The impact of adverse childhood experiences on obesity and unhealthy weight control behaviors among adolescents

Childhood adversity trajectories and weight status in young adult men: a register-based study including 359,783 Danish men

BACKGROUND

Childhood adversity has previously been associated with overweight and obesity in adult life, but there is a need for larger population-based studies using prospectively obtained adversity trajectories across childhood to confirm these associations. Moreover, childhood adversity may also be associated with underweight, which is less often studied. The aim of the current study is to investigate the association between childhood adversity trajectories from 0-15 years with weight categories in young adult men.

METHODS

The Danish Life Course Cohort (DANLIFE) was linked with the Danish Conscription Registry resulting in a study sample of 359,783 men, who have been assigned to one of five previously identified adversity trajectories from 0-15 years: "low adversity", "early material deprivation", "persistent material deprivation", "loss or threat of loss", and "high adversity". Height and weight in young adulthood was assessed at a draft board examination at age 18-26 years. Associations of adversity trajectories and weight categories were investigated in multinomial regression models.

RESULTS

Compared with the "low adversity" group, the four other adversity groups had higher risks of underweight, overweight, and obesity. The "high adversity" group showed the strongest associations with both underweight (1.44 (1.32, 1.58)) and obesity (1.50 (1.39, 1.61)) when adjusted for parental origin, birth year, age at draft board examination, and maternal age.

CONCLUSION

Childhood adversity, experienced between 0 and 15 years of life, was associated with a higher risk of underweight, overweight, and obesity in young adulthood among men.

Allostasis, health, and development in Latin America

The lifespan is influenced by adverse childhood experiences that create predispositions to poor health outcomes. Here we propose an allostatic framework of childhood experiences and their impact on health across the lifespan, focusing on Latin American and Caribbean countries. This region is marked by significant social and health inequalities nested in environmental and social stressors, such as exposure to pollution, violence, and nutritional deficiencies, which critically influence current and later-life health outcomes. We review several manifestations across cognition, behavior, and the body, observed at the psychological (e.g., cognitive, socioemotional, and behavioral dysfunctions), brain (e.g., alteration of the development, structure, and function of the brain), and physiological levels (e.g., dysregulation of the body systems and damage to organs). To address the complexity of the interactions between environmental and health-related factors, we present an allostatic framework regarding the cumulative burden of environmental stressors on physiological systems (e.g., cardiovascular, metabolic, immune, and neuroendocrine) related to health across the life course. Lastly, we explore the relevance of this allostatic integrative approach in informing regional interventions and public policy recommendations. We also propose a research agenda, potentially providing detailed profiling and personalized care by assessing the social and environmental conditions. This framework could facilitate the delivery of evidence-based interventions and informed childhood-centered policy-making.

Early life adversity and obesity risk in adolescence: a 9-year population-based prospective cohort study

BACKGROUND

There are few prospective studies of factors that mediate the association between exposure to adverse childhood experiences (ACEs) and obesity in adolescence. Our aim was to address this limitation.

METHODS

We used prospective data from the Growing up in Ireland cohort study, with measurements at 9, 13, and 18 years old. The exposures were 14 adverse experiences before age 9. The main outcome was body mass index (BMI) at 18 years. Mediators were daily activity, diet quality, self-image and behavioural difficulties at 13 years.

RESULTS

Among the 4561 adolescents in the final cohort, 77.2% experienced any adversity, 50.5% were female and 26.7% were overweight/obese at 18 years. BMI Z was higher at ages 9 (0.54 vs 0.43, p < 0.05, 95% CI of difference: -0.22, -0.01) and 13 years (0.50 vs 0.35, p < 0.05, 95% CI of difference: -0.25, -0.06), in those exposed to an ACE, compared to those unexposed. Structural equation models revealed that behavioural difficulties (β = 0.01; 95% CI: 0.007-0.018, p < 0.001) and self-concept (β = 0.0027; 95% CI: 0.0004-0.0050, p = 0.026) indirectly mediate the association between exposure to ACEs and BMI at 18 years.

CONCLUSIONS

The association between ACEs and BMI in adolescence is mediated by behavioural difficulties and self-concept.

IMPACT

In a previous study, we found modest associations between exposure to a range of adverse childhood experiences and weight gain at 13 years of age. The strength of the association between adverse childhood experiences and weight gain was lower at 18 years of age compared to the association observed at 13 years and was no longer significant after controlling for confounding and including possible mediators. The association between adverse childhood experiences and BMI in adolescence is indirectly mediated by behavioural difficulties and self-concept.

Associations between adverse childhood experiences and history of weight cycling

Background

Adverse childhood experiences (ACEs) predict obesity onset; however, the relationship between ACEs and history of weight cycling has not been adequately explored. This gap is problematic given the difficulty in weight loss maintenance and the impact of ACEs on obesity development, chronicity, and associated weight stigma. The objective of this study was to examine associations between self-reported history of ACEs and weight cycling in a sample of weight loss treatment-seeking adults with overweight/obesity.

Methods

The number of participants in the analyzed sample was 78, mostly white educated adult women (80% female, 81% Caucasian, 75% ≥ bachelor's degree) with excess adiposity enrolled in the Cognitive and Self-regulatory Mechanisms of Obesity Study. ACEs were measured at baseline using the ACEs Scale. History of weight cycling was measured using the Weight and Lifestyle Inventory that documented weight loss(es) of 10 or more pounds.

Results

Higher ACE scores were associated with a greater likelihood of reporting a history of weight cycling. Participants with four or more ACEs had 8 times higher odds (OR = 8.301, 95% CI = 2.271-54.209, p = 0.027) of reporting weight cycling compared with participants with no ACEs. The association of weight cycling for those who endorsed one to three ACEs was not significant (OR = 2.3, 95% CI = 0.771-6.857, p = 0.135) in this sample.

Conclusions

The role of ACEs in health may be related to associations with weight cycling. Results indicated that those who reported four or more ACEs had significantly higher odds of reporting weight cycling compared with those with no ACEs. Further research is needed to further explore how ACEs predict the likelihood of weight cycling, which may be prognostic for sustained weight loss treatment response and weight stigma impacts.

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

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

Clinical review: Implementation of trauma informed care to optimally impact the treatment of childhood obesity

Background

Traumatic events that occur in infancy, childhood, and adolescence can be impactful over the course of a lifespan. Adverse childhood experiences (ACEs) are associated with chronic health problems and mental illness, and can negatively impact educational and job opportunities. There is a growing body of evidence about the relationship between ACEs and the risk of childhood obesity. Trauma informed care (TIC) is an approach to patient care both at the clinical and organizational level that is responsive to the impact past trauma can have on an individual.

Methods

This clinical review will focus on the impact of toxic stress from trauma on the child through threats to normal physiology, including the manifestation of obesity through energy regulation pathophysiology, followed by a discussion of TIC principles. Available resources and how trauma informed principles can be used in practice are discussed using case study methodology.

Results

TIC programs recognize the impact of trauma on both patients and clinicians. TIC implementation includes application of TIC four assumptions and six key principles out-lined by Substance Abuse and Mental Health Services Administration's guidance. Clinicians supported by well-designed systems recognize that disclosure is not the goal of TIC; instead, broad trauma inquiry, proceeding to risk and safety assessment if indicated, and connection to interventions is the focus. Best practice communication allows clinicians to access information without retraumatizing the patient with ongoing repetition of their trauma experience.

Conclusion

Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.

Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment

Racial trauma refers to experiences related to threats, prejudices, harm, shame, humiliation, and guilt associated with various types of racial discrimination, either for direct victims or witnesses. In North American, European, and colonial zeitgeist societies, Black, Indigenous, and people of color (BIPOC) experience racial microaggressions and interpersonal, institutional, and systemic racism on a repetitive, constant, inevitable, and cumulative basis. Although complex trauma differs from racial trauma in its origin, the consistency of racist victimization beyond childhood, and the internalized racism associated with it, strong similarities exist. Similar to complex trauma, racial trauma surrounds the victims’ life course and engenders consequences on their physical and mental health, behavior, cognition, relationships with others, self-concept, and social and economic life. There is no way to identify racial trauma other than through a life-course approach that captures the complex nature of individual, collective, historical, and intergenerational experiences of racism experienced by BIPOC communities in Western society. This article presents evidence for complex racial trauma (CoRT), a theoretical framework of CoRT, and guidelines for its assessment and treatment. Avenues for future research, intervention, and training are also presented.

Adverse childhood experiences and disordered eating among middle-aged adults: Findings from the coronary artery risk development in young adults study

Adverse childhood experiences (ACEs) include childhood abuse, neglect, and household substance abuse. Childhood abuse is a risk factor for disordered eating (DEB). Less well established are associations of childhood neglect and household substance abuse with DEB, and little research has examined ACE associations with DEB in middle adulthood. The objective of this study was to examine associations between ACEs and DEBs among middle-aged adults and examine sex differences. ACEs prior to age 18 were retrospectively assessed in the Coronary Artery Risk Development in Young Adults study in 2000-2001 (N = 3340, ages 32 to 46). DEB outcomes (i.e., concerns about weight and shape, anxiety about eating or food, unhealthy weight control behaviors, chronic dieting, overeating, and binge eating) were assessed in 1995-1996 (ages 27 to 41). Modified Poisson regressions estimated risk ratios (RRs) for associations of a history of any ACE, each ACE, and cumulative ACEs with DEB outcomes. Among women, emotional abuse, physical neglect, and emotional neglect were each modestly associated with most DEBs (RRs = 1.21-1.35, 1.21-1.45, and 1.23-1.41 across DEBs, respectively) after adjustment for sociodemographic variables, BMI, and depressive symptoms. A cumulative ACE score was associated with all DEBs in a stepwise manner (p for trend ≤0.05) except concerns about weight and shape and overeating. Among men, emotional abuse was most consistently related to the majority of DEBs (RRs = 1.23-1.92); household substance abuse was modestly associated with overeating (RR = 1.26, 95% CI = 1.04-1.53). ACEs were cumulatively associated with unhealthy weight control behaviors, overeating, and binge eating (p for trend <0.01).

BMI moderates the association between adverse childhood experiences and COPD

OBJECTIVES

Cigarette smoking and obesity are leading risk factors for chronic obstructive pulmonary disease (COPD). Although studies have established an association between adverse childhood experiences (ACEs) and COPD, few studies have examined whether this association is moderated by cigarette smoking or body mass index (BMI). This cross-sectional study examined the association between ACEs and COPD, and whether cigarette smoking or BMI moderates this association.

METHODS

Data for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,700 adults aged 18-79 years (50.7% female) were analyzed using binary logistic regression. The outcome variable investigated was self-reported physician-diagnosed COPD, and the main explanatory variable was ACEs.

RESULTS

Of the 75,700 respondents examined, 8.1% had COPD. About one in three (33.6%) respondents had no ACEs, 23.1% had one ACE, and about one in five (20.2%) had four or more ACEs. In the multivariable binary logistic regression, we found that the association between ACEs and COPD differs by BMI status. Controlling for the effects of other factors, the association between ACEs and COPD is strongest for respondents who are obese (AOR = 1.41, 95% CI = 1.04-1.91).

CONCLUSIONS

The findings of this study demonstrate that ACEs are associated with COPD later in adulthood, and BMI moderated this association. The findings of this study add to the number of studies demonstrating the adverse impact of ACEs on chronic health outcomes among adults.

Validity of Scottish predictors of child obesity (age 12) for risk screening in mid-childhood: a secondary analysis of prospective cohort study data-with sensitivity analyses for settings without various routinely collected predictor variables

OBJECTIVE

To analyse the Growing Up in Scotland cohort for predictors of obesity at age 12, present at school entry (age 5-6).

METHODS

The initial model included literature-based risk factors likely to be routinely collected in high-income countries (HICs), as well as "Adverse/Protective Childhood Experiences (ACEs/PCEs)". Missing data were handled by Multiple Chained Equations. Variable-reduction was performed using multivariable logistic regression with backwards and forwards stepwise elimination, followed by internal validation by bootstrapping. Optimal sensitivity/specificity cut-offs for the most parsimonious and accurate models in two situations (optimum available data, and routinely available data in Scotland) were examined for their referral burden, and Positive and Negative Predictive Values.

RESULTS

Data for 2787 children with full outcome data (obesity prevalence 18.3% at age 12) were used to develop the models. The final "Optimum Data" model included six predictors of obesity: maternal body mass index, indoor smoking, equivalized income quintile, child's sex, child's BMI at age 5-6, and ACEs. After internal validation, the area under the receiver operating characteristic curve was 0.855 (95% CI 0.852-0.859). A cut-off based on Youden's J statistic for the Optimum Data model yielded a specificity of 77.6% and sensitivity of 76.3%. 37.0% of screened children were "Total Screen Positives" (and thus would constitute the "referral burden".) A "Scottish Data" model, without equivalized income quintile and ACEs as a predictor, and instead using Scottish Index of Multiple Deprivation quintile and "age at introduction of solid foods," was slightly less sensitive (76.2%) but slightly more specific (79.2%), leading to a smaller referral burden (30.8%).

CONCLUSION

Universally collected, machine readable and linkable data at age 5-6 predict reasonably well children who will be obese by age 12. However, the Scottish treatment system is unable to cope with the resultant referral burden and other criteria for screening would have to be met.

Social consequences and genetics for the child with overweight and obesity: An obesity medicine association (OMA) clinical practice statement 2022

Background

This Obesity Medicine Association (OMA) clinical practice statement (CPS) covers two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA clinical practice statement details two topics: 1) genetics and 2) social consequences for the child with overweight and obesity.

Conclusions

This OMA clinical practice statement on genetics and social consequences for the child with overweight and obesity is an overview of current literature. The literature provides a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

Early life stress exacerbates obesity in adult female mice via mineralocorticoid receptor-dependent increases in adipocyte triglyceride and glycerol content

Previously, we have shown that Maternal Separation and Early Weaning (MSEW) exacerbates high fat diet (HF)-induced visceral obesity in female offspring compared to normally reared female mice. Stress hormones such as glucocorticoids and mineralocorticoids are critical mediators in the process of fat expansion, and both can activate the mineralocorticoid receptor (MR) in the adipocyte. Therefore, this study aimed to, comprehend the specific effects of MSEW on adipose tissue basic homeostatic function, and investigate whether female MSEW mice show an exacerbated obesogenic response mediated by MR. Gonadal white adipose tissue (gWAT), a type of visceral fat, was collected to assess lipidomics, transcriptomics, and in vitro lipolysis assay. Obese female MSEW mice showed increased adiposity, elevated 44:2/FA 18:2 + NH4 lipid class and reduced mitochondrial DNA density compared to obese control counterparts. In addition, single-cell RNA sequencing in isolated pre- and mature adipocytes showed a ~9-fold downregulation of aquaglycerolporin 3 (Aqp3), a channel responsible for glycerol efflux in adipocytes. Obese MSEW mice showed high levels of circulating aldosterone and gWAT-derived corticosterone compared to controls. Further, the MR blocker spironolactone (Spiro, 100 mg/kg/day, 2 weeks) normalized the elevated intracellular glycerol levels, the greater in vitro lipolysis response, and the number of large size adipocytes in MSEW mice compared to the controls. Our data suggests that MR plays a role promoting adipocyte hypertrophy in female MSEW mice by preventing lipolysis via glycerol release in favor of triglyceride formation and storage.

Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review

OBJECTIVE

To examine and synthesise the literature on adverse childhood experience (ACE) screening in clinical and healthcare settings servicing children (0-11) and young people (12-25).

DESIGN

A systematic review of literature was undertaken.

DATA SOURCE

PsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken.

ELIGIBILITY CRITERIA

English language studies were included if they reported results of an ACE tool being used in a clinical or healthcare setting, participants were aged between 0 and 25 years and the ACE tool was completed by children/young people or by parents/caregivers/clinicians on behalf of the child/young person. Studies assessing clinicians' views on ACE screening in children/young people attending health settings were also included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively.

RESULTS

Initial searches identified 5231 articles, of which 36 were included in the final review. Findings showed that the most commonly used tool for assessing ACE was the ACE questionnaire; administering ACE tools was found to be feasible and acceptable; there were limited studies looking at the utility, feasibility and acceptability of assessing for ACE in First Nations people; and while four studies provided information on actions taken following ACE screening, no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services.

CONCLUSION

As the evidence stands, widespread ACE screening is not recommended for routine clinical use. More research is needed on how and what specific ACE to screen for and the impact of screening on well-being.

PROSPERO REGISTRATION NUMBER

University of York Centre for Reviews and Dissemination (CRD42021260420).

Adverse childhood experiences, child poverty, and adiposity trajectories from childhood to adolescence: evidence from the Millennium Cohort Study

Objective

This study investigated associations between adverse childhood experiences (ACEs) in early childhood (at ages 9 months and 3 years) and adiposity trajectories of children/adolescents from age 5 to age 17, and the potential interaction between ACEs and poverty on adiposity trajectories.

Methods

Data from the UK Millennium Cohort Study was used. Eight commonly studied ACEs and poverty were measured when the child was aged 9 months and 3 years. ACEs were considered as a cumulative score and as individual experiences. Linear-mixed effect models were employed, modelling BMI and fat mass index (FMI) trajectories from age 5 to 17 (main outcome), adjusting for covariates and stratified by sex. Interactions with poverty were also tested. The sample sizes were 7282 and 6912 for BMI and FMI sample respectively.

Results

Cumulative ACE score was associated with steeper increase in BMI and FMI among boys with 3+ ACEs (BMI: β = 0.13, 95% CI: 0.02–0.24; FMI: β = 0.09, 95% CI: 0.01–0.19). For individual ACEs, parental depression was associated with steeper increase in BMI/FMI trajectories in both sexes (BMI: boys: β = 0.15, 95% CI: 0.07–0.23, girls: β = 0.13, 95% CI: 0.05–0.20; FMI: boys: β = 0.09, 95% CI: 0.03–0.15, girls: β = 0.09, 95% CI: 0.02–0.16). In addition, parental separation and physical punishment were associated with steeper increase in BMI/FMI trajectories among girls (BMI: parental separation: β = 0.25; 95% CI: 0.06–0.44, physical punishment: β = 0.14; 95% CI: 0.03–0.26; FMI: parental separation: β = 0.20; 95% CI: 0.03–0.37, physical punishment: β = 0.12; 95% CI: 0.02–0.22). No interaction effect had been found between ACEs and poverty on the adiposity trajectories.

Conclusions

A complex relationship between ACEs in early childhood and adiposity trajectories for children/adolescents was found, highlighting the different effects of specific ACEs and sex differences in the association.

Assessment of adult learning outcomes from a school-based training on adverse childhood experiences science and trauma-informed care

BACKGROUND

Implementing trauma-informed care (TIC) practices in educational settings requires preparing school staff to understand adverse childhood experiences (ACEs) and their impact to provide a restorative rather than a punitive response.

OBJECTIVES

To assess learning outcomes of a TIC training delivered to kindergarten to 12-grade (K-12) staff.

PARTICIPANTS AND SETTING

A TIC training informed by the Substance Abuse and Mental Health Service Administration (SAMHSA) Framework was delivered August to December 2017 to twenty-seven K-12 staff in Southeastern U.S. Majority were women (93 %) aged 25 to 58 years; 52 % were White and 48 % were Black/African American (48 %).

METHODS

Curricular content included an overview of ACEs; stress physiology; recognition of symptoms in self and others; strategies for response; and self-care. A post-training questionnaire with 11 learning statements was administered to assess participants' level of agreement with learning each concept using a 5-point Likert scale. Self-reflective narratives of challenging situations with students were also submitted and qualitatively analyzed for applications of TIC.

RESULTS

Between 62.9 % to 96 % of participants agreed/strongly agreed with learning new concepts related to ACEs and their symptoms. Qualitative data indicated that participants were able to recognize stress symptoms in students and in themselves and integrate strategies learned such as breathing and creating safe space to allow students to have voice and choice.

CONCLUSIONS

TIC training curriculum that includes ACEs and toxic stress science is a critical component that promotes recognition of trauma symptoms in themselves and others. Self-reflective practice using narratives is an essential training tool for implementing TIC.

Prevalence, risk factors, and interventions for obesity in Saudi Arabia: A systematic review

Saudi Arabia (SA) has a reported obesity prevalence greater than the global average. Here, we systematically review firstly the prevalence and associated factors (59 studies) and secondly the pharmacological, lifestyle, and surgical interventions for obesity (body mass index, >30 kg/m² ) in SA (29 studies) between December 2020 and March 2021 in PubMed, Medline, Embase, PsycINFO, and Cochrane. Peer-reviewed articles in Arabic and English on human adults (aged >18 years) were searched. Among the eight largest studies with sample sizes over 10,000 people, the maximum-reported obesity prevalence was 35.6%, with notable variations in gender and geographic region. Diet, specifically the move towards Western diet and heavy consumption of sugary beverages, and high levels of inactivity are major contributing factors to obesity. The reported obesity-risk polymorphisms are not specific. Bariatric surgery is underrepresented, and in general, there is a lack of nationally coordinated studies on weight loss interventions. In particular, the systematic review did not find a body of research on psychological interventions. There is no trial data for the use of GLP-1 analogs in SA, despite their widespread use. These findings can help policymakers, and practitioners prioritize future research efforts to reduce obesity prevalence in SA.

Association Between Interpersonal Violence With Inadequate Nutritional Status Among Brazilian Adolescents

Research focusing on the relationship between interpersonal violence and nutritional status in adolescence is scarce and has distinct results. The objective of this study is to investigate the association of family physical and sexual violence with inadequate nutritional status in Brazilian adolescents. We used data from the 2015 Brazilian National Survey of School Health. This study includes 11.850 students, older than 13 years, attending from sixth to ninth grade of elementary school and from the 1st to the 3rd year of high school. The exposures were family physical violence and rape. The outcome was nutritional status, assessed through body mass index. The association between exposures and outcome were investigated using a multinomial logistic regression model. These analyses were adjusted for demographic, socioeconomic, and family variables. The prevalence of family physical violence victimization was approximately 14% among adolescents for both sexes. The prevalence of rape was 4.6% and 5.7% among male and female adolescents, respectively. Family physical violence was not associated with being underweight, overweight, or obese, in either crude or adjusted models for both sexes. Sexual violence was inversely associated with being underweight only for male adolescents (OR: 0.21, CI 95%: 0.06-0.75). In female adolescents, sexual violence was associated with overweight/obesity (OR: 1.64, CI 95%:1.15-2.33). In this study, rape, but not family physical violence victimization, was associated with nutritional status in adolescents of both sexes. Nonetheless, this association was different between boys and girls. Rape was inversely associated with being underweight in male adolescents, whereas, in female adolescents, it was associated with excess body weight.

Association of adverse childhood experiences (ACEs) with obesity and underweight in children

PURPOSE

The aim of the study was to test the hypothesis that adverse childhood experiences (ACEs) are related to both obesity and underweight from childhood, and that the association of ACEs with weight abnormalities is modulated by type of ACEs, sex and socioeconomic status (SES) indices.

METHODS

The relations between ACEs (0 vs ≥ 1), ACE accumulation and ACE type with weight status and z scores BMI were assessed in 503 children aged 6-12 years from Poznan, Poland. The effects of interaction of ACEs with sex and SES on z scores BMI were included in the analyses.

RESULTS

ACEs were significantly related to both obesity and underweight, in unadjusted analysis, and when sex and SES indices, such as size of place of residence, people per room in household, and parental education were controlled. The relation of ACEs with z scores BMI was modulated by ACE type, parental subjective assessment of economic situation of a family and parental education. ACE accumulation was not related to an increase of obesity or underweight rate, or z scores BMI.

CONCLUSION

The study implicates the need for both obesity and underweight prevention in individuals with adverse experiences as early as in childhood.

LEVEL OF EVIDENCE

III: evidence obtained from well-designed cohort study.

Limitations of the protective measure theory in explaining the role of childhood sexual abuse in eating disorders, addictions, and obesity: an updated model with emphasis on biological embedding

In addition to its immediate negative consequences, childhood sexual abuse is associated with lifelong deleterious mental and physical health outcomes. This review employs a biopsychosocial perspective to better understand pathways from childhood sexual abuse to eating disorders, food and drug addictions, and obesity across the life course. Guided by an updated conceptual model, this review delineates how the biological embedding of childhood sexual abuse triggers a cascade of interrelated conditions that often result in failed attempts at weight suppression and eventually obesity. Such biological embedding involves pathways such as inflammation, allostatic load, reward sensitivity, activation of the hypothalamic-pituitary-adrenal axis, epigenetics, and structural and functional changes in the brain. These pathways are in turn theorized to lead to food addiction, substance use disorder, and eating disorders-each with potential pathways toward obesity over time. Predisposing factors to childhood sexual abuse including gender, culture, and age are discussed. This model calls into question the longstanding "protective measure" theory that purports individuals exposed to sexual abuse will deliberately or subconsciously gain weight in attempt to prevent future victimization. A more comprehensive understanding of the mechanisms by which childhood sexual abuse becomes biologically embedded may help clinicians and survivors normalize and/or address disordered eating and weight-related outcomes, as well as identify intervention strategies.Level of evidence: Level V: opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Adverse experiences as predictors of maladaptive and adaptive eating: Findings from EAT 2018

Adverse experiences, such as childhood abuse and other violence victimization, are associated with problematic eating. However, whether different types of adversity relate to both maladaptive and adaptive eating behaviors is unclear. This study examined the associations of different adverse experiences with maladaptive (i.e., overeating and binge eating) and adaptive (i.e., intuitive eating and mindful eating) eating by gender. Data were derived from the EAT-2018 (Eating and Activity over Time) study (N = 1411, aged 18-30 years in 2017-2018). Modified Poisson regressions were used to examine the associations between adverse experiences and the prevalence of maladaptive eating. Linear regressions were used to examine the associations between adverse experiences and adaptive eating scores. Each adverse experience was associated with greater prevalence of maladaptive eating and lower adaptive eating scores. Among women, intimate partner sexual violence was strongly associated with more overeating (PR = 2.1 [95% CI = 1.4-3.1]) and binge eating (PR = 2.4 [95% CI = 1.5-3.9]), and less mindful eating (β = -0.6, [95% CI = -0.8, -0.3]); being attacked, beaten, or mugged was most associated with less intuitive eating (β = -0.5, [95% CI = -0.8, -0.2]). Among men, being attacked, beaten, or mugged was strongly associated with more overeating (PR = 2.1 [95% CI = 1.2-3.5]) and binge eating (PR = 3.2 [95% CI = 1.6-6.5]); intimate partner physical violence was strongly associated with less intuitive eating (β = -0.6, [95% CI = -0.9, -0.2]); childhood emotional abuse was strongly associated with less mindful eating (β = -0.8, [95% CI = -1.0, -0.5]). To improve eating behaviors, adverse life experiences and the potential impact on maladaptive and adaptive eating should be considered.

Using phenome-wide association studies and the SF-12 quality of life metric to identify profound consequences of adverse childhood experiences on adult mental and physical health in a Northern Nevadan population

In this research, we examine and identify the implications of Adverse Childhood Experiences (ACEs) on a range of health outcomes, with particular focus on a number of mental health disorders. Many previous studies observed that traumatic childhood events are linked to long-term adult diseases using the standard Adverse Childhood Experience Questionnaire. The study cohort was derived from the Healthy Nevada Project, a volunteer-based population health study in which each adult participant is invited to take a retrospective questionnaire that includes the Adverse Childhood Experience Questionnaire, the 12-item Short Form Survey measuring quality of life, and self-reported incidence of nine mental disorders. Using participant's cross-referenced electronic health records, a phenome-wide association analysis of 1,703 phenotypes and the incidence of ACEs examined links between traumatic events in childhood and adult disease. These analyses showed that many mental disorders were significantly associated with ACEs in a dose-response manner. Similarly, a dose response between ACEs and obesity, chronic pain, migraine, and other physical phenotypes was identified. An examination of the prevalence of self-reported mental disorders and incidence of ACEs showed a positive relationship. Furthermore, participants with less adverse childhood events experienced a higher quality of life, both physically and mentally. The whole-phenotype approach confirms that ACEs are linked with many negative adult physical and mental health outcomes. With the nationwide prevalence of ACEs as high as 67%, these findings suggest a need for new public health resources: ACE-specific interventions and early childhood screenings.

Frequency of malnutrition in children and adolescents with child maltreatment

INTRODUCTION

child maltreatment (CM) can have a negative impact on physical and mental health in childhood and throughout life.

OBJECTIVE

to determine the frequency of malnutrition in cases of CM from the Clínica de Atención Integral al Niño Maltratado (CAINM) of the Instituto Nacional de Pediatría (INP), Mexico.

MATERIAL AND METHODS

this was a cross-sectional, retrospective, descriptive study of children with CM. Height/age, weight/height, and body mass index/age were used to determine malnutrition status (undernutrition and overweight or obesity). The frequency of malnutrition by age group and sex were compared using X2 tests. The prevalence of malnutrition at CAINM was compared to that expected in Mexico (ENSANUT-2012), serving as a reference for children without CM, using one-sample Poisson tests.

RESULTS

of the 117 cases, 41 % presented wasting or overweight/obesity, and 25 % were growth-stunted. Neither wasting nor stunting displayed any difference between age groups (p > 0.05). Overweight/obesity was observed more frequently in adolescents than in schoolchildren (p < 0.05). Being overweight or obese was most frequently associated with sexual abuse, and wasting and stunting were most often associated with neglect. Compared to the population without CM, the group under 5 years of age had a higher prevalence of wasting (p < 0.01), and those aged 5 to 11 years had a higher prevalence of both wasting and stunting (p < 0.001).

CONCLUSIONS

CM cases were characterized by acute undernutrition and stunting as well as by adolescents who were overweight or obese. Malnutrition in the pediatric population should be analyzed from a wider perspective, including possible CM.

Plant-based dietary intake moderates adverse childhood experiences association with early mortality in an older Adventist cohort

BACKGROUND

Adverse Childhood Experiences (ACEs) consistently predict poor mental and physical health as well as early all-cause mortality. Much work examines health harming behaviors that may be used to cope with ACEs associated stress responses and dysregulation. Limited research has been conducted assessing plant-based dietary intake on the ACEs and mortality relationship. We investigate moderators of the ACEs and mortality association including plant-based dietary intake.

OBJECTIVE

The purpose of this study is to examine if the association between ACEs and early mortality is potentially moderated by plant-based dietary intake.

PARTICIPANTS

An observational, prospective cohort study that included 9301 Seventh-day Adventists were assessed from 2006 to 2017 in the Biopsychosocial Religion and Health Study (BRHS).

METHODS

We examined the potential impact of plant-based intake frequency on the ACEs and all-cause mortality relationship, while adjusting for potential confounders (e.g., demographics, health risks, mental and physical health) in a cox regression survival analysis.

RESULTS

ACEs were adversely associated with survival time (HR = 2.76, 95% CI: 1.15-6.64). Plant-based intake was associated with a reduction in the association of 4+ ACEs with early mortality (HR = 0.73, 95% CI: 0.59-0.90) above and beyond demographics, animal-based intake, physical health, mental health, BMI, exercise, and worship. We estimate that after 4+ ACEs, those eating high versus low plant-based dietary intake may live 5.4 years longer.

CONCLUSION

Plant-based dietary intake may potentially moderate the ACEs and early mortality relationship; however, observational studies cannot determine causality.

Importance of Family Connection for Healthy Weight Behaviors Amid Adverse Family Experiences and Behavioral Difficulties

OBJECTIVE

Adverse family experiences (AFEs), including parent divorce and domestic violence, negatively affect obesogenic behaviors and engagement in healthy weight behaviors (HWBs). The current study used a moderated mediation model to investigate the role of family connection in the relationship between AFEs and HWBs for children with behavioral difficulties.

METHOD

Youth (6-17 years old; n = 13,921) from the 2016 National Survey of Children's Health data set were included in the study.

RESULTS

Family connection mediated the relationship between AFEs and each HWB. The models of physical activity and screen time had significant direct effects. Behavioral difficulties moderated the direct effect of AFEs and screen time and physical activity.

CONCLUSION

Family connection mediated the relationships between each HWB and AFEs. The findings suggest that for children without behavioral difficulties, family connection was a stronger protective factor for adequate physical activity and decreased screen time.

Obesity and Eating Disorders in Children and Adolescents: The Bidirectional Link

Obesity, eating disorders and unhealthy dieting practices among children and adolescents are alarming health concerns due to their high prevalence and adverse effects on physical and psychosocial health. We present the evidence that eating disorders and obesity can be managed or prevented using the same interventions in the pediatric age. In the presence of obesity in the pediatric age, disordered eating behaviors are highly prevalent, increasing the risk of developing eating disorders. The most frequently observed in subjects with obesity are bulimia nervosa and binge-eating disorders, both of which are characterized by abnormal eating or weight-control behaviors. Various are the mechanisms overlying the interaction including environmental and individual ones, and different are the approaches to reduce the consequences. Evidence-based treatments for obesity and eating disorders in childhood include as first line approaches weight loss with nutritional management and lifestyle modification via behavioral psychotherapy, as well as treatment of psychiatric comorbidities if those are not a consequence of the eating disorder. Drugs and bariatric surgery need to be used in extreme cases. Future research is necessary for early detection of risk factors for prevention, more precise elucidation of the mechanisms that underpin these problems and, finally, in the cases requiring therapeutic intervention, to provide tailored and timely treatment. Collective efforts between the fields are crucial for reducing the factors of health disparity and improving public health.

Adverse Childhood Experiences Are Associated with Cardiometabolic Risk among Hispanic American Adolescents

OBJECTIVE

To assess the relationship between adverse childhood experiences (ACEs) and cardiometabolic risk among Hispanic adolescents.

STUDY DESIGN

This cross-sectional study was conducted at an academic research center in Gainesville, Florida. Participants were locally recruited, and data were collected from June 2016 to July 2018. Participants (n = 133, 60.2% female) were healthy adolescents aged 15-21 years who self-identified as Hispanic, were born in the US, and had a body mass index (BMI) between ≥18.5 and ≤40 kg/m². Primary outcomes were BMI, body fat percentage, waist circumference, and resting blood pressure. Associations between ACEs and cardiometabolic measures were assessed by multivariable logistic regression models, which controlled for sex, age, parental education, and food insecurity. Results were sex-stratified to assess potential variations.

RESULTS

Reporting ≥4 ACEs (28.6%) was significantly associated with a greater BMI (P = .004), body fat percentage (P = .02), and diastolic blood pressure (P = .05) compared with reporting <4 ACEs. Female participants reporting ≥4 ACEs were significantly more likely to have a greater BMI (P = .04) and body fat percentage (P = .03) whereas male participants reporting ≥4 ACEs were significantly more likely to have a greater BMI (P = .04), systolic blood pressure (P = .03), and diastolic blood pressure (P = .03).

CONCLUSIONS

Hispanic adolescent participants who experienced ≥4 ACEs were more likely to have elevated risk markers of obesity and cardiometabolic disease. Further research is needed to elucidate the physiological mechanisms driving these relationships.

Investigating Adverse Childhood Experiences and Nutrition and Physical Activity Behaviors Using the Omaha System

The aim of the current study was to examine the relationship between adverse childhood experiences (ACEs) and nutrition and physical activity behaviors using the Omaha System. A descriptive cross-sectional design was used with 227 women recruited from three vocational institutes. Measures included Omaha System Knowledge, Behavior, and Status ratings for nutrition and physical activity; sociodemographic information; and the ACE Questionnaire. Results demonstrated that more than one half of participants had a history of at least one ACE (n = 132; 58.1%), and 33 (14.5%) had four or more. ACEs score was significantly associated with nutrition, but not physical activity behavior. Understanding the links between ACEs and health behaviors and including a brief screening for ACEs in primary care practice settings may help nurses holistically customize health promotion interventions and lead to better health outcomes. The Omaha System can efficiently measure health-related behaviors; examine their relationship to risk factors, such as ACEs; and capture individual and population-level changes. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Sexual Identity Differences in Health Behaviors and Weight Status among Urban High School Students

Although racial/ethnic disparities in childhood obesity are well documented in the United States (U.S.), fewer studies have investigated elevated body mass index (BMI) and related health behaviors among sexual minority youth (SMY; gay/lesbian, bisexual, not sure). We examined pooled data from the 2009-2017 Youth Risk Behavior Surveys, which included high school students from 12 urban U.S. school districts. We used sex-stratified logistic regression models to estimate the association of sexual identity with health behaviors and elevated BMI (reference = heterosexual participants). A total of 133,615 participants were included. Sexual minority boys were more likely to report physical inactivity than heterosexual boys. Gay and not sure boys were also less likely to consume the recommended daily intake of fruit. Bisexual girls were more likely than heterosexual girls to report watching television ≥ 3 hours on a school day and to consume sugar-sweetened beverages (AOR 1.30, 95% CI= 1.18-1.43). All SMY reported higher rates of current tobacco use than their heterosexual peers. Sexual minority girls and bisexual boys had significantly higher rates of obesity than their heterosexual counterparts. These findings can inform tailored health promotion initiatives to reduce obesity risk in SMY.

Do measures of healthy eating differ in survivors of early adversity?

Early life adversity has been linked to poor health, including obesity. Understanding the role of unhealthy food intake, may elucidate the importance of self-soothing behaviors in explaining the association between early life adversity and poor health in adulthood. The purpose of this study was to assess the association between early life adversity and dietary quality in a sample of adults from the Lifestyle Influences of Family Environment study. Early life adversity, demographic, and dietary data were obtained for 145 participants using formal interviews and two days of interviewer-administered 24-h recalls. Dietary quality was measured using the 2015 Healthy Eating Index (HEI) scoring algorithm to compute total and component scores. The association between early life adversity and dietary quality was assessed through linear regression and in models adjusted for age and sex. The mean ± SD HEI score for all participants was 54.6 ± 12.8. Individuals with early life adversity had a 4.51 lower overall HEI score when compared to those without early life adversity, 95% CI (0.35, 8.68). After adjusting for age and sex, early life adversity was associated with a 4.6 lower HEI score, 95% CI (0.45, 8.73). HEI component scores indicated that individuals with early life adversity were significantly more likely to have lower whole grain (0.7 versus 2.4) and total dairy (4.3 versus 6.1) scores compared to those without early life adversity. ELA was associated with lower measures of dietary quality. Results warrant future research on dietary and behavioral factors that underly the association between early life adversity and poor health outcomes.

The association between adverse childhood experiences and childhood obesity: A systematic review

Adverse childhood experiences (ACEs) are associated with numerous physical and mental health issues in children and adults. The effect of ACEs on development of childhood obesity is less understood. This systematic review was undertaken to synthesize the quantitative research examining the relationship between ACEs and childhood obesity. PubMed, PsycInfo, and Web of Science were searched in July 2020; Rayyan was used to screen studies, and the Newcastle-Ottawa Scale was used to assess risk of bias. The search resulted in 6,966 studies screened at title/abstract and 168 at full-text level. Twenty-four studies met inclusion criteria. Study quality was moderate, with greatest risk of bias due to method of assessment of ACEs or sample attrition. Findings suggest ACEs are associated with childhood obesity. Girls may be more sensitive to obesity-related effects of ACEs than boys, sexual abuse appears to have a greater effect on childhood obesity than other ACEs, and co-occurrence of multiple ACEs may be associated with greater childhood obesity risk. Further, the effect of ACEs on development of childhood obesity may take 2-5 years to manifest. Considered collectively, findings suggest a need for greater attention to ACEs in the prevention and treatment of childhood obesity.

Associations of adverse childhood experiences with stress physiology and insulin resistance in adolescents at risk for adult obesity

Adverse childhood experiences (ACEs) heighten the risk for adult obesity and cardiometabolic disease, but physiological factors underlying this connection are not well understood. We determined if ACEs were associated with physiological stress response and insulin resistance in adolescents at risk for adult obesity. Participants were 90 adolescents 12.0-17.5 years (50% female, 30% Hispanic/Latinx), at risk for adult obesity by virtue of above-average body mass index (BMI; kg/m² ≥ 70th percentile) or parental obesity (BMI ≥ 30 kg/m² ). ACEs were determined as presence (vs. absence) based upon the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Physiological stress response was measured as heart rate/blood pressure response to the Trier Social Stress Test. Homeostatic model assessment of insulin resistance was determined from fasting glucose/insulin. Sixty-one percent of adolescents reported positive ACE history. The presence of ACEs predicted greater heart rate (p < .001) and diastolic blood pressure (p = .02) response to stress, controlling for age, sex, race/ethnicity, puberty, and BMI standard score. Systolic blood pressure and insulin resistance did not differ by ACE history (p-values > .08). Findings suggest heightened sympathetic stress response in adolescence could be explanatory in how ACEs increase the risk for later cardiometabolic disease. Future studies should characterize ACEs in relationship to day-to-day variations in adolescents' stress physiology and glucose homeostasis.

Adverse childhood experiences and obesity over time

OBJECTIVE

The effects of adverse childhood experiences (ACE) on children and adolescents' health status such as obesity are understudied. The current study addressed the effect of ACE on obesity status during childhood utilising multiple waves of national panel data.

DESIGN

Longitudinal survey.

SETTING

Data were drawn from three waves of the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II). NSCAW II study sampled cases from Child Protective Services investigations that were closed between February 2008 and April 2009 nationwide. We measured ACE cumulatively and as separate events and stratified by gender.

PARTICIPANTS

Totally, 3170 youth births to 14 years of age at baseline.

RESULTS

A count measure of ACE is indeed associated with greater odds of obesity during childhood. Differential effects for different types of ACE were also found, most notably neglect. For girls, physical and psychological neglect increased odds of obesity.

CONCLUSIONS

Findings support evidence for the importance of using both a count measure of ACE as well as separating out single events by gender.

Passion and Persistence: Investigating the Relationship Between Adverse Childhood Experiences and Grit in College Students in China

Adverse childhood experiences (ACEs) are known to have deleterious effects on individuals across the life span, but less is known about how they affect grit, a strong predictor of achievements and well-being. This study seeks to investigate the effect of ACEs on grit in a sample of Chinese college students during the COVID-19 pandemic. Data were collected from 1,871 students across 12 universities in China. Findings indicated a significant effect of ACEs on grit, particularly abuse and neglect dimensions of ACE. Since grit is particularly important for professional success, those who have experienced abuse and neglect victimization may struggle throughout their education, and subsequently, in their careers. This calls for interventions to buffer the effects of ACEs on grit.

The Association of Adverse Childhood Experiences and Resilience With Health Outcomes in Adolescents: An Observational Study

The relationship between Adverse childhood experiences (ACEs), resilience, and health outcomes has not been as thoroughly studied in adolescents. Adolescents completed the ACEs Questionnaire and a validated resilience measure (Child Youth Resilience Measure, or CYRM). Poor health outcome was having 1 or more: obesity, hypertension, and/or depression. 34.5% of teens had a poor health outcome, 38.6% had ACE scores of 4 or more, and resilience ranged from 45 to 84 (mean = 74.6). By univariate and bivariate analysis, ACEs (OR = 1.11, 95% CI = 1.03-1.19, P = .0039; OR = 1.08, 95% CI = 1.0-1.16, P = .045) and resilience (OR = 0.95, 95% CI = 0.92-0.98, P = .0016; OR = 0.96, 95% CI = 0.93-0.99, P = .016) were significantly associated with poor health outcome. Resilience relationship subscale was significantly associated with reduced health risk (OR = 0.85, 95%CI = 0.75-0.95, P = .005). ACEs are associated with poor health outcomes in adolescents, resilience is inversely related, and the caregiver relationship may be the driving force.

Assessing adverse childhood experiences, social, emotional, and behavioral symptoms, and subjective health complaints among Hungarian adolescents

BACKGROUND

Adverse Childhood Experiences (ACEs) can have lifelong adverse impacts; they can play a role in the development of subsequent emotional, cognitive, and social impairments leading to somatic and mental difficulties, as well as health damaging behaviours. Unfortunately, there are currently no research data available in Hungary regarding the frequency of ACEs among adolescents.

AIMS

A cross sectional questionnaire survey was conducted in a community sample of Hungarian adolescents to assess the frequency of ACEs and analyse their association with current social, emotional, and behavioural symptoms (SEB), and subjective health complaints (SHC).

METHODS

Demographic data, ACEs, SEB and SHC status of 516 adolescents aged 12 to 17 were collected. ACEs were assessed using the ACE Score Calculator; for SEB the Strengths and Difficulties Questionnaire, and for SHC some specific items from the Health Behaviour of School Children questionnaire were employed. To analyse the relationship of ACEs to SEB and SHC logistic regression was performed.

RESULTS

Our results showed that the frequency of ACEs, SEB and SHC is high among adolescents. One-fourth of the students reported ≥ 2 categories of childhood exposures, and 7.4% reported having experienced ≥ 4 types of ACEs. The most prevalent forms of child maltreatment were emotional neglect (15.5%) and emotional abuse (14.5%). The most frequent dysfunctional household condition was parental divorce or separation (23.8%), followed by household substance abuse (8.9%) and household mental illness (8.1%). Almost one-fifth of students (17.5%) reported SEB symptoms (peer relationship problems in 21.7%, emotional symptoms in 14.6%, conduct problems in 18.3%, hyperactivity in 15%). The prevalence of SHC was also high: more than half of the students experienced at least one subjective health complaint multiple times a week. Significant associations were found between ACEs and the SEB/SHC reported by students.

CONCLUSIONS

Adverse childhood experiences, social, emotional, and behavioural symptoms, and SHC are common among Hungarian adolescents. The cumulation of ACEs is associated with a higher number of SEB and SHC symptoms. Therefore, prevention programmes, early recognition, risk reduction, and therapy are needed.

Adverse childhood experiences and development of obesity and diabetes in adulthood-A mini review

Obesity has been steadily rising in the last few decades and to some extent, have been linked to exposure of adverse childhood experiences (ACEs). ACEs are intense stressors or traumatic events experienced or witnessed by children, ranging from all types of abuse (physical, emotional, and sexual), neglect, substance abuse or community violence. These traumatic events deprive the sense of safety and stability of a child, leaving psychological and physiological effects that span into adulthood. The prevalence of ACEs is common across developed and developing countries alike, though the rates differ across ethnicities. Using the United States as an example, the prevalence of ACEs experienced by communities of color is higher than white children. Children around the world could all be exposed to ACEs, hence the original questionnaire capturing the score of ACE has been adapted to different cultural situations. The mechanism linking ACEs to obesity during adulthood include biological, psychological, and environmental factors. Nevertheless, a higher ACE score heightens the risk of poor mental health, attempted suicide and development of obesity and diabetes in adulthood. Prevention of ACEs starts from building positive relationships within families, developing healthy relationship skills, and screening of ACEs during early and routine pediatrician's and primary care visits. Intervention needs to include case management services and psychosocial support programs. When these risk factors are intervened early, it lessens the risk of obesity and diabetes in adulthood.

The impact of change in neighborhood poverty on BMI trajectory of 37,544 New York City youth: a longitudinal study

BACKGROUND

Neighborhood poverty may increase childhood obesity risk. However, evidence for the neighborhood poverty-obesity relationship is limited. The purpose of this study was to examine how moving to a higher or lower poverty neighborhood impacts body mass index (BMI) z-score trajectories among youth, with the goal of informing policy change, interventions, and clinical practices to reduce childhood obesity.

METHODS

Methods entailed secondary analysis of existing longitudinal data. The sample included youth attending New York City public schools in grades kindergarten through twelfth from school years 2006/2007 through 2016/2017. Eligibility criteria included moving to a higher or lower poverty neighborhood during the data midpoint [school years 2010/2011 through 2013/2014] of the 12-year data-period; New York City-specific metrics were used to define both neighborhood (Neighborhood Tabulation Area) and relevant neighborhood poverty levels (< 5, 5 to < 10%, 10 to < 20%, 20 to < 30%, 30 to < 40% and ≥ 40% of individuals below Federal Poverty Level). Two-piece latent growth curve models were used to describe BMI z-score trajectories of youth who moved to higher versus lower poverty neighborhoods, with propensity score weighting to account for preexisting differences between the two groups. Primary analyses were stratified by sex and exploratory subgroup analyses were stratified by sex and developmental stage (early childhood, middle childhood, and adolescence) to explore sensitive periods for neighborhood poverty exposure.

RESULTS

Of 532,513 youth with home address data, 18,370 youth moved to a higher poverty neighborhood and 19,174 moved to a lower poverty neighborhood (n = 37,544). Females and males who moved to a higher poverty neighborhood experienced less favorable BMI z-score trajectories for obesity risk, though effects were small. Exploratory subgroup analyses demonstrated that negative effects of neighborhood poverty were most pronounced among young and adolescent females and young males, whereas effects were mixed for other subgroups.

CONCLUSIONS

Youth who moved to higher poverty neighborhoods experienced less favorable BMI z-score trajectories for obesity risk, though effects were small and most consistent for females and younger youth. Additional research is needed to illuminate neighborhood poverty's impact on obesity, in order to inform policy, intervention, clinical, and research efforts to reduce obesity and improve child well-being.

Clinical and neuroendocrine correlates of childhood maltreatment history in adults with bipolar disorder

OBJECTIVES

Childhood maltreatment has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD. Therefore, we explored the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis.

METHODS

One hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM-). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test.

RESULTS

Sixty-two patients had a history of childhood maltreatment and 44 had not. Maltreatment was significantly more frequent in females than males. CM+ patients showed a significant higher body mass index, a significant higher number of suicide attempts, and more severe mania symptoms than CM- ones. Logistic regression indicated a significant association between lifetime suicide attempts and any type of childhood maltreatment and between emotional abuse and the presence of psychotic symptoms or mixed mood episodes. CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM- ones.

DISCUSSION

Our results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatments and show for the first time that childhood trauma exposure is associated to an impaired CAR in adults with BD.

Brain-gut-microbiome interactions in obesity and food addiction

Normal eating behaviour is coordinated by the tightly regulated balance between intestinal and extra-intestinal homeostatic and hedonic mechanisms. By contrast, food addiction is a complex, maladaptive eating behaviour that reflects alterations in brain-gut-microbiome (BGM) interactions and a shift of this balance towards hedonic mechanisms. Each component of the BGM axis has been implicated in the development of food addiction, with both brain to gut and gut to brain signalling playing a role. Early-life influences can prime the infant gut microbiome and brain for food addiction, which might be further reinforced by increased antibiotic usage and dietary patterns throughout adulthood. The ubiquitous availability and marketing of inexpensive, highly palatable and calorie-dense food can further shift this balance towards hedonic eating through both central (disruptions in dopaminergic signalling) and intestinal (vagal afferent function, metabolic endotoxaemia, systemic immune activation, changes to gut microbiome and metabolome) mechanisms. In this Review, we propose a systems biology model of BGM interactions, which incorporates published reports on food addiction, and provides novel insights into treatment targets aimed at each level of the BGM axis.

Association between cumulative exposure to adverse childhood experiences and childhood obesity

Background

Exposure to adverse childhood experiences (ACEs) is associated with many childhood diseases and poor health outcomes in adulthood. However, the association with childhood obesity is inconsistent. We investigated the association between reported cumulative ACE score and body mass index (BMI) in a large sample of patients at a single institution.

Methods

This cross-sectional study included children aged 2–20 years that were screened in a general pediatrics clinic for ACEs utilizing the Center for Youth Wellness ACEs questionnaire between July 2017 and July 2018. Overall ACE score was categorized as ‘no exposure’ (score = 0), ‘low exposure’ (score = 1), and ‘high exposure’ (score≥ 2). BMI was categorized as overweight/obese (BMI percentile ≥ 85) or non-obese (BMI percentile < 85). The association between ACEs score and obesity was determined using univariate and multivariable logistic regression.

Results

Of the 948 patients included in the study, 30% (n = 314) were overweight/obese and 53% (n = 504) had no ACE exposure, 19% (n = 179) had low ACE exposure, and 28% (n = 265) had high ACE exposure. High ACE exposure was associated with increased odds of obesity (OR = 1.47, 95%CI = 1.07–2.03, p = 0.026). However, after adjusting for age, race/ethnicity, insurance type, and birth weight, the association attenuated and was null (OR = 1.01, 95%CI = 0.70–1.46, p = 0.97).

Conclusion

The study findings may suggest an association between ACE and childhood obesity. However, the association attenuated after adjusting for age, race/ethnicity, insurance type, and birth weight. Larger prospective studies are warranted to better understand the association.

The Association Between Adverse Childhood Experiences (ACEs) and Postoperative Bariatric Surgery Weight Loss Outcomes

PURPOSE

Previous research demonstrates that exposure to adverse childhood experiences (ACEs) is associated with development of obesity. The same mechanisms mediating this relationship could theoretically affect attempts to lose weight in adulthood. However, it is unclear whether or not exposure to ACEs impacts the effectiveness of bariatric surgery. The present study aimed to examine the association of exposure to ACEs to postoperative weight loss outcomes.

MATERIALS AND METHODS

One hundred ninety-eight patients undergoing bariatric surgery were evaluated for their exposure to ACEs, determined by a presurgical questionnaire and recorded as an ACEs score. Percent total weight loss (%TWL) was calculated to evaluate postoperative weight loss at 1-, 3-, and 6-month intervals postoperatively. One hundred forty-two participants were available for follow-up at the 6-month postoperative interval.

RESULTS

The sample consisted of 167 women and 31 men with a mean age of 47.7. Twenty-five percent of participants experienced high exposure to ACEs, defined as experiencing ≥ 4 ACEs. The average %TWL at 6 months was 16.52%. Multilevel modeling found no significant relationship between ACEs score and %TWL at any of the postoperative time intervals, both before and after adjusting for age, sex, and race.

CONCLUSION

High exposure to ACEs was not associated with poorer weight loss outcomes, and participants with a large number of ACEs generally lost the anticipated amount of weight.

Eviction in early childhood and neighborhood poverty, food security, and obesity in later childhood and adolescence: Evidence from a longitudinal birth cohort

Eviction affects a substantial share of U.S. children, but its effects on child health are largely unknown. Our objectives were to examine how eviction relates to 1) children's health and sociodemographic characteristics at birth, 2) neighborhood poverty and food security at age 5, and 3) obesity in later childhood and adolescence. We analyzed data from the Fragile Families and Child Wellbeing Study, a longitudinal cohort of children born in 20 large U.S. cities. Children who lived in rental housing with known eviction histories and measured outcomes were included. We compared maternal and infant health and sociodemographic characteristics at the time of the child's birth. We then characterized the associations between eviction and neighborhood poverty and food security at age 5 and obesity at ages 5, 9, and 15 using log binomial regression with inverse probability of treatment and censoring weights. Of the 2556 children included in objective 1, 164 (6%) experienced eviction before age 5. Children who experienced eviction had lower household income and maternal education and were more likely to be born to mothers who were unmarried, smoked during pregnancy, and had mental health problems. Evicted and non-evicted children were equally likely to experience high neighborhood poverty at age 5 (prevalence ratio (PR) = 1.03, 95% CI 0.82, 1.29) but had an increased prevalence of low food security (PR = 2.16, 95% CI 1.46, 3.19). Obesity prevalence did not differ at age 5 (PR = 1.01; 95% CI 0.58, 1.75), 9 (PR = 1.08; 95% CI 0.715, 1.55); or 15 (PR = 1.05; 95% CI 0.51, 2.18). In conclusion, children who went on to experience eviction showed signs of poor health and socioeconomic disadvantage already at birth. Eviction in early childhood was not associated with children's likelihood of neighborhood poverty, suggesting that eviction may not qualitatively change children's neighborhood conditions in this disadvantaged sample. Though we saw evidence supporting an association with low child food security at age 5, we did not find eviction to be associated with obesity in later childhood and adolescence.

•

Children who experience eviction have health and socioeconomic disadvantages at birth.

•

Eviction was not associated with neighborhood poverty or childhood obesity.

•

Evicted children (vs. not) had over twice the prevalence of food insecurity at age 5.

•

Interventions to prevent eviction can protect children from hunger and adversity.

Practitioner Review: Twenty years of research with adverse childhood experience scores - Advantages, disadvantages and applications to practice

BACKGROUND

Adverse childhood experience (ACE) scores have become a common approach for considering childhood adversities and are highly influential in public policy and clinical practice. Their use is also controversial. Other ways of measuring adversity - examining single adversities, or using theoretically or empirically driven methods - might have advantages over ACE scores.

METHODS

In this narrative review we critique the conceptualisation and measurement of ACEs in research, clinical practice, public health and public discourse.

RESULTS

The ACE score approach has the advantages - and limitations - of simplicity: its simplicity facilitates wide-ranging applications in public policy, public health and clinical settings but risks over-simplistic communication of risk/causality, determinism and stigma. The other common approach - focussing on single adversities - is also limited because adversities tend to co-occur. Researchers are using rapidly accruing datasets on ACEs to facilitate new theoretical and empirical approaches but this work is at an early stage, e.g. weighting ACEs and including severity, frequency, duration and timing. More research is needed to establish what should be included as an ACE, how individual ACEs should be weighted, how ACEs cluster, and the implications of these findings for clinical work and policy. New ways of conceptualising and measuring ACEs that incorporate this new knowledge, while maintaining some of the simplicity of the current ACE questionnaire, could be helpful for clinicians, practitioners, patients and the public.

CONCLUSIONS

Although we welcome the current focus on ACEs, a more critical view of their conceptualisation, measurement, and application to practice settings is urgently needed.

Early life socioeconomic circumstances and cardiometabolic health in childhood: Evidence from the Generation XXI cohort

Social adversity is thought to become biologically embedded during sensitive periods of development which could set children on a trajectory of increased risk for later diseases. This study estimated the association between early socioeconomic circumstances and cardiometabolic biomarkers during childhood. We analyzed data from 2962 participants in the birth cohort Generation XXI. Early socioeconomic circumstances included parental education and occupation and household income measured at the child's birth; cardiometabolic biomarkers included a set of parameters that were determined at seven and 10years old. The association between early socioeconomic circumstances and cardiometabolic biomarkers in children aged seven and 10years old was estimated using generalized estimating equations. We observed, after adjustment for birth weight, sex, five-a-day fruit and vegetable intake and sedentary activity, that children with low educated mothers presented higher body mass index z-score (β=0.22; 95%CI: 0.12, 0.33), higher waist circumference (β=1.14; 95%CI: 0.55, 1.73) and increased systolic blood pressure z-score (β=0.15; 95%CI: 0.08, 0.22) at the age of seven. At 10years, children with mothers with low education, presented higher body mass index z-score (β =0.32; 95%CI: 0.21, 0.43), higher waist circumference (β=2.79; 95%CI: 1.94, 3.64), increased diastolic blood pressure z-score (β=0.11; 95%CI: 0.06, 0.17) and increased systolic blood pressure s-score (β=0.20; 95%CI: 0.12, 0.28). When repeated measures of cardiometabolic biomarkers were taken into account, the association between socioeconomic circumstances and cardiometabolic biomarkers remained significant. Low socioeconomic circumstances have a possible detrimental effect on children's cardiometabolic health. Thus, socioeconomic adversity might impact health outcomes already in the first decade of life, emphasizing the early social patterning of cardiometabolic health and the need of social policies targeting children and families to modify or reverse its negative impact on health.

Association of Adverse Childhood Experiences with Glycemic Control and Lipids in Children with Type 1 Diabetes

Adverse childhood experiences (ACE) have been associated with a greater prevalence of risky behaviors and chronic health conditions, such as diabetes in adulthood. While adolescents with risk taking behaviors experience worsening of diabetic metabolic control, it is yet to be determined whether glycemic management in children and adolescents is negatively and independently influenced by ACEs. This study examines the relationship between ACEs in children and adolescents with type 1 diabetes (T1DM) and glycemic control, BMI and lipids. For such children, we hypothesized that hemoglobin A1c (HbA1c) is positively correlated with ACE scores. Parents of children (age 2–18 years) with T1DM completed a validated ACE questionnaire. The associations between parent and child ACE score and HbA1c, lipids and BMI z-scores were assessed using linear regression. The prevalence of any ACE was 27.9% among children and 49.0% among parents. HbA1c was significantly higher in children who had exposure to three or more ACEs (β: 0.63 (4.5 mmol/mol); p = 0.02), in those who had a parent exposed to four or more ACEs (β: 0.87 (7.2 mmol/mol); p = 0.03), in children who had exposure to household incarceration (β: 0.62 (4.4 mmol/mol); p = 0.05) and children who witnessed or had been victim of violence in the neighborhood (β: 0.71 (5.4 mmol/mol); p = 0.02). ACEs were highly prevalent among children with T1DM and had a positive association with glycemic control.

Childhood exposure to violence is associated with risk for mental disorders and adult's weight status: a community-based study in Tunisia

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.

Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort

Background

Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset.

Methods

Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes.

Results

T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2–3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (OR_adj = 1.14; 95% CI 1.02–1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI).

Conclusion

ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.