Adverse childhood experiences and risk of diabetes: A systematic review and meta-analysis

Abstract

Background The association between adverse childhood experiences (ACEs) and diabetes is unclear. This systematic review and meta-analysis aims to quantify the association between the number and types of ACEs and diabetes during adulthood based on available observational studies. Methods A comprehensive literature search of studies exploring the association between ACEs and diabetes was conducted in PubMed, Medline, and Embase databases until 15 April 2022. A random-effects model was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) for the number and types of ACEs with diabetes. Regarding the association between the number of ACEs and diabetes, we used funnel plots to examine publication bias, subgroup analysis to explore sources of heterogeneity, and sensitivity analysis to explore the robustness of the pooled results. Results A total of 49 studies were included. Individuals with higher continuous ACEs (per each additional ACE: OR = 1.06, 95% CI = 1.02-1.10), any ACE (OR = 1.22, 95% CI = 1.16-1.28), or ≥4 ACEs (OR = 1.44, 95% CI = 1.27-1.63) were at an increased risk of diabetes in adulthood when compared with individuals without ACEs. Across specific ACE types, childhood economic adversity (OR = 1.11, 95% CI = 1.04-1.19), physical abuse (OR = 1.14, 95% CI = 1.07-1.21), sexual abuse (OR = 1.25, 95% CI = 1.12-1.39), verbal abuse (OR = 1.11, 95% CI = 1.03-1.20), and incarceration (OR = 1.22, 95% CI = 1.03-1.45) were associated with diabetes. However, neglect, emotional abuse, domestic violence, parental divorce or separation, parental death, and living with a family member with substance abuse or mental disorders were not significantly associated with diabetes. Conclusions Individuals with ACEs may have a cumulative risk for diabetes in adulthood. It is critical to prevent ACEs and build resilience in individuals affected by ACEs.

Childhood maltreatment and risk of endocrine diseases: an exploration of mediating pathways using sequential mediation analysis

“…Our findings of an association between childhood maltreatment and subsequent endocrine diseases are consistent with previous studies, most of which, however, focused on diabetes [15]. For instance, the results of two meta-analyses including a total of 20 observational studies concluded that individuals exposed to sexual abuse had 39% [52] and 25% [8] increased risk of diabetes, respectively, later in life. Our study extends the body of existing knowledge by demonstrating an association of childhood maltreatment with any and multiple endocrine diseases, in line with previous research demonstrating the effects of ACEs on various endocrine axes, such as the initial hyperactivity and the subsequent hypoactivity of HPA axis [11], modified basal HPT functions [12], faster sexual maturation [13], and the alternations of hormone secretion [53].…”

“…disturbances of multiple hormone-producing cells and organs throughout the body, particularly diabetes and obesity, have been increasing in virtually all regions of the world [7]. A recent meta-analysis of 49 observational studies demonstrated a positive association between ACEs and diabetes, yielding an odds ratio of 1.22 for any ACEs and 1.27 for neglect [8]. Similarly, ACEs have been consistently associated with increased odds of childhood [9] and adult [10] obesity.…”

“…However, despite evidence from human and animal studies supporting a wide range of endocrine dysfunctions which possibly involve all endocrine-related axes after ACEs [11][12][13][14], to date, there is no comprehensive evaluation of the association of ACEs with multiple endocrine diseases. Also, existing data are mainly derived from cross-sectional studies with limited sample size [10,15,16] and little focus on mediation factors [8,16], which precludes the application of these data for causal inference or further mechanistic exploration.…”

Adverse Childhood Experience as a Risk Factor for Developing Type 2 Diabetes among the Jazan Population: A Cross-Sectional Study

“…Similarly, a systematic literature review and meta-analysis showed that ACEs, particularly childhood neglect, family dysfunction, and two or more ACEs, are associated with a higher risk of T2DM [ 15 ]. It was found that childhood economic adversity and physical, sexual, and verbal abuse were associated with T2DM [ 16 , 17 ]. On the other hand, a systematic literature review by Zhu et al [ 16 ] reported that emotional abuse, domestic violence, parental divorce, parental death, neglect, and living with a family member with substance abuse were not significantly associated with diabetes.…”

“…It was found that childhood economic adversity and physical, sexual, and verbal abuse were associated with T2DM [ 16 , 17 ]. On the other hand, a systematic literature review by Zhu et al [ 16 ] reported that emotional abuse, domestic violence, parental divorce, parental death, neglect, and living with a family member with substance abuse were not significantly associated with diabetes. It is noteworthy that the sample size in these studies is different from our study sample, and the explanation for these variations might be related to the heterogeneity of the population and the high risk of recall bias in the previous studies.…”