Childhood maltreatment and adult diseases in the general population: the mediating role of smoking and overweight in a time-sequence design

Background Childhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health problems, although the underlying pathways remain unclear. This study examined whether smoking and overweight mediate the association between childhood abuse/...

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Published in:BMC public health Vol. 25; no. 1; pp. 3613 - 17
Main Authors: Klinger-König, Johanna, Streit, Fabian, Völker, Maja P., Frank, Josef, Sekula, Peggy, Jaskulski, Stefanie, Leitzmann, Michael, Meinke-Franze, Claudia, Schmidt, Carsten O., Keil, Thomas, Willich, Stefan N., Pischon, Tobias, Velásquez, Ilais M., Frost, Jonas, Schmidt, Börge, Heise, Jana-Kristin, Klett-Tammen, Carolina J., Koch-Gallenkamp, Lena, Obi, Nadia, Harth, Volker, Mons, Ute, Berger, Klaus, Greiser, Karin H., Mikolajczyk, Rafael, Schulze, Matthias B., Grabe, Hans J.
Format: Journal Article
Language:English
Published: London BioMed Central 27.10.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Abuse
Adults
Age
Age of onset
Analysis
Anxiety
Biostatistics
Body weight
Cancer
Care and treatment
Cerebral infarction
Child abuse
Child abuse & neglect
Childhood
Childhood abuse
Childhood neglect
Children
Chronic non-communicable diseases
Chronic obstructive pulmonary disease
Communicable diseases
Complications and side effects
Diabetes
Diabetes mellitus (non-insulin dependent)
Diagnosis
Disease
Disease prevention
Disorders
Education
Environmental Health
Epidemiology
Esophagus
German language
Health aspects
Health problems
Health risks
Heart attack
Heart attacks
Larynx
Lifestyles
Longitudinal studies
Lung diseases
Lung diseases, Obstructive
Mediation
Mediators
Medical diagnosis
Medicine
Medicine & Public Health
Men
Mental depression
Mental disorders
Mental health
Mental illness
Myocardial infarction
Obesity
Overweight
Prevention
Public Health
Risk factors
Sex education
Sexual abuse
Smoking
Somatic symptoms
Statistics
Stroke
Trauma
Type 2 diabetes
Type 2 diabetes mellitus
Urogenital system
Vaccine
Weight control
Women
Womens health
Germany
Childhood abuse
Childhood neglect
Age of onset
Chronic non-communicable diseases
Mental health
ISSN:1471-2458, 1471-2458
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Summary:Background Childhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health problems, although the underlying pathways remain unclear. This study examined whether smoking and overweight mediate the association between childhood abuse/neglect and frequent adult diseases, including cancer, myocardial infarction, stroke, type 2 diabetes, chronic obstructive pulmonary disease, depression, and anxiety. Methods Childhood maltreatment was assessed in 152,887 German National Cohort (NAKO) participants using the Childhood Trauma Screener. Information on smoking initiation age, weight history, and respective age at diagnosis was incorporated to ensure that smoking and overweight preceded the diagnosis. Mediation analyses were adjusted for age, sex, study center, and education. Results For childhood abuse, larger proportions of associations with adult somatic diseases were mediated through preexisting smoking and overweight compared to adult mental disorders. Smoking most strongly mediated myocardial infarction (36.88% [95% confidence interval (CI): 17.88%; 55.89%]), with more pronounced effects in men (48.62% [14.28%; 82.97%]) than in women (20.82% [2.75%; 38.89%]). For overweight, a substantial mediation was only found for type 2 diabetes (13.69% [9.85%; 17.52%]), with stronger effects in women (16.16% [8.92%; 23.39%]) compared to men (8.43% [4.52%; 12.35%]). Comparable results were found for childhood neglect. Conclusions To smoke or be overweight before the first diagnosis of myocardial infarction and type 2 diabetes mediated the association between childhood abuse/neglect and these somatic diseases. However, while the mediation through smoking and overweight contributed to the disease risk linked to childhood maltreatment, strong direct effects of childhood abuse/neglect persisted for both mental and somatic health problems. These findings underscore the need for further longitudinal studies to better understand the pathways.
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ISSN:1471-2458
1471-2458
DOI:10.1186/s12889-025-24854-y