Childhood Adversity and Cardiometabolic Outcomes

Authors:
Suglia SF, Koenen KC, Boynton-Jarrett R, et al.
Citation:
Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association. Circulation 2017;Dec 18:[Epub ahead of print].

The following are key points to remember from this American Heart Association scientific statement regarding childhood and adolescent adversity and cardiometabolic health outcomes:

  1. Childhood and adolescent adversity (hereby known as “childhood adversity”) includes broad categories of physical or emotional neglect or abuse, sexual abuse, household dysfunction, or more specific forms of adversity such as community violence, homelessness, peer bullying, poverty, discrimination, or death of family or friends.
  2. Cardiometabolic outcomes refer to obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease: the leading causes of US morbidity and mortality.
  3. In multiple literature reviews, childhood adversity has been associated with an increased risk of cardiometabolic disease. Childhood adversity may be affected by factors such as sex, socioeconomic status, race, ethnicity, and immigration status.
  4. Several studies suggest a dose-response relationship: more intense or severe adversity results in more serious adverse cardiometabolic outcomes. Some studies suggest a threshold effect, and one study identified a sensitive developmental period for the success of a therapeutic intervention.
  5. Mechanisms hypothesized to explain the relationship between childhood adversity and cardiometabolic disease include behavioral, mental health, and biological factors. These three factors can interact; for example, poor mental health may affect appetite and sleep.
  6. Behavioral factors include exercise or inactivity, diet, overeating, sleeping, and smoking.
  7. Mental health factors include substance use, development of post-traumatic stress disorder or mood and anxiety disorders that are associated with cardiometabolic disease, more persistent and treatment-refractory mental illness, the association of major depressive disorder and bipolar illness with accelerated atherosclerosis, and weight gain associated with some antipsychotic and mood-stabilizing drugs.
  8. Biological factors include stress-induced disruption of neuroendocrine, immune, metabolic, and autonomic responses. Activation of the hypothalamic-pituitary-adrenal axis results in altered glucocorticoid metabolism and immune function. Childhood adversity is associated with increased biomarkers of inflammation and may be associated with epigenetic changes. Stress affects hormones regulating appetite and energy balance.
  9. Limitations of the existing literature include lack of agreement on definitions of childhood adversity, few truly prospective studies, and limited identification of causative mechanisms. Most research has been cross-sectional and retrospective, and limited research is available regarding timing of childhood adversity, peer bullying, environmental conditions, or mediation models.
  10. Future research should utilize longitudinal prospective studies and modern epidemiological methods. Research should focus on evaluating modifiable resilience factors, vulnerability factors, and causation mechanisms; developing effective interventions; and identifying methods to screen individuals and populations for such interventions.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Diet, Hypertension, Smoking

Keywords: Adolescent, Child, Mental Health, Risk Factors, Depressive Disorder, Major, Stress Disorders, Post-Traumatic, Anxiety Disorders, Biological Factors, Social Class, Diet, Violence, Sex Offenses, Bullying, Obesity, Diabetes Mellitus, Type 2, Smoking, Hypertension, Atherosclerosis


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