title: Detailed assessments of childhood adversity enhance prediction of central obesity independent of gender, race, adult psychosocial risk and health behaviors.
abstract: OBJECTIVE
  This study examined whether a novel indicator of overall childhood adversity, incorporating number of adversities, severity, and chronicity, predicted central obesity beyond contributions of "modifiable" risk factors including psychosocial characteristics and health behaviors in a diverse sample of midlife adults. The study also examined whether the overall adversity score (number of adversities × severity × chronicity) better predicted obesity compared to cumulative adversity (number of adversities), a more traditional assessment of childhood adversity.
  
  
  METHODS
  210 Black/African Americans and White/European Americans, mean age=45.8; ±3.3 years, were studied cross-sectionally. Regression analysis examined overall childhood adversity as a direct, non-modifiable risk factor for central obesity (waist-hip ratio) and body mass index (BMI), with and without adjustment for established adult psychosocial risk factors (education, employment, social functioning) and heath behavior risk factors (smoking, drinking, diet, exercise).
  
  
  RESULTS
  Overall childhood adversity was an independent significant predictor of central obesity, and the relations between psychosocial and health risk factors and central obesity were not significant when overall adversity was in the model. Overall adversity was not a statistically significant predictor of BMI.
  
  
  CONCLUSIONS
  Overall childhood adversity, incorporating severity and chronicity and cumulative scores, predicts central obesity beyond more contemporaneous risk factors often considered modifiable. This is consistent with early dysregulation of metabolic functioning. Findings can inform practitioners interested in the impact of childhood adversity and personalizing treatment approaches of obesity within high-risk populations. Prevention/intervention research is necessary to discover and address the underlying causes and impact of childhood adversity on metabolic functioning.
authors.affiliation: Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA. Electronic address: crdavis@jbcc.harvard.edu.
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Davis
authors.affiliation: Boston College, Boston, MA.
authors.forename: Eric
authors.initials: E
authors.lastname: Dearing
authors.affiliation: Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Usher
authors.affiliation: Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Trifiletti
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Lesya
authors.initials: L
authors.lastname: Zaichenko
authors.affiliation: Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ollen
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Brinkoetter
authors.affiliation: Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Crowell-Doom
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Kyoung
authors.initials: K
authors.lastname: Joung
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Korea.
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Park
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA.
authors.forename: Christos S
authors.initials: CS
authors.lastname: Mantzoros
authors.affiliation: Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA; Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, Stony Brook, NY.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Crowell
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000706:statistics & numerical data*; D001741:Black or African American / Q000706:statistics & numerical data*; D015992:Body Mass Index; D001900:Boston / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000706:statistics & numerical data; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003643:Death; D017579:Domestic Violence / Q000706:statistics & numerical data; D004522:Educational Status; D004651:Employment; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology* / Q000378:metabolism; D010290:Parents; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D049629:Waist-Hip Ratio; D044465:White People / Q000706:statistics & numerical data*
keywords: AHEI; BMI; Central obesity; Childhood adversity; DSM; ECG; FFQ; GC; Glucocorticoids; HPA; MetS; Metabolic Syndrome; Modifiable risk factors; Psychosocial risk factors; SES; Socioeconomic Status; WHR; alternative healthy eating index; body mass index; diagnostic and statistical manual; electrocardiogram; food frequency questionnaire; hypothalamic–pituitary–adrenal; waist–hip ratio