Childhood Socioeconomic Disadvantage and Risk of Fatty Liver in Adulthood: The Cardiovascular Risk in Young Finns Study

Abstract

Fatty liver is a preventable cause of liver failure, but early risk factors for adulthood fatty liver are poorly understood. We examined the association of childhood socioeconomic disadvantage with adulthood fatty liver and tested adulthood risk factors of fatty liver as possible mediators of this link. The study population comprised 2,042 participants aged 3‐18 years at baseline (1980) from the longitudinal Cardiovascular Risk in Young Finns Study. Follow‐up with repeated clinical examinations was 31 years. Childhood socioeconomic disadvantage was assessed using data from parents’ socioeconomic position and socioeconomic circumstances in participants’ residential neighborhoods, categorized as high versus low socioeconomic disadvantage. Fatty liver was determined by ultrasound during the last follow‐up (2011) at ages 34‐49 years. Childhood and adulthood risk factors, including metabolic biomarkers and lifestyle variables, were assessed in clinical examinations. A total of 18.9% of the participants had fatty liver in adulthood. High childhood socioeconomic disadvantage was associated with an increased risk of fatty liver (risk ratio [95% confidence interval], 1.42 [1.18‐1.70]; P = 0.0002). This association was robust to adjustment for age, sex, and childhood risk factors of fatty liver, including high body mass index, elevated insulin, and low birth weight (1.33 [1.09‐1.62]; P = 0.005). High childhood socioeconomic disadvantage was also associated with the development of risk factors of fatty liver in adulthood. Adulthood risk factors linking childhood socioeconomic disadvantage with fatty liver included waist circumference (proportion mediated of the total effect of childhood socioeconomic disadvantage, 45%), body mass index (40%), systolic blood pressure (29%), insulin (20%), physical activity (15%), triglycerides (14%), and red meat consumption (7%). Conclusion: Childhood socioeconomic disadvantage was associated with multiple risk factors of fatty liver and increased likelihood of fatty liver in adulthood.

The multiple roles of life stress in metabolic disorders

“…In light of the above-reviewed evidence on cardiometabolic and immune dysfunction and stress-acceleration of ageing amplified by unhealthy behaviours and mental health problems, an association of life stress with a broad set of clinical conditions is expected. Supporting this hypothesis, life stress has been linked to metabolic disorders, such as diabetes 7,22,25,120 , fatty liver 23,121,122 , and composite morbidity indices 123 in separate prospective studies across multiple stressors. This evidence is strengthened by the dose-response pattern observed between stress and risks of diabetes and liver disease across the life course: higher exposure to early life stress seems to increase adulthood disease risk in a graded fashion 7 .…”

Lifestyle, inadequate environments in childhood and their effects on adult cardiovascular health

“…The explanation seems to be related to same physiological and behavioral adaptations, which at the same time determine a greater chance of survival under risk conditions, and worse long-term metabolic patterns. 12 …”

Nonalcoholic Fatty Liver Disease Incidence and Remission and Their Predictors During 7 Years of Follow-up Among Finns

“…Further potential limitation is the lack of information on known secondary causes of fatty liver, such as medications possibly inducing fatty liver or viral hepatitis and autoimmune hepatitis. This limitation is probably minor since none of the individuals of our cohort had diagnosed viral or autoimmune hepatitis according to hospital registries at the baseline of this study ( 81 ). Furthermore, the prevalence of hepatitis B and C, and autoimmune hepatitis, has been observed to be low (0.00%, 0.03%, and 0.01%, respectively) in Finland ( 82 , 83 ).…”