title: Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study.
abstract: BACKGROUND
  Early life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking.
  
  
  METHODS
  A cross-sectional sample of 151 males and females (age: 45.6±3.5 years, BMI: 30.0±7.1 kg/m(2)) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5 years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA-PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics.
  
  
  RESULTS
  Individuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above lifestyle parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants.
  
  
  CONCLUSIONS
  Fewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index.
authors.affiliation: Section of Endocrinology, Boston VA Healthcare System/Harvard Medical School, 150 S. Huntington Avenue, Jamaica Plain, MA 02130, USA; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Gavrieli
authors.affiliation: Section of Endocrinology, Boston VA Healthcare System/Harvard Medical School, 150 S. Huntington Avenue, Jamaica Plain, MA 02130, USA; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: ofarr@bidmc.harvard.edu.
authors.forename: Olivia M
authors.initials: OM
authors.lastname: Farr
authors.affiliation: Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA.
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Davis
authors.affiliation: Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA; Department of Psychiatry, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, NY 11794, USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Crowell
authors.affiliation: Section of Endocrinology, Boston VA Healthcare System/Harvard Medical School, 150 S. Huntington Avenue, Jamaica Plain, MA 02130, USA; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Christos S
authors.initials: CS
authors.lastname: Mantzoros
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet; D002149:Energy Intake; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D012890:Sleep; D012907:Smoking; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology*; D013315:Stress, Psychological; D014481:United States
keywords: Diet quality; Early life adversity; PTSD; Physical activity; Resting and sleeping