Childhood Adversity: Another Risk Factor for Type 2 Diabetes?

Kids who face more adversity during childhood may have a higher risk for type 2 diabetes in early adulthood, according to a Danish population-wide cohort study.

Among over 1.2 million individuals born in 1980 through 2001, there was an increased risk of type 2 diabetes in the group with high rates of adversity across the domains of material deprivation, loss or threat of loss, and family dynamics compared with the low adversity group for both men (adjusted HR 2.41, 95% CI 2.04-2.85) and women (HR 1.58, 95% CI 1.31-1.91), reported Leonie K. Elsenburg, PhD, of the University of Copenhagen in Denmark, and colleagues.

This translated into 36.2 more cases of type 2 diabetes per 100,000 person-years for men and 18.6 more cases among women over a mean 11-year follow-up, the group noted in Diabetologia.

Material deprivation included family poverty and parental long-term unemployment, while those who experienced loss or threat of loss faced parental somatic illness, sibling somatic illness, parental death, and sibling death. Various family dynamics also played into adversity, which included foster care placement, parental psychiatric illness, sibling psychiatric illness, parental alcohol abuse, parental drug abuse, and maternal separation.

Those who faced any kind of childhood adversity had a significantly increased risk of diabetes compared with those who experienced low levels of childhood adversity, although men and women with "high adversity" childhoods saw the highest risk:

• Early-life material deprivation: HR 1.45 (95% CI 1.30-1.63); HR 1.34 (95% CI 1.21-1.49), respectively
• Persistent material deprivation: HR 1.66 (95% CI 1.49-1.86); HR 1.51 (95% CI 1.36-1.68)
• Loss or threat of loss: HR 1.76 (95% CI 1.53-2.03); HR 1.46 (95% CI 1.28-1.67)
• High adversity: HR 2.41 (95% CI 2.04-2.85); HR 1.58 (95% CI 1.31-1.91)

"Individuals exposed to childhood adversity, such as poverty, illness or death in the family, and a dysfunctional household, are at higher risk of developing type 2 diabetes in young adulthood compared with individuals who experience low levels of adversity in childhood," Elsenburg's group wrote. "This study shows that a share of the type 2 diabetes cases in young adulthood could likely be prevented by intervening on the fundamental causes generating childhood adversity."

"Disentangling underlying mechanisms, such as overweight, obesity, health behaviors, mental health and biological pathways, calls for further attention," they noted.

For this study, Elsenburg and team used data on 1,277,429 individuals from the Danish Life Course Cohort Study (DANLIFE) who were free of diabetes at age 16 and were followed from age 16 to Dec. 31, 2018. They were divided into five childhood adversity groups based on their annual exposure to childhood adversities from ages 0-15 years.

Analyses were adjusted for parental origin, maternal age at birth, parental diabetes, and year of birth.

Effect estimates were attenuated when the associations were also adjusted for parental educational level, size for gestational age, and preterm birth, particularly for women in the high adversity group compared with the low adversity group (HR 1.23, 95% CI 1.00-1.50; 17.3 additional cases per 100,000 person-years), largely due to adjustment for parental educational level.

Among those whose parents did not have a diabetes diagnosis, the relative risks of diabetes associated with childhood adversity appeared to be slightly higher than in the main analysis, specifically for men, while the absolute risks were lower.

Because the study focused on teens and young adults, Elsenburg and colleagues said it's possible that some cases of type 1 diabetes got counted in the mix, which was a limitation to their study.

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