Childhood trauma and metabolic syndrome in men and women
Introduction
Metabolic syndrome (MetS) is a cluster of conditions—abdominal obesity, glucose intolerance, high blood pressure, and both low “good” and high “bad” blood cholesterol levels—which co-occur, heightening an individual's risk of cardiovascular disease (CVD), coronary heart disease (CHD), and stroke. Each of these disorders is among the leading causes of adult mortality in the U.S. (Ford, 2005). The MetS-related mortality rate and the costs of treatment have increased over the past three decades, burdening individuals and health care systems (Boudreau et al., 2009).
MetS typically emerges during adulthood, yet the risk of developing MetS is affected by social and economic factors in early life, such as childhood abuse (Danese and Tan, in press, Riley et al., 2010). Most studies, however, have focused on either a single type of childhood abuse—physical, sexual, or emotional—or a single symptom of MetS, typically obesity. Moreover, most studies have not explored how the severity of abuse affects the risk of developing MetS. While many studies have documented sex differences in the type of abuse (Sedlak et al., 2010), relatively little attention has been given to sex differences in the impact of childhood abuse on the development of MetS. This omission is surprising given that the biological and psychosocial mechanisms (e.g., estrogen, depression, and stress-induced eating) associated with both childhood abuse and MetS differ by sex (Carr, 2003, Tanofsky et al., 1997). Documenting the proximate pathways linking childhood abuse to MetS and potential sex differences is important, as it may help inform sex-specific interventions to modify behaviors associated with MetS.
Using data from Midlife in the United States (MIDUS), we (1) investigate the association between childhood trauma and MetS in men and women and (2) evaluate the extent to which these associations are explained by social, psychological, and behavioral mechanisms. Our study contributes to research on the long-term health effects of early life adversity by (1) showing how different types and severities of childhood trauma explain variation in adult health, (2) linking victims' potentially modifiable health conditions/behaviors to adult health, and (3) identifying sex differences in these processes.
Section snippets
Childhood trauma and MetS
Over the past three decades, CHD has been the leading cause of death among adults in the U.S. (Jemal, Ward, Hao, & Thun, 2005). MetS is one of the main contributors to CHD (Alberti, Zimmet, & Shaw, 2006). About 34% of U.S. adults met the criteria for MetS in the 2003–2006 National Health and Nutrition Examination Survey (Ervin, 2009). Individuals who have MetS are three to four times more likely to die of CHD, have a threefold greater risk of developing type 2 diabetes (Ford, 2005), and a
Socioeconomic status (SES)
Childhood abuse may occur at all levels of SES, although higher rates have been documented in low-income and impoverished family environments, possibly due to increased exposure to stressful circumstances, including economic insecurity and substance abuse (Kelleher et al., 1994, Sedlak et al., 2010). Victims of abuse are at greater risk of poor educational outcomes, unemployment, and low adult SES, even after adjusting for childhood SES (Currie & Widom, 2010). Therefore, SES in adulthood might
Sex differences
We also assess the extent to which the effect of abuse on MetS, and the specific pathways that account for the association, vary by sex. The nature of childhood trauma differs by sex; for example, women are more likely to encounter sexual abuse (Sedlak et al., 2010), although this difference is partly attributable to men's tendency to underreport such experiences (Holmes & Slap, 1998). Moreover, biological mechanisms may affect men and women in different ways. During young adulthood and early
Sample
The analytic sample comes from the Biomarker Substudy of MIDUS, a longitudinal study of health and aging among individuals in the 48 contiguous states. MIDUS I (N = 7108), which was conducted from 1995 to 1996, included non-institutionalized, English-speaking individuals between 25 and 75 years old (b. 1920–1970). A follow-up study (MIDUS II) was conducted 10 years after the baseline assessment for 4963 MIDUS I respondents (70% response rate). To increase the total number of Black respondents
Descriptive statistics
Table 1 presents descriptive statistics by sex. Women were more likely than men to experience emotional abuse and sexual abuse, and they had higher levels of cumulative abuse, but there was no sex difference in physical abuse. Women reported higher levels of anxiety, depressive symptoms, sleep quality, stress-induced eating, and lower levels of exercise. Even after adjusting for age, women had fewer symptoms of MetS (1.85 vs. 2.27, p < .001) and were less likely to have a MetS diagnosis (31%
Discussion
Our study is the first that we know of that assesses the effects of specific types of childhood abuse on two measures of MetS, identifies specific psychosocial and behavioral pathways accounting for these associations, and evaluates sex differences in these patterns. Several key contributions emerge from our findings. First, childhood trauma increases both the number of MetS symptoms and the risk of having a MetS diagnosis. Our findings are consistent with prior studies documenting an
Acknowledgments
The authors are grateful for comments from Allan V. Horwitz, Helene R. White, and Kristen W. Springer on an earlier version of this paper.
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