), 3) adolescent emotional abuse (9%), 4) child and adolescent physical and emotional abuse (16 %), and 5) child and adolescent sexual abuse (1%). LCs were uniquely associated adult health outcomes among both women and men. Associations of LCs with eating disorder behaviors appeared stronger for men than women. CONCLUSIONS Individuals experience distinct patterns of maltreatment based on the types, developmental timing, and duration of abuse. These patterns are uniquely associated with adverse health outcomes in adulthood, and can be identified using LCA.
Collapse
Affiliation(s)
- Hannah N Ziobrowski
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Stephen L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam J Sullivan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, MA, USA
| | - Melissa Simone
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
11
|
Vega-Torres JD, Azadian M, Rios-Orsini RA, Reyes-Rivera AL, Ontiveros-Angel P, Figueroa JD. Adolescent Vulnerability to Heightened Emotional Reactivity and Anxiety After Brief Exposure to an Obesogenic Diet. Front Neurosci 2020; 14:562. [PMID: 32694970 PMCID: PMC7338851 DOI: 10.3389/fnins.2020.00562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Emerging evidence demonstrates that diet-induced obesity disrupts corticolimbic circuits underlying emotional regulation. Studies directed at understanding how obesity alters brain and behavior are easily confounded by a myriad of complications related to obesity. This study investigated the early neurobiological stress response triggered by an obesogenic diet. Furthermore, this study directly determined the combined impact of a short-term obesogenic diet and adolescence on critical behavioral and molecular substrates implicated in emotion regulation and stress. METHODS Adolescent (postnatal day 31) or adult (postnatal day 81) Lewis rats were fed for 1 week with an experimental Western-like high-saturated fat diet (WD, 41% kcal from fat) or a matched control diet (CD, 13% kcal from fat). We used the acoustic fear-potentiated startle (FPS) paradigm to determine the effects of the WD on cued fear conditioning and fear extinction. We used c-Fos mapping to determine the functional influence of the diet and stress on corticolimbic circuits. RESULTS We report that 1-week WD consumption was sufficient to induce fear extinction deficits in adolescent rats, but not in adult rats. We identify fear-induced alterations in corticolimbic neuronal activation and demonstrate increased prefrontal cortex CRHR1 messenger RNA (mRNA) levels in the rats that consumed the WD. CONCLUSION Our findings demonstrate that short-term consumption of an obesogenic diet during adolescence heightens behavioral and molecular vulnerabilities associated with risk for anxiety and stress-related disorders. Given that fear extinction promotes resilience and that fear extinction principles are the foundation of psychological treatments for posttraumatic stress disorder (PTSD), understanding how obesogenic environments interact with the adolescent period to affect the acquisition and expression of fear extinction memories is of tremendous clinical relevance.
Collapse
Affiliation(s)
- Julio D. Vega-Torres
- Physiology Division, Department of Basic Sciences, Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Matine Azadian
- Stanford University School of Medicine, Stanford, CA, United States
| | | | | | - Perla Ontiveros-Angel
- Physiology Division, Department of Basic Sciences, Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Johnny D. Figueroa
- Physiology Division, Department of Basic Sciences, Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, United States
| |
Collapse
|
12
|
Pittner K, Buisman RSM, van den Berg LJM, Compier-de Block LHCG, Tollenaar MS, Bakermans-Kranenburg MJ, van IJzendoorn MH, Elzinga BM, Alink LRA. Not the Root of the Problem-Hair Cortisol and Cortisone Do Not Mediate the Effect of Child Maltreatment on Body Mass Index. Front Psychiatry 2020; 11:387. [PMID: 32457665 PMCID: PMC7225356 DOI: 10.3389/fpsyt.2020.00387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Experiencing maltreatment during childhood exerts substantial stress on the child and increases the risk for overweight and obesity later in life. The current study tests whether hair cortisol-a measure of chronic stress-and its metabolite cortisone mediate the relation between abuse and neglect on the one hand, and body mass index (BMI) on the other. METHOD The sample consisted of 249 participants aged 8 to 87 years (M = 36.13, SD = 19.33). We collected data on child abuse and neglect using questionnaires, measured cortisol and cortisone concentrations in hair, and BMI. In a structural model, the effects of abuse and neglect on hair cortisol, hair cortisone, and BMI were tested, as well as the covariance between hair cortisol and BMI, and hair cortisone and BMI. RESULTS Within the sample, 23% were overweight but not obese and 14% were obese. Higher levels of experienced abuse were related to higher cortisone concentrations in hair (β = 0.24, p < .001) and higher BMI (β = 0.17, p =.04). Neglect was not related to hair cortisol, hair cortisone, or BMI. Hair cortisol and cortisone did not mediate the association between maltreatment, and BMI. Sensitivity analyses demonstrate the same pattern of results in a subsample of adult participants currently not living with their parents. However, in younger participants who were still living with their parents, the associations between abuse and cortisone (β = 0.14, p =.35) and abuse and BMI (β = 0.02, p =.92) were no longer significant. CONCLUSION These findings confirm that experiencing abuse is related to higher BMI but suggest that hair cortisol and cortisone are not the mechanism underlying the association between child maltreatment and BMI. This is the first study to show abuse may be associated to elevated concentrations of hair cortisone-evidence of long-term alterations in chronic stress levels. Future research may benefit from exploring the effects of maltreatment on weight gain in longitudinal designs, including measures of other potential mediators such as eating as a coping mechanism, and more direct indicators of metabolic health.
Collapse
Affiliation(s)
- Katharina Pittner
- Centre for Forensic Family and Youth Care Studies, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
- Institute of Medical Psychology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Renate S. M. Buisman
- Centre for Forensic Family and Youth Care Studies, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lisa J. M. van den Berg
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, Netherlands
| | - Laura H. C. G. Compier-de Block
- Centre for Forensic Family and Youth Care Studies, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Marieke S. Tollenaar
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, Netherlands
| | | | - Marinus H. van IJzendoorn
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Bernet M. Elzinga
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, Netherlands
| | - Lenneke R. A. Alink
- Centre for Forensic Family and Youth Care Studies, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| |
Collapse
|
13
|
El Mhamdi S, Lemieux A, Abroug H, Ben Salah A, Bouanene I, Ben Salem K, al'Absi M. Childhood exposure to violence is associated with risk for mental disorders and adult's weight status: a community-based study in Tunisia. J Public Health (Oxf) 2019; 41:502-510. [PMID: 30137394 DOI: 10.1093/pubmed/fdy149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We sought to investigate the relationship between social violence and adult overweight/obesity and the role of common mental disorders (CMD) in mediating this relationship. METHODS A cross-sectional study was conducted from January to June 2016 in Tunisia. Participants were selected from randomly selected Primary Health Care Centers. The Arabic version of the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used. RESULTS A total of 2120 participants were included. Women exposed to social ACEs had higher rates of overweight/obesity than men (13.5 versus 9.5%; P = 0.004). For women, statistically significant partial mediation effects of CMD were observed for exposure to community violence (% mediated = 17.7%). For men, partial mediation was found for the exposure to peer violence (% mediated = 12.5%). CONCLUSION Our results provide evidence of the independent increase of overweight/obesity after exposure to social ACEs. Efforts to uncover and address underlying trauma in health care settings may increase the effectiveness of obesity interventions.
Collapse
Affiliation(s)
- Sana El Mhamdi
- Department of Preventive and Community Medicine, University Hospital Tahar Sfar, Mahdia, Tunisia.,Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir,Tunisia.,Research Laboratory, 'Epidemiology Applied to Maternal and Child Health', Tunisia
| | - Andrine Lemieux
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Hela Abroug
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir,Tunisia
| | - Arwa Ben Salah
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir,Tunisia.,Research Laboratory, 'Epidemiology Applied to Maternal and Child Health', Tunisia
| | - Ines Bouanene
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir,Tunisia.,Research Laboratory, 'Epidemiology Applied to Maternal and Child Health', Tunisia
| | - Kamel Ben Salem
- Department of Preventive and Community Medicine, University Hospital Tahar Sfar, Mahdia, Tunisia.,Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir,Tunisia
| | - Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| |
Collapse
|
14
|
Raue S, Wedekind D, Wiltfang J, Schmidt U. The Role of Proopiomelanocortin and α-Melanocyte-Stimulating Hormone in the Metabolic Syndrome in Psychiatric Disorders: A Narrative Mini-Review. Front Psychiatry 2019; 10:834. [PMID: 31798479 PMCID: PMC6867997 DOI: 10.3389/fpsyt.2019.00834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
The metabolic syndrome (MetS) comprises abdominal obesity, preclinical or full diabetes type 2, arterial hypertension, and dyslipidemia and affects a significant proportion of the general population with a remarkably higher prevalence in patients suffering from psychiatric disorders. However, studies exploring the pathogenetic link between MetS and psychiatric diseases are rare. Here, we aim to narrow this gap in knowledge by providing a narrative review on this topic that focuses on two psychiatric diseases, namely on schizophrenia and posttraumatic stress disorder (PTSD) since we assume them to be associated with two different main causalities of MetS: in schizophrenia, MetS evidently develops or aggravates in response to antipsychotic drug treatment while it assumingly develops in response to stress-induced endocrine and/or epigenetic alterations in PTSD. First, we compared the prevalences of MetS and associated pathologies (which we took from the latest meta-analyses) among different psychiatric disorders and were surprised that the prevalences of arterial hypertension and hyperglycemia in PTSD almost doubles those of the other psychiatric disorders. Next, we performed a literature search on the neurobiology of MetS and found numerous articles describing a role for proopiomelanocortin (POMC) in MetS. Thus, we concentrated further analysis on POMC and one of its downstream effector hormones, α-melanocyte-stimulating hormone (α-MSH). We found some evidence for a role of POMC in both PTSD and schizophrenia, in particular in antipsychotic-induced MetS, as well as for α-MSH in schizophrenia, but, surprisingly, no study on α-MSH in PTSD. Taken together, our synopsis reveals, first, a potential interaction between the POMC system and stress in the assumingly at least partially shared pathogenesis of psychiatric disorders and MetS, second, that modulation of the POMC system, in particular of the melanocortin 3 and 4 receptors, might be a promising target for the treatment of MetS and, third, that the DNA methylation status of POMC might speculatively be a promising biomarker for MetS in general and, possibly, in particular in the context of stress-related psychiatric conditions such as PTSD. To best of our knowledge, this is the first review on the role of the POMC system in MetS in psychiatric disorders.
Collapse
Affiliation(s)
- Stefan Raue
- Psychotrauma Treatment Unit & RG Stress Modulation of Neurodegeneration, Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, Georg August University, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, Georg August University, University Medical Center Göttingen (UMG), Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany.,Medical Sciences Department, iBiMED, University of Aveiro, Aveiro, Portugal
| | - Ulrike Schmidt
- Psychotrauma Treatment Unit & RG Stress Modulation of Neurodegeneration, Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, Netherlands
| |
Collapse
|
15
|
Ports KA, Holman DM, Guinn AS, Pampati S, Dyer KE, Merrick MT, Lunsford NB, Metzler M. Adverse Childhood Experiences and the Presence of Cancer Risk Factors in Adulthood: A Scoping Review of the Literature From 2005 to 2015. J Pediatr Nurs 2019; 44:81-96. [PMID: 30683285 PMCID: PMC6355255 DOI: 10.1016/j.pedn.2018.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 02/07/2023]
Abstract
Exposure to Adverse Childhood Experiences (ACEs) is associated with a host of harmful outcomes, including increased risk for cancer. A scoping review was conducted to gain a better understanding of how ACEs have been studied in association with risk factors for cancer. This review includes 155 quantitative, peer-reviewed articles published between 2005 and 2015 that examined associations between ACEs and modifiable cancer risk factors, including alcohol, environmental carcinogens, chronic inflammation, sex hormones, immunosuppression, infectious agents, obesity, radiation, ultraviolet (UV) radiation, and tobacco, among U.S. adults. This review highlights the growing body of research connecting ACEs to cancer risk factors, particularly alcohol, obesity, and tobacco. Fewer studies investigated the links between ACEs and chronic inflammation or infectious agents. No included publications investigated associations between ACEs and environmental carcinogens, hormones, immunosuppression, radiation, or ultraviolet radiation. Mitigating the impact of ACEs may provide innovative ways to effect comprehensive, upstream cancer prevention.
Collapse
Affiliation(s)
- Katie A Ports
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Dawn M Holman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Angie S Guinn
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sanjana Pampati
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Karen E Dyer
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, Richmond, VA, USA.
| | - Melissa T Merrick
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Natasha Buchanan Lunsford
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Marilyn Metzler
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
16
|
Alhalal E. Obesity in women who have experienced intimate partner violence. J Adv Nurs 2018; 74:2785-2797. [DOI: 10.1111/jan.13797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/03/2018] [Accepted: 07/01/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Eman Alhalal
- Nursing College, King Saud University Riyadh Saudi Arabia
| |
Collapse
|
17
|
Exposure to an obesogenic diet during adolescence leads to abnormal maturation of neural and behavioral substrates underpinning fear and anxiety. Brain Behav Immun 2018; 70:96-117. [PMID: 29428401 PMCID: PMC7700822 DOI: 10.1016/j.bbi.2018.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/08/2018] [Accepted: 01/21/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) and obesity are highly prevalent in adolescents. Emerging findings from our laboratory and others are consistent with the novel hypothesis that obese individuals may be predisposed to developing PTSD. Given that aberrant fear responses are pivotal in the pathogenesis of PTSD, the objective of this study was to determine the impact of an obesogenic Western-like high-fat diet (WD) on neural substrates associated with fear. METHODS Adolescent Lewis rats (n = 72) were fed with either the experimental WD (41.4% kcal from fat) or the control diet. The fear-potentiated startle paradigm was used to determine sustained and phasic fear responses. Diffusion tensor imaging metrics and T2 relaxation times were used to determine the structural integrity of the fear circuitry including the medial prefrontal cortex (mPFC) and the basolateral complex of the amygdala (BLA). RESULTS The rats that consumed the WD exhibited attenuated fear learning and fear extinction. These behavioral impairments were associated with oversaturation of the fear circuitry and astrogliosis. The BLA T2 relaxation times were significantly decreased in the WD rats relative to the controls. We found elevated fractional anisotropy in the mPFC of the rats that consumed the WD. We show that consumption of a WD may lead to long-lasting damage to components of the fear circuitry. CONCLUSIONS Our findings demonstrate that consumption of an obesogenic diet during adolescence has a profound impact in the maturation of the fear neurocircuitry. The implications of this research are significant as they identify potential biomarkers of risk for psychopathology in the growing obese population.
Collapse
|
18
|
Jain KM, Davey-Rothwell M, Crossnohere NL, Latkin CA. Post-Traumatic Stress Disorder, Neighborhood Residency and Satisfaction, and Social Network Characteristics among Underserved Women in Baltimore, Maryland. Womens Health Issues 2018; 28:273-280. [PMID: 29699907 DOI: 10.1016/j.whi.2018.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/25/2018] [Accepted: 02/12/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) prevalence is high, but not well-understood, among women living in urban, impoverished areas. Although previous studies have established social support as an important factor in PTSD development and maintenance, little is known about how perceptions of neighborhood are linked to PTSD. This study examined the relationship between PTSD and social network and neighborhood factors among women with a low socioeconomic status. METHODS We analyzed cross-sectional data collected from a human immunodeficiency virus/sexually transmitted infection peer network study in Baltimore, Maryland (n = 438). We used bivariate analyses to examine the associations between PTSD and social network characteristics and time in neighborhood and satisfaction. We then constructed multivariable regression models that controlled for the following with PTSD: homelessness, cocaine/heroin use, and unemployment. MAIN FINDINGS Overall, 30% of women had PTSD symptom severity consistent with a clinical diagnosis. In the multivariable model, dissatisfaction with neighborhood block (odds ratio [OR], 1.80; p = .03) and living in one's neighborhood for more than 5 years (OR, 1.69; p = .03) were associated with PTSD. Social network factors that were significantly associated with PTSD included a higher number of network members in conflict with the participant (OR, 1.28; p = .02), presence of a network member who would let the participant stay with them (OR, 0.4; p = .004), and the number of network members with whom the participant socialized (OR, 0.6; p = .04). CONCLUSIONS In this sample of impoverished urban women with a high prevalence of PTSD, duration of residency, satisfaction with neighborhood, and network characteristics were found to be strongly associated with PTSD symptom severity.
Collapse
Affiliation(s)
- Kriti M Jain
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Melissa Davey-Rothwell
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Norah L Crossnohere
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
19
|
Wright AL. Relationship between obesity, childhood sexual abuse, and attitudes toward obesity in sexual-minority women. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2018. [DOI: 10.1080/19359705.2018.1429975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Amy L. Wright
- School of Social Work, Louisiana State University, Baton Rouge, Louisiana, USA
| |
Collapse
|
20
|
Screaming Body and Silent Healthcare Providers: A Case Study with a Childhood Sexual Abuse Survivor. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010094. [PMID: 29316709 PMCID: PMC5800193 DOI: 10.3390/ijerph15010094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/30/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
Stressful early life experiences cause immune dysregulation across the lifespan. Despite the fact that studies have identified childhood sexual abuse (CSA) survivors as a particularly vulnerable group, only a few attempts have been made to study their lived-experience of the physical health consequences of CSA. The aim of this study was to explore a female CSA survivor’s lived-experience of the physical health consequences of CSA and how she experienced the reactions of healthcare providers. Seven interviews were conducted with this 40-year-old woman, Anne, using a phenomenological research approach. Anne was still a young child (two to three years old) when her father started to rape her. Since her childhood, she has experienced complex and widespread physical health consequences such as repeated vaginal and abdominal infections, widespread and chronic pain, sleeping problems, digestive problems, chronic back problems, fibromyalgia, musculoskeletal problems, repeated urinary tract infections, cervical dysplasia, inflammation of the Fallopian tubes, menorrhagia, endometrial hyperplasia, chlamydia, ovarian cysts, ectopic pregnancies, uterus problems, severe adhesions, and ovarian cancer. Anne disclosed her CSA experience to several healthcare providers but they were silent and failed to provide trauma-informed care. Anne’s situation, albeit unique, might reflect similar problems in other female CSA survivors.
Collapse
|
21
|
Nagl M, Lehnig F, Stepan H, Wagner B, Kersting A. Associations of childhood maltreatment with pre-pregnancy obesity and maternal postpartum mental health: a cross-sectional study. BMC Pregnancy Childbirth 2017; 17:391. [PMID: 29166875 PMCID: PMC5700738 DOI: 10.1186/s12884-017-1565-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/06/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Michaela Nagl
- Leipzig University Medical Center, IFB AdiposityDiseases, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweissstr. 10, 04103, Leipzig, Germany
| | - Franziska Lehnig
- Leipzig University Medical Center, IFB AdiposityDiseases, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweissstr. 10, 04103, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Birgit Wagner
- Department of Clinical Psychology and Psychotherapy, MSB Medical School Berlin, Calandrellistraße 1-9, 12247, Berlin, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweissstr. 10, 04103, Leipzig, Germany.
| |
Collapse
|
22
|
The Importance of Assessing for Childhood Abuse and Lifetime PTSD in Bariatric Surgery Candidates. J Clin Psychol Med Settings 2017; 24:341-354. [DOI: 10.1007/s10880-017-9518-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Tran NK, Van Berkel SR, van IJzendoorn MH, Alink LR. The association between child maltreatment and emotional, cognitive, and physical health functioning in Vietnam. BMC Public Health 2017; 17:332. [PMID: 28420377 PMCID: PMC5395851 DOI: 10.1186/s12889-017-4258-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 04/11/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is a paucity of research on correlates of child maltreatment in limited-resource countries with a relatively high tolerance of harsh discipline. This Vietnamese study aimed to investigate associations between different types of child maltreatment and child emotional, cognitive, and physical health functioning as well as moderation effects of gender and ethnicity. METHODS This cross-sectional study was conducted with 1851 randomly selected students aged 12-17 years. Both self-report and more objective measures (weight, height, study ranking, and a memory test) were used. RESULTS All types of child maltreatment were associated with emotional dysfunctioning. Life time and past year experiences of physical abuse and life time experiences of sexual abuse and neglect were related to poorer perceived physical health. The study did not find associations between any type of child maltreatment and overweight or underweight status. Regarding cognitive functioning, life time experience of sexual abuse and neglect were related to poorer working memory performance. Noticeably, emotional abuse was related to better academic performance, which might be an indication of "tiger parenting" practice in Vietnam, implying academic performance stimulation at the expense of emotional security. No significant moderation effects by gender and ethnicity were found. CONCLUSION Even in a culture in which harsh discipline is normative, child maltreatment was related to negative aspects of child wellbeing including emotional, cognitive, and physical health functioning. Efficient and low-cost interventions on child maltreatment should be developed and conducted in Vietnam as well as other countries with similar contexts.
Collapse
Affiliation(s)
- Nhu K. Tran
- Centre for Child and Family Studies, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands
| | - Sheila R. Van Berkel
- Centre for Child and Family Studies, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands
| | - Marinus H. van IJzendoorn
- Centre for Child and Family Studies, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands
| | - Lenneke R.A. Alink
- Centre for Child and Family Studies, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands
| |
Collapse
|
24
|
Differential Influences of Parenting Dimensions and Parental Physical Abuse during Childhood on Overweight and Obesity in Adolescents. CHILDREN-BASEL 2017; 4:children4030017. [PMID: 28272353 PMCID: PMC5368428 DOI: 10.3390/children4030017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/22/2022]
Abstract
Besides other explanatory variables, parenting styles and parental violence might also be responsible for setting a path towards overweight/obesity in childhood. While this association has consistently been observed for adults, findings for adolescents still remain scarce and inconsistent. Therefore, the goal of this study is to add evidence on this topic for children and adolescents. Analyses are based on a sample of 1729 German, ninth-grade students. To analyze associations between parenting dimensions and weight status, non-parametric conditional inference trees were applied. Three gender-specific pathways for a heightened risk of overweight/obesity were observed: (1) female adolescents who report having experienced severe parental physical abuse and medium/high parental warmth in childhood; (2) male adolescents who report having experienced low or medium parental monitoring in childhood; and (3) this second pathway for male adolescents is more pronounced if the families receive welfare. The importance of promoting parenting styles characterized by warmth and a lack of physical abuse is also discussed. This is one of only a few studies examining the association of parenting dimensions/parental physical abuse and weight status in adolescence. Future studies should include even more parenting dimensions, as well as parental physical abuse levels, in order to detect and untangle gender-specific effects on weight status.
Collapse
|
25
|
Koski M, Naukkarinen H. The Relationship between Stress and Severe Obesity: A Case-Control Study. Biomed Hub 2017; 2:1-13. [PMID: 31988895 PMCID: PMC6945898 DOI: 10.1159/000458771] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 02/03/2017] [Indexed: 11/19/2022] Open
Abstract
Background Several etiological factors for obesity have been identified, whereas other factors related to obesity, such as stress, remain poorly understood. This study used psychiatric methods to examine the relationship between stress and obesity. Methods Matched study and control groups were established, and the female and male control subjects were selected separately by random sampling. The control subjects were matched with the case subjects with respect to place of residence, sex, age, date that a pension was granted, and occupation. Psychiatric and psychological methods were assessed using a questionnaire and statistical analyses. Results Psychiatric interviews indicated that stress was more prevalent in the study group than in the control group. Separation from parents was nearly significantly more frequently in the study group than in the control group. The questionnaire on coping mechanisms revealed that case subjects tended to resolve their problems in an active manner. Conclusions The aim of this case-control study was to examine the relationship between stress and obesity in individuals receiving a disability pension. We identified stress factors that affect the development of obesity. We believe our study is both necessary and important, as these findings provide valuable insight into the relationship between severe obesity and stress.
Collapse
Affiliation(s)
- Marja Koski
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Hannu Naukkarinen
- Department of Psychiatry, University of Helsinki, Helsinki, Finland.,Carea Hospital District, Kymenlaakso Psychiatric Hospital, Kuusankoski, Finland
| |
Collapse
|
26
|
Udo T, Grilo CM. Perceived weight discrimination, childhood maltreatment, and weight gain in U.S. adults with overweight/obesity. Obesity (Silver Spring) 2016; 24:1366-72. [PMID: 27112217 DOI: 10.1002/oby.21474] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Perceived weight discrimination and childhood maltreatment have been independently associated with physical and mental health issues, as well as weight gain. It is not known, however, whether childhood maltreatment modifies the relationship between perceived weight discrimination and weight changes. METHODS This study examined the relationship between perceived weight discrimination, childhood maltreatment, and changes in body mass index (BMI) over 3 years in 21,357 men and women with overweight and obesity from Wave 1 and Wave 2 surveys of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS Reporting childhood maltreatment, regardless of the specific form of maltreatment, was associated with a significantly greater likelihood of perceived weight discrimination in women. Perceived weight discrimination was associated with a significantly greater increase in BMI in both genders. Among all women with perceived weight discrimination, those who also reported having experienced childhood maltreatment had significantly less BMI increase compared to those reporting not having experienced childhood maltreatment. CONCLUSIONS Perceived weight discrimination may foster weight gain rather than encouraging weight loss in individuals with overweight/obesity and should be addressed in prevention efforts and clinical settings. Childhood maltreatment may perhaps sensitize individuals to subsequent stressors and increase vulnerability to perceived weight discrimination, particularly in women.
Collapse
Affiliation(s)
- Tomoko Udo
- School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- National Center on Addiction and Substance Abuse (at Yale), New Haven, Connecticut, USA
| |
Collapse
|
27
|
Palmisano GL, Innamorati M, Vanderlinden J. Life adverse experiences in relation with obesity and binge eating disorder: A systematic review. J Behav Addict 2016; 5:11-31. [PMID: 28092189 PMCID: PMC5322988 DOI: 10.1556/2006.5.2016.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/14/2016] [Accepted: 01/17/2016] [Indexed: 01/11/2023] Open
Abstract
Background and aims Several studies report a positive association between adverse life experiences and adult obesity. Despite the high comorbidity between binge eating disorder (BED) and obesity, few authors have studied the link between trauma and BED. In this review the association between exposure to adverse life experiences and a risk for the development of obesity and BED in adulthood is explored. Methods Based on a scientific literature review in Medline, PubMed and PsycInfo databases, the results of 70 studies (N = 306,583 participants) were evaluated including 53 studies on relationship between adverse life experiences and obesity, 7 studies on post-traumatic stress disorder (PTSD) symptoms in relation to obesity, and 10 studies on the association between adverse life experiences and BED. In addition, mediating factors between the association of adverse life experiences, obesity and BED were examined. Results The majority of studies (87%) report that adverse life experiences are a risk factor for developing obesity and BED. More precisely a positive association between traumatic experiences and obesity and PTSD and obesity were found, respectively, in 85% and 86% of studies. Finally, the great majority of studies (90%) between trauma and the development of BED in adulthood strongly support this association. Meanwhile, different factors mediating between the trauma and obesity link were identified. Discussion and conclusions Although research data show a strong association between life adverse experiences and the development of obesity and BED, more research is needed to explain this association.
Collapse
Affiliation(s)
| | - Marco Innamorati
- Department of Science and Technology of Education, University of Rome “Tor Vergata”, Rome, Italy
| | - Johan Vanderlinden
- Eating Disorder Unit, University Psychiatric Center K.U. Leuven, Leuven, Belgium
| |
Collapse
|