Table 2a.
Characteristics and results of included cross-sectional studies
| Author, Year | Study and Sample | ACEs Definition | ACEs Measure | Obesity Measure | Analytic Method and Results | Were ACEs Associated with Obesity? |
|---|---|---|---|---|---|---|
| Cross-sectional Studies | ||||||
| Ahn, 2019 | N=42,193 10–17 years 2011/12 National Survey of Children’s Health Subsample USA |
Yes/no for each: 1) Extreme economic hardship 2) Parents divorced or separated 3) Lived with person with an alcohol/drug problem 4) Witnessed/victim of neighborhood violence 5) Lived with someone who was mentally ill/suicidal 6) Witnessed domestic violence 7) Parent incarcerated 8) Treated or judged unfairly due to race/ethnicity 9) Death of parent |
9 ACE summary score Parent-report via phone survey |
Weight category (healthy, obese); BMI Parent-report |
Pearson chi-square, path analysis 1.11±1.54 ACEs for healthy weight, 1.52±1.4 ACEs for obese, p<0.001 ACEs and BMI: β=0.05, p<0.01 |
Yes |
| Burke, 2011 | N=701 0–20 years Patients at urban pediatric clinic USA |
Yes/no for each: 1) Recurrent physical abuse 2) Recurrent emotional abuse 3) Contact sexual abuse 4) An alcohol/drug abuser in household 5) Incarcerated household member 6) Someone chronically depressed, mentally ill, institutionalized, suicidal 7) Mother treated violently 8) One or no parents 9) Emotional or physical neglect |
9 ACE summary score categorized as ≥4 and <4, and ≥1 and <1 Assessment via clinical care |
Weight category (healthy, overweight/ obese) Assessment via clinical care |
Multivariate logistic regression ≥1 ACE and obesity: OR 1.1, p=0.65 ≥4 ACEs and obesity: OR 2.0, p=0.02 |
Yes, but only ≥4 |
| Gooding, 2015 | N=147 13–17 years USA |
Yes/no for each: 1) Physical abuse 2) Sexual abuse 3) Emotional abuse 4) Domestic violence |
Each ACE individually yes/no; abuse severity score based on abuse ACEs only; any abuse yes/no Youth-report for experiencing ever |
BMI z Youth-report |
Multivariate linear regression Physical abuse and BMIz: β=0.52, p=0.01 Sexual abuse and BMIz: β=0.16, p=0.36 Emotional abuse and BMIz: β=0.36, p=0.14 Any abuse and BMIz: β=0.20, p=0.22 Domestic violence and BMIz: β=0.85, p<0.01 Abuse severity and BMIz: β=0.018, p=0.11 |
Yes, but only physical abuse and domestic violence |
| Heerman, 2016 | N=42,239 10–17 years 2011/12 National Survey of Children’s Health Subsample USA |
Yes/no or 4-point Likert for each: 1) Extreme economic hardship 2) Parents divorced or separated 3) Lived with person with an alcohol/drug problem 4) Witnessed/victim of neighborhood violence 5) Lived with someone who was mentally ill/suicidal 6) Witnessed domestic violence 7) Parent incarcerated 8) Treated or judged unfairly due to race/ethnicity 9) Death of parent |
9 ACE summary score categorized as ≥1 or <1, or ≥2 or <2 Parent-report via phone survey |
Weight category (healthy, overweight, obese) Parent-report |
Proportional odds survey regression ≥1 ACE and obesity: OR 1.3, p<0.001 ≥2 ACE and obesity: OR 1.8, p<0.001 |
Yes |
| Isohooka, 2016 | N=449 12–17 years Admitted to inpatient psychiatric unit Finland |
Yes/no for each: 1) Witnessed domestic violence 2) Physical abuse 3) Sexual abuse 4) Parent substance use problem 5) Parent psychiatric problem 6) Parent divorce 7) Parent death |
Each ACE individually yes/no Youth-report via clinical interview |
Weight category (under, healthy, overweight, obese) Objectively measured |
Multivariate logistic regression: Girls: Sexual abuse and obesity: OR 2.6, p=0.038 Boys: NS, data not shown |
Yes, but only for girls and only for sexual abuse |
| Keeshin, 2013 | N=1,434 3–20 years Admitted to inpatient psychiatric unit USA |
Yes/no for each: 1) Physical abuse 2) Sexual abuse |
Each type of abuse yes/no Parent- or youth-reported as documented in chart |
Weight category (healthy, overweight/obese, severe obesity) Objectively measured |
Multinomial Logistic Regression Sexual abuse and overweight/obesity: OR 1.41, 95%CI 1.01–1.98 Physical abuse and overweight/obesity: OR 0.95, 95%CI 0.68–1.33 Severe obesity: NS, data not shown |
Yes, but only sexual abuse |
| Kidman, 2020 | N=2,089 10–16 years Extension of Malawi Longitudinal Study of Families and Health Malawi |
Yes/no for each: 1) Emotional neglect 2) Emotional abuse 3) Physical neglect 4) Physical abuse 5) Sexual abuse 6) Substance abuse by householder 7) Mental health issues in householder 8) Incarcerated household member 9) Domestic violence 10) Parents dead or divorced 11) Peer bullying 12) Community violence 13) Collective violence |
13 ACE summary score Youth-report via in-person interview |
Weight category (obese, non-obese) Objectively measured |
Multivariate logistic regression Boys: NS, data not shown Girls: ACEs and obesity: OR 1.08, 95%CI 1.01–1.15 Top vs bottom quintile of ACE score and obesity: OR 1.94, 95% CI 1.19–3.16 |
Yes, but only for girls |
| Lynch, 2016 | N=43,864 10–17 years 2011/12 National Survey of Children’s Health subsample USA |
Yes/no or 4-point Likert for each: 1) Extreme economic hardship 2) Parents divorced or separated 3) Lived with person with an alcohol/drug problem 4) Witnessed/victim of neighborhood violence 5) Lived with someone who was mentally ill/suicidal 6) Witnessed domestic violence 7) Parent incarcerated 8) Treated or judged unfairly due to race/ethnicity 9) Death of parent |
9 ACE summary score categorized as 0, 1, and ≥2; each ACE individually Parent-report via phone interview |
Weight category (healthy, overweight, obese) Parent-report |
>=2 ACEs and obesity: OR 1.21, 95%CI 1.02–1.44 Parent death and obesity: OR 1.59, 95%CI 1.18–2.15 Other ACEs: NS, data not shown |
Yes, both collectively and individually for parent death |
| Mehari, 2020 | N=180 2–7 years Neurodevelopmental delays USA |
Yes/no for each: 1) Parent divorce/separation 2) Household substance use 3) Incarcerated Family member 4) Witnessing domestic violence 5) Household member w/ mental illness 6) Death of parent 7) Witnessing domestic violence 8) Experiencing discrimination |
Any ACE yes/no Parent-report via survey |
Weight category (under, healthy, overweight, obese) Objectively measured |
Hierarchical linear regression ACEs and obesity: β 0.08, p=0.31 |
No |
| Pinhas-Hamiel, 2009 | N=145 4–18 years Referred to obesity clinic Israel |
Yes/no for each: 1) Penetrative sexual abuse |
Sexual abuse yes/no Youth-report via clinical intake interview |
BMIz Objectively measured |
BMIz for abused versus non-abused: 4.76±1.34 vs. 3.39±1.28, p=0.02 |
Yes |
| Purswani, 2020 | N=948 2–20 years Attending general pediatrics clinic USA |
Yes/no for: 1) “10 ACEs described in the Adverse Childhood Experiences Study” [not listed] 2) Living in a foster care 3) Being bullied 4) Death of a caregiver 5) Deportation or migration 6) Discrimination 7) Experiencing a life-threatening illness or invasive medical procedure 8) Exposure to community or school violence |
18 ACE summary score, categorized as 0 or ≥1, or <2 or ≥2 Parent-report via survey |
Weight category (overweight/obese, healthy) | >=1 ACE and overweight/obesity: OR 1.03, 95%CI 0.68–1.55, p=0.89 >=2 ACEs and obesity: OR 1.01, 95%CI 0.70–1.46, p=0.97 |
No |
| Veldwijk, 2012 | N=51,856 13–16 years Netherlands |
Yes/no for each: 1) Physical abuse 2) Sexual abuse 3) Mental abuse |
Physical abuse yes/no, sexual abuse yes/no, mental abuse yes/no Youth-report via survey |
Weight category (under, healthy, overweight, obese) Youth-report |
Generalized estimating equations Boys: Physical abuse and obesity: OR 1.77, 95% CI 1.29–2.42 Sexual abuse and obesity: OR 2.49, 95% CI 1.82–3.42 Mental abuse and obesity: OR 2.98, 95%CI 2.32–3.83 Girls: Mental abuse and obesity: OR 5.07, 95%CI 3.84–6.70 |
Yes, but physical/sexual/ mental for boys and mental only for girls |
Note. 95%CI=95% confidence interval, ACE=adverse childhood experience, BMI=body mass index, NS=not significant, OR=odds ratio, USA=United States of America