Physical and sexual abuse in childhood and adolescence appear to increase the risk of type 2 diabetes in adult women in a dose-response fashion, based on the results of an epidemiologic study involving almost 70,000 women.
Moderate and severe physical abuse in childhood and adolescence were associated with 26%-54% higher risks of diabetes in women. Those who had experienced forced sex once had a 34% higher risk of diabetes than were women who were not sexually abused as girls and a 69% higher risk when sexual abuse occurred more frequently. Even after accounting for adult body mass index, there remained a 10%-30% increased risk of diabetes among women who had experienced moderate physical abuse or the most severe forms of physical or sexual abuse (Am. J. Prev. Med. [doi:10.1016/j.amepre.2010.09.007]).
"The PAR [population attributable risk] percent derived from this model indicates that child/adolescent abuse accounted for 14% (7%-21%) of type 2 diabetes in this cohort. Applying the hazard ratio from this study to the 43% prevalence of any child or adolescent abuse reported by women in the National Violence Against Women Survey, an estimated 9% of diabetes in U.S. women may be attributed to early abuse," wrote Janet W. Rich-Edwards, Sc.D., and her colleagues.
An association consistently has been reported between child abuse and adult obesity. Studies indicate "that early trauma may cause lasting dysregulated responsivity which may link child abuse with diabetes through physiologic pathways independent of adiposity," wrote Dr. Rich-Edwards, director of developmental epidemiology at the Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital, Boston, and her colleagues. However, the association between childhood abuse and adult diabetes has not been studied before in a large population.
The new findings highlight the importance of recognizing abuse in children and adolescents and asking adults about a history of abuse, according to Dr. Lawrence S. Phillips, a professor of endocrinology at Emory University, Atlanta.
Physicians need to be aware that "there are not only emotional and behavioral consequences of abuse in childhood and adolescence; there are physical consequences as well," he said in an interview.
"We need to be much more sensitive to issues of abuse and in the history, because they demonstrably now have mental and physical downstream impacts."
For this study, the researchers used data from the Nurses Health Study II (NHSII), a cohort of 116,430 registered nurses, who were aged 25-42 years when the cohort was established in 1989. The cohort has been followed by biennial mailed questionnaires, which inquire about risk factors and disease incidence. …