Early Psychosocial Environment and Cardiometabolic Risk

“It is easier to build strong children that to repair broken men”

-Frederick Douglass

This quote comes from a previous lecture on adverse childhood experiences (ACEs) and comes to mind after reading a recent study: JR Doom et al. J Pediatr 2019; 209; 85-91.

This study examined 588 adolescents (16-18 yrs) from a longitudinal cohort that began in infancy (in Chile).

Methods: Psychosocial environmental factors including depressive symptoms, stressful life events, poor support for child development, father absence, and socioeconomic status was reported by mothers at 6-12 months of age.  These factors were analyzed to determine association with adolescent cardiometabolic parameters including BMI, higher blood pressure, anthropometric risk factors for cardiovascular disease, biomarkers for cardiovascular disease (e.g. triglycerides, HOMA, cholesterol) and metabolic syndrome

Key findings:

  • Infants with poor psychosocial environments had higher BMIs at 10 years and in adolescence, higher blood pressures, greater anthropometric risk, worsened cardiovascular biomarkers, and higher likelihood of metabolic syndrome (aOR 1.5)
  • The Figure in the article shows sequential worsening by quartiles -those with the highest risk based on psychosocial stress composite were worse on these outcomes compared to the 2nd highest risk factor quartile group. And in turn, the 2nd highest risk group >3rd highest risk group >lowest quartile.
  • “It is unknown whether these associations may be reversible.”

My take: While these results show a clear association of early life factors and worsened cardiovascular/metabolic outcomes, the mechanism for this is unclear.  Is this related to diet, less physical activity, stress hormones, a combination or other factors?

Related blog post:

Adverse Childhood Experiences

Recently, I attended the 17th Annual Donald Schaffner lecture.  This lecture honors the legacy of an outstanding surgeon who I had the opportunity to work with many years ago.  One of my partners, Dr. Jeff Lewis, has been instrumental in arranging these annual lectures.

This terrific lecture by Emory physician, Dr. Stan Sonu, focused on Adverse Childhood Experiences (ACEs).  While this has been a pervasive long-standing problem, there has been heightened interest in this topic following the shameful policy of promoting childhood separations at the U.S.-Mexico border.

This lecture explained how widespread the problem of ACEs is among children born in the U.S., even among the affluent.  Much of the lecture focused on the ACEs study which included a cohort of 17,000 –all of whom were insured and 75% were white and 75% were college educated.

Here are pictures of some of the slides -which explain the scope the problem and the consequences of ACEs:

The above slide provides the three take home points.

The slide above shows associations between ACEs and smoking drinking, and IV drug use. The slides below shows associations between ACEs and negative mental health outcomes,  chronic diseases, and poor work performance.

The slide above demonstrates that adverse health effects are increased even among 18-34 year olds. The slide below showed that learning problems are associated with ACEs as well; thus, the effects of ACEs start in childhood.

The slide above coincided with discussions (&other slides) of how toxic stress can result in physical changes to the brain.

The slide above (which is difficult to see)  indicates that while we see the health effects, we often are not seeing ACEs directly.

Dr. Sonu stated the single most protective factor was having a stable relationship with caregiver.