An overview of child maltreatment (neglect and abuse) associations with developmental trajectories and long-term outcomes in the 1958 British birth cohort.

Childhood maltreatment types (neglect and psychological, physical, or sexual abuse) are associated with many poor outcomes in adulthood. Yet, research mainly focuses on the cumulative adversity burden rather than specificities and commonalities of associations with adult outcomes and intervening pathways. To build understanding of life-course pathways to a range of outcomes, this overview summarises evidence from several original research studies using the 1958 British Birth Cohort on specific maltreatment types, child development trajectories, adult intermediaries and outcomes. About one-in-five participants were identified as neglected or abused in childhood (~10% were identified for neglect, 10% for psychological abuse, 6% for physical abuse and 1.4% for sexual abuse). Neglect was associated with key dimensions of development, for example, slower height growth, delayed maturation, faster BMI gain, and poorer emotional and cognitive development. Associated adulthood outcomes included harmful behaviours (notably smoking), poorer physical health (e.g. shorter height, excess BMI, poorer blood lipids and glucose, poor-rated health and physical functioning), worse mental health, lower socioeconomic circumstances (e.g. poorer living conditions) and elevated mortality in mid-adulthood. Childhood abuse associations were less widespread and were often only for specific types: most types were unrelated to childhood height and cognitive abilities, but all types were associated with poorer child emotional development, adult mental health, smoking, blood lipids and self-rated health. Additionally, physical abuse was associated with faster BMI gain, higher adult BMI, blood glucose, inflammation and mortality in mid-adulthood; sexual abuse with faster BMI gain, higher adult BMI, poor physical functioning at 50y and higher mortality in mid-adulthood. Adult health measures associated with neglect and abuse are key predictors of serious disease, disability and death. Therefore, neglect and abuse associations with these measures represent an important burden for individuals and society.

Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood in a prospective British birth cohort: associations and potential explanations.

OBJECTIVES: Research on associations between childhood maltreatment and adult cardiometabolic disease risk is sparse. We aimed to investigate associations between different forms of child maltreatment and mid-adult cardiometabolic markers and whether potential intermediaries could account for the associations observed. SETTING: 1958 British birth cohort. PARTICIPANTS: Approximately 9000 cohort members with data on cardiometabolic markers. OUTCOMES: Adult (45y) cardiometabolic markers (blood pressure, lipids and glycated haemoglobin [HbA1c]). RESULTS: Seventeen per cent of participants were identified as neglected; 6.1%, 1.6% and 10.0% were identified as experiencing physical, sexual and psychological abuse, respectively. Childhood neglect and physical abuse were associated with high body mass index (BMI) and large waist circumference when adjusting for early-life covariates. For neglect, the adjusted odds ratio (AOR) was 1.16 (95% CI: 1.02 to 1.32) and 1.15 (1.02 to 1.30) for general and central obesity, respectively, and for physical abuse, the respective AOR was 1.36 (1.13 to 1.64) and 1.38 (1.16 to 1.65). Neglect was also associated with raised triglycerides by 3.9 (0.3 to 7.5)% and HbA1c by 1.2 (0.4 to 2.0)%, and among females, lower high-density lipoprotein cholesterol (HDL-c) by 0.05 (0.01 to 0.08)mmol/L after adjustment. For physical abuse, the AOR was 1.25 (1.00 to 1.56) for high low-density lipoprotein cholesterol, HbA1c was raised by 2.5 (0.7 to 4.3)% (in males) and HDL-c was lower by 0.06 (0.01 to 0.12)mmol/L (in females). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. For psychological abuse, the AOR for elevated triglycerides was 1.21 (1.02 to 1.44) and HDL-c was lower by 0.04 (0.01 to 0.07)mmol/L. Maltreatments were not associated with raised blood pressure. In analyses of potential intermediary factors, several associations attenuated after adjustment for adult lifestyles (mainly smoking and alcohol consumption rather than physical activity) and child-to-adult BMI. CONCLUSIONS: Childhood maltreatments, particularly neglect and physical abuse, were associated with greater adiposity and poorer lipid and HbA1c profiles decades later in adulthood. Associations were modest but independent of early-life factors linked to these outcomes. Findings implicate adult lifestyles as an important intermediary between child maltreatment and outcomes.

Combined early and adult life risk factor associations for mid-life obesity in a prospective birth cohort: assessing potential public health impact.

OBJECTIVE: The combined effect of life-course influences on obesity development and thus their potential public health impact is unclear. We evaluated combined associations and predicted probabilities for early and adult life risk factors with central and general obesity in mid-adulthood. SETTING: 1958 British birth cohort. PARTICIPANTS: 4629 males and 4670 females with data on waist circumference. OUTCOME MEASURES: 45 year obesity measured via waist circumference, waist-hip ratio (WHR) and BMI. RESULTS: At 45 years, approximately a third of the population were centrally obese and a quarter were generally obese. Three factors (parental overweight, maternal smoking during pregnancy and adult inactivity) were consistently associated with central and general obesity. Predicted probabilities for waist obesity increased from those with none to all three risk factors (0.15-0.33 in men; 0.19-0.39 in women (ptrend<0.001)), with a similar trend for general obesity. Additional factors (adult smoking, low fibre and heavy alcohol consumption) were associated with WHR obesity, although varying by gender. Prevalence of risk factors was higher in manual than non-manual groups: for example, in men 38% versus 25%, respectively, had ≥2 risk factors for waist and general obesity. CONCLUSIONS: Early-life and adult factors that are amenable to change are highly prevalent and accumulate in association with central and general obesity in mid-adulthood. The increase in probabilities for mid-adult obesity associated with cumulative levels of risk factors suggests the potential for public health impact.

Life-course body mass index trajectories and blood pressure in mid life in two British birth cohorts: stronger associations in the later-born generation.

BACKGROUND: Little is known about the impact of recent increases in obesity and more rapid gains in body mass index (BMI) on cardiovascular risk factors. We investigated life-course BMI trajectories associations with adult blood pressure (BP) across two generations. METHODS: We used the the 1946 and 1958 British birth cohorts. Joint multivariate response models were fitted to longitudinal BMI measures [7, 11, 16, 20, 26, 36, 43 and 50 y (years): 1946 cohort, n = 4787; 7, 11, 16, 23, 33 and 45 y: 1958 cohort, n = 16,820] and mid-adult BP. We adopted linear spline models with random coefficients to characterize childhood and adult BMI slopes. RESULTS: Mean systolic BP (SBP) decreased from the earlier- to later-born cohort by 2.8 mmHg in females, not males; mean diastolic BP (DBP) decreased by 3.2-3.3 mmHg (both sexes). Adult BMI was higher in the later- than the earlier-born cohort by 1.3-1.8 kg/m(2), slopes of BMI trajectory were steeper from early adulthood and associations with adult BP were stronger. Associations between adult BMI and SBP were stronger in the later-born cohort. For males, childhood BMI slope was associated with SBP only in the later-born cohort; the association for adult BMI slope was stronger in the later-born cohort: correlation coefficient r = 0.28 [95% confidence interval (CI): 0.25,0.33] versus 0.13 (0.06,0.20). For females, childhood slope was associated with SBP in both cohorts; adult slope was associated with SBP only in the 1958 cohort [r = 0.34 (0.31,0.37)]. Patterns of child-to-adult BMI associations were similar in relation to DBP. CONCLUSIONS: BP did not increase between two generations born 12 y apart despite higher BMI levels. A stronger association between BMI trajectory and BP in the later-born cohort suggests that BMI-related effects may have been offset by improvements in other factors linked to BP, such as diet and smoking.

Early Life Factors and Adult Leisure Time Physical Inactivity Stability and Change.

PURPOSE: Physical inactivity has a high prevalence and associated disease burden. A better understanding of influences on sustaining and changing inactive lifestyles is needed. We aimed to establish whether leisure time inactivity was stable in midadulthood and whether early life factors were associated with inactivity patterns. METHODS: In the 1958 British birth cohort (n = 12,271), leisure time inactivity (frequency, less than once a week) assessed at 33 and 50 yr was categorized as "never inactive," "persistently inactive," "deteriorating," or "improving." Early life factors (birth to 16 yr) were categorized into three (physical, social, and behavioral) domains. Using multinomial logistic regression, we assessed associations with inactivity persistence and change of factors within each early life domain and the three domains combined with and without adjustment for adult factors. RESULTS: Inactivity prevalence was similar at 33 and 50 yr (approximately 31%), but 17% deteriorated and 18% improved with age. In models adjusted for all domains simultaneously, factors associated with inactivity persistence versus never inactive were prepubertal stature (8% lower risk/height SD), poor hand control/coordination (17% higher risk/increase on four-point scale), cognition (16% lower/SD in ability) (physical); parental divorce (25% higher), class at birth (7% higher/reduction on four-point scale), minimal parental education (16% higher), household amenities (2% higher/increase in 19-point score (high = poor)) (social); and inactivity (22% higher/reduction in activity on four-point scale), low sports aptitude (47% higher), smoking (30% higher) (behavioral). All except stature, parental education, sports aptitude, and smoking were associated also with inactivity deterioration. Poor hand control/coordination was the only factor associated with improved status (13% lower/increase on four-point scale) versus persistently inactive. CONCLUSIONS: Adult leisure time inactivity is moderately stable. Early life factors are associated with persistent and deteriorating inactivity over decades in midadulthood but rarely with improvement.

Psychological health throughout life and adult cortisol patterns at age 45 y.

Population-based studies of cortisol and psychological health over long periods are rare. This study aims to establish whether cortisol levels in mid-adulthood are associated with chronicity and life-stage of psychological ill-health onset. We used data from the 1958 British birth cohort (3209 males; 3315 females) with cortisol measures 45 min post-waking (t1) and 3h later (t2) on the same day at 45y. Lifetime psychological health was identified from child and adult measures (ages 7, 11, 16, 23, 33, 42, 45y). t1 cortisol was lower by 3-4% in those with lifetime (child and adult) ill-health than those with no ill-health, after adjustment for socio-economic position and smoking. t1 cortisol was similarly lowered in those with adult onset of ill-health, but not among the group whose ill-health was of recent onset. t2 cortisol was elevated among all lifetime ill-health groups, by 6-9%, except for those whose ill-health did not extend beyond childhood. Simple analyses across the separate ages of follow-up suggest that elevations in t2 cortisol reflect associations for adult ill-health. Our study suggests that psychological ill-health over years and decades "blunts" post-awakening cortisol secretion, possibly reflecting HPA dysregulation due to social stressors.

Intergenerational influences on childhood body mass index: the effect of parental body mass index trajectories.

BACKGROUND: Parental obesity in adulthood is a strong determinant of offspring obesity. Whether parental body mass index (BMI; in kg/m2) at earlier life stages is associated with offspring BMI is unknown. OBJECTIVE: The main objective was to assess whether recent BMI of parents in adulthood and their recent BMI gain are more strongly associated with offspring BMI than are BMI or changes in parental BMI in childhood. DESIGN: Two generations in the 1958 British birth cohort were studied, including cohort members (parents' generation) with BMI at 7, 11, 16, 23, and 33 y (n = 16,794) and a one-third sample of their offspring selected in 1991 aged 4-18 y (n = 2908). We applied multilevel models to allow for within-family correlations. RESULTS: Childhood BMI increased on average by 0.25-1.10 between the 2 generations, depending on sex and age group, and overweight/obesity increased from 10% to 16%. Parents' BMI in childhood and adulthood independently influenced offspring BMI, but no significant difference in the strength of influence was observed. For example, adjusted increase in BMI for offspring aged 4-8 y was equivalent to 0.37 and 0.23 for a 1-SD increase in maternal BMI at 7 and 33 y, respectively. Similar patterns were observed for risk of overweight/obesity and for paternal BMI at most ages. CONCLUSIONS: Excessive BMI gains of parents during childhood and adulthood were associated with a higher BMI and risk of obesity in the offspring. Reductions in the incidence of child obesity in the current population may reduce obesity in future generations.

Early life influences on adult leg and trunk length in the 1958 British birth cohort.

OBJECTIVES: Short leg length has been associated with increased disease risk. We investigated (1) whether taller childhood stature predicts longer adult leg than trunk length; (2) the effects of early life factors on adult leg/trunk length. METHODS: We used data from the 1958 British birth cohort on height in childhood and at 45 years, leg and trunk length at 45 years and early life factors (n approximately 5,900). RESULTS: For a SD increase in height at 7 years, adult leg length increased more than trunk length (2.5-2.8 cm vs. 1.9 cm). Parental height had a stronger association with adult than childhood height, and leg than trunk length. Prenatal factors were associated with leg (maternal smoking) and trunk length (birth order); birth weight had a similar effect on leg and trunk lengths. Large family size, overcrowding, and social housing were more strongly associated with leg than trunk length: deficits in adult height (0.4-0.8 cm) were mostly due to shorter legs. CONCLUSIONS: Socio-economic adversity in childhood is associated with delayed early growth, shorter adult leg length, and stature. Leg length is the height component most sensitive to early environment. Studies of early life and adult disease could usefully assess adult leg length in addition to height.

Life-time socio-economic position and cortisol patterns in mid-life.

The influence of adversity over long periods of the life-span on adult cortisol metabolism is not established. We assess whether morning cortisol levels are associated with socio-economic position (SEP) from birth to mid-adulthood, and if so, whether the association is due primarily to SEP in childhood, adulthood or both. Data are from 6335 participants in the 1958 British birth cohort, with salivary cortisol samples collected at 45 yr. Two saliva samples were obtained on the same day: 45 min post-waking (t1) and 3 h later (t2). Median t1 and t2 cortisol values were 18.80 and 7.10 nmol/l for men; 19.60 and 6.60 nmol/l for women. Three outcomes were constructed: (1) extreme t1 cortisol (top and bottom 5%), (2) area-under-curve (AUC), and (3) abnormal t1-t2 pattern. All three outcomes were associated with lifetime SEP but the relative contribution of childhood and adulthood SEP varied by outcome measure. Our results suggest that the impact of less advantaged SEP over a lifetime would lead to an approximate doubling of the proportion of extreme post-waking cortisol levels for both sexes; an 8% and 10% increase, respectively for females and males in AUC, and an increased risk of having an abnormal cortisol pattern of 60% and 91%. SEP differences were independent of time of waking and sample collection, and in most instances, remained after adjustment for smoking and body mas index (BMI). Thus, our study provides evidence for effects of chronic adversity on cortisol in mid-adult life.

Influences on childhood height: comparing two generations in the 1958 British birth cohort.

BACKGROUND: Genetics and early environment are known to influence height, but evidence is sparse on changes in these influences over time. METHODS: The 1958 British birth cohort study includes all children born between March 3, 1958 and March 9, 1958, who were followed to age 41 yr, and one-third of their offspring in 1991. Childhood height in each generation (measured at 7 yr for cohort members and 4-18 yr for offspring) was converted to a standard deviation score based on the 1990 British growth reference. We used multilevel models to analyse influences on height in order to allow for the hierarchical within-family data structure. RESULTS: Childhood height increased by 1 cm between 1958 cohort members and their offspring. Several influences on childhood height in the older generation (maternal smoking, breastfeeding, maternal age, social class, maternal education, and parental divorce) did not affect childhood height in the younger generation. Parental height was most strongly associated with childhood height and effects did not diminish between generations [adjusted increase approximately 2 cm for 1 maternal or paternal height standard deviation score (SDS)]. Third- or later-borns and those with three or more siblings had deficits of 1-2 cm (adjusted estimates) in both generations. Other factors, particularly indicators of socioeconomic position, showed weaker effects in the younger generation. For example, the growth deficit of 1.1 cm (adjusted estimate) among cohort members from households with >1.5 persons/room had disappeared in the offspring. CONCLUSIONS: Within Great Britain, the adverse effects of environmental factors on childhood height have lessened between recent generations.

Early environment and child-to-adult growth trajectories in the 1958 British birth cohort.

BACKGROUND: Genetics and environmental conditions early in life are known to influence height. However, evidence is restricted to studies conducted at a specific age, and thus the effect on the entire growth trajectory has been neglected. OBJECTIVE: The objective was to determine when parental height and factors early in offspring life start to affect offspring height, when these variables have the strongest effect, and whether these variables persist to adulthood. DESIGN: Longitudinal data from the 1958 British birth cohort (all of whom were born during 1 wk in March 1958), including height measurements at 7, 11, 16, and 33 y of age, were analyzed by using multivariate multilevel response models. RESULTS: Parental height, birth weight, maternal smoking during pregnancy, breastfeeding, parental divorce, and socioeconomic factors were all significantly associated with childhood height, but their effects differed thereafter. Parental height and birth weight were most strongly associated with offspring height, and their effects persisted (adjusted increase in adult height: 2 cm for 1 SD of maternal or paternal height, or 1 kg of birth weight). Socioeconomic disadvantage (manual social class, large family size, and overcrowded households) was associated with substantial deficits of 2-3 cm (adjusted estimates) in height at 7 y. Catch-up growth was apparent but was insufficient to overcome the initial insult on growth; the adjusted deficit was as high as 1 cm in adulthood. CONCLUSIONS: Children from disadvantaged backgrounds have a delayed pattern of growth before the pubertal spurt, which is followed by catch-up growth. The health consequences of this pattern of growth need to be examined in future studies.