Early life adversity can increase cardiovascular risks, research shows
Stressful conditions like abuse or food insecurity, when experienced at a young age, can have knock-on health effects that set young people up for conditions like heart disease and type 2 diabetes.
Faced with a traumatic situation, a child’s biology responds in the only way it can, shunting all resources toward survival. Unfortunately, that might also mean taking resources away from the processes that lead to healthy, long-term growth and development.
New research finds that extreme stress in childhood — for example, from abuse or malnutrition — correlates with worsened cardiac health in later adolescence and likely adulthood. Even when a child is only exposed to adverse conditions in the first few years of life, before the age of 5, those conditions can have measurable, negative effects on their health for at least the next decade.
In a recent study, Brie Reid, an assistant professor of public health and health sciences at Northeastern University, and her intercollegiate team examined almost 200 young people between the ages of 12 and 21. Half the group had been adopted from international orphanages or similar institutions into affluent homes in the Midwestern United States. The other half, as a control group, had been raised from birth in similarly affluent households.
Reid found a stark difference between the two groups.
Surviving adversity
Reid, who studies how stress and nutrition impact human development, says that researchers have long known that prolonged stress can have deleterious impacts on a child’s development, but she wanted to know more: First, how impactful would stress over a relatively short period of time be, and second, how early could they detect the signs of cardiovascular danger?
To answer these questions, Reid and her team looked at young people who had faced extreme levels of stress very young in life before being adopted into better socioeconomic conditions with higher levels of food security.
The average age at which her subjects were adopted was around 16 months, she says, and with the youngest participant in the study at 12 years old, “that means we’ve got at least a decade of time between when their extreme stress happened” and when the researchers’ tests were conducted.
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Even in “the best orphanage with the best caregivers, the caregiver-to-infant ratio is just not what it needs to be, and so a lot of these kids come into the country with pretty severe levels of neglect,” she says.
Reid says that the kind of adversity they are focused on includes food insecurity, abuse, separation from parents or something as simple as low socioeconomic status.
Conversely, high socioeconomic status can be a “huge protective factor for people. That unfortunately buys you into a lot of health early in life and later as you age,” she says.
The children who had suffered from extreme stress in those early months of life displayed signs of arterial stiffening of the kind usually seen “in older adults or middle-aged adults,” she continues.
Arterial stiffness or hardening occurs naturally over time, but certain conditions can cause this stiffening to occur more rapidly and indicate premature aging, just as Reid noticed in her study.
Arterial stiffening also contributes to an increased risk of cardiac events as we get older, she notes.
Reid says that they also performed dual-energy X-ray absorptiometry, often known as DEXA scans, which produce whole-body analyses of bone density and the distribution of fat in the body. The subjects who experienced extreme adversity early in life displayed more visceral fat than the control group.
Visceral fat appears inside the torso, surrounding abdominal organs like the liver, kidneys and others. An excess of visceral fat can contribute to Type 2 diabetes and circulatory diseases like atherosclerosis, according to the Cleveland Clinic.
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The mechanism
Reid says she often reminds her students that a child is “not just a small adult.” In addition to their bodies growing and changing, a child’s “neurodevelopmental scaffolding,” as she calls it, is under rapid construction.
The adopted children in Reid’s study also didn’t respond to stressors as anticipated, she says, producing less of the stress hormone cortisol than their peers. It seems, Reid postulates, that their bodies respond to adverse cues in their environment by focusing on survival, which removes resources from developmental processes important to a person’s long-term health.
“Sometimes catch-up growth is good,” Reid continues, noting that these children may also have growth delays compared to their age group, but “sometimes it means that the nutrients that could be going to building your neurons are actually going to building your bones or muscle tissue.”
She also says that “the ideal early intervention plan” would involve society-wide changes, including more support for pregnant people. Further, “in the event that a person can’t care for an infant, rather than placing them in an institution or an orphanage, there’s been work that finds that foster care placement” tends to provide better outcomes than the institutional alternatives, which often can’t afford to staff enough caregivers, according to Reid.
Reid hopes that this research will help physicians understand that those who come from impoverished circumstances, especially in their formative years, may need earlier health interventions than others. She also hopes to empower patients to talk to their doctors earlier.
“Most 15-, 18-year-olds are probably not thinking about their cardiometabolic health,” she says, even though they may already be on track for heart disease.
