Child maltreatment and living standards in adulthood: findings from a prospective birth cohort

BackgroundChild maltreatment (abuse and neglect) has well-established effects on mental health, but less is known about its influence on adult life economic circumstances. We aimed to establish associations of child maltreatment with such outcomes in mid-life.MethodsWe used data from the 1958 British birth cohort (n=8076) on child neglect and abuse (physical, sexual, psychological, and witnessing abuse) and adult (at age 50 years) long-term sickness absence, not in employment, education, or training (NEET), lacking assets, income-related support, poor educational qualifications, financial insecurity, manual social class, and social mobility. Logistic regression was used to assess associations with maltreatment separately and combined as a score (0, 1, ≥2) with and without adjustment for potential confounding factors (maternal age, birthweight, birth order, social class at birth, parental education, household amenities, crowding, and tenure at age 7 years). Missing values were imputed with multiple imputation chained equations.FindingsAbuse prevalence varied from 1% (n=115) for sexual abuse to 10% (776) for psychological abuse; 1208 (16%) were defined as neglected. 1506 (19%) of the population experienced one type of maltreatment, and 585 (7%) experienced two or more. All maltreatments were associated with most outcomes (eg, for physical abuse, adjusted odds ratio [OR] of long-term sickness absence was 2·33, 95% CI 1·62–3·35). There was a trend across multiple types of maltreatment and unfavourable outcomes—eg, adjusted OR for NEET increased for one and two or more maltreatments compared with no maltreatment (1·30 [1·02–1·65] and 1·72 [1·28–2·33], respectively; p_trend<0·0001). Likewise, adjusted OR for three or more unfavourable adult outcomes increased with more maltreatment compared with none (1·94 [1·59–2·37] for one and 2·23 (1·75–2·84] for two or more; p_trend<0·0001). Children who were sexually abused or neglected were less likely than those not sexually abused or neglected, respectively, to be upwardly mobile from birth to mid-adulthood (unadjusted OR 0·49 [0·30–0·81] and 0·45 [0·39–0·53]).InterpretationChild abuse was reported retrospectively in adulthood, although child neglect and potential confounding factors were ascertained prospectively and we examined a wide range of adult socioeconomic outcomes that are important because of their costs to individuals and society. That childhood maltreatments were associated with most unfavourable outcomes in mid-adulthood, has implications for the broader field of health equity. The increasing risk of poor adult outcome associated with multiple types of maltreatment suggests that they have an accumulating burden.FundingThis work was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health.     

Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood: associations and potential explanations

BackgroundEvidence of the association between childhood maltreatment and risk of adult cardiometabolic disease is sparse. We investigated associations of different forms of child maltreatment with adult cardiometabolic markers and potential explanations.MethodsIn the 1958 British birth cohort, we tested associations of childhood neglect (ascertained at age 7 years and 11 years) and abuse (physical, sexual, psychological, self-reported at 45 years) with adult (45 years) cardiometabolic markers (blood pressure, lipids, glycated haemoglobin [HbA_1c]) using linear and logistic regressions. Models were adjusted, first for factors affecting measurements (eg, room temperature, postal delay of blood sample, and for women oral contraception and hormone replacement therapy) and early life factors (eg, birthweight, socioeconomic status) and second for explanatory factors (change in body-mass index from childhood to adulthood, adult socioeconomic status, lifestyles, mental health). We applied multiple imputation to missing data on neglect and covariates, and restricted analyses to individuals with observed cardiometabolic data.FindingsAmong 9349 participants (4650 men, 4699 women), 12% (1143) reported any form of abuse. Prevalence for sexual abuse was 1·6% (149), physical abuse 6·0% (565), and psychological abuse 10·0% (926), and 1627 (17·4%) had two or more indicators of childhood neglect. Childhood neglect was associated in adulthood with raised triglycerides by 3·9% (95% CI 0·4–7·4) and HbA_1c by 1·2% (0·4–2·0), and for women lower HDL by 0·05 mmol/L (0·01–0·08), after adjusting for early life covariates. Physical abuse was associated with increased risk of high LDL (odds ratio [OR] 1·24, 95% CI 1·00–1·55) and raised HbA_1c in men by 2·4% (0·6–4·2), and lower HDL in women by 0·06 mmol/L (0·01–0·12). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. Psychological abuse was associated with increased risk of high triglycerides (OR 1·23, 1·03–1·46) and low HDL by 0·04 mmol/L (0·01–0·07). Maltreatment was not associated with raised blood pressure. All associations disappeared after further adjustment: adult lifestyle was a key explanatory factor for most associations, adult socioeconomic status was important for associations with neglect but not abuse, body-mass index was important for neglect and physical abuse, and mental health was important for psychological abuse.InterpretationChildhood maltreatments were associated with poor lipid and HbA_1c profiles decades later in adulthood in this population cohort. Explanations for associations varied by form of maltreatment. Further work is needed on the role of life-course explanatory factors and on effective strategies to reduce or prevent long-term health consequences of maltreatment.FundingThis work was funded by the Department of Health Policy Research Programme through the Public Health Research Consortium and supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health. Data collection for participants at age 45 years was funded by the Medical Research Council (grant G0000934).     

Associations of early-life adversities with inflammatory profiles in midlife: evidence from two cohorts in the UK and USA

Background

Inflammation is one hypothesised mechanism by which early-life adversities (ELAs) impact adult health. In cohorts from the UK and USA, we aimed to establish associations between ELAs and adult inflammation, and whether adult adiposity or socioeconomic disadvantage are key intermediaries.

Childhood adversity in those with lived experiences of homelessness in Wales: a cross-sectional study

BackgroundHomelessness is a complex societal and public health issue, with multiple causes and solutions. Efforts to reduce homelessness have tended to focus on crisis, with little attention paid to early intervention and primary prevention. Dealing with homelessness involves both supporting people at risk of homelessness and addressing personal and structural causes throughout the lifecourse, including adverse childhood experiences (ACEs). We examined the relationship between ACEs and homelessness in Wales.MethodsWe retrospectively analysed data from a 2017 cross-sectional national survey of adults aged 16–69 years, living in Wales (total respondents n=2497), using a stratified random probability sampling methodology. Outcome measures included number of ACEs (0, 1, 2–3, or ≥4) and lived experience of homelessness. The 11 categories of ACEs included childhood abuse (physical, sexual, and emotional); neglect (physical and emotional); parental separation or divorce; exposure to domestic violence; or living in a household affected by alcohol misuse, drug use, mental illness, or where someone is incarcerated. Bivariate analysis, adjusted for sociodemographic variables (age, deprivation, gender, and ethnicity), was used to assess the associations between homelessness and ACEs.FindingsWhen weighted to reflect the Welsh national population using mid-2015 population estimates for lower super output areas by sex, age group, and deprivation quintile, homelessness affected 141 (7·0%) of 2005 people in their lifetime. From the unweighted data (n=2497), of the 2333 participants without lived experience of homelessness, 1259 (54·0%) reported no ACEs, compared with 22 (13·4%) of the 164 with experience of homelessness. By contrast, the proportion of participants who reported four or more ACEs was lower among those without (n=253 [10·8%]) than in those with experience of homelessness (n=82 [50·0%]). Those with four or more ACEs were 16·0 times more likely to report lived experience of homelessness in their adult lives (95% CI 9·73–26·43, p<0·0001). Each ACE type was significantly associated with later homelessness, with the strongest associations seen for physical neglect (adjusted odds ratio 8·0 [95% CI 4·98–12·87], p<0·0001), physical abuse (7·0 [5·00–9·87], p<0·0001), sexual abuse (7·1 [4·69–10·78], p<0·0001), and emotional neglect (6·9 [4·63–10·19], p<0·0001).InterpretationThis large study using national, representative data indicates that early intervention that prevents ACEs, combined with a trauma-informed approach that builds resilience in at-risk children and adults, is likely to contribute to reducing and preventing homelessness. Possible limitations include the potential recall bias from retrospective, self-reported data.FundingPublic Health Wales Pump Prime Fund.     

Self-reported child maltreatment and cardiometabolic risk in 30-year-old adults

Background

Childhood maltreatment (CM) is associated with both dietary fat intake and obesity in later life. There is less information on associations with metabolic risk factors and specific types of CM such as physical, sexual and emotional abuse, as well as neglect.

Aims

To assess the association between five types of self-reported CM and a range of obesity and metabolic indicators in a subsample of a birth cohort.

Methods

This was a study of 1689 adults born in a major metropolitan maternity hospital in Australia and followed up 30 years later. Body mass index, bioimpedance and fasting lipid levels/insulin resistance were measured. Details on self-reported CM were collected using the Child Trauma Questionnaire. We adjusted for birth weight, parental income and relationship at participants' birth, as well as maternal age and alcohol or tobacco use. We also adjusted for participants' smoking, depression, educational level, marital and employment status at follow up.

Results

One-fifth reported maltreatment (n = 362), most commonly emotional neglect (n = 175), followed by emotional abuse (n = 128), physical neglect (n = 123), sexual (n = 121) and physical abuse (n = 116). On adjusted analyses, there were significant associations for CM, particularly neglect or emotional abuse, and one or more of the following outcomes: obesity, the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and HDL levels. Results for other outcomes were more equivocal.

Conclusions

Of child maltreatment types, emotional abuse and neglect show the strongest associations with obesity and several cardiometabolic risk factors, therefore highlighting the public health importance of early intervention to reduce childhood adversity.     

Are long-term trends in child maltreatment decreasing in England and Wales? A time-series analysis of official record data, 1858–2016

Background

Child maltreatment can result in serious immediate and long-term consequences for the child, family, and society. With mounting pressure from media scrutiny and public debate, establishing whether rates of child maltreatment are increasing or decreasing in England and Wales is a public health priority.

Psychological distress in childhood trauma survivors who abuse drugs

The relationships between the level of childhood maltreatment and current psychological distress were examined in a community sample of 676 substance abusing men and women using a validated self-report instrument (the Childhood Trauma Questionnaire) designed to measure physical, emotional, and sexual abuse and physical and emotional neglect. Current levels of self-reported psychological distress/symptoms were measured using a 53-item Brief Symptom Inventory. Prevalence of early trauma ranged from 44% for emotional neglect to 65% for sexual abuse. The severity of all forms of childhood maltreatment were directly associated with current psychological distress.     

Physical abuse and neglect of children

Child maltreatment includes physical abuse and neglect, and happens in all countries and cultures. Child maltreatment usually results from interactions between several risk factors (such as parental depression, stress, and social isolation). Physicians can incorporate methods to screen for risk factors into their usual appointments with the family. Detection of physical abuse is dependent on the doctor's ability to recognise suspicious injuries, such as bruising, bite marks, burns, bone fractures, or trauma to the head or abdomen. Neglect is the most common form of child maltreatment in the USA. It can be caused by insufficient parental knowledge; intentional negligence is rare. Suspected cases of child abuse should be well documented and reported to the appropriate public agency which should assess the situation and help to protect the child.     

Long-term mortality risk in mothers of infants with neonatal abstinence syndrome: an international cohort study in England and Canada

BackgroundOpioid addiction is a major public health issue, but little is known about long-term mortality for mothers with opioid use in pregnancy. The prevalence of neonatal abstinence syndrome is high in England and Ontario (Canada). We aimed to compare maternal mortality among mothers of infants with and without neonatal abstinence syndrome in these regions.MethodsIn this population-based study, we used administrative data to obtain parallel cohorts of linked mother–child records from singleton hospital births in England and Ontario between April 1, 2002, and Dec 31, 2012. Death records captured maternal mortality up to 10 years after delivery. We used neonatal abstinence syndrome as a marker of opioid-use during pregnancy. We modelled the association between neonatal abstinence syndrome and all-cause maternal mortality using Cox regression, and the cumulative incidence of cause-specific mortality within a competing risks framework. The primary exposure was neonatal abstinence syndrome among all mothers (aged 12–49 years) who had a live birth during the study period; mothers of infants without neonatal abstinence syndrome were controls. The main outcome was all deaths among mothers following index delivery. We estimated all-cause mortality rates, 10-year cumulative incidence risk of death, and crude and adjusted hazard ratios (HRs).FindingsThe study included 13 577 and 4 205 675 mothers of infants with neonatal abstinence syndrome in England and Ontario, respectively, and 4966 and 929 985 mothers of infants without neonatal abstinence syndrome in England and Ontario, respectively. 10-year mortality among mothers of infants with neonatal abstinence syndrome was 5·1% in England and 4·6% in Ontario compared with 0·4% in controls (both p<0·0001). Crude HRs for all-cause mortality were 12·1 (95% CI 11·1–13·2) in England and 11·4 (9·7–13·4) in Ontario. Compared with controls, the cumulative incidence of death was higher among mothers of infants with neonatal abstinence syndrome than mothers of infants without neonatal abstinence syndrome for almost all causes of death. Most deaths were due to avoidable causes.InterpretationApproximately one in 20 mothers of infants with neonatal abstinence syndrome died within 10 years of delivery in both England and Canada. Our study was limited by the paucity of direct measures of maternal opioid use and treatment. Policy responses to the current opioid epidemic require effective strategies for long-term support to improve the health and welfare of mothers who use opioids and their children.FundingInstitute for Clinical Evaluative Sciences, Ontario Ministry of Health and Long-Term Care.     

Domestic violence and abuse in gay and bisexual men attending a sexual health clinic: pilot testing of an educational support intervention for sexual health practitioners

BackgroundDomestic violence and abuse is recognised globally as a pervasive public health issue, but there is less research in relation to gay and bisexual men. This study aimed to measure the occurrence of negative and potentially abusive behaviour and associations with health problems in gay and bisexual men; and pilot test an educational intervention for practitioners to increase awareness of domestic violence and abuse and provide skills in inquiry and support.MethodsBetween Sept 21, 2010, and May 25, 2011, an anonymous Health and Relationships survey was administered to English-literate men (aged 18 years) attending a sexual health clinic in London, UK. Negative behaviour included: feeling frightened of the behaviour of a partner; having to ask permission (beyond being considerate to and checking with a partner); being slapped, hit, kicked, or physically hurt; and forced sex or sexual activity. Health problems included mental health, sexual health, and alcohol and illicit drug use. Sexual health practitioners received training on the educational intervention HERMES (HEalthcare Responding to MEn for Safety). 6 weeks after training, 21 semi-structured interviews were conducted with the practitioners to assess acceptability of HERMES, changes in awareness, and confidence in identifying and responding to gay and bisexual men who were experiencing domestic violence and abuse.FindingsOf 2657 men who attended the clinic, 1132 (42·4%) completed the survey. 532 (47·2%) self-identified as gay or bisexual. 33·9% (95% CI 24·9–37·9) of gay and bisexual men reported ever experiencing a negative and potentially abusive behaviour from a partner. Ever being frightened by a partner and having to ask a partner's permission were associated with increased odds of being anxious (odds ratio [OR] 2·5, 95% CI 2·0–3·1 and 2·7, 1·6–4·7, respectively). Being frightened of a partner, being physically hurt, and physically hurting a partner were associated with increased odds of using a class A drug in the previous 12 months (OR 2·2, 1·5–3·2; 2·3, 1·4–3·8; and 3·1, 2·3–4·2, respectively). Practitioners welcomed HERMES and felt that it raised their awareness and confidence in dealing with domestic violence and abuse among gay and bisexual men.InterpretationIn this clinical setting the occurrence of potentially abusive behaviours in gay and bisexual men was high. HERMES increased sexual health practitioners’ awareness of domestic violence and abuse and confidence in asking about abuse. The results can only be interpreted within the context of the sexual health clinic. Because of the cross-sectional design, it is not possible to determine the temporal direction of the associations between negative behaviour and health problems.FundingThis report presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0108-10084).     

Effects of opiate substitution treatment on mortality for opioids users: a systematic review and meta-analysis

Background

Opioid dependence is associated with high risk of premature death. Opiate-substitution treatment (OST) is the major treatment in community for opioid dependence worldwide. We aimed to estimate crude mortality rates (CMRs) and the effects of OST on mortality risk by meta-analysis.

Child maltreatment in China: comparison of parent and child reports

Background

Reporting of the incidence of child maltreatment by parents and children might differ with implications for optimum research methodologies to determine the incidence of maltreatment. Our aim was to compare parent and child reports of child maltreatment in mainland China.

Prevalence of finding sexual partners online and associations with sexual behaviour and sexual health outcomes: a British national probability survey

BackgroundOnline venues provide opportunities to facilitate sexual encounters, but the extent to which finding partners online is associated with risky sexual behaviour and poor sexual health outcomes is unclear; much of the research to date has focused on subpopulations, or convenience samples. We aimed to describe individuals' use of the internet to find sexual partners in a representative sample of the British population.MethodsThe third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) was a cross-sectional probability survey of 15 162 adults aged 16–74 years, which used computer-assisted personal-interview and self-interview, undertaken during 2010–12. The sample was weighted to account for selection probability and non-response, and corrected for differences in demographics according to the UK 2011 census. We estimated the prevalence of, and identified factors associated with, finding sexual partners online in the past year among 5698 men and 8198 women who reported sexual experience ever.FindingsUse of the internet to find sexual partners in the past year was reported by 5·2% of men (95% CI 4·7–5·8) (unweighted n=389) and 2·4% of women (2·1–2·8) (unweighted n=249), and was associated with younger age. After adjustment for age, individuals reporting a non-heterosexual identity (adjusted odds ratio for men 8·87, 5·95–13·22; for women 3·56, 2·20–5·78) were more likely to report finding partners online. This outcome was also associated with reporting sexual risk behaviours including sex without a condom with two or more partners (men 5·24, 3·71–7·39; women 6·36, 4·25–9·53), reporting five or more partners (11·19, 6·36–19·67; 17·44, 7·32–41·52), and reporting a new partner (13·27, 9·49–18·54; 14·93, 9·97–22·37). Sexual health clinic attendance (men 1·92, 1·18–3·15; women 2·25, 1·08–4·69), HIV testing (2·91, 1·91–4·44; 1·82 1·09–3·03), and diagnoses of sexually transmitted infections (men only 2·19, 1·17–4·12) were more common among individuals reporting finding partners online after adjustment for age and number of partners.InterpretationFinding partners online was strongly associated with markers of sexual risk and health-service uptake. Online opportunities have increased since 2010–12, so these data might underestimate the importance of this social phenomenon for public health and control of sexually transmitted infections. Given the cross-sectional survey design, neither directionality nor causality can be inferred.FundingNatsal-3 was supported by grants from the Medical Research Council (G0701757) and the Wellcome Trust (084840), with contributions from the Economic and Social Research Council and Department of Health.     

Association of depression screening in cardiometabolic disease with future vascular events and mortality: a cohort study

BackgroundRoutine screening for depression in patients with cardiometabolic disease is advocated but its benefits remain unclear. We examined the association between such screening in a large UK cohort of patients with cardiometabolic diseases and all-cause mortality and vascular events at 4 years.MethodsPatients in Greater Glasgow with one of three cardiometabolic diseases—coronary heart disease, diabetes, or stroke—underwent screening for depression with the Hospital Anxiety and Depression Scale (HADS-D). The health board offered monetary incentives for depression screening to primary care practitioners, and people with positive depression screens were treated (psychological or pharmacological) according to national guidelines. 125 143 patients with at least one of the diseases were listed on primary care registers during 12 months' observation in 2008–09. 10 670 (8·5%) receiving treatment for depression were exempt from screening. HADS-D was recorded for 35 537 patients (31·1% of eligible); the remaining 78 936 (68·9%) were not screened. We studied all-cause mortality and vascular events (using International Classification of Diseases 10 codes for myocardial infarction and stroke) by linking 124 414 patients (99·4%) on primary care registers to hospital discharge and mortality records for 4 years from April, 2009, and used Cox proportional hazards for survival analysis.FindingsMean age for the screened and unscreened population was 69 years (SD 11·9) and 67 years (14·3), respectively; 58% (20 658) of the screened population were men and 65·3% (22 726) belonged to a deprived socioeconomic group, compared with 54·2 % (42 727) and 67·4% (51 686), respectively, in the unscreened population. 4989 (6·3%) of 789 366 of the unscreened population were started on new antidepressants during the observation period compared with 1268 (3·5%) of 35 537 of the screened population and 572 of 7080 (8·02%) of those HADS-D positive. The screened population had lower all-cause mortality and vascular events than the unscreened population (hazard ratio 0·74, 95% CI 0·72–0·77, p<0·0001 vs 0·69, 0·67–0·72, p<0·0001) at 4 years. Results remained significant after adjusting for age, sex, socioeconomic status, and comorbidity.InterpretationScreening for depression was associated with a reduction in all-cause mortality and vascular events in patients with cardiometabolic diseases. The uptake of screening was poor for unknown reasons. The possibility of reverse causality and the possible confounding effect of disease severity are important limitations. Further research to determine reproducibility and explore underlying mechanisms is merited.FundingThe study was funded by BUPA Foundation. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the abstract.     

Childhood sexual abuse among men who have sex with men in urban north China: a cross-sectional survey

Background

Childhood sexual abuse is associated with HIV vulnerabilities and psychological distress. Research indicates that childhood sexual abuse is also more common among sexual minorities. However, there is limited research into childhood sexual abuse among sexual minorities in China. We describe the prevalence and correlates of penetrative childhood sexual abuse among men who have sex with men (MSM) in urban north China.

Gender specific associations between types of childhood maltreatment and the onset, escalation and severity of substance use in cocaine dependent adults

We examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. In men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.     

Gender Specific Associations Between Types of Childhood Maltreatment and the Onset,Escalation and Severity of Substance Use in Cocaine Dependent Adults

We examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. In men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.     

Fresh fruit consumption,physical activity,and five-year risk of mortality among patients with type 2 diabetes: A prospective follow-up study

Background and aimsWe explored the associations among fruit consumption, physical activity, and their dose–response relationship with all-cause and cardiovascular disease (CVD) mortality in type 2 diabetic patients.Methods and resultsWe prospectively followed 20,340 community-dwelling type 2 diabetic patients aged 21–94 years. Information on diets and physical activity was collected using standardized questionnaires. All-cause and CVD mortality were assessed. Hazard ratios (HRs) for all-cause mortality were estimated with Cox regression models, and HRs for CVD mortality were derived from a competing risk model. Restricted cubic spline regression was used to analyze dose–response relationships. We identified 1362 deaths during 79,844 person-years. Compared to non-consumption, fruit consumption >42.9 g/d was inversely associated with all-cause mortality (HR 0.76; 95% CI 0.64–0.88), CVD mortality (HR 0.69, 0.51–0.94) and stroke mortality (HR 0.57, 0.36–0.89), but not with heart disease mortality (HR 0.93, 0.56–1.52). The HRs comparing the top vs bottom physical activity quartiles were 0.44 (0.37–0.53) for all-cause mortality, 0.46 (0.33–0.64) for CVD mortality, 0.46 (0.29–0.74) for stroke mortality and 0.51 (0.29–0.88) for heart disease mortality. Lower fruit consumption combined with a lower physical activity level was associated with a greater mortality risk. A nonlinear threshold of 80 g fruit/day was identified; all-cause mortality risk was reduced by approximately 24% at this value. A physical activity threshold of eight metabolic equivalents (MET) h/day was also identified, after which the risk of mortality did not decrease.ConclusionsFruit consumption and physical activity may reduce all-cause, CVD, and stroke mortality in type 2 diabetic patients.     

Adverse childhood experiences,inflammation, and depressive symptoms in later life: a prospective cohort study

BackgroundExposure to adverse childhood experiences (ACEs) has been associated with both inflammation and depression. However, little research has examined the potential mediational role of inflammation in the link between ACEs and depression using longitudinal data. Therefore, we investigated the direct and indirect effects of ACEs on inflammation, depression, and their change trajectories over time.MethodsWe used data from the English Longitudinal Study of Ageing. Four ACE categories were assessed retrospectively at wave 3 (2006–07): abuse (physical or sexual abuse or physical assault), family dysfunction (parent arguments, parent mental illness or substance abuse, or parent separation or divorce), poor parent–child bonding (maternal or paternal), and loss of an attachment figure (separation from mother for >6 months, parent death, foster care or adoption, or institutionalisation). A cumulative ACE score was calculated representing the total number of ACEs experienced by the participants. Concentration of C-reactive protein (CRP), an inflammatory marker, was measured at waves 2 (2004–05), 4 (2008–09), and 6 (2012–13). Depressive symptoms were ascertained using the 8-item Centre for Epidemiological Studies Depression Scale from waves 6 to 8 (2016–17). The longitudinal direct and indirect effects of ACEs were estimated using parallel process latent growth curve modelling. All analyses were adjusted for relevant confounders. Missing data were estimated using multiple imputation.ResultsAmong the study sample (N=4382; mean age 70 years; 56% female), 24% of participants reported one ACE and 13% had two or three ACEs. The percentage of participants with three or more depressive symptoms was 21% at baseline. Greater cumulative exposure to ACEs was associated with increased CRP concentration (β=0·042, p=0·010) and depressive symptoms (β=0·164, p<0·0001) at baseline and predicted a steeper increase in these outcomes throughout the study (β_CRP=0·074, p=0·011; β_Depression=0·338, p<0·0001). However, indirect effects of ACEs on depression mediated by CRP were not observed, with only weak associations between CRP and depressive symptoms (β_iDepression=0·032, p=0·173; β_sDepression=0·067, p=0·240). Sensitivity analyses using only somatic depressive symptoms as the outcome revealed a positive association between CRP and somatic symptoms at baseline (β_iDepression=0·068, p=0·008), although the indirect effects remained non-significant in this model.InterpretationBiological mechanisms other than inflammation might underlie the relationship between ACEs and depression. Psychosocial interventions to reduce the negative effects of ACEs on children's development could help to reduce the risk of depression and of other medical conditions linked to inflammation.FundingEconomic and Social Research Council–Biotechnology and Biological Sciences Research Council Soc-B Centre for Doctoral Training (ES/P000347/1).