Early Life Adversity with Height Stunting Is Associated with Cardiometabolic Risk in Adolescents Independent of Body Mass Index

J Pediatr. 2018 Nov:202:143-149. doi: 10.1016/j.jpeds.2018.06.047. Epub 2018 Aug 23.

Abstract

Objective: To evaluate cardiovascular and metabolic function in youths adopted internationally from orphanages/institutions (postinstitutionalized) who were height-stunted at adoption.

Study design: A total of 30 postinstitutionalized youths (age, 9-18 years; body mass index [BMI] percentile, 7.2-90.4) who were height-stunted at adoption were compared with age- and BMI percentile-matched youths (n = 90). Measurements included total body fat and visceral adipose tissue (dual radiograph absorptiometry), arterial stiffness (augmentation index and pulse wave velocity), cardiac autonomic function (heart rate variability), blood pressure, and fasting lipid, glucose, and insulin levels. Linear regression analyses were computed controlling for parent education, age, trunk tissue fat, height-for-age, sex, and race.

Results: Compared with controls of the same age, sex, and BMI, the postinstitutionalized children had higher systolic blood pressure (P = .018), augmentation index (P= .033), total cholesterol (P= .047), low-density lipoprotein cholesterol (P= .03), triglycerides (P= .048), insulin (P= .005), and HOMA-IR (P= .01) values. The postinstitutionalized children had a lower low-frequency to high-frequency ratio (P = .008), indicating lower sympathetic tone, as well as a lower total lean mass (P = .016), a lower gynoid lean mass (P = .039), and a higher proportion of trunk tissue fat (P = .017). The postinstitutionalized and control children did not differ in any other body composition measures.

Conclusions: Early life stress, as represented by height-stunted growth in institutional care, may be associated with early pathways to cardiovascular and metabolic risk in youths even after moving into well-resourced homes early in life and in the absence of increased adiposity. These findings suggest that postinstitutionalized youths with a history of height stunting may need to be closely monitored for emergent cardiometabolic risk factors.

Keywords: adolescence; arterial stiffness; body composition; early adversity; heart rate variability; height stunting.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Body Height / physiology
  • Body Mass Index*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology
  • Child
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Growth Disorders / complications*
  • Growth Disorders / diagnosis
  • Humans
  • Hypercholesterolemia / diagnosis
  • Hypercholesterolemia / epidemiology
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Incidence
  • Longitudinal Studies
  • Male
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / etiology*
  • Metabolic Syndrome / physiopathology
  • Orphanages
  • Reference Values
  • Risk Assessment
  • Stress, Physiological
  • Stress, Psychological
  • Time Factors
  • United States / epidemiology