Association between cumulative exposure to adverse childhood experiences and childhood obesity

Abstract

Background Exposure to adverse childhood experiences (ACEs) is associated with many childhood diseases and poor health outcomes in adulthood. However, the association with childhood obesity is inconsistent. We investigated the association between reported cumulative ACE score and body mass index (BMI) in a large sample of patients at a single institution. Methods This cross-sectional study included children aged 2-20 years that were screened in a general pediatrics clinic for ACEs utilizing the Center for Youth Wellness ACEs questionnaire between July 2017 and July 2018. Overall ACE score was categorized as 'no exposure' (score = 0), 'low exposure' (score = 1), and 'high exposure' (score� 2). BMI was categorized as overweight/obese (BMI percentile � 85) or non-obese (BMI percentile < 85). The association between ACEs score and obesity was determined using univariate and multivariable logistic regression. Results Of the 948 patients included in the study, 30% (n = 314) were overweight/obese and 53% (n = 504) had no ACE exposure, 19% (n = 179) had low ACE exposure, and 28% (n = 265) had high ACE exposure. High ACE exposure was associated with increased odds of obesity (OR = 1.47, 95%CI = 1.07-2.03, p = 0.026). However, after adjusting for age, race/ethnicity, insurance type, and birth weight, the association attenuated and was null (OR = 1.01, 95% CI = 0.70-1.46, p = 0.97).

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

“…After removal of duplicates, 6,966 studies were screened in Rayyan with 6,801 excluded at the title/abstract level and 143 excluded at the full‐text level due to not examining the association between ACEs and obesity ( n = 102), sample population not children ( n = 36), or not being peer reviewed ( n = 5). Twenty‐four studies remained for inclusion, including 12 cross sectional 45–55 and 12 longitudinal 20,22,56–65 …”

“…Characteristics and results of individual studies are presented in Tables 2a and 2b. Twelve were cross sectional 45–55,66 and 12 were longitudinal 20,22,56–65 . Although the search was not limited by year, 23 of the 24 were published since 2010, with the exception of two published in 2009 54 and 2007 22 .…”

“…Assessment of ACEs and obesity varied across studies. Many considered lists of seven or more ACEs, which were then analyzed in one or more ways including individually yes/no, 47,49,52 as a summary score, 45,47,51,57 categorized at 0 versus any, 20,46–48,52,53,55,59 ≥2, 20,48,52,55 and/or ≥4 20,46 . Other studies focused on maltreatment‐related ACEs (physical, sexual, and/or emotional abuse and neglect), which were examined individually (each type of maltreatment yes/no) 50,60,64,66 or collectively (no maltreatment vs. any type of maltreatment) 65 .…”

“…Of note, the study included participants through adulthood and although the adult portion of the study was not included in this review, a relationship between sexual abuse and adult obesity was observed 22 . The second was a cross‐sectional study which focused on 18 ACEs, categorized as 0 versus any and <2 versus ≥2, reported by parents during their child's general pediatric care 55 . The third 53 was a cross‐sectional study that found a relationship between parent‐reported ACEs (any of eight ACEs yes/no) and childhood obesity only when children lived in poverty, with poverty operationalized as whether a child's home census block group fell above versus below the federal poverty threshold for a family of four.…”

“…No notable differences existed by risk of bias. Two used parent‐reported measure of multiple ACEs summarized and categorized dichotomously, 53,55 while one assessed only substantiated sexual abuse 22 . One involved a unique population of children with neurodevelopment delays 53 and one was longitudinal 22 .…”