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Obesity Risk for Female Victims of Childhood Sexual Abuse: A Prospective Study
Pediatrics
Abstract
Efforts are under way to articulate environmental, psychosocial, and biological conditions that may predispose the development and maintenance of obesity. There is increasing evidence that adverse childhood experiences such as childhood abuse may be implicated in the development of obesity. Given the dearth of prospective evidence for this link, the objective of this study was to track body mass across development (from childhood, through adolescence, and into young adulthood [ie, ages 6-27]) in a prospective, longitudinal study of abused and nonabused female subjects.
Height and weight were obtained for 84 female subjects with substantiated childhood sexual abuse and 89 demographically similar comparison female subjects at 6 points during development. Obesity status was examined at various stages during development, and body-mass growth trajectories were contrasted across the 2 groups. It was hypothesized that, in comparison with their nonabused peers, abused female subjects would be more likely to (1) manifest obesity by early adulthood and (2) manifest high-risk growth trajectories throughout development.
Obesity rates were not different across groups in childhood or adolescence. By young adulthood (ages 20-27), abused female subjects were significantly more likely to be obese (42.25%) than were comparison female subjects (28.40%). Hierarchical linear modeling growth-trajectory analyses indicated that abused female subjects, on average, acquired body mass at a significantly steeper rate from childhood through young adulthood than did comparison female subjects after controlling for minority status and parity.
Psychosocial difficulties (eg, depression) and psychobiological conditions (eg, hypothalamic-pituitary-adrenal axis dysregulation) that have been shown to be related to both childhood abuse and obesity may help to explain these results. The identification of high-risk growth trajectories may improve health outcomes for victims. Systematic study of the mechanistic pathways and mediating processes that would help to explain the connection between childhood sexual abuse and later obesity is encouraged.
... Most sources sought to quantify associations between specific forms of sexual violence affecting children, including girls, and indicators of subsequent nutrition status in childhood and adolescence. Some studies conducted analyses that permit more nuanced understandings of causal mechanisms including use of community-based comparator groups [56][57][58][59]; moderation by cortisol reactivity [57]; moderation by HPA axis attenuation [41]; interaction of caregiver abuse and IPV/dating violence [60]; interaction of child marriage and age at first pregnancy [61]; and stratification by age [62] and developmental period [56]. ...
... Most sources sought to quantify associations between specific forms of sexual violence affecting children, including girls, and indicators of subsequent nutrition status in childhood and adolescence. Some studies conducted analyses that permit more nuanced understandings of causal mechanisms including use of community-based comparator groups [56][57][58][59]; moderation by cortisol reactivity [57]; moderation by HPA axis attenuation [41]; interaction of caregiver abuse and IPV/dating violence [60]; interaction of child marriage and age at first pregnancy [61]; and stratification by age [62] and developmental period [56]. ...
... Rigorous measurement of GBV and nutrition was assessed using a variety of indicators including, whether the variables were clearly defined, accurately measured and applied consistently, measurements were justified and appropriate for answering the research question, measurements reflected what they are supposed to measure, measures were collected using validated and reliability tested tools/instruments/questions, variables were measured using 'gold standard' tools, and questionnaires were pre-tested prior to data Table 5 presents participant recruitment and sample details. Gender-stratified samples ranged from under 100 females [56] to over 26,000 [63]. The range of sample sizes is a reflection of the study designs utilized; studies with smaller sample sizes focused on newly reported cases of CSA obtained from Child Protective Services [41,[56][57][58][59], or other similar organizations such as a clinic for victims of child abuse [64], and larger sample sizes pertained to secondary data analyses of nationally representative and/or longitudinal datasets of child and adolescent health [60,62,63,[65][66][67][68][69][70][71]. ...
Background
An emerging evidence base has explored the nutritional consequences of gender-based violence (GBV) perpetrated against girls during childhood/adolescence. We conducted a rapid evidence assessment of quantitative studies describing associations between GBV and girls’ nutrition.
Methods
We adapted systematic review methods and included empirical, peer-reviewed studies, published after 2000 (until November, 2022), that were written in Spanish or English and reported quantitative associations between girls’ exposure to GBV and nutrition outcomes. A variety of GBV forms were considered: childhood sexual abuse (CSA), child marriage, preferential feeding of boys, sexual IPV and dating violence. Nutrition outcomes included anemia, underweight, overweight, stunting, micronutrient deficiencies, meal frequency, and dietary diversity.
Results
In total, 18 studies were included, 13 of which were conducted in high-income countries. Most sources utilized longitudinal or cross-sectional data to quantify associations between CSA, sexual assault, and intimate partner/dating violence and elevated BMI/overweight/obesity/adiposity. Findings suggest that CSA perpetrated by parents/caregivers is associated with elevated BMI/overweight/obesity/adiposity via cortisol reactivity and depression; this relationship may be compounded by additional intimate partner/dating violence in adolescence. The effects of sexual violence on BMI are likely to emerge during a sensitive period of development between late adolescence and young adulthood. Emerging evidence was found regarding the relationship between child marriage (and the related exposure: age at first pregnancy) and undernutrition. The association between sexual abuse and reduced height and leg length was inconclusive.
Conclusion
Given that only 18 studies were included, the relationship between girls’ direct exposure to GBV and malnutrition has received little empirical attention, especially with respect to studies conducted in LMIC and fragile settings. Most studies focused on CSA and overweight/obesity, where significant associations were found. Future research should test the moderation and mediation effects of intermediary variables (depression, PTSD, cortisol reactivity, impulsivity, emotional eating) and consider sensitive periods of development. Research should also explore the nutritional consequences of child marriage.
... 11 A prospective study of women in Washington, DC, found that women who experienced CSA were almost 3 times more likely to be obese by young adulthood. 12 Larger samples, including data from the 2011 Behavioral Risk Factor Surveillance System survey, showed that CSA was associated with a 59% increased adjusted odds ratio of obesity. 13 Similarly, a 2011 longitudinal study and a 2010 secondary analysis found that intrafamilial CSA was associated with obesity in adulthood. ...
... Population-based, national, prospective, and longitudinal studies have found an increased risk of obesity in adults who experienced CSA. [11][12][13][14][15] Secondary analysis of a large cross-sectional study of Pittsburgh-based women showed that on multivariate analysis, intrafamilial CSA was independently associated with obesity ( p = .014). 15 This finding was reiterated in a 2019 umbrella review (OR = 1.4, ...
Objective
The aim of the study is to assess the relationship between childhood sexual abuse, obesity, and vulvodynia among adult women participating in a population-based longitudinal vulvodynia study.
Materials and Methods
Surveys assessed health status, diagnoses, risk factors, and screening test outcomes for women with vulvodynia. Associations between childhood sexual abuse (CSA) and obesity, CSA and vulvodynia, and obesity and vulvodynia were investigated. A multivariate model was used to determine if obesity mediates and/or modifies the relationship between CSA and vulvodynia.
Results
Of 2,277 women participating in the study, 1,647 completed survey data on CSA at 18 months, body mass index at 24 months, and vulvodynia over the first 54 months of the survey. Mean age was 50.9 ± 15.8 years. Overall, race and ethnicity were 77.4% White, 15.7% Black, 2.4% Hispanic, and 4.5% other. Five hundred thirty-nine participants (32.7%) were obese (body mass index >30) and 468 (28.4%) were overweight. Physical CSA before age of 18 years was reported by 20.0% ( n = 329). During the study, 22.0% ( n = 362) screened positive for vulvodynia on one or more surveys. After controlling for demographic variables, both obesity and screening positive for vulvodynia were associated with a history of CSA before age of 18 years ( p = .013 and p < .001, respectively), but obesity was not associated with screening positive for vulvodynia ( p = .865). In addition, multivariate analysis indicated no mediation of the CSA/vulvodynia relationship by obesity.
Conclusions
Although obesity and vulvodynia were independently associated with a history of CSA, obesity did not mediate or modify the relationship between CSA and vulvodynia in adulthood.
... Furthermore, we did not find any associations between individual ACEs and measures of adiposity such as BMI or waist circumference, unlike several prior studies (Boynton-Jarrett et al., 2012;Hemmingsson et al., 2014;Hughes et al., 2017). One reason for our lack of associations is that unlike prior studies, we statistically controlled for maternal BMI before childbirth, which is causally associated with offspring adiposity (Noll et al., 2007;Richmond et al., 2017). We also controlled for early life factors which are associated with CVD risk in later life such as childhood socioeconomic position and birth weight, which prior studies have tended not to do (Lynch & Smith, 2005;Noll et al., 2007). ...
... One reason for our lack of associations is that unlike prior studies, we statistically controlled for maternal BMI before childbirth, which is causally associated with offspring adiposity (Noll et al., 2007;Richmond et al., 2017). We also controlled for early life factors which are associated with CVD risk in later life such as childhood socioeconomic position and birth weight, which prior studies have tended not to do (Lynch & Smith, 2005;Noll et al., 2007). Additionally, some studies that have found associations between child maltreatment and BMI have relied on self-report measures of BMI and have rarely extended beyond young adulthood (Shin & Miller, 2012). ...
Studies that have examined associations between adverse childhood experiences (ACEs) and cardiometabolic biomarkers in adulthood are limited as they mainly focus on childhood maltreatment. This study aimed to examine the association between a range of prospectively and retrospectively reported ACEs and cardiometabolic biomarkers in mid-adulthood. Multiply-imputed data on 8511 participants from the National Child Development Study (1958 British birth cohort) were used. ACEs were prospectively reported at ages 7, 11 and 16, and retrospectively reported at age 33/44/45. Cardiometabolic outcomes assessed at age 44/45 included glycated haemoglobin (HbA1c), cholesterol (total, low- and high-density lipoprotein), triglycerides, blood pressure (systolic and diastolic), body mass index, waist circumference and metabolic syndrome. Parental separation/divorce, physical neglect, emotional neglect and psychological abuse were associated with lower HDL cholesterol. Parental offending and physical neglect were associated with higher triglyceride concentrations. Parental offending was also associated with increased HbA1c. Exposure to 2+ (vs. 0) prospective ACEs was associated with lower HDL cholesterol. All these associations were after adjustment for sex and multiple early life factors. To conclude, several individual ACEs are associated with poorer cardiometabolic risk factor profiles in mid-adulthood. Furthermore, exposure to two or more prospective ACEs is associated with lower HDL cholesterol concentrations in mid-adulthood.
... Elevated levels of CRP are also associated with cardiovascular disease (Kiecolt-Glaser 2015; Ananthan & Lyon 2020;Pitharoulli et al., 2021) and obesity (Matthews et al., 2014), and certain cancers (Ananthan & Lyon 2020). In addition, elevated CRP concentrations (Keicolt-Glaser 2015; Ananthan & Lyon 2020;Pitharoulli et al., 2021) in traumatized individuals later in life can be associated with not only abuse histories but also with elevated measures of body mass index (BMI), anxiety, as well as depressive symptoms (Noll et al., 2007). ...
... Childhood sexual abuse has pernicious effects on later life mental and physical health, including a) increased prevalence of later life mood disorders and elevations in BMI (Moraes et al., 2017) and b) increased association between CRP levels and obesity in later life depression (Pitharouli et al., 2021). Because elevated CRP and BMI are recognized as biophysical consequences of abuse (Noll et al., 2007;Matthews et al., 2014;Kiecolt-Glaser 2015;Ananthan & Lyon, 2020;Pitharoulli et al., 2021), we examined associations between BMI and CRP with CTQ scores of abuse history subtypes. ...
Background:
Early life adversity such as childhood emotional, physical, and sexual trauma is associated with later-life psychiatric and chronic medical conditions, including elevated inflammatory markers. Although previous research suggests a role for chronic inflammatory dysfunctions in several disease etiologies, specific associations between childhood trauma types and later life inflammation and health status are poorly understood.
Methods:
We studied patients (n=280) admitted to a psychiatric rehabilitation center. Self-reported histories of childhood emotional, physical, and sexual trauma were collected with a standard instrument. At the time of admission, we also assessed individuals' body mass index (BMI) and collected blood samples used to examine inflammatory marker C-reactive protein (CRP) levels.
Results:
The prevalence of all three types of abuse was relatively high, at 21% or more. 50% of the sample had elevations in CRP, with clinically significant elevations in 26%. We found that compared to a history of emotional or physical abuse, a history of childhood sexual trauma was more specifically associated with elevated CRP. This result held up when using linear regressions to examine the contribution of BMI.
Limitation:
Our sample is relatively young, with an average age of 27.2 years and minimal representation of ethnic and racial minority participants.
Conclusion:
Relative to childhood emotional and physical trauma, childhood sexual trauma may lead to elevated inflammatory responses, confirmed in our finding of an association between CRP and sexual abuse. Future studies need to assess the causal link between childhood sexual trauma and poorer health outcomes later in life.
... Possible explanations for the lack of association between depressive symptoms and obesity in the current study may be sample characteristics, developmental timing, and/or the cross-sectional design of the study. Prior work shows that the effects of abuse on obesity are more robust in young and middle adulthood (e.g., Danese & Tan, 2014;Noll et al., 2007). Our sample of children was on average about 10 years old. ...
Objetivo: El maltrato infantil se ha vinculado con la obesidad a lo largo de la vida. El objetivo del presente estudio fue evaluar dos mecanismos contrapuestos que subyacen a la asociación entre la exposición al maltrato infantil y la obesidad infantil. En concreto, examinamos si los síntomas depresivos y la proporción de cortisol y DHEA, dos hormonas esenciales para el sistema de respuesta al estrés, mediaban la relación entre el maltrato infantil y la obesidad. Métodos: Este estudio empleó una muestra de 1,229 niños en situación de pobreza (63.5% Afroamericanos, 49.1% mujeres biológicas). Aproximadamente el 40% de los participantes estuvo expuesto a abuso físico, sexual o emocional en la infancia (n = 471, 38.3%), según consta en los registros codificados del Servicio de Protección Infantil. Se midieron los niveles de cortisol y DHEA con muestras de saliva tomadas por la mañana durante varios días. Resultados: Los resultados del modelado de ecuaciones estructurales indicaron que los niños con antecedentes de abuso presentaron una relación cortisol/DHEA más baja, lo cual se asoció con una mayor probabilidad de obesidad infantil. Cabe destacar que esta vía se mantuvo al controlar la vía de síntomas depresivos, lo que indica la influencia única de la desregulación adrenocortical en la relación entre abuso infantil y obesidad. Si bien el abuso infantil se asoció con mayores síntomas depresivos, estos no se relacionaron con la obesidad. Conclusiones: Estos hallazgos subrayan que la adversidad infantil puede ser profunda y afectar la salud, incluso desde la infancia, y destacan que los enfoques basados en el trauma para la atención clínica de niños con antecedentes de abuso representan una vía prometedora para la prevención de la obesidad. Prevenir el abuso infantil y apoyar a los niños después de la exposición al abuso pueden ser puntos críticos de intervención para la prevención de la obesidad.
... Household dysfunction connected to ACEs may detract from developing routines and behaviors associated with maintaining a healthy weight [35]. While research findings are not entirely consistent, certain types and/or frequency of ACEs -such as sexual abuse among women and higher number of ACEs experienced -are associated with higher risk for the development of obesity [26,49,50]. ...
Evaluation of relevant psychosocial variables is an important aspect of comprehensive, high-quality metabolic and bariatric surgery (MBS) care. Given the high rates of adverse childhood experience (ACEs) and other forms of trauma experienced later in life reported by individuals with class III obesity, it is time to apply the principles of trauma-informed care to the multidisciplinary care of MBS patients. This narrative review begins with a summary of the literature on the psychosocial functioning of individuals who present for MBS. Emphasis is placed upon the relationship between ACEs, class III obesity, and MBS. Trauma-informed care is defined, and its principles are applied to the MBS care continuum. The paper ends with a recommendation on how the field of MBS can integrate trauma-informed care into clinical practice and future research.
... In 2022, over 60,000 children in the U.S. were determined to be victims of CSA by statewide child protection service systems [5]; the highest prevalence observed among children aged 7-13 years old [6]. CSA is associated with life-long biopsychosocial consequences [7] including psychological [8][9][10][11][12][13][14][15][16][17], biological [18][19][20][21], and interpersonal [22,23] outcomes, altogether conferring a lifetime economic burden estimated to exceed $9.3 billion [24]. CSA is not limited to a particular gender, socioeconomic class, or racial groupall children can be at risk for victimization. ...
Background
Child sexual abuse (CSA) affects 1 in 5 girls and 1 in 12 boys before age 18. Universal school-based prevention programs are an effective and cost-efficient method of teaching students an array of personal safety skills. However, the programmatic reach of universal school-based programs is limited by the inherent reliance on the school infrastructure and a dearth of available alternative delivery modalities.
Methods
The design for this study will use a rigorous cluster randomized design (N = 180 classrooms) to determine the equivalence of two delivery modalities of Safe Touches: as usual vs. modified. The as usual workshop will be delivered by two facilitators with live puppet skits (n = 90). Whereas, the modified workshop will be delivered by one facilitator using prerecorded skit videos (n = 90). We will determine the equivalence by measuring concept learning acquisition preworkshop to immediate postworkshop (Aim 1) and retention at 3-months postworkshop (Aim 2) among students in classrooms that receive the as usual or modified workshops. To conclude equivalence, it is imperative to also examine factors that may impact future dissemination and implementation, specifically program adoption among school personnel and implementation fidelity between the two modalities (Aim 3).
Conclusion
Study findings will inform the ongoing development of effective CSA prevention programs and policy decisions regarding the sustainable integration of such programs within schools.
Clinical trial registration
NCT06195852.
... There is evidence of a link between sexual abuse and OSA (Krakow et al., 2002(Krakow et al., , 2015Rich-Edwards et al., 2012), raising the question of whether women with OSA are more likely to have experienced childhood sexual abuse. Given that obesity is also another well-established risk factor for OSA (Jehan et al., 2017), a possible underlying mechanism could be childhood trauma-associated weight gain (Gooding et al., 2015), which is also common in women (Felitti, 1993;Noll et al., 2007;Midei et al., 2010;Smith et al., 2010;Richardson et al., 2014;Gooding et al., 2015). The link between childhood sexual abuse and obesity is well established, as is the obesity-OSA connection; the question is whether childhood sexual trauma is an independent risk factor for OSA, specifically in women. ...
Study objectives
Women who experienced childhood sexual abuse have higher rates of obesity, a risk factor for obstructive sleep apnea (OSA). We assessed if prior childhood sexual abuse was more common in women with OSA vs. those in the control group, with possible mediation by obesity.
Methods
In a secondary analysis of a larger project, we studied 21 women with OSA (age mean ± SD 59 ± 12 years, body mass index [BMI] 33 ± 8 kg/m ² , respiratory event index [REI] 25 ± 16 events/hour, and Epworth Sleepiness Scale [ESS] score 8 ± 5) and 21 women without OSA (age 53 ± 9 years, BMI 25 ± 5 kg/m ² , REI [in 7/21 women] 1 ± 1 events/hour, and ESS score, 5 ± 3). We evaluated four categories of trauma (general, physical, emotional, and sexual abuse) with the Early Trauma Inventory Self-Report–Short Form (ETISR-SF). We assessed group differences in trauma scores with independent samples t -tests and multiple regressions. Parametric Sobel tests were used to model BMI as a mediator for individual trauma scores predicting OSA in women.
Results
Early childhood sexual abuse reported on the ETISR-SF was 2.4 times more common in women with vs. without OSA ( p = 0.02 for group difference). Other trauma scores were not significantly different between women with and without OSA. However, BMI was a significant mediator ( p = 0.02) in predicting OSA in women who experienced childhood physical abuse.
Conclusion
Childhood sexual abuse was more common in women with vs. without OSA. BMI was a mediator for OSA of childhood physical but not sexual abuse. This preliminary hypothesis-generating study suggests that there may be physiological impacts of childhood trauma in women that predispose them to OSA.
... Also, since CORT participates in lipid accumulation [41], it might facilitate the elevated body weight of adults of the two postnatal stress models. The association between an impaired development of neuroendocrine axis and obesity has also been observed in humans [38,[42][43][44][45][46][47], and explains the 17% prevalence of obesity among adults experiencing early-life stress. Our results are helpful to understand that a specific outcome, such as obesity and hyperphagia, may result from various postnatal adversities that differ in type or intensity of the inflicted stress during early periods of life. ...
Background
Different types of stress inflicted in early stages of life elevate the risk, among adult animals and humans, to develop disturbed emotional-associated behaviors, such as hyperphagia or depression. Early-life stressed (ELS) adults present hyperactivity of the hypothalamus-pituitary-adrenal (HPA) axis, which is a risk factor associated with mood disorders. However, the prevalence of hyperphagia (17%) and depression (50%) is variable among adults that experienced ELS, suggesting that the nature, intensity, and chronicity of the stress determines the specific behavioral alteration that those individuals develop.
Methods
We analyzed corticosterone serum levels,Crh, GR, Crhr1 genes expression in the hypothalamic paraventricular nucleus, amygdala, and hippocampus due to their regulatory role on HPA axis in adult rats that experienced maternal separation (MS) or limited nesting material (LNM) stress; as well as the serotonergic system activity in the same regions given its association with the corticotropin-releasing hormone (CRH) pathway functioning and with the hyperphagia and depression development.
Results
Alterations in dams’ maternal care provoked an unresponsive or hyper-responsive HPA axis function to an acute stress in MS and LNM adults, respectively. The differential changes in amygdala and hippocampal CRH system seemed compensating alterations to the hypothalamic desensitized glucocorticoids receptor (GR) in MS or hypersensitive in LNM. However, both adult animals developed hyperphagia and depression-like behavior when subjected to the forced-swimming test, which helps to understand that both hypo and hypercortisolemic patients present those disorders.
Conclusion
Different ELS types induce neuroendocrine, brain CRH and 5-hydroxytriptamine (5-HT) systems’ alterations that may interact converging to develop similar maladaptive behaviors.
... Lack of nutrition not only leads to malnutrition but also challenges the physical development of the affected children leading to the development of failure to thrive. Indeed, child maltreatment increases the predisposition of abused children to obesity in their later phases of life [68,69]. Also, physical misconduct and violence against children result in brain dysfunction, deafness, complete blindness, and death. ...
... Notwithstanding, the study was carried out in an exclusively female sample, a tenth of the size of NESDA and the authors did not report how CT across all types was linked to MetS incidence over time. Essentially, a large body of the literature supports the link between CT and metabolic abnormalities and indicate that CT-related metabolic abnormalities may have their onset in early to mid-adulthood (Noll, Zeller, Trickett, & Putnam, 2007;Power et al., 2015;Su et al., 2015). Taken together, these findings suggest that individuals with a history of CT, compared to their peers without CT, may undergo a faster metabolic deterioration in early to midadulthood, leading to a worse metabolic profile which stabilizes over time. ...
Background
Childhood trauma (CT) has been cross-sectionally associated with metabolic syndrome (MetS), a group of biological risk factors for cardiometabolic disease. Longitudinal studies, while rare, would clarify the development of cardiometabolic dysregulations over time. Therefore, we longitudinally investigated the association of CT with the 9-year course of MetS components.
Methods
Participants ( N = 2958) from the Netherlands Study of Depression and Anxiety were assessed four times across 9 years. The CT interview retrospectively assessed childhood emotional neglect and physical, emotional, and sexual abuse. Metabolic outcomes encompassed continuous MetS components (waist circumference, triglycerides, high-density lipoprotein [HDL] cholesterol, blood pressure [BP], and glucose) and count of clinically elevated MetS components. Mixed-effects models estimated sociodemographic- and lifestyle-adjusted longitudinal associations of CT with metabolic outcomes over time. Time interactions evaluated change in these associations.
Results
CT was reported by 49% of participants. CT was consistently associated with increased waist ( b = 0.32, s.e. = 0.10, p = 0.001), glucose ( b = 0.02, s.e. = 0.01, p < 0.001), and count of MetS components ( b = 0.04, s.e. = 0.01, p < 0.001); and decreased HDL cholesterol ( b = −0.01, s.e. <0.01, p = .020) and systolic BP ( b = −0.33, s.e. = 0.13, p = 0.010). These associations were mainly driven by severe CT and unaffected by lifestyle. Only systolic BP showed a CT-by-time interaction, where CT was associated with lower systolic BP initially and with higher systolic BP at the last follow-up.
Conclusions
Over time, adults with CT have overall persistent poorer metabolic outcomes than their non-maltreated peers. Individuals with CT have an increased risk for cardiometabolic disease and may benefit from monitoring and early interventions targeting metabolism.
... This contrasts with a recent systematic review and may be due to the high-risk LONGSCAN sample and study measures. Past studies finding a relationship between sexual abuse and obesity have used samples receiving inpatient psychiatric care (Isohookana et al., 2016;Keeshin et al., 2013) or smaller, localized samples comparing youths with CPS records of sexual abuse to those with no child welfare records (Noll et al., 2007;Schneiderman et al., 2015). Those cases may differ in notable ways from LONGSCAN's high-risk, national sample of youths. ...
Objective: Obesity and substance use are leading preventable causes of mortality, yet their origins in violence remain poorly understood. This study examined child maltreatment in relation to obesity and symptoms consistent with substance use disorder (SUD) in late adolescence, determining the roles of the child maltreatment type and timing, and gender. Method: The sample (N = 1,161) was drawn from the Longitudinal Studies of Child Abuse and Neglect. Obesity and SUD were measured at 18 years. Lifetime child protective services records and youth self-reports indicated physical abuse, sexual abuse, supervisory neglect, failure-to-provide neglect, and emotional maltreatment during early childhood, middle childhood, and adolescence. Results: In the overall sample, emotional maltreatment during adolescence was associated with obesity (OR = 2.03, 95% CI [1.25, 3.30]) and SUD (OR = 2.00, 95% CI [1.20, 3.35]), and adolescent physical abuse with obesity (OR = 2.20, 95% CI [1.36, 3.58]). In girls, early childhood physical abuse was associated with SUD (OR = 2.35, 95% CI [1.08, 5.12]), and emotional maltreatment during adolescence with obesity (OR = 2.16, 95% CI [1.10, 4.23]) and SUD (OR = 3.21, 95% CI [1.37, 7.3 5]). Adolescent physical abuse and obesity were associated in boys (OR = 3.18, 95% CI [1.45, 6.98]). Gender moderation was identified for an inverse relationship between supervisory neglect and obesity in girls (OR = .26, 95% CI [.07, .99]). Conclusions: Type and timing contribute to the effects of child maltreatment, contingent upon gender. Intervention focused on adolescent emotional maltreatment may reduce both SUD and obesity.
... However, the population studied comprised predominantly overweight or obese patients at a specialized lymphology clinic (▶ Fig. 2 [26]). Such a connection is well known for obesity [27,28,29]. ...
This review summarizes current data to bring the discussion about lipoedema, which was conducted emotionally by Bertsch and Erbacher in their series of articles “Lipoedema – Myths and Facts”, back to a factual level.
The issue of progression cannot be answered from the available data.
The issue of psychological disorders preceding the onset of lipohyperplasia dolorosa (LiDo), as postulated by Erbacher and Bertsch, has not been clarified overall.
There are no valid data that LiDo alone leads to increased fluid retention in the affected extemitic segments. “Lipolymphoedema,” defined as stage VI, represents an unfortunate connection of LiDo with obesity-associated lymphoedema in the presence of coincident obesity. Nevertheless, complex physical decongestive therapy or at least compression therapy is likely to show positive effects if decongestive effects are disregarded.
Probably one of the biggest problems of the disease LiDo is the coincident occurrence of overweight and obesity. This obesity develops independently of LiDo and masks the disproportionate fat distribution disorder of LiDo. So far, there is no evidence that weight loss has an effect on the symptoms typical of LiDo, but of course on the coincident obesity.
... In particular, childhood sexual abuse is experienced more frequently by women than men and can increase the risk of developing many sleep disorders [2][3][4][5][6][7][8][9]. Given obesity is also another well-established risk factor for OSA [10], a possible underlying mechanism could be childhood trauma-associated weight gain [11], also common in women [11][12][13][14][15][16]. The link between childhood sexual abuse and obesity is well established, as is the obesity-OSA connection; the question is whether childhood sexual trauma is an independent risk factor for OSA. ...
Study objectives. Women who experienced childhood sexual abuse have higher rates of obesity, a risk factor for obstructive sleep apnea (OSA). We assessed if prior childhood sexual abuse was more common in women with OSA vs. control, with possible mediation by obesity.
Methods. We studied 21 women with OSA (age mean±s.d. 59±12 years, body mass index (BMI) 33±8 kg/m², respiratory event index [REI] 25±16 events/hour, Epworth Sleepiness Scale [ESS] 8±5) and 21 women without OSA (age 53±9 years, BMI 25±5 kg/m², REI (in 7/21 women) 1±1 events/hour, ESS 5±3). We evaluated four categories of trauma (general trauma, physical, emotional, and sexual abuse) with the early trauma inventory self-report-short form (ETISR-SF). We assessed group differences in trauma scores with independent samples t-tests and multiple regressions. Parametric Sobel tests were used to model BMI as a mediator for individual trauma scores predicting OSA in women.
Results. Early childhood sexual abuse reported on the ETISR-SF was 2.4 times more common in women with vs. without OSA (p=0.02 for group difference). Other trauma scores were not significantly different between women with and without OSA. However, BMI was a significant mediator (p=0.02) in predicting OSA in women who experienced childhood physical abuse.
Conclusions. Childhood sexual abuse was more common in a group of women with OSA than those without OSA. Additionally, BMI was a mediator for OSA of childhood physical but not sexual abuse. There may be physiological impacts of childhood trauma in women that predispose them to OSA.
... Many of these negative outcomes are also comorbid, with obesity increasing the prevalence and symptom severity of fibromyalgia, as well as the incidence of anxiety and depression (14). Males and females exposed to physical and sexual abuse early in life are two times more likely to develop severe obesity (15) and have an average body weight nearly nine pounds higher than their unabused peers (12,(16)(17)(18). ELS exposure, which can occur in many forms including neglect, abuse, and premature birth, is highly prevalent in the United States as over 64% of the adult population reports at least one adverse childhood experience (9). ...
Exposure to stress early in life has been associated with adult-onset co-morbidities such as chronic pain, metabolic dysregulation, obesity, and inactivity. We have established an early life stress model using neonatal maternal separation (NMS) in mice, which displays evidence of increased body weight and adiposity, widespread mechanical allodynia, and hypothalamic-pituitary-adrenal axis dysregulation in male mice. Early life stress and consumption of a western style diet contribute to the development of obesity, however, relatively few pre-clinical studies have been performed in female rodents, which are known to be protected against diet induced obesity and metabolic dysfunction. In this study we gave naïve and NMS female mice access to a high-fat/high-sucrose (HFS) diet beginning at 4 weeks of age. Robust increases in body weight and fat were observed in HFS-fed NMS mice during the first 10 weeks on the diet, driven partly by increased food intake. Female NMS mice on a HFS diet showed widespread mechanical hypersensitivity compared to either naïve mice on a HFS diet or NMS mice on a control diet. HFS diet-fed NMS mice also had impaired glucose tolerance and fasting hyperinsulinemia. Strikingly, female NMS mice on a HFS diet showed evidence of hepatic steatosis with increased triglyceride levels and altered glucocorticoid receptor levels and phosphorylation state. They also exhibited increased energy expenditure as observed via indirect calorimetry and expression of pro-inflammatory markers in perigonadal adipose. Altogether, our data suggest that early life stress exposure increased the susceptibility of female mice to develop diet-induced metabolic dysfunction and pain-like behaviors.
... In humans, neglectful parental behavior has been associated with an elevated risk of obesity in childhood (Whitaker et al., 2007) and adolescence (Shin & Miller, 2012). Childhood sexual and physical abuse is associated with increased risks of obesity in adulthood (Bentley & Widom, 2009;Noll et al., 2007). Long-term neglect and emotional abuse have also been found to predict growth failure in height and weight in preschool-aged boys (Oliván, 2003). ...
In cross‐sectional analyses, early institutional care is associated with shorter stature but not obesity during puberty in children adopted into US families. We examined whether shorter stature and leaner body composition in youth adopted internationally from institutions would continue as puberty progressed. We also examined whether current psychosocial stress would moderate the association between early institutional deprivation and growth during adolescence. Using an accelerated longitudinal design and linear mixed‐effects models, we examined the height and body mass index (BMI) of 132 previously institutionalized (PI) and 176 nonadopted (NA) youth. We examined youth aged 7–15 at the beginning of the study three times across 2 years. Nurses assessed anthropometrics and pubertal status. Current psychosocial stress was measured using the Youth Life Stress Interview. Our results indicated that PI youth remained shorter and leaner across three assessments than NA youth. However, age‐and‐sex‐adjusted BMI increased faster in PI youth. Psychosocial stress during puberty predicted greater age‐and‐sex‐adjusted BMI, but this effect did not differ by group. The gap in BMI but not height appears to close between PI and NA youth. Higher psychosocial stress was associated with higher BMI during puberty.
... In a meta-review of longterm physical health consequences of CSA, Irish and her colleagues (2010) found that males and females with a CSA history reported more complaints of general health prob lems, gastrointestinal disorders, gynecologic or reproductive disorders, pain, cardiopul monary symptoms, and obesity. Previous research confirmed a strong correlation be tween child abuse (physical and sexual) and obesity in a prospective longitudinal sample of girls (Noll et al., 2007;Williamson et al., 2002). Rich-Edwards and her colleagues (2010) found that physical and sexual abuse in childhood and adolescence was highly associated with type 2 diabetes in a large nationally representative sample of women. ...
Incest is recognized as a societal taboo in many cultures. Despite customs, laws, and moral edicts that forbid sex between familial adults and children or minors and adults, incest continues to occur. Although incidence rates have generally declined over the last three decades, incest is still a prevalent problem in society. The primary focus of this article is incest between adults and children, between siblings, and between children in the United States. The article provides content on the complex interplay of individual, family, and cultural structures that shape survivors’ lives using an ecological, person-in-environment perspective and an examination of the clinical and empirical forces that drive assessment, evaluation, and treatment approaches in support of culturally informed trauma recovery and healing.
... In the USA, 61,000 children were victims of a substantiated report of CSA in 2019 alone (US Department of Health & Human Services Administration for Children and Families, 2021); it is estimated that 27% of females and 5% of males will experience CSA before age 18 (Finkelhor et al., 2014). Those who experience CSA are at particular risk of lifelong adverse psychosocial outcomes (Noll, 2021), including risky sexual behaviors (Skinner et al., 2016), teenage motherhood (Noll & Shenk, 2013;Noll et al., 2019), and increased behavioral health concerns (e.g., depression and substance misuse; Herrenkohl et al., 2013;Hussey et al., 2006), as well as negative physical health outcomes such as early pubertal timing (Noll et al., 2017) and obesity (Noll et al., 2007). All told, the lifetime economic obligation of CSA in the USA is estimated to exceed $9.3 billion (Letourneau et al., 2018). ...
Cost analyses are used to determine overall costs of implementing evidence-based programming and may help decision makers determine how best to allocate finite resources. Child sexual abuse (CSA), regularly viewed as a human rights violation, is also a public health concern estimated to impact 27% of females and 5% of males by age 18. Universal, school-based CSA programs are one prevailing prevention strategy. However, there are no known cost analyses of school-based CSA prevention programming, thereby limiting potential scalability. Using the ingredients method, this cost analysis presents the findings of implementing Safe Touches, an evidence-based universal prevention program, across four sites (i.e., counties) in one mid-Atlantic state. Reaching a total of 14,235 s grade students, results indicate an average cost of 859, an average district cost of 154,243. There was a noted decrease in costs when more students were reached, suggesting a need to focus efforts on bolstering the reach of implementation efforts. Sensitivity analyses explored variations in implementation constraints such as personnel and facilities suggesting a range of per-student costs (lower-bound per-student cost = 64). Findings presented herein may be used to inform future universal CSA prevention efforts by providing detailed information about the costs of large-scale implementation of an evidence-based program among elementary-aged children.
... The associations between sexual abuse and BMI in females are in line with a study identifying higher increases in BMI between childhood and young adulthood among females who did experience sexual abuse as opposed to females who did not (Noll et al., 2007). The transition to adulthood seems to be a crucial period for the emergence of changes in BMI development following sexual abuse in females. ...
We examined whether childhood abuse is related to body mass index (BMI) in young adults and whether this relationship is mediated by depression and anxiety. Data are from the Dutch longitudinal cohort study TRAILS (n females = 836, n males = 719). At wave 4, childhood sexual, physical and verbal abuse, and lifetime major depressive disorder (MDD) and generalized anxiety disorder (GAD) were assessed. BMI was measured at wave 4 and 5 (mean age = 19.2/22.4 years). Sex-stratified structural equation models were estimated. Females who had experienced sexual abuse had a higher BMI at wave 4 (B = 0.97, 95%CI = [−0.01,1.96]) and a higher increase in BMI between wave 4 and 5 (B = 0.52, 95%CI = [0.04,1.01]) than females who had not experienced sexual abuse. Additionally, MDD and BMI at wave 4 were related in females (B = 1.35, 95%CI = [0.52,2.18]). MDD mediated the relationship between sexual abuse and BMI at wave 4 in females. In addition, sexual abuse moderated the relationship between MDD and BMI at wave 4. The relationship was stronger among females who had experienced sexual abuse than among females who had not. Prevention of BMI changes among females who experienced sexual abuse may thus be warranted, particularly when they developed MDD. MDD treatment, such as abuse-focused psychotherapy, may aid this prevention.
... Early-life adversity is a potent risk factor for childhood obesity. Longitudinal and cross-sectional studies demonstrate exposure to childhood maltreatment (CM; e.g., physical/sexual abuse and neglect) is associated with accelerated increases in BMI through adolescence and early adulthood, thereby elevating risk of obesity in adulthood [15][16][17] . Differences in epigenetic programming offer an intriguing possibility to further account for this association. ...
New insights into mechanisms linking obesity to poor health outcomes suggest a role for cellular aging pathways, casting obesity as a disease of accelerated biological aging. Although obesity has been linked to accelerated epigenetic aging in middle-aged adults, the impact during childhood remains unclear. We tested the association between body mass index (BMI) and accelerated epigenetic aging in a cohort of high-risk children. Participants were children (N = 273, aged 8 to 14 years, 82% investigated for maltreatment) recruited to the Child Health Study, an ongoing prospective study of youth investigated for maltreatment and a comparison youth. BMI was measured as a continuous variable. Accelerated epigenetic aging of blood leukocytes was defined as the age-adjusted residuals of several established epigenetic aging clocks (Horvath, Hannum, GrimAge, PhenoAge) along with a newer algorithm, the DunedinPoAm, developed to quantify the pace-of-aging. Hypotheses were tested with generalized linear models. Higher age-and sex- adjusted z-scored BMI was significantly correlated with household income, blood cell counts, and three of the accelerated epigenetic aging measures: GrimAge (r = 0.31, P < .0001), PhenoAge (r = 0.24, P < .0001), and DunedinPoAm (r = 0.38, P < .0001). In fully adjusted models, GrimAge (β = 0.07; P = .0009) and DunedinPoAm (β = 0.0017; P < .0001) remained significantly associated with higher age- and sex-adjusted z-scored BMI. Maltreatment-status was not associated with accelerated epigenetic aging. In a high-risk cohort of children, higher BMI predicted epigenetic aging as assessed by two epigenetic aging clocks. These results suggest the association between obesity and accelerated epigenetic aging begins in early life, with implications for future morbidity and mortality risk.
... High rates of obesity in the United States and globally have led to growing interest in identifying precursors of obesity already present in childhood in order to identify potential early intervention targets. Existing research suggests that childhood adversity is consistently associated with overweight and obesity in adulthood (Danese & Tan, 2014;Farrell et al., 2017;Noll et al., 2007;Wells et al., 2010;Ziol-Guest et al., 2009), most likely due to a combination of cognitive, emotional, social, behavioral, and biological factors linking adversity to greater weight. Animal models similarly demonstrate that early life adversity causes greater body weight (Coccurello et al., 2009;Kaufman et al., 2007). ...
Childhood adversity is associated with higher adult weight, but few investigations prospectively test mechanisms accounting for this association. Using two socioeconomically high-risk prospective longitudinal investigations, the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA; N = 267; 45.3% female) and the Fragile Families and Child Wellbeing Study (FFCWS; n = 2,587; 48.5% female), pathways between childhood adversity and later body mass index (BMI) were tested using impulsivity, emotion dysregulation, and overeating as mediators. Childhood adversity from 0 to 5 years included four types of adversities: greater unpredictability, threat/abuse, deprivation/neglect, and low socioeconomic status. Parents reported on child impulsivity, emotion dysregulation, and overeating. Height and weight were self-reported and measured at 32 and 37 years in MLSRA and at 15 years in FFCWS. FFCWS results indicated that threat, deprivation, and low socioeconomic status predicted greater impulsivity and emotion dysregulation at 5 years, which in turn predicted greater overeating at 9 years and higher BMI z-score at 15 years. Early unpredictability in FFCWS predicted higher BMI through greater impulsivity but not emotion dysregulation at age 5. MLSRA regression results replicated the threat/abuse → emotion dysregulation → overeating → higher BMI pathway. These findings suggest that different dimensions of early adversity may follow both similar and unique pathways to predict BMI.
... Over half a million children are confirmed victims of child maltreatment annually in the United States (U.S. Department of Health & Human Services, 2020), with the negative repercussions of maltreatment on individual health and well-being appearing in childhood and extending into adulthood (Gilbert et al., 2009;Noll et al., 2007;Peterson et al., 2018;Widom et al., 2006;Wilson & Widom, 2008). Child maltreatment prevention has evolved from a narrow focus on parents' individual characteristics to ecological models that turn attention to interactions within larger communities (Coulton et al., 2007;Molnar et al., 2016). ...
We conducted a longitudinal observational study of 9873 micro-neighborhoods in a Midwestern city from 2015 to 2018 and estimated multilevel zero-inflated negative binomial models to evaluate if seasonal lawn maintenance of vacant properties was associated with a reduction in microneighborhoods’ annual summer maltreatment rates. We found a between-micro-neighborhood effect of maintenance whereby micro-neighborhoods where the entire area was maintained for the full duration of all summers had a maltreatment rate 0.43 (95% CI 0.25, 0.73) times that of micro-neighborhoods that received no maintenance. We also found a within-micro-neighborhood effect, whereby when a given micro-neighborhood had the entire area maintained the full duration of a summer, it was expected to have a maltreatment rate 0.43 (95% CI 0.19, 0.97) times that of when the same micro-neighborhood had no area maintained. Future cluster-randomized controlled trials are needed to determine if this association is causal.
... However, most studies link a history of CM with overweight and obesity in adulthood (12)(13)(14)(15). Little is known about the frequency of the different malnutrition conditions in children who have experienced CM (16)(17)(18). ...
Introduction:
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.
... Longitudinal and crosssectional studies demonstrate exposure to childhood maltreatment (CM; e.g., physical/sexual abuse and neglect) is associated with accelerated increases in BMI through adolescence and early adulthood, thereby elevating risk of obesity in adulthood. [18][19][20] Differences in epigenetic 40 programming offer an intriguing possibility to further account for this association. Developing an understanding of the association between obesity and accelerated aging in early life, both in the moderating context of CM and more broadly in all children, is critical to prevention efforts of many obesity-related negative health outcomes. ...
Background: New insights into mechanisms linking obesity to poor health outcomes suggest a role for cellular aging pathways, casting obesity as a disease of accelerated biological aging. Although obesity has been linked to accelerated epigenetic aging in middle-aged adults, the impact during childhood remains unclear. We tested the association between body mass index (BMI) and accelerated epigenetic aging in a cohort of high-risk children. Participants were children (N=273, aged 8 to 14 years, 82% investigated for maltreatment) recruited to the Child Health Study, an ongoing prospective study of youth investigated for maltreatment and a comparison youth. BMI was measured as a continuous variable. Accelerated epigenetic aging of blood leukocytes was defined as the age-adjusted residuals of several established epigenetic aging clocks (Horvath, Hannum, GrimAge, PhenoAge) along with a newer algorithm, the DunedinPoAm, developed to quantify the pace-of-aging. Hypotheses were tested with generalized linear models.
Results: Higher BMI was significantly correlated with older chronological age, maltreatment status, household income, blood cell counts, and three of the accelerated epigenetic aging measures: GrimAge (r=0.29, P<.0001), PhenoAge (r=0.25, P<.0001), and DunedinPoAm (r=0.37, P<.0001). In fully adjusted models, GrimAge (b=.06; P=.007) and DunedinPoAm (b=.0017; P<.0001) remained significantly associated with higher BMI. Maltreatment-status was not independently associated with accelerated epigenetic aging after accounting for other factors.
Conclusion: In a high-risk cohort of children, higher BMI predicted epigenetic aging as assessed by two epigenetic aging clocks. These results suggest the association between obesity and accelerated epigenetic aging begins in early life, with implications for future morbidity and mortality risk.
... In adolescence, the effects of psychosocial factors on eating can be detected, allowing for the identification of risky health trajectories before obesity-related disease is established. For instance, in a longitudinal study of abused and non-abused girls, groups did not differ in obesity rates during childhood, and only trended towards showing group differences in adolescence; however, by early adulthood, abused women were more likely to be obese than were non-abused women (Noll, Zeller, Trickett, & Putnam, 2007), suggesting that childhood adversity may contribute to obesogenic processes during adolescence that progress to obesity by adulthood. Therefore, understanding how negative affect and childhood adversity drive adolescents' obesogenic behaviors may elucidate targets for prevention efforts that can be administered during this sensitive developmental window. ...
Obesity commonly emerges by adolescence and is associated with serious health consequences. Emotional eating (consuming calories, fats, and sugars in response to negative affect) may promote obesity; however, evidence is mixed as to whether negative affect increases obesogenic eating. Early-life adversity may shape malleable neurobiological systems that govern inhibitory control, physiological regulation, coping strategies, and eating behavior, contributing to greater obesogenic eating in response to negative affect. Therefore, this study tested whether childhood adversity moderates the association between negative affect and food consumption in a diverse sample of female adolescents. After completing a childhood adversity assessment, 157 female adolescents (13–17 years; 28.7% African American, 39.5% Hispanic/Latina, 31.8% Non-Hispanic White) rated their negative affect in response to a standard social stress paradigm before consuming a buffet lunch, which was evaluated for calories, added sugars, and solid fats consumed. Results did not support that negative affect exerted a main effect on eating behavior. However, negative affect and childhood adversity interacted to predict calories and solid fats consumed, such that negative affect was associated with more obesogenic eating for those with high adversity exposure but not for those with low adversity exposure. Adversity and affect did not interact to predict added sugars consumed. Findings support that eating patterns in response to negative affect may differ by childhood adversity history. Reducing children's adversity exposure and bolstering emotion regulation techniques for adolescents who have been exposed to adversity may provide pathways to protect health and well-being by reducing maladaptive eating patterns.
... These findings provide more insight into the details and experiences of CSA-exposed females and suggest that a large amount of the bullying they experience is focused on their interactions with romantic partners and their appearance. Research links childhood maltreatment with distorted perceptions of body mass (Ruiz & Font, 2020); CSA in particular may increase risks for rapid weight gain (Noll et al., 2007) and eating disorder symptomology (Smolak & Murnen, 2002;Swanston et al., 2003). Future research should explore whether heightened exposure to bullying focused on weight and appearance explains associations between CSA, body image, and disordered eating. ...
Females exposed to child sexual abuse (CSA) are at an increased risk of experiencing further victimization in adolescence. Associations between CSA and several forms of cyber and in-person peer bullying victimization were assessed in a prospective, longitudinal study. Females exposed to substantiated CSA and a matched comparison group (N = 422) were followed over a two-year period. Bullying experiences were assessed in both survey and qualitative interviews. Qualitative data were coded and used to describe the types (e.g., cyber, physical, verbal), and foci (e.g., threats, physical appearance) of bullying victimization. Logistic regression was used to assess the odds that CSA was associated with subsequent bullying victimization, adjusted for demographics, social networking use, and prior bullying. CSA-exposed females were at an increased risk of multiple forms of bullying victimization with a persistent risk of bullying victimization over time. Specifically, they had 2.6 times higher odds of experiencing any bullying at follow-up, 2.9 times higher odds of experiencing cyberbullying at follow-up, and 2 times higher odds of experiencing combined cyber/in-person bullying at follow-up. CSA-exposed females were more likely than comparison females to experience bullying regarding their appearance/weight and dating relationships. Findings provide further insight into the unique circumstances of the cyberbullying and in-person bullying experienced by CSA-exposed females. Females exposed to child sexual abuse (CSA) are at an increased risk of experiencing bullying victimization, specifically cyberbullying and combined cyber/in-person bullying, as well as bullying about their appearance and dating relationships. These findings indicate that bullying prevention needs to include trauma-focused components to target these uniquely vulnerable females.
... In the first large epidemiologic study assessing the impact of CM on physical health in adulthood more than 20 years ago, Felitti and colleagues found largely increased odds for several health problems including cardiovascular diseases in individuals who have experienced adverse childhood experiences (ACEs), encompassing CM and household dysfunctions, such as parental substance abuse or mental illness [3]. Today, there are numerous publications including cohort studies, adjusting for socioeconomic and psychosocial factors, showing the devastating impact of CM on adult health [4][5][6][7][8][9][10], leading to a reduction of lifespan up to 20 years [11]. ...
Psychological stress is a major risk factor for cardiovascular diseases. While the relevance of early life stress, such as that which is due to child maltreatment (CM), is well known to impact individual stress responses in the long-term, and data on the interplay between CM and stressful events in adulthood on cardiovascular health are sparse. Here, we aimed to assess how stressful life events in adulthood are associated with cardiovascular health infarction in later life and whether this association is independent of CM. In a cross-sectional design, a probability sample of the German population above the age of 14 was drawn using different sampling steps. The final sample included 2510 persons (53.3% women, mean age: 48.4 years). Participants were asked about sociodemographic factors, adult life events, CM, and health conditions in adulthood. Results indicate that the number of experienced adverse life events in adulthood is associated with significantly increased odds for obesity (Odds Ration (OR)women = 1.6 [1.3; 2.0], ORmen = 1.4 [1.1;1.9]), diabetes (ORwomen = 1.5 [1.1; 2.1], ORmen = 1.5 [1.1;2.3]) and myocardial infarction (ORwomen = 2.1[1.0; 4.3], ORmen=1.8[1.1;2.8]). This association is not moderated by the experience of CM, which is associated with cardiovascular problems independently. Taken together, adult stressful life events and CM are significantly and independently associated with cardiovascular health in men and women in the German population in a dose-dependent manner. General practitioners, cardiologists and health policy-makers should be aware of this association between psychosocial stressors during childhood and adulthood and cardiovascular health.
... Also, research has demonstrated that childhood sexual abuse is associated with obesity (BMI≥30) (Aaron & Hughes, 2007). A prospective longitudinal study examined the developmental changes in BMI among girls with and without childhood sexual abuse and showed that the two groups did not vary significantly in BMI until early adulthood (Noll et al., 2007). Depression is often reported by adults who have experienced childhood sexual abuse and may impact health symptoms through health behaviors (Irish et al., 2010). ...
To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE ( p < .0001). ACEs’ exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about 165 per adult) and 292 per adult) in TN and VA respectively. The total costs associated with ACEs was about 3948) per person) and 6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.
This study investigated the comparison of abuse experiences and mindful eating in women with high body mass index with and without binge eating disorder and women with normal weight. This study was descriptive with comparative design. The study population consisted of women referring to two nutrition counseling centers in Rasht in 1400. The sample consisted of 179 women who were selected by purposive sampling method. Data were collected using Stice's Eating Disorder Diagnostic Scale (2000), Bernstein's Childhood Trauma Questionnaire (2003), and Framson's Mindful Eating Questionnaire (2009). Results of univariate and multivariate analysis of covariance showed that the abuse experiences in overweight and obese women with binge eating disorder were higher than overweight and obese women without the disorder and in both groups were more than normal weight women. Women in the binge eating group had lower scores in mindful eating than women without the disorder, and both groups had lower scores than normal-weight women, even when controlling for age. According to the findings, abuse experiences and mindful eating have important role in the pathology of obesity, overweight and binge eating disorder. Designing educational/therapeutic programs aimed at reducing the psychological consequences of abuse and teaching mindful eating techniques can be helpful.
Background
Early-life trauma (before age 18) is hypothesized to increase risk for adverse pregnancy outcomes through stress pathways, yet epidemiologic findings are mixed.
Methods
Sister Study participants (U.S. women aged 35-74 years enrolled 2003-2009) completed an adapted Brief Betrayal Trauma Survey at the first follow-up visit. Lifetime history of gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP: pregnancy-related high blood pressure, pre-eclampsia/toxemia, or eclampsia) in pregnancies lasting ≥20 weeks was self-reported. We used log–binomial regression to estimate relative risks (RR) and 95% confidence intervals (CI) for the association between early-life trauma (modeled using conventional measures [ e.g., any experience, substantive domains, individual types] and latent classes of co-occurring traumas) and GDM or HDP among 34,879 parous women.
Results
Approximately, 4% of participants reported GDM and 11% reported HDP. Relative to no early-life trauma, the RRs for any were 1.1 (95% CI = 1.0, 1.3) for GDM and 1.2 (95% CI = 1.2, 1.3) for HDP. Women reporting physical trauma had the highest risk of GDM and HDP in comparison to other substantive domains. In analyses using latent classes of early-life trauma, high trauma was associated with elevated risk of both GDM (RR = 1.9, 95% CI = 1.5, 2.6) and HDP (RR = 1.7, 95% CI = 1.4, 2.0) compared to low trauma.
Conclusions
Women experiencing high levels of trauma in early life were at higher risk of GDM and HDP, adding to a growing evidence base for this association.
Juvenile male hamsters exposed to chronic social stress eat more, gain weight, and have larger fat pads. The purpose of the present study was to address possible changes in food hoarding and orexin/hypocretin innervation in response to social stress. Male hamsters in early adolescence were exposed to a resident‐intruder social stress paradigm or control condition daily for 2 weeks. Metabolism‐related physiological measures and behaviors were tracked, and brains were immunocytochemically labeled for orexin‐A. Our data confirm our previous observations on appetite, weight gain, and obesity, and showed a strong trend toward enhanced food hoarding as in prior studies. In addition, there were no statistically significant differences in orexin innervation in any brain area analyzed. However, unique correlation patterns were observed between orexin innervation and appetite or metabolic outcome. In particular, opposite correlations were observed between groups within the dorsal raphe nucleus, lateral parabrachial nucleus, and nucleus of the solitary tract. These opposite patterns of correlations suggest chronic social stress causes site‐specific alterations in synaptic activity in relation with these behaviors.
CME Educational Objectives
1. Review the basic components of the acute stress response, including the hypothalamic-pituitaryadrenal axis (HPA), corticotropinreleasing factor system, and locus coeruleus-norepinephrine system.
2. Explain the potential, long-term medical consequences of child abuse, including risk for heart disease and obesity, as well as alterations in HPA axis reactivity, the autonomic nervous system, and immune function in adults who were exposed to early-life trauma.
3. List other long-standing consequences associated with abuse.
Background: The role of neighborhood factors in the association between adverse childhood experiences (ACEs) and body mass index (BMI) has not been widely studied. A neighborhood ACEs index (NAI) captures neighborhood environment factors associated with ACE exposure. This study examined associations between BMI and an NAI among New York City (NYC) youth. An exploratory objective examined the NAI geographic distribution across NYC neighborhoods. Methods: Data for students attending NYC public general education schools in kindergarten-12th grade from 2006-2017 (n = 1,753,867) were linked to 25 geospatial datasets capturing neighborhood characteristics for every census tract in NYC. Multivariable hierarchical linear regression tested associations between BMI and the NAI; analyses also were conducted by young (<8 years), school age (8-12 years), and adolescent (>12 years) subgroups. In addition, NAI was mapped by census tract, and local Moran's I identified clusters of high and low NAI neighborhoods. Results: Higher BMI was associated with higher NAI across all sex and age groups, with largest magnitude of associations for girls (medium NAI vs. low NAI: unstandardized β = 0.112 (SE 0.008), standardized β [effect size]=0.097, p < 0.001; high NAI vs. low NAI: unstandardized β = 0.195 (SE 0.008), standardized β = 0.178, p < 0.001) and adolescents (medium NAI vs. low NAI: unstandardized β = 0.189 (SE 0.014), standardized β = 0.161, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.364 (SE 0.015), standardized β = 0.334, p < 0.001 for adolescent girls; medium NAI vs. low NAI: unstandardized β = 0.122 (SE 0.014), standardized β = 0.095, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.217 (SE 0.015), standardized β = 0.187, p < 0.001 for adolescent boys). Each borough of NYC included clusters of neighborhoods with higher and lower NAI exposure, although clusters varied in size and patterns of geographic dispersion across boroughs. Conclusions: A spatial index capturing neighborhood environment factors associated with ACE exposure is associated with higher BMI among NYC youth. Findings complement prior literature about relationships between neighborhood environment and obesity risk, existing research documenting ACE-obesity associations, and the potential for neighborhood factors to be a source of adversity. Collectively, evidence suggests that trauma-informed place-based obesity reduction efforts merit further exploration as potential means to interrupt ACE-obesity associations.
The Cambridge Handbook of International Prevention Science offers a comprehensive global overview on prevention science with the most up-to-date research from around the world. Over 100 scholars from 27 different countries (including Australia, Bhutan, Botswana, India, Israel, Mexico, Singapore, South Korea, Spain and Thailand) contributed to this volume, which covers a wide range of topics important to prevention science. It includes major sections on the foundations of prevention as well as examples of new initiatives in the field, detailing current prevention efforts across the five continents. A unique and innovative volume, The Cambridge Handbook of International Prevention Science is a valuable resource for established scholars, early professionals, students, practitioners and policy-makers.
Background
Previous studies have linked childhood adversities to dementia risk, yet most studies are cross-sectional in design and utilize retrospective self-reports to assess childhood experiences. These design characteristics make it difficult to establish temporal order and draw firm conclusions.
Objective
Using a longitudinal design, we sought to determine whether childhood maltreatment predicts dementia risk factors in middle adulthood.
Methods
Data have been obtained from a prospective cohort design study of children with documented cases of childhood maltreatment (ages 0-11 years at case identification) and demographically matched controls who were followed up and interviewed in middle adulthood. Outcomes were assessed through a medical examination and interview, and 807 of the cases that included blood collection at mean age 41. Dementia risk were investigated using 11 potentially modifiable risk factors.
Results
Compared to controls, individuals with histories of childhood maltreatment had a higher risk of low educational attainment, low social contact, smoking, and clinical depression, and a higher total number of dementia risk factors. In general, childhood maltreatment predicted a higher risk of dementia for females, males, and Black and White participants. Black maltreated participants had a greater risk for traumatic brain injury compared to Black controls. Physical abuse, sexual abuse, and neglect, each predicted a higher number of dementia risk factors in mid-life.
Conclusion
These findings provide evidence that childhood maltreatment increases the risk for dementia in mid-life and has a demonstrable impact lasting over 30 years. Reducing the prevalence of mid-life dementia risk factors could reduce the risk of later-life dementia.
Creating innovation in child maltreatment research and practice begins with novel and rigorous approaches to training future professionals. This chapter describes a new program for professionals seeking formalized training in child maltreatment. The Child Maltreatment T32 (CMT32) Training Program at Penn State is supported by a Federal grant from the National Institutes of Health and offers dedicated, transdisciplinary training in multiple areas of child maltreatment for both graduate students and postdoctoral fellows. In addition to a core set of general program requirements, CMT32 fellows specialize their training across four related tracks: Biology and Health, Developmental Processes, Policy and Administrative Data Systems, and Prevention and Treatment. Each track offers access to a wide range of Mentors, who further shape the training experience of each fellow through their own diverse experiences, training, and research methods as applied to the substantive area of child maltreatment. This chapter describes the CMT32 Training Program at Penn State while identifying the innovative ways in which we are preparing the next generation of scholars to address current and future challenges for children and families affected by maltreatment.KeywordsChild maltreatmentTrainingT32FellowshipsBiology and healthDevelopmental processesPolicy and administrative data systemsPrevention and treatmentPolicy
Bariatric surgery is an extremely effective treatment for severe and complex obesity. However, changes are dramatic and rapid and therefore, it is a psychologically demanding intervention even for patients who experience very positive outcomes. A person’s weight and eating history, past attempts to lose weight, and self-efficacy will influence the decision to have weight loss surgery. Past dieting “failure” can result in desperation and the belief that weight loss is not possible by any other means. The complex relationship between mental health and obesity also impacts on a person’s ability to make lifestyle changes. There is a wide range of adjustments to be made postoperatively as a result of the significant changes to eating, weight, identity, and coping. Difficulties can occur with each of these issues and therefore, appropriate detection and provision of psychological support is required. Better understanding of factors which previously led to, and maintained, obesity and postoperative issues may help to improve outcome for the significant minority of patients who either regain weight or have other adjustment difficulties. Health professionals need to have a greater understanding of the range of psychological and social factors influencing outcome.
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.
Childhood maltreatment (abuse and neglect) is associated with a range of negative outcomes, but a gap remains in understanding how specific maltreatment types, particularly neglect and non-familial sexual abuse, relate to health and behavior. This study examined the association of neglect and sexual abuse (both familial and non-familial), as well as familial physical and emotional abuse with depressive mood and eating disorders; tobacco and marijuana use; and BMI ≥ 25 kg/m² and BMI ≥ 30 kg/m² in young adults. Data came from Project EAT (Eating and Activity in Teens and Young Adults), a population-based longitudinal study of weight-related health from adolescence into young adulthood. Maltreatment before age 18 was retrospectively reported at ages 26–33. Risk differences (RDs) and 95% confidence intervals (CIs) were estimated for those with a given maltreatment type to those without, and also for the cumulative number of maltreatment types experienced. One in 3 participants reported abuse or neglect. All maltreatment types were associated with at least one adverse health outcome, with physical abuse being least consistently related to the outcomes. Emotional abuse showed the strongest association with depressive mood. All maltreatment types were associated with eating disorder diagnosis, tobacco use, and marijuana use (except physical abuse for eating disorder). There was little evidence of a maltreatment association with BMI ≥ 25 kg/m²; emotional abuse and neglect were associated with BMI ≥ 30 kg/m². Prevention of maltreatment needs to be a top public health priority.
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.
Objective
To review and synthesize peer-reviewed research in scientific journals related to violence against children and adolescents (direct) and/or witness IPV (indirect) associated with nutritional status in adolescents.
Methods
Seven electronic databases were searched. There was no limitation on the period of publication. Articles published in English, Portuguese or Spanish were included. The selection, data extraction and quality analyses were performed by three reviewers.
Results
A search retrieved 1634 references, and after applying the inclusion and eligibility criteria, 15 studies were included in this review. All studies were published between 2007 and 2021. Almost all research took place in high-income countries. The sample size ranged from 136 to 105,759. Fourteen studies focused on direct family violence. Only four studies evaluated indirect violence by witnessing IPV. The literature is mixed in relation to the association between direct and indirect family violence victimization and inadequate nutritional status in adolescents. The findings differed between the study design, sample sizes, measurement instruments, social and cultural contexts.
Conclusion
Analyzing the existing literature so far, we consider that there is not enough evidence to affirm the existence or absence of this association. Further studies are important to explore these relationships better.
This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and address neighborhood-level influences on health among individuals affected by ACEs. Methods entailed cross-sectional secondary analysis connecting individual-level ACEs data from the Philadelphia ACE Survey (n = 1677) with 25 spatial datasets capturing neighborhood characteristics. Four methods were tested for index creation (three methods of principal components analysis, Bayesian index regression). Resulting indexes were compared using Akaike Information Criteria for accuracy in explaining ACEs exposure. Exploratory linear regression analyses were conducted to examine associations between ACEs, the neighborhood ACEs index, and a health outcome—in this case body mass index (BMI). Results demonstrated that Bayesian index regression was the best method for index creation. The neighborhood ACEs index was associated with higher BMI, both independently and after controlling for ACEs exposure. The neighborhood ACEs index attenuated the association between BMI and ACEs. Future research can employ a neighborhood ACEs index to inform upstream, place-based interventions and policies to promote health among individuals affected by ACEs.
This cross-sectional study examines the association of childhood and adolescent/adult adversities with obesity across four racial/ethnic groups among emerging adult women aged 18 to 25 (n = 9310). Latent class analysis was used to identify racial/ethnicity-specific classes arising from childhood and adolescent/adult adversity indicators in the 2015 and 2018 College Student Health Surveys (sampled from Minnesota, U.S.) Distal outcome procedure and Bolck-Croon-Hagenaars methods were used to assess each class's association with body mass index (BMI) and obesity probability. Models were adjusted for post-secondary school type and parental education. We identified 7 classes for White women, 4 classes for Asian and Latina women, and 5 classes for Black women. Weight distributions of Black and Latina women leaned towards “overweight”, whereas White and Asian women's BMI leaned towards “normal weight.” Latina and Black women had a wider BMI range (~5 kg/m²) between classes with the highest versus lowest BMI than White and Asian women (~3 kg/m²), suggesting a stronger association between adversities and BMI. For Asian, Black, and White women, the “Low Adversities” class had the lowest obesity prevalence, while the “High Lifetime Adversities” class had the highest prevalence. In contrast, Latina women had the lowest obesity prevalence in the “High Adolescent/Adult Adversities & Low Childhood Adversities” class, and highest prevalence in the “Household Mental Illness” class. Results indicate that racial/ethnic disparities in obesity-related measures are reduced when racial/ethnic groups experience low adversity. Future research should explore tailored adversity interventions that consider adversity exposure differences across race/ethnicity as a strategy for reducing obesity risk.
Six and a half years after adoption, 6-to 12-year-old children reared in Romanian orphanages for more than 8 months in their first years of life (RO, n = 18) had higher cortisol levels over the daytime hours than did early adopted (EA, ≤ 4 months of age, n = 15) and Canadian born (CB, n = 27) children. The effect was marked, with 22% of the RO children exhibiting cortisol levels averaged over the day that exceeded the mean plus 2 SD of the EA and CB levels. Furthermore, the longer beyond 8 months that the RO children remained institutionalized the higher their cortisol levels. Cortisol levels for EA children did not differ in any respect from those of CB comparison children. This latter finding reduces but does not eliminate concerns that the results could be due to prenatal effects or birth family characteristics associated with orphanage placement. Neither age at cortisol sampling nor low IQ measured earlier appeared to explain the findings. Because the conditions in Romanian orphanages at the time these children were adopted were characterized by multiple risk factors, including gross privation of basic needs and exposure to infectious agents, the factor(s) that produced the increase in cortisol production cannot be determined. Nor could we determine whether these results reflected effects on the limbic–hypothalamic–pituitary– adrenal axis directly or were mediated by differences in parent–child interactions or family stress occasion by behavioral problems associated with prolonged orphanage care in this sample.
Childhood sexual abuse is associated with an increased incidence of age-concurrent and adult psychopathology. Little is known, however, about the biological manifestations and sequelae of childhood sexual abuse. In this study, we characterized the hypothalamic-pituitary-adrenal axis of a self-selected sample of sexually abused and control girls recruited from a prospective longitudinal study. Plasma ACTH and total and free cortisol responses to ovine CRH (oCRH) stimulation were measured in 13 sexually abused and 13 control girls, aged 7-15 yr. Psychiatric profiles and 24-h urinary free cortisol (UFC) measures were also obtained. Sexually abused girls had a greater incidence of suicidal ideation (chi 2 = 4.51; df = 1; P < 0.05), suicide attempts (chi 2 = 4.51; df = 1; P < 0.05), and dysthymia (chi 2 = 8.85; df = 1; P < 0.01) than control girls. Sexually abused girls showed significantly lower basal (t = 2.1; df = 24; P < 0.05), and net oCRH stimulated (t = 2.2; df = 24; P < 0.05) ACTH levels and significantly reduced total ACTH responses (t = 2.5; df = 24; P < 0.05) compared with control subjects. Their total and free basal and oCRH-stimulated plasma cortisol levels and 24-h UFC measures, however, were similar to those in controls. The attenuated plasma ACTH with corresponding robust plasma cortisol responses to oCRH stimulation and normal 24-h UFC measures in sexually abused girls suggest a dysregulatory disorder of the HPA axis in these individuals. This may reflect pituitary hyporesponsiveness to oCRH. The ability of sexually abused subjects to correct for the proposed pituitary hyporesponsiveness to CRH may be related to their young age and the presence of intact glucocorticoid feedback regulatory mechanisms.
This paper presents a critical appraisal of resilience, a construct connoting the maintenance of positive adaptation by individuals despite experiences of significant adversity. As empirical research on resilience has burgeoned in recent years, criticisms have been levied at work in this area. These critiques have generally focused on ambiguities in definitions and central terminology; heterogeneity in risks experienced and competence achieved by individuals viewed as resilient; instability of the phenomenon of resilience; and concerns regarding the usefulness of resilience as a theoretical construct. We address each identified criticism in turn, proposing solutions for those we view as legitimate and clarifying misunderstandings surrounding those we believe to be less valid. We conclude that work on resilience possesses substantial potential for augmenting the understanding of processes affecting at-risk individuals. Realization of the potential embodied by this construct, however, will remain constrained without continued scientific attention to some of the serious conceptual and methodological pitfalls that have been noted by skeptics and proponents alike.
To examine rates of reported childhood maltreatment in binge eating disorder (BED), and to explore associations with obesity, gender, eating disorder features, and associated functioning.
Subjects were 145 consecutive outpatients with BED as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition. Subjects were interviewed and they completed questionnaires to assess eating disorder features and functioning. The Childhood Trauma Questionnaire was given to assess childhood maltreatment in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect).
A total of 83% of BED patients reported some form of childhood maltreatment. A total of 59% of BED patients reported emotional abuse, 36% reported physical abuse, 30% reported sexual abuse, 69% reported emotional neglect, and 49% reported physical neglect. There were no differences in the distribution of any form of childhood maltreatment by gender or by obesity status. The different forms of maltreatment were not associated with variability in current body mass index, binge eating, or in the attitudinal features of eating disorders. Only one of the five forms of maltreatment (physical neglect) was associated with dietary restraint in women. Emotional abuse was significantly associated with greater body dissatisfaction, higher depression, and lower self-esteem in men and women and sexual abuse was associated with greater body dissatisfaction in men. The different forms of maltreatment were unrelated to the age at onset of overweight, dieting, or binge eating.
BED outpatients reported a wide range of childhood experiences of maltreatment that do not differ by gender or obesity status. Different forms of maltreatment were not associated with the onset of overweight, dieting, or binge eating, or with variability in current body mass index or eating disorder features (except for one association between physical neglect and dietary restraint). Reports of emotional abuse were associated with greater body dissatisfaction and depression and lower self-esteem in men and women and sexual abuse with greater body dissatisfaction in men.
Six and a half years after adoption. 6- to 12-year-old children reared in Romanian orphanages for more than 8 months in their first years of life (RO. n = 18) had higher cortisol levels over the daytime hours than did early adopted (EA, < or = 4 months of age, n = 15) and Canadian born (CB, n = 27) children. The effect was marked, with 22% of the RO children exhibiting cortisol levels averaged over the day that exceeded the mean plus 2 SD of the EA and CB levels. Furthermore, the longer beyond 8 months that the RO children remained institutionalized the higher their cortisol levels. Cortisol levels for EA children did not differ in any respect from those of CB comparison children. This latter finding reduces but does not eliminate concerns that the results could be due to prenatal effects or birth family characteristics associated with orphanage placement. Neither age at cortisol sampling nor low IQ measured earlier appeared to explain the findings. Because the conditions in Romanian orphanages at the time these children were adopted were characterized by multiple risk factors, including gross privation of basic needs and exposure to infectious agents, the factor(s) that produced the increase in cortisol production cannot be determined. Nor could we determine whether these results reflected effects on the limbic-hypothalamic-pituitary-adrenal axis directly or were mediated by differences in parent-child interactions or family stress occasion by behavioral problems associated with prolonged orphanage care in this sample.
Two classes of modern missing data procedures, maximum likelihood (ML) and multiple imputation (MI), tend to yield similar results when implemented in comparable ways. In either approach, it is possible to include auxiliary variables solely for the purpose of improving the missing data procedure. A simulation was presented to assess the potential costs and benefits of a restrictive strategy, which makes minimal use of auxiliary variables, versus an inclusive strategy, which makes liberal use of such variables. The simulation showed that the inclusive strategy is to be greatly preferred. With an inclusive strategy not only is there a reduced chance of inadvertently omitting an important cause of missingness, there is also the possibility of noticeable gains in terms of increased efficiency and reduced bias, with only minor costs. As implemented in currently available software, the ML approach tends to encourage the use of a restrictive strategy, whereas the MI approach makes it relatively simple to use an inclusive strategy.
Public health officials and organizations have disseminated health messages regarding the dangers of obesity, but these have not produced the desired effect.
To estimate the expected number of years of life lost (YLL) due to overweight and obesity across the life span of an adult.
Data from the (1) US Life Tables (1999); (2) Third National Health and Nutrition Examination Survey (NHANES III; 1988-1994); and (3) First National Health and Nutrition Epidemiologic Follow-up Study (NHANES I and II; 1971-1992) and NHANES II Mortality Study (1976-1992) were used to derive YLL estimates for adults aged 18 to 85 years. Body mass index (BMI) integer-defined categories were used (ie, <17; 17 to <18; 18 to <19; 20 to <21; 21 to 45; or > or =45). A BMI of 24 was used as the reference category.
The difference between the number of years of life expected if an individual were obese vs not obese, which was designated YLL.
Marked race and sex differences were observed in estimated YLL. Among whites, a J- or U-shaped association was found between overweight or obesity and YLL. The optimal BMI (associated with the least YLL or greatest longevity) is approximately 23 to 25 for whites and 23 to 30 for blacks. For any given degree of overweight, younger adults generally had greater YLL than did older adults. The maximum YLL for white men aged 20 to 30 years with a severe level of obesity (BMI >45) is 13 and is 8 for white women. For men, this could represent a 22% reduction in expected remaining life span. Among black men and black women older than 60 years, overweight and moderate obesity were generally not associated with an increased YLL and only severe obesity resulted in YLL. However, blacks at younger ages with severe levels of obesity had a maximum YLL of 20 for men and 5 for women.
Obesity appears to lessen life expectancy markedly, especially among younger adults.
Binge eating disorder (BED) and the night eating syndrome (NES) have been linked to obesity. This review summarizes their characteristics, implications of their diagnoses and treatment outcomes.
Selective review of the literature on BED and NES.
BED was proposed as a distinctive disorder on the basis of two large multisite studies in the early 1990s. It is associated with more severe and earlier onset of obesity, earlier onset of dieting and greater psychopathology. It shows large placebo responses and reduction of bingeing in patients on waiting-list controls. Traditional weight reduction programs reduce bingeing at least as well as psychological treatments designed for this purpose. NES is a stress-related eating, sleeping and mood disorder that is associated with disordered neuroendocrine function. It follows a characteristic circadian pattern and has responded to an agent that enhances serotonin function.
BED responds well to weight reduction programs. It is proposed that this diagnosis be used as a marker for psychological problems that deserve treatment in their own right. NES is an eating, sleep, and mood disorder with distinctive behavioral and neuroendocrine characteristics. Studies of treatment for NES are in their infancy but selective serotonin reuptake inhibitors (SSRI) show promise.
The sexual attitudes and activities of 77 sexually abused and 89 comparison women (mean age = 20.41, SD = 3.38) were assessed 10 years after disclosure in a longitudinal, prospective study of the long-term effects of childhood sexual abuse. Abused participants were more preoccupied with sex, younger at first voluntary intercourse, more likely to have been teen mothers, and endorsed lower birth controlefficacy than comparison participants. When psychological functioning earlier in development was examined, sexual preoccupation was predicted by anxiety, sexual aversion was predicted by childhood sexual behavior problems, and sexual ambivalence (simultaneous sexual preoccupation and sexual aversion) was predicted by pathological dissociation. Findings also indicate that biological father abuse may be associated with greater sexual aversion and sexual ambivalence.
The prevalence of overweight and obesity has increased markedly in the last 2 decades in the United States.
To update the US prevalence estimates of overweight in children and obesity in adults, using the most recent national data of height and weight measurements.
As part of the National Health and Nutrition Examination Survey (NHANES), a complex multistage probability sample of the US noninstitutionalized civilian population, both height and weight measurements were obtained from 4115 adults and 4018 children in 1999-2000 and from 4390 adults and 4258 children in 2001-2002.
Prevalence of overweight (body mass index [BMI] > or =95th percentile of the sex-specific BMI-for-age growth chart) among children and prevalence of overweight (BMI, 25.0-29.9), obesity (BMI > or =30.0), and extreme obesity (BMI > or =40.0) among adults by sex, age, and racial/ethnic group.
Between 1999-2000 and 2001-2002, there were no significant changes among adults in the prevalence of overweight or obesity (64.5% vs 65.7%), obesity (30.5% vs 30.6%), or extreme obesity (4.7% vs 5.1%), or among children aged 6 through 19 years in the prevalence of at risk for overweight or overweight (29.9% vs 31.5%) or overweight (15.0% vs 16.5%). Overall, among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese. Among children aged 6 through 19 years in 1999-2002, 31.0% were at risk for overweight or overweight and 16.0% were overweight. The NHANES results indicate continuing disparities by sex and between racial/ethnic groups in the prevalence of overweight and obesity.
There is no indication that the prevalence of obesity among adults and overweight among children is decreasing. The high levels of overweight among children and obesity among adults remain a major public health concern.
Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years. Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings.
We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched the Cochrane Library from 1996 to April 2004. We searched Medline, PsycINFO, DARE, and CINAHL from 1966 to April 2004. One reviewer abstracted relevant information from each included article into standardized evidence tables, and a second reviewer checked key elements. Two reviewers quality-graded each article with US Preventive Services Task Force criteria.
Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >or=1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m(2)) is >or=50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals.
BMI measurements of overweight among older adolescents identify those at increased risk of developing adult obesity. Interventions to treat overweight adolescents in clinical settings have not been shown to have clinically significant benefits, and they are not widely available. Screening to categorize overweight among children under age 12 or 13 who are not clearly overweight may not provide reliable risk categorization for adult obesity. Screening in this age group is compromised by the fact that there is little generalizable evidence for primary care interventions. Because existing trials report modest short- to medium-term improvements (approximately 10-20% decrease in percentage of overweight or a few units of change in BMI), however, overweight improvements among children and adolescents seem possible.
Several naturally occurring polypeptide and amine hormones possess adipokinetic activity. The present investigation compares the adipokinetic activity of these hormones in the rabbit, guinea pig hamster, rat, pig and dog. Activity was assayed by measuring the effect of various concentrations of hormone upon the production of free fatty acids (FFA) by slices of perirenal adipose tissue incubated in Krebs-Ringer phosphate solution. As described by previous investigators, when the medium does not contain albumin, the FFA produced by lipolysis accumulate only within the tissue slice; when albumin is present in the medium, the FFA produced by lipolysis accumulate in the medium as well as in the tissue slice. In the albumin- free assay system, the concentration of FFA in the tissue after 3 hours' incubation is linearly related to the logarithm of the concentration of hormone in the medium.
The following 6 components of the pituitary gland possess adipokinetic activity upon the adipose tissue of one or more mammalian species: ACTH, TSH, α-MSH, β-MSH, arginine vasopressin and fraction H. The slopes of the dose-response equations for the adipokinetic action of these 6 pituitary components do not show a statistically significant difference from each other. Epinephrine and norepinephrine also possess high adipokinetic activity in certain species. Each of these 8 hormones exhibits marked variation in the magnitude of its action upon the adipose tissue of different species. Each hormone possesses high activity in some mammalian species and no detectable activity in others. α-MSH and β-MSH possess an identical pattern of species variation. Another pattern is exhibited by epinephrine and norepinephrine. Additional different patterns of species variation are shown by each of the other adipokinetic hormones.
Correlation of amino acid sequences of naturally occurring polypeptides with their adipokinetic activities suggests that an arginine moiety is essential for adipokinetic activity in this class of adipokinetic substance. Arginine vasopressin possesses adipokinetic activity while lysine vasopressin does not.
Objective: To examine rates of self-reported childhood maltreatment in extremely obese bariatric surgery candidates and to explore associations with sex, eating disorder features, and psychological functioning.
Research Methods and Procedures: Three hundred forty (58 men and 282 women) extremely obese consecutive candidates for gastric bypass surgery completed a questionnaire battery. The Childhood Trauma Questionnaire was given to assess childhood maltreatment.
Results: Overall, 69% of patients self-reported childhood maltreatment: 46% reported emotional abuse, 29% reported physical abuse, 32% reported sexual abuse, 49% reported emotional neglect, and 32% reported physical neglect. Except for higher rates of emotional abuse reported by women, different forms of maltreatment did not differ significantly by sex. Different forms of maltreatment were generally not associated with binge eating, current BMI, or eating disorder features. At the Bonferonni-corrected significance level, emotional abuse was associated with higher eating concerns and body dissatisfaction, and emotional neglect was associated with higher eating concerns. In terms of psychological functioning, at the Bonferonni-corrected level, emotional abuse and emotional neglect were associated with higher depression and lower self-esteem, and physical abuse was associated with higher depression.
Discussion: Extremely obese bariatric surgery candidates reported rates of maltreatment comparable with those reported by clinical groups and roughly two to three times higher than normative community samples. Reported experiences of maltreatment differed little by sex and were generally not significantly associated with current BMI, binge eating, or eating disorder features. In contrast, maltreatment—notably emotional abuse and neglect—were significantly associated with higher depression and lower self-esteem.
This study examined the effects of stressful environments on physiological and affective functioning among 131 maltreated school-aged children attending a summer day camp. Sixty-six nonmaltreated children also attending the camp served as a comparison group. Salivary Cortisol measures were obtained daily at 10:00 a.m. and at 4:00 p.m. Depression was measured using the Child Depression Inventory. Children with scores of 19 or higher were classified as depressed. Internalizing and externalizing behavior problems were determined from the Teacher Report Form of the Child Behavior Checklist. Children with t scores of 70 or higher were classified as having clinical levels of these problems. Maltreated children had slightly elevated afternoon Cortisol concentrations, but their morning concentrations did not differ significantly from those of nonmaltreated children. Neither clinical levels of depression, internalizing, or externalizing problems were predictive of the elevated afternoon values. Depression among maltreated children was, however, associated with altered activity of the hypothalamic-pituitary-adrenocortical (HPA) axis. Depressed maltreated children had lower morning Cortisol concentrations compared to nondepressed maltreated children and were more likely to show a rise rather than the expected decrease in Cortisol from morning to afternoon. These data replicated earlier findings. There was no evidence that depressed, nonmaltreated children exhibited this change in diurnal Cortisol activity.
As outlined in Chapter 2, the long-term medical consequences of obesity are well-documented, with precursors for adult disease
becoming increasingly prevalent in overweight youth. It is asserted, however, that the greater immediate and observable costs
of pediatric obesity are psychosocial (Dietz, 1998). The purpose of this chapter is to review the known psychosocial correlates
of pediatric obesity derived from the empiri cal literature. These psychosocial correlates cross a number of domains and environments
that are central to understanding healthy child and adolescent development. We have organized the chapter to reflect specific
psychosocial factors within the family and peer environments and then psychosocial functioning at the individual level. Throughout
the chapter and in our summary, we discuss the implications of these data for weight management treatment as well as important
directions for future research.
Early-life stimulation (e.g. brief handling) attenuates the behavioral and neuroendocrine responses to stressors encountered in adulthood, particularly with respect to activation of hypothalamic-pituitary-adrenal (HPA) activity. In contrast, if neonates were subjected to a more severe stressor, such as protracted separation from the dam or exposure to an endotoxin, then the adult response to a stressor was exaggerated. These early-life experiences program HPA functioning, including negative feedback derived from stimulation of hippocampal glucocorticoid receptors, and corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) coexpression in PVN neurons, to modify the response to subsequent stressor experiences. The persistent variations of HPA activity observed in handled/stimulated animals may stem from alterations in dam–pup interactions (e.g. increased arched-back feeding, licking, grooming). In addition genetic makeup is critical in determining stress reactivity. For instance, BALB/cByJ mice are more reactive to stressors than C57BL/6ByJ mice, exhibiting greater HPA hormonal alterations and behavioral disturbances. BALB/cByJ also fail to acquire a spatial learning response in a Morris water-maze paradigm, which has been shown to be correlated with hippocampal cell loss associated with aging. Early-life handling of BALB/cByJ mice prevented these performance deficits and attenuated the hypersecretion of ACTH and corticosterone elicited by stressors. The stressor reactivity may have been related to maternal and genetic factors. When BALB/cByJ mice were raised by a C57BL/6ByJ dam, the excessive stress-elicited HPA activity was reduced, as were the behavioral impairments. However, cross-fostering the more resilient C57BL/6ByJ mice to a BALB/cByJ dam failed to elicit the behavioral disturbances. It is suggested that genetic factors may influence dam–pup interactive styles and may thus proactively influence the response to subsequent stressors among vulnerable animals. In contrast, in relatively hardy animals the early-life manipulations may have less obvious effects.
Corticotropin-releasing factor (CRF) has been implicated in the development of obesity in genetically obese rodents. We have investigated the effect of 100 micrograms of intravenous CRF on energy expenditure in women, comparing the response in obese and lean volunteers. In response to CRF, energy expenditure as measured by indirect calorimetry increased rapidly with a peak response in both groups reached by two minutes with a ten minute post-CRF response averaging 9.0% in the lean and 11.0% in the obese. Subsequently, energy expenditure remained elevated for a longer duration in the lean compared to the obese. Overall, the total 30 min cumulative metabolic rise was similar in the lean and obese. The increments in energy expenditure were associated with elevation of plasma noradrenaline levels, suggesting the possible involvement of the sympathetic nervous system. The adrenocorticotrophic (ACTH) and cortisol responses to CRF were similar in obese and lean. Intravenous administration of CRF therefore acutely increases energy expenditure in both lean and obese healthy subjects.
The debate among developmental psychologists over how best to combine longitudinal and cross-sectional data sequences can be traced back at least four decades. During the 1970s, a variation of this theme received much attention: could the developmental influences of age, cohort, and time be unraveled by sufficiently ingenious application of combined data sequences? We believe discussion of this question has been needlessly parochial and confused. Substantive and methodological contributions from other disciplines have, until recently, been largely ignored by developmental psychologists. Moreover, the solutions debated by psychologists have generally been formulated in language that obscured, rather than explicated, the formal indeterminacy implicit in models of age, cohort, and time parameters. Methodologists have outlined formal solutions to problems of indeterminacy in the contexts of model identification and estimability theory. Sociologists have proposed solutions, based on explicitly theoretical assumptions, that permit model identification and unambiguous interpretation. We review these contributions, and suggest a hierarchy of solutions to the problem of age, cohort, and time indeterminacy.
The existing literature on the long-term sequelae of child sexual abuse is reviewed. The evidence suggests that sexual abuse is an important problem with serious long-term sequelae; but the specific effects of sexual abuse, independent of force, threat of force, or such family variables as parental psychopathology, are still to be clarified. Adult women with a history of childhood sexual abuse show greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than nonabused women to be revictimized. Anxiety, fear, and suicidal ideas and behavior have also been associated with a history of childhood sexual abuse but force and threat of force may be a necessary concomitant. As yet, there is insufficient evidence to confirm a relation between a history of childhood sexual abuse and a postsexual abuse syndrome and multiple or borderline personality disorder. Male victims of child sexual abuse show disturbed adult sexual functioning. The relation between age of onset of abuse and outcome is still equivocal. Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm.
The effects of physiological glucocorticoids such as cortisol and corticosterone, as well as dexamethasone, on proliferation and differentiation of rat fat cell precursors kept in primary culture were analyzed. In serum-containing medium (10%), glucocorticoids markedly decreased cell proliferation, either on subconfluent or on confluent cultures. This effect was independent of the presence of insulin. In contrast, acute amplification of adipose conversion was observed mainly when glucocorticoids and insulin were added simultaneously. Morphological quantification of lipid-containing cells confirmed acceleration of the maturation process, and an early and specific reorganization of the cytoskeleton was detected at the ultrastructural level. In the presence of insulin, glucocorticoids also enhanced the main marker enzymes, lipoprotein lipase, and glycerol phosphate dehydrogenase. Glucocorticoid effects on precursor proliferation and differentiation were clearly dose-dependent, dexamethasone being 10 times more potent than cortisol and corticosterone. Similar results were obtained in serum-free medium, as well as in preadipocyte cultures derived from different fat deposits. This study demonstrates that in addition to an acute inhibition of precursor growth, glucocorticoids exert a clear stimulation of adipose conversion, which depends mainly on the presence of insulin and the glucocorticoid concentration.
This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome.
1. Corticotropin-stimulated lipolysis in adipocytes of rats, mice, hamsters, guinea pigs and rabbits. Melanotropins elicited high lipolytic activity only in guinea pig and rabbit adipocytes. Opiate peptides were active only in rabbit adipocytes. Pituitary and chorionic gonadotropins and somatotropin were lipolytic in guinea pig adipocytes. Other hormones tested including prolactin, somatostatin, substance P, neurotensin, angiotensin II, thyrotropin releasing hormone and pancreatic polypeptide were devoid of lipolytic activity in all of the adipocytes studied. 2. In the rabbit adipocytes gamma-melanotropin was lipolytic only at high doses. At these doses the peptide inhibited the lipolytic response to a high dose of corticotropin. 3. Lipolysis stimulated by vasoactive intestinal peptide and epinephrine in rat adipocytes was antagonized by insulin. The lipolytic hormones corticotropin, epinephrine, vasoactive intestinal peptide and secretin suppressed basal and insulin-stimulated lipogenesis.
One hundred thirty-one patients who gave a history of childhood sexual abuse were seen in a general medical practice decades after the event and were compared with a control group. The subject patients were found to be distinct for chronic depression, morbid obesity, marital instability, high utilization of medical care, and certain psychosomatic symptoms, particularly chronic gastrointestinal distress and recurrent headaches. It is clear that these remote events can underlie difficult chronic medical problems. Questions about childhood sexual abuse must become part of the practitioner's review of systems in these difficult cases, if not routinely.
To study the in vitro differentiation of human adipocyte precursor cells and its regulation by hormones, primary cultures of stromal vascular cells of human adipose tissue were established. A 30- to 70-fold increase in the number of developing fat cells was achieved by the addition of cortisol or related corticosteroids in the presence of insulin. Either of the two hormones alone was ineffective. The stimulatory action of cortisol was dose dependent and occurred at physiological concentrations. The results suggest that glucocorticoids may play a role in the development of human hyperplastic obesity by stimulating the formation of adipocytes from precursor cells.
The association of various features of family life with obesity in childhood is well established, but less is known about the effect of these influences on the risk of later obesity. In this prospective, population-based study, we examined the influence of parental care in childhood on the risk of obesity in the offspring in young adulthood. In 1974, 1258 pupils aged 9-10 years were randomly selected from the third grade of Copenhagen schools. Information on 987 pupils was obtained from the form teachers on family structure and the perceived support from the parents; school medical services reported on the child's general hygiene. 756 (86%) of the 881 eligible participants were followed up 10 years later. The influence of family factors in childhood on the risk of obesity (body-mass index > 95th centile) in young adulthood was estimated by odds ratios with control for age and body-mass index in 1974, sex, and social background. Family structure (biological or other parents and number of siblings) did not significantly affect the risk of adult obesity. Parental neglect greatly increased the risk in comparison with harmonious support (odds ratio 7.1 [95% CI 2.6-19.3]). Dirty and neglected children had a much greater risk of adult obesity than averagely groomed children (9.8 [3.5-28.2]). However, being an only child, receiving overprotective parental support, or being well-groomed had no effect. Parental neglect during childhood predicts a great risk of obesity in young adulthood, independent of age and body-mass index in childhood, sex, and social background.
The objective of this study was to examine urinary catecholamine excretion in a self-selected sample of sexually abused and demographically matched control girls recruited from a prospective, longitudinal study.
Twenty-four--hour urinary catecholamine and metabolite concentrations of epinephrine, norepinephrine, dopamine, 3-methoxy-4-hydroxyphenylglycol, metanephrine, normetanephrine, vanillylmandelic acid, 3,4-dihydroxyphenylacetic acid, and homovanillic acid were measured in 12 sexually abused and 9 control girls, aged 8 to 15 years. Psychiatric profiles also were obtained.
The abused subjects excreted significantly greater amounts of metanephrine, vanillylmandelic acid, homovanillic acid, and total catecholamine synthesis as measured by the sum of epinephrine, norepinephrine, dopamine, and their metabolites compared to values from control subjects. When the means of all significant biochemical measures were adjusted by the covariate effect of height, only homovanillic acid and group interaction remained significant. There were positive trends toward significantly higher urinary excretion of metanephrine, vanillylmandelic acid, and total catecholamine synthesis. Sexually abused girls also had a greater incidence of suicidal ideation, suicide attempts, and dysthymia than control girls.
These findings support the idea that sexually abused girls show evidence of higher catecholamine functional activity compared with controls. The clinical significance of these findings in their similarity to the psychobiology of both post-traumatic stress disorder and major depressive disorder. Results from this pilot study may be of value in understanding the mechanisms of depressive and anxiety disorders and in the clinical treatment of maltreated children.
This study has sought to investigate whether diabetic neuropathy is a major determinant of the basal tone of the hypothalamic-pituitary-adrenal axis in diabetes mellitus. We have analyzed the changes in ACTH and cortisol by measuring hourly samples from 0800-1900 h in diabetic patients carefully characterized for the presence of neuropathy. The circadian variation for ACTH and cortisol was normal in these patients. However, integrated secretion (area under the curve) of both ACTH and cortisol was increased specifically in the 25 diabetic patients with symptomatic polyneuropathy (43 +/- 20 pmol/L and 3609 +/- 169 nmol/L, respectively) compared to 19 diabetic patients without neuropathy (30 +/- 10 pmol/L and 2800 +/- 690 nmol/L, respectively) (P < 0.02) and to 11 normal controls (26 +/- 10 pmol/L and 2694 +/- 476 nmol/L, respectively) (P < 0.007). These differences occurred independently of the type of diabetes and were significant for most individual time points. ACTH and cortisol concentrations correlated with most clinical and neurophysiological parameters of neuropathy (P < 0.05-0.001), but not with glycemic control, retinopathy, or proteinuria. Overall, these results suggest that diabetic neuropathy is associated with a specific and persistent increase in the activity of the hypothalamic-pituitary-adrenal axis.
To investigate whether obese subjects with abdominal obesity may be characterized by hyperactivity of the hypothalamic-pituitary-adrenal axis, we examined two groups of obese women with a waist to hip ratio (WHR) lower than 0.80 (n = 13), therefore having peripheral body fat distribution (P-BFD), or a WHR higher than 0.85 (n = 12), thus having abdominal body fat distribution (A-BFD). A group of seven normal weight healthy women served as controls. All subjects underwent the following protocol study that included 1) measurement of daily urinary free cortisol excretion rate; 2) a CRF test (human CRF, 1 microgram/kg BW, as iv bolus), with blood samples taken at regular intervals for ACTH and cortisol determination; and 3) an ACTH test, performed by administering two boli of ACTH (Synacthen, 0.2 microgram/kg BW, iv), at 90-min intervals, with blood samples taken for cortisol determination. Each woman also had a control saline study. Basal levels of both ACTH and cortisol rose significantly after CRF administration in all groups, but this increase was significantly higher in A-BFD than in P-BFD and control women. A significant correlation was found between the incremental area of cortisol and that of ACTH during the CRF test (r = 0.502), but not between these parameters and WHR values. Although the cortisol increase after the ACTH test was higher in A-BFD than in the other groups, these differences were only significant at 60 min during the test and when the analysis for repeated measures was applied. On the contrary, the incremental cortisol area after the ACTH test was not significantly different in the three groups. Moreover, it was not significantly correlated with the incremental cortisol area after CRF test or WHR values. Daily urinary free cortisol excretion rates (per g creatinine), however, were significantly higher in A-BFD than in P-BFD and control women. These results, therefore, suggest that obese women with A-BFD may have hyperactivity of the hypothalamic-pituitary-adrenal axis. This abnormality could be central in origin, due to hypersecretion of CRF or ACTH; alternatively, it could represent an adaptive phenomenon secondary to a state of functional cortisol resistance.
Restricted maximum likelihood (REML) is now well established as a method for estimating the parameters of the general Gaussian linear model with a structured covariance matrix, in particular for mixed linear models. Conventionally, estimates of precision and inference for fixed effects are based on their asymptotic distribution, which is known to be inadequate for some small-sample problems. In this paper, we present a scaled Wald statistic, together with an F approximation to its sampling distribution, that is shown to perform well in a range of small sample settings. The statistic uses an adjusted estimator of the covariance matrix that has reduced small sample bias. This approach has the advantage that it reproduces both the statistics and F distributions in those settings where the latter is exact, namely for Hotelling T2 type statistics and for analysis of variance F-ratios. The performance of the modified statistics is assessed through simulation studies of four different REML analyses and the methods are illustrated using three examples.
Understanding of the genetic influences on obesity has increased at a tremendous rate in recent years. By some estimates,
40 to 70 percent of the variation in obesity-related phenotypes in humans is heritable. Although several single-gene mutations
have been shown to cause obesity in animal models, the situation in humans is considerably more complex. The most common forms
of human obesity arise from the interactions of multiple genes, environmental factors, and behavior, and this complex etiology
makes the search for obesity genes especially challenging. This article discusses the strategies currently being used to search
for human obesity genes and recent promising results from these efforts.
This longitudinal study examines how childhood and early adolescent (age 6 to 15) peer and nonpeer social networks relate to sexual attitudes and behaviors in adolescence and young adulthood (age 12 to 25) for sexually abused and comparison girls. A large number of male peers in childhood is related to heightened sexual activity, sexual preoccupation, increased sexual pressure, and risky sexual behavior in adolescence. High-quality, female, nonpeer relationships have a positive effect on attitudes toward casual sex. Multiple group models illuminate several cross-lag group moderators: (a) Abused girls who are happier with male nonpeers are less preoccupied with sex; (b) abused girls who are happier with male peers are more likely to use birth control; and (c) abused girls who have early physical relationships are more likely to engage in risky sexual behavior. Treatment implications include monitoring the effects of low-status peer groups, encouraging contact with female role models, and encouraging the formation of high-quality relationships with male peers and nonpeers.
This study examines short- and long-term maladaptive outcomes in a sample of sexually abused females and a comparison group. The sample consists of intrafamilial sexual abuse victims ages 6-16 years at entry into the study and a demographically similar comparison group. The outcomes examined included measures of behavior and psychological problems such as aggressive behavior, depression, dissociation, and low self-esteem; and measures at two time points, first at entry into the study (median age 11 years) and approximately 7 years later (median age 18 years). The specific questions being addressed were (a) whether subgroups or profiles. based on the specific characteristics of the sexual abuse experienced, can be identified in this sample of abused females; and (b) whether these profile groups predict different patterns of adverse short- or long-term outcomes.
Little is known about childhood factors and adult obesity. A previous study found a strong association between childhood neglect and obesity in young adults.
To estimate associations between self-reported abuse in childhood (sexual, verbal, fear of physical abuse and physical) adult body weight, and risk of obesity.
Retrospective cohort study with surveys during 1995-1997.
A total of 13,177 members of California health maintenance organization aged 19-92 y.
Body weight measured during clinical examination, followed by mailed survey to recall experiences during first 18 y of life. Estimates adjusted for adult demographic factors and health practices, and characteristics of the childhood household.
Some 66% of participants reported one or more type of abuse. Physical abuse and verbal abuse were most strongly associated with body weight and obesity. Compared with no physical abuse (55%), being 'often hit and injured' (2.5%) had a 4.0 kg (95% confidence interval: 2.4-5.6 kg) higher weight and a 1.4 (1.2-1.6) relative risk (RR) of body mass index (BMI) > or = 30. Compared with no verbal abuse (53%), being 'often verbally abused' (9.5%) had an RR of 1.9 (1.3-2.7) for BMI > or = 40. The abuse associations were not mutually independent, however, because the abuse types strongly co-occurred. Obesity risk increased with number and severity of each type of abuse. The population attributable fraction for 'any mention' of abuse (67%) was 8% (3.4-12.3%) for BMI > or = 30 and 17.3% (-1.0-32.4%) for BMI > or = 40.
Abuse in childhood is associated with adult obesity. If causal, preventing child abuse may modestly decrease adult obesity. Treatment of obese adults abused as children may benefit from identification of mechanisms that lead to maintenance of adult obesity.
Type 2 diabetes is the most common form of hyperglycemia. The disease exists in all populations, but in developed societies, the prevalence has risen as the population ages and above all becomes more obese. In the prediabetic state, type 2 diabetes involves two defects, peripheral insulin resistance and hyperinsulinemia, which is followed by the failure of insulin secretion to compensate for the insulin resistance. As with nearly any disease, it is likely that multiple environmental and genetic factors are involved in the development of insulin resistance. An acquired pathogenic factor is obesity, particularly visceral obesity. Compelling evidence suggests that progressive dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, with elevated levels of circulating cortisol, is implicated in the development of visceral obesity. The HPA axis perturbations associated with visceral obesity can be accounted for, in part, by increased environmental stress that destabilizes the hypothalamic-pituitary system in individuals with genetic susceptibility.
It has been shown that girls from families in which mothers and fathers had high dietary intake and low physical activity (i.e., obesigenic families) were at increased risk of obesity from ages 5 to 7 years. This follow-up study uses additional data collected when girls were 9 and 11 years old to examine whether girls from obesigenic families continued to show greater increases in BMI over time and reported unhealthy dietary and activity patterns.
Families from the original cohort were reexamined when girls were 9 and 11 years of age. Parents' and girls' BMI, dietary intake, and physical activity and girls' percentage body fat and television viewing were assessed.
In comparison with girls from non-obesigenic families, girls from obesigenic families showed greater increases in BMI and BMI z score from ages 5 to 7 years that were maintained across ages 7 to 11 years. Furthermore, girls from obesigenic families had higher percentage body fat at ages 9 and 11 years. These results were independent of parents' BMI. Additional findings showed that girls from obesigenic families had diets higher in percentage fat and had higher levels of television viewing than girls from non-obesigenic families.
The environment that parents create, by way of their own dietary and physical activity behaviors, may have a lasting negative effect on children's weight trajectories and their emerging obesity risk behaviors, such as their dietary patterns. These findings further highlight the importance of the family in establishing children's obesity risk and the necessity of targeting parents of young children in obesity prevention efforts.
Copyright © 2007 by the American Academy of Pediatrics All and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk publication, it has been published continuously since 1948. PEDIATRICS is owned, published, PEDIATRICS is the official journal of the
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Grove Village, Illinois, 60007. Copyright © 2007 by the American Academy of Pediatrics. All and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk publication, it has been published continuously since 1948. PEDIATRICS is owned, published, PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly by guest on May 31, 2013 pediatrics.aappublications.orgDownloaded from
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