Adverse Childhood Experiences and Accelerometer-Measured Physical Activity and Sleep in Preadolescents.

OBJECTIVE: To assess the relationship between adverse childhood experiences (ACEs) and objective measures of physical activity and sleep. METHODS: Data from the baseline and 2-year follow-up of the Adolescent Brain and Cognitive Development study were analyzed (n = 6227 for physical activity; n = 4151 for sleep). ACEs were assessed by parent report at baseline (mean age 9.9 years) with 3 levels: none, exposure to 1 ACE, and exposure to 2 or more ACEs. Objective measures of physical activity and sleep were assessed with an accelerometer at 2-year follow-up (mean age 11.9 years). Multivariate linear regression analyses were used to examine the relationship between ACEs and physical activity as well as sleep, adjusting for family income and sex. RESULTS: Compared to children with no ACEs, children with ACEs had fewer daily steps: 1 ACE (ß = -323 (95% CI: -508 to -138), P < .001) and 2 or more ACEs (ß = -417 (95% CI: -624 to -209), P < .001). ACEs were also associated with shorter sleep duration (minutes), although only for participants with 2 or more ACEs (1 ACE: ß = -2.2 (-5.3 to 0.8), P = .16; 2 or more ACEs: ß = -6.2 (95% CI: -9.6 to -2.7), P < .001). Rapid eye movement (REM) sleep specifically was reduced in participants with ACEs (1 ACE (ß = -1.4 (-2.7 to -0.01), P = .05) and 2 or more ACEs (ß = -2.3 (-3.8 to -0.8), P = .003). CONCLUSIONS: There is a dose-response relationship between ACEs and reduced daily steps, total sleep duration, and REM sleep in preadolescents.

Associations of early life stress with leptin and ghrelin in healthy young adults.

BACKGROUND: Childhood adversity is a major risk factor for cardiometabolic health problems. Stress-related changes in diet suggest a role for endocrine factors that influence dietary intake, such as leptin and ghrelin. These hormones influence metabolism and may contribute to the relationship of early adversity, mental, and cardiometabolic health. This study examined levels of leptin and ghrelin in a sample of young adults with and without early life stress (ELS). METHODS: Young adults ages 18-40 (N = 200; 68.5% female) were recruited from the community. Participants with ELS (N = 118) had childhood maltreatment, and a subset, n = 92 (78.0%) also had parental loss, and n = 65 (55.1%) also had a current psychiatric disorder. Control participants (N = 82) had no maltreatment, parental loss, or psychiatric disorders. Standardized interviews and self-reports assessed demographics, adversity, medical/psychiatric history, and health behaviors. Exclusion criteria included medical conditions and current medications other than hormonal contraceptives. Body Mass Index (BMI) and other anthropometrics were measured, and fasting plasma was assayed for total ghrelin and leptin with the Bio-Plex Pro Human Diabetes Panel. RESULTS: While ELS was significantly associated with greater leptin (r = .16, p = .025), a finding which held when adjusted for age and sex (F(3196)= 28.32, p = .011), this relationship was abolished when accounting for BMI (p = .44). Participants with ELS also had significantly lower total ghrelin (r = .21, p = .004), which held adjusting for age and sex (p = .002) and was attenuated (p = .045) when the model included BMI (F=46.82, p < .001). Current psychiatric disorder was also a significant predictor of greater leptin (r = .28, p < .001) and lower ghrelin (r = .29, p = .003). In the model with ELS and covariates, psychiatric disorder remained significant (F=7.26, p = .008) and ELS was no longer significant (p = .87). Associations with severity and recent perceived stress were also examined. CONCLUSION: The relationship of ELS and leptin was no longer significant when accounting for BMI, suggesting potential avenues for intervention. Ghrelin findings persisted after correction for BMI, which may be secondary to physiological differences in the regulation of these hormones (leptin is produced by adipocytes, whereas ghrelin is produced primarily in the GI tract). Lastly, these findings suggest that psychiatric functioning may be a key component contributing to the relationship of lower total ghrelin and childhood adversity.

Association Between Adverse Childhood Experiences and Diet, Exercise, and Sleep in Pre-adolescents.

OBJECTIVE: To understand the relationship between adverse childhood experiences (ACEs) and diet, sleep, and exercise in pre-adolescents. METHODS: Baseline and 1-year follow-up data from the adolescent brain and cognitive development (ABCD) study were analyzed (age 10-11, n = 11,875). ACEs were measured by parent report at baseline. Three levels of ACEs were created: none, exposure to one ACE, and exposure to two or more ACEs. Health-promoting behaviors were assessed at 1 year. Diet quality was measured from parent report; sleep problems were measured by parent report, with higher scores indicating worse sleep; and amount of exercise was measured by youth report. Linear regression analyses were used to assess the relationship between ACEs and each health-promoting behavior, adjusting for family income and sex. RESULTS: Compared to children with no adversity, ACEs were associated with worse diet - one ACE (ß = -0.30 [95% CI, -0.49 to -0.12], P = .002) and 2 or more ACEs (ß = -0.56 [-0.78 to -0.34, P < .001). Similarly, ACEs were associated with poor sleep - one ACE (ß = 1.51 [1.00-2.03], P < .001) and 2 or more ACEs (ß = 2.96 [2.38-3.53], P < .001). Finally, amount of exercise was not different in children with ACEs - 2 or more ACEs (ß = -0.24, 95% CI, -0.51 to 0.04, P = .08). CONCLUSIONS: ACEs in pre-adolescents show a dose-response relationship with unhealthy diet and sleep disruption. These findings suggest potential behaviors to target to mitigate the negative impact of childhood adversity on adult health.

History of Depression, Elevated Body Mass Index, and Waist-to-Height Ratio in Preadolescent Children.

OBJECTIVE: This study aimed to evaluate whether a history of depression or self-injurious thoughts and behaviors predict elevated body mass index (BMI) and elevated waist-to-height ratio in preadolescents. METHODS: Baseline data were evaluated from a large, nationally representative cohort study of 9- and 10-year-old children (unweighted n = 11,875), the Adolescent Brain and Cognitive Development study. RESULTS: In the weighted sample, 10.6% of children had a history of depression, 7.0% had engaged in nonsuicidal self-injury, 13.1% had experienced suicidal ideation in their lifetime, and 1.1% had a history of attempted suicide. Among the children, 34.1% had an elevated BMI in the overweight or obese range and 31.9% had a waist-to-height ratio >0.5. In multivariate analyses, history of depression was associated with elevated BMI and waist-to-height ratio. Furthermore, interactions with sex were found; girls with a history of depression were more likely to have an elevated BMI (odds ratio = 1.47, 95% confidence interval = 1.24-1.74) and elevated waist-to-height ratio (odds ratio = 1.48, 95% confidence interval = 1.18-1.86) than girls without a history of depression, but no differences were observed between boys with and without a history of depression. Self-injurious thoughts and behaviors were not associated with elevated BMI or elevated waist-to-height. CONCLUSIONS: In this study, 9- and 10-year-old girls with a history of depression were more likely to have an elevated BMI and elevated waist-to-height ratio than girls with no history of depression. These results provide important clinical context in caring for preadolescents with a history of depression.

Trends in Intravenous Antibiotic Duration for Urinary Tract Infections in Young Infants.

OBJECTIVES: To assess trends in the duration of intravenous (IV) antibiotics for urinary tract infections (UTIs) in infants ≤60 days old between 2005 and 2015 and determine if the duration of IV antibiotic treatment is associated with readmission. METHODS: Retrospective analysis of infants ≤60 days old diagnosed with a UTI who were admitted to a children's hospital and received IV antibiotics. Infants were excluded if they had a previous surgery or comorbidities, bacteremia, or admission to the ICU. Data were analyzed from the Pediatric Health Information System database from 2005 through 2015. The primary outcome was readmission within 30 days for a UTI. RESULTS: The proportion of infants ≤60 days old receiving 4 or more days of IV antibiotics (long IV treatment) decreased from 50% in 2005 to 19% in 2015. The proportion of infants ≤60 days old receiving long IV treatment at 46 children's hospitals varied between 3% and 59% and did not correlate with readmission (correlation coefficient 0.13; P = .37). In multivariable analysis, readmission for a UTI was associated with younger age and female sex but not duration of IV antibiotic therapy (adjusted odds ratio for long IV treatment: 0.93 [95% confidence interval 0.52-1.67]). CONCLUSIONS: The proportion of infants ≤60 days old receiving long IV treatment decreased substantially from 2005 to 2015 without an increase in hospital readmissions. These findings support the safety of short-course IV antibiotic therapy for appropriately selected neonates.