The long-term effects of childhood trauma on health are well-documented, but few population-based studies have explored how childhood trauma affects the risk of developing metabolic syndrome (MetS) in adulthood. Using data from 1,234 adults in the second wave of the Midlife Development in the U.S. survey (2004), we investigate (1) the extent to which childhood abuse affects the risk of developing MetS in adulthood; (2) how the severity of different types of abuse (emotional, physical, sexual, or cumulative abuse) affects this risk; and (3) the extent to which adult socioeconomic status (SES), maladaptive stress responses, and unhealthy behaviors mediate the association. We also test whether these associations differ significantly by sex. We find that emotional and physical abuse increase the risk of developing MetS for both sexes, whereas sexual abuse is a predictor for women only. For both sexes, individuals who experienced more cumulative abuse have a greater risk of developing MetS. Adult SES partially explains the association between childhood abuse and MetS. Maladaptive stress responses and unhealthy behaviors further explain the association. Among the potential mediators, poor sleep quality was a significant pathway for men and women, while stress-induced eating was a significant pathway for women only. Our findings suggest that the well-documented health consequences of early life trauma may vary by the nature of the trauma, the victim’s sex, and the coping mechanisms that he or she employs.

Background While the preclinical development of type 2 diabetes is partly explained by obesity and central adiposity, psychosocial research has shown that chronic stressors such as discrimination have health consequences as well. Purpose We investigated the extent to which the well-established effects of obesity and central adiposity on nondiabetic glycemic control (indexed by HbA1c) were moderated by a targeted psychosocial stressor linked to weight: perceived weight discrimination. Methods Data came from the nondiabetic subsample (n=938) of the Midlife in the United States (MIDUS II) survey. Results Body mass index (BMI), waist-to-hip ratio, and waist circumference were linked to significantly higher HbA1c (p < .001). Multivariate-adjusted models showed that weight discrimination exacerbated the effects of waist-to-hip ratio on HbA1c ( p < .05), such that people who had higher WHR and reported weight discrimination had the highest HbA1c levels. Conclusions Understanding how biological and psychosocial factors interact at nondiabetic levels to increase vulnerability could have important implications for public health and education strategies. Effective strategies may include targeting sources of discrimination, rather than solely targeting health behaviors and practices of overweight and obese persons.

The epidemic of obesity and its related chronic diseases has provoked interest in the predictors of eating behavior. Eating in response to stress has been extensively examined, but currently unclear is whether stress eating is associated with obesity and morbidity. We tested whether self-reported stress eating was associated with worse glucose metabolism among nondiabetic adults as well as with increased odds of prediabetes and diabetes. Further, we investigated whether these relationships were mediated by central fat distribution. Participants were 1138 adults (937 without diabetes) in the Midlife in the U.S. study (MIDUS II). Glucose metabolism was characterized by fasting glucose, insulin, insulin resistance (HOMAIR), glycosylated hemoglobin (HbA1c), prediabetes, and diabetes status. Multivariate-adjusted analyses showed that stress eating was associated with significantly higher nondiabetic levels of glucose, insulin, insulin resistance, and HbA1c as well as higher odds of prediabetes or diabetes. Relationships between stress eating and all outcomes were no longer statistically significant once waist circumference was added to the models, suggesting that it mediates such relationships. Findings add to the growing literature on the relationships among psychosocial factors, obesity, and chronic disease by documenting associations between stress eating and objectively measured health outcomes in a national sample of adults. The findings have important implications for interventive targets related to obesity and chronic disease, namely, strategies to modify the tendency to use food as a coping response to stress.

Population-based studies of health typically focus on psychosocial contributors to illness and disease. We examine findings from a national longitudinal study of American adults, known as MIDUS (Midlife in the U.S.) to examine the role of psychosocial factors in promoting resilience, defined as the maintenance, recovery, or improvement in health following challenge. Classic studies of resilience are briefly noted, followed by a look at three categories of resilience in MIDUS. The first pertains to having good health and well-being in the face of low socioeconomic standing. The second pertains to maintaining good health and well-being despite the challenges that accompany aging. The third pertains to resilience in the face of targeted life challenges such as abuse in childhood, loss of spouse in adulthood, or having cancer. Across each area, we summarize evidence of positive health, and where possible, highlight protective influences that account for such salubrious outcomes. We conclude with opportunities for future research in MIDUS such as examining cultural and genetic influences on resilience as well as utilizing laboratory challenge data to illuminate underlying mechanisms.

These results suggest that psychological well-being and socioeconomic status interact in important ways in influencing nondiabetic glucose metabolism.

Objective We examined the relationship between childhood socioeconomic status (SES) and glucoregulation in later life and used a life-course framework to examine critical periods and underlying pathways. Methods Data came from the MIDUS (Midlife in the U.S.) national study (n=895). Childhood SES indicators retrospectively reported at MIDUS I were used to create a childhood SES disadvantage index. Adult SES disadvantage and potential pathways were measured at MIDUS I and included waist circumference, depressive symptoms, and physical activity. Glucose and HbA1c, measured approximately 9-10 years later at MIDUS II, were used to create the ordinal outcome measure (no diabetes/prediabetes/diabetes). Results Childhood SES disadvantage predicted increased odds of prediabetes and diabetes net of age, gender, race, and smoking (OR=1.11, 95% CI: 1.01-1.22). Childhood SES disadvantage predicted adult SES disadvantage (β=.26, p=.001) and the three key mediators: higher waist circumference (β=.10, p=.002), lower physical activity (β=−.11, p=.001), and marginally higher depressive symptoms (β=.07, p=.072). When childhood and adult SES disadvantage were in the same model, only adult SES predicted glucoregulation (OR=1.07, 95% CI: 1.01-1.13). The SES disadvantage measures were no longer significantly associated with glucoregulation after including waist circumference, physical activity, and depressive symptoms, all of which were significant predictors of glucoregulation. Conclusions The consequences of childhood SES disadvantage are complex and include both critical period and pathway effects. The lack of a direct effect of childhood SES on glucoregulation does not negate the importance of early environment but suggests that early-life socioeconomic factors propel unequal life-course trajectories that ultimately influence health.

Objective: This study investigated whether different psychosocial factors predicted levels of glycosylated hemoglobin (HbA 1c ) over time, after adjusting for covariates and baseline level of HbA 1c . Design: These questions were investigated with a longitudinal sample (N ϭ 97, age ϭ 61-91) of older women without diabetes. HbA 1c levels and psychosocial measures were obtained at baseline and 2-year follow-up. Main Outcome Measures: Coping strategies, positive affect, medical history, and health behaviors were assessed using self-administered questionnaires. HbA 1c were obtained during the respondents' overnight stay at the General Clinical Research Center (GCRC) at the University of Wisconsin-Madison. Results and Conclusion: Regression analyses showed that higher levels of problem-focused coping, venting, and positive affect predicted lower levels of HbA 1c , after controlling for baseline HbA 1c and sociodemographic and health factors. Furthermore, positive affect was found to moderate the effects of problemfocused coping (active, instrumental social support, suppressing competing activities). The pattern of interaction showed that the adverse effects of low problem-focused coping on cross-time changes in HbA 1c were amplified among those who also had low levels of positive affect.Keywords: coping, positive affect, glycosylated hemoglobin, HbA 1cGlycosylated hemoglobin (HbA 1c ) is the central clinical indicator of glycemic control, a fundamental part of diabetes care in Type 1 and Type 2 diabetes (Alam, Weintraub, & Weinreb, 2005). The relevance of HbA 1c levels to the health of people without diabetes is, however, increasingly recognized. Regardless of diabetes status, HbA 1c is an independent progressive risk factor for cardiovascular outcomes, with every 1-percentage point absolute increase above normoglycemic levels predicting a 20% increase in incidence of cardiovascular events (Gerstein, 2004 Heuch, Ingebretsen, and Jacobsen, (2004), for example, found that metabolic changes reflected by HbA 1c levels contributed to the development of hard carotid artery plaques, even at modestly elevated levels. Higher levels of HbA 1c in people without diabetes have also been identified as a risk factor for atherosclerosis, peripheral arterial disease, and nondiabetic kidney disease (Menon, Greene, Pereira, Wang, Beck, Kusek, Collins, Levey, & Sarnak, 2005;Muntner, Wildman, Reynolds, Desalvo, Chen, & Fonseca, 2005; Vitelli, Shahar, Heiss, McGovern, Brancati, Eckfeldt, & Folsom, 1997). Finally, Khaw, Wareham, Bingham, Luben, Welch, & Day, (2004) documented that all-cause mortality associated with HbA 1c concentrations increased continuously through the sampling distribution.Previous studies, as we will review below, have also linked psychosocial factors to glycemic control in people with diabetes. Our focus is specifically on coping strategies (problem-focused, emotion-focused) and affect (positive, negative). The purpose of the present investigation was to examine the relevance of these factors for changes in HbA 1c ...

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