Population, Policy and Practice Programme, University College London Great Ormond Street Institute of Child Health, London, UK.
BMJ Open. 2019 Mar 23;9(3):e024079. doi: 10.1136/bmjopen-2018-024079.
Research on associations between childhood maltreatment and adult cardiometabolic disease risk is sparse. We aimed to investigate associations between different forms of child maltreatment and mid-adult cardiometabolic markers and whether potential intermediaries could account for the associations observed.
1958 British birth cohort.
Approximately 9000 cohort members with data on cardiometabolic markers.
Adult (45y) cardiometabolic markers (blood pressure, lipids and glycated haemoglobin [HbA]).
Seventeen per cent of participants were identified as neglected; 6.1%, 1.6% and 10.0% were identified as experiencing physical, sexual and psychological abuse, respectively. Childhood neglect and physical abuse were associated with high body mass index (BMI) and large waist circumference when adjusting for early-life covariates. For neglect, the adjusted odds ratio (AOR) was 1.16 (95% CI: 1.02 to 1.32) and 1.15 (1.02 to 1.30) for general and central obesity, respectively, and for physical abuse, the respective AOR was 1.36 (1.13 to 1.64) and 1.38 (1.16 to 1.65). Neglect was also associated with raised triglycerides by 3.9 (0.3 to 7.5)% and HbA by 1.2 (0.4 to 2.0)%, and among females, lower high-density lipoprotein cholesterol (HDL-c) by 0.05 (0.01 to 0.08)mmol/L after adjustment. For physical abuse, the AOR was 1.25 (1.00 to 1.56) for high low-density lipoprotein cholesterol, HbA was raised by 2.5 (0.7 to 4.3)% (in males) and HDL-c was lower by 0.06 (0.01 to 0.12)mmol/L (in females). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. For psychological abuse, the AOR for elevated triglycerides was 1.21 (1.02 to 1.44) and HDL-c was lower by 0.04 (0.01 to 0.07)mmol/L. Maltreatments were not associated with raised blood pressure. In analyses of potential intermediary factors, several associations attenuated after adjustment for adult lifestyles (mainly smoking and alcohol consumption rather than physical activity) and child-to-adult BMI.
Childhood maltreatments, particularly neglect and physical abuse, were associated with greater adiposity and poorer lipid and HbA profiles decades later in adulthood. Associations were modest but independent of early-life factors linked to these outcomes. Findings implicate adult lifestyles as an important intermediary between child maltreatment and outcomes.
关于儿童期虐待与成人心血管代谢疾病风险之间关联的研究很少。本研究旨在探讨不同形式的儿童虐待与成年中期心血管代谢标志物之间的关联，以及潜在的中介因素是否可以解释观察到的关联。
1958 年英国出生队列。
约 9000 名有心血管代谢标志物数据的队列成员。
成人（45 岁）心血管代谢标志物（血压、血脂和糖化血红蛋白[HbA]）。
17%的参与者被认定为被忽视；6.1%、1.6%和 10.0%分别被认定为经历过身体、性和心理虐待。在调整早期生活协变量后，儿童期忽视和身体虐待与高体重指数（BMI）和大腰围有关。对于忽视，调整后的比值比（AOR）分别为 1.16（95%CI：1.02 至 1.32）和 1.15（1.02 至 1.30），用于一般和中央肥胖，对于身体虐待，相应的 AOR 分别为 1.36（1.13 至 1.64）和 1.38（1.16 至 1.65）。忽视还与甘油三酯升高 3.9（0.3 至 7.5）%和 HbA 升高 1.2（0.4 至 2.0）%有关，在女性中，高密度脂蛋白胆固醇（HDL-c）降低 0.05（0.01 至 0.08）mmol/L。对于身体虐待，高 LDL-c 的 AOR 为 1.25（1.00 至 1.56），HbA 升高 2.5（0.7 至 4.3）%（男性），HDL-c 降低 0.06（0.01 至 0.12）mmol/L（女性）。性虐待的关联与身体虐待相似，但 95%CI 较宽。对于心理虐待，升高甘油三酯的 AOR 为 1.21（1.02 至 1.44），HDL-c 降低 0.04（0.01 至 0.07）mmol/L。虐待与血压升高无关。在分析潜在的中介因素时，在调整成年生活方式（主要是吸烟和饮酒，而不是体力活动）和儿童到成年 BMI 后，一些关联减弱。
儿童期虐待，特别是忽视和身体虐待，与数十年后成年期更大的肥胖和更差的血脂和 HbA 特征有关。这些关联虽然不大，但与这些结果相关的早期生活因素无关。研究结果表明，成人生活方式是儿童虐待与结果之间的一个重要中介因素。
