Adverse Childhood Experiences, BMI, and Diabetes Among U.S. Adults: The Moderating Effect of Sex

Background and Purpose: Diabetes is a pervasive chronic disease affecting millions of individuals in the United States (U.S.). Studies have established a link between body mass index (BMI) and diabetes. Other studies have also found that exposure to psychosocial stressors such as adverse childhood experience (ACEs) could contribute to the onset of chronic diseases, including diabetes. Although previous studies have investigated the association between ACEs and diabetes, few studies have examined sex as a moderator of this association. However, socio-demographic disparities in diabetes prevalence emphasize the critical need for tailored interventions and healthcare strategies that consider demographic factors. Thus, the objective of this study was to examine the association between ACEs, BMI, and diabetes among U.S. adults, and the potential moderating effect of sex on this association. Findings from the study can enhance the field's capacity to identify potential risk differences and inform targeted prevention strategies for this population.

Methods: Data for this study came from the 2020 Behavioral Risk Factor Surveillance System (n= 97,592; 50.9 % Females). The outcome variable examined in this study was self-reported lifetime diagnosis of diabetes. The main explanatory variables examined in this study are ACEs and BMI. Covariates examined in this study were grouped under SES (education, income, and healthcare coverage) and health behaviors (heavy alcohol drinking, cigarette smoking, and physical activity). Multivariable logistic regression analyses were conducted to examine the associations between diabetes, ACEs, and BMI, and the interaction between BMI and sex on diabetes. All analyses were performed using Stata.

Results: Of 97,592 respondents, 12.0% had diabetes, 19.6% experienced four or more ACEs, 28.9% were normal weight, 34.1% were overweight, and 35.2% were obese. Controlling for demographic characteristics and other covariates, ACEs was associated with 1.04 times higher odds of having diabetes (AOR=1.04, 95% CI=1.01-1.06). Further, respondents who were overweight (AOR=1.32, 95% CI=1.01-1.72) and obese had higher odds of having diabetes (AOR= 3.01, 95% CI=2.35-3.86). Sex moderated the association between BMI and diabetes, with females who were overweight (AOR= 1.63, 95% CI=1.17-2.28) or obese (AOR= 1.66, 95% CI=1.22-2.26) having a higher risk of diabetes compared to males in the same BMI categories.

Conclusion and Implications: The findings of the study suggest that ACEs and BMI are potential risk factors for diabetes and may be important factors to target when designing interventions and prevention strategies for reducing the risk of diabetes. These results have important implications for healthcare providers, public health practitioners, and policymakers in their efforts to prevent and manage diabetes. The interaction between BMI and sex on diabetes highlights the importance of considering sex-specific strategies as well as the impact of early life experiences on long-term health outcomes, in diabetes prevention and management efforts. Furthermore, recognizing how sex shapes diabetes risk profiles emphasizes the importance of gender-sensitive approaches in policy development and delivering healthcare. Interventions targeting modifiable risk factors such as obesity, should be developed and evaluated to inform diabetes prevention and management efforts.