Adverse Childhood Experiences and BMI: Lifecourse Associations in a Black-White U.S. Women Cohort.

INTRODUCTION: Although adverse childhood experiences (ACEs) have been positively associated with adiposity, few studies have examined long-term race-specific ACE-BMI relationships.

METHODS: A Black and White all-women cohort (N=611; 48.6% Black) was followed between 1987 and 1997 from childhood (ages 9-10 years) through adolescence (ages 19-20 years) to midlife (ages 36-43 years, between 2015 and 2019). In these 2020-2022 analyses, the interaction between race and individual ACE exposures (physical abuse, sexual abuse, household substance abuse, multiple ACEs) on continuous BMI at ages 19-20 years and midlife was evaluated individually through multivariable linear regression models. Stratification by race followed as warranted at α=0.15.

RESULTS: Race only modified ACE-BMI associations for sexual abuse. Among Black women, sexual abuse was significantly associated with BMI (B=3.24, 95% CI=0.92, 5.57) at ages 19-20 years and marginally associated at midlife (B=2.37, 95% CI= -0.62, 5.35); among White women, corresponding associations were null. Overall, having ≥2 ACEs was significantly associated with adolescent BMI (B=1.47, 95% CI=0.13, 2.80) and was marginally associated at midlife (B=1.45, 95% CI= -0.31, 3.22). This was similarly observed for physical abuse (adolescent BMI: B=1.23, 95% CI= -0.08, 2.54; midlife BMI: B=1.03, 95% CI= -0.71, 2.78), but not for substance abuse.

CONCLUSIONS: Direct exposure to certain severe ACEs is associated with increased BMI among Black and White women. It is important to consider race, ACE type, and life stage to gain a more sophisticated understanding of ACE-BMI relationships. This knowledge can help strengthen intervention, prevention, and policy efforts aiming to mitigate the impacts of social adversities and trauma on persistent cardiometabolic health disparities over the lifecourse.