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 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
London
BioMed Central
27.10.2025
BioMed Central Ltd Springer Nature B.V BMC |
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| ISSN: | 1471-2458, 1471-2458 |
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| Abstract | 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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| AbstractList | 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. Keywords: Childhood abuse, Childhood neglect, Age of onset, Mental health , Chronic non-communicable diseases Abstract 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. BackgroundChildhood 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.MethodsChildhood 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.ResultsFor 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.ConclusionsTo 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. 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. 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. 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. 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. 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. |
| ArticleNumber | 3613 |
| Audience | Academic |
| Author | Koch-Gallenkamp, Lena Greiser, Karin H. Harth, Volker Schmidt, Börge Willich, Stefan N. Schmidt, Carsten O. Berger, Klaus Völker, Maja P. Streit, Fabian Frank, Josef Sekula, Peggy Meinke-Franze, Claudia Schulze, Matthias B. Pischon, Tobias Jaskulski, Stefanie Leitzmann, Michael Obi, Nadia Klett-Tammen, Carolina J. Klinger-König, Johanna Velásquez, Ilais M. Keil, Thomas Mons, Ute Grabe, Hans J. Mikolajczyk, Rafael Frost, Jonas Heise, Jana-Kristin |
| Author_xml | – sequence: 1 givenname: Johanna surname: Klinger-König fullname: Klinger-König, Johanna email: johanna.klinger-koenig@med.uni-greifswald.de organization: Department of Psychiatry and Psychotherapy, University Medicine Greifswald – sequence: 2 givenname: Fabian surname: Streit fullname: Streit, Fabian organization: Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm – sequence: 3 givenname: Maja P. surname: Völker fullname: Völker, Maja P. organization: Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University – sequence: 4 givenname: Josef surname: Frank fullname: Frank, Josef organization: Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University – sequence: 5 givenname: Peggy surname: Sekula fullname: Sekula, Peggy organization: Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg – sequence: 6 givenname: Stefanie surname: Jaskulski fullname: Jaskulski, Stefanie organization: Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg – sequence: 7 givenname: Michael surname: Leitzmann fullname: Leitzmann, Michael organization: Institute for Epidemiology and Preventive Medicine, University of Regensburg – sequence: 8 givenname: Claudia surname: Meinke-Franze fullname: Meinke-Franze, Claudia organization: Institute for Community Medicine, University Medicine Greifswald – sequence: 9 givenname: Carsten O. surname: Schmidt fullname: Schmidt, Carsten O. organization: Institute for Community Medicine, University Medicine Greifswald – sequence: 10 givenname: Thomas surname: Keil fullname: Keil, Thomas organization: Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Institute for Clinical Epidemiology and Biometry, University Würzburg, Landesinstitut Gesundheit I, Bavarian Health and Food Safety Authority – sequence: 11 givenname: Stefan N. surname: Willich fullname: Willich, Stefan N. organization: Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin – sequence: 12 givenname: Tobias surname: Pischon fullname: Pischon, Tobias organization: Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin – sequence: 13 givenname: Ilais M. surname: Velásquez fullname: Velásquez, Ilais M. organization: Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) – sequence: 14 givenname: Jonas surname: Frost fullname: Frost, Jonas organization: Institute for Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin Luther University Halle-Wittenberg – sequence: 15 givenname: Börge surname: Schmidt fullname: Schmidt, Börge organization: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen – sequence: 16 givenname: Jana-Kristin surname: Heise fullname: Heise, Jana-Kristin organization: Department of Epidemiology, Helmholtz Centre for Infection Research – sequence: 17 givenname: Carolina J. surname: Klett-Tammen fullname: Klett-Tammen, Carolina J. organization: Department of Epidemiology, Helmholtz Centre for Infection Research – sequence: 18 givenname: Lena surname: Koch-Gallenkamp fullname: Koch-Gallenkamp, Lena organization: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ) – sequence: 19 givenname: Nadia surname: Obi fullname: Obi, Nadia organization: Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf – sequence: 20 givenname: Volker surname: Harth fullname: Harth, Volker organization: Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf – sequence: 21 givenname: Ute surname: Mons fullname: Mons, Ute organization: Division Primary Cancer Prevention, German Cancer Research Center (DKFZ), Medical Faculty Mannheim, Heidelberg University – sequence: 22 givenname: Klaus surname: Berger fullname: Berger, Klaus organization: Institute of Epidemiology and Social Medicine, University of Münster – sequence: 23 givenname: Karin H. surname: Greiser fullname: Greiser, Karin H. organization: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) – sequence: 24 givenname: Rafael surname: Mikolajczyk fullname: Mikolajczyk, Rafael organization: Institute for Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin Luther University Halle-Wittenberg – sequence: 25 givenname: Matthias B. surname: Schulze fullname: Schulze, Matthias B. organization: Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Institute of Nutritional Science, University of Potsdam – sequence: 26 givenname: Hans J. surname: Grabe fullname: Grabe, Hans J. organization: Department of Psychiatry and Psychotherapy, University Medicine Greifswald, German Center for Neurodegenerative Diseases (DZNE) |
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Childhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health problems,... Background Childhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health problems,... Childhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health problems, although the... BackgroundChildhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health problems, although... Abstract Background Childhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health... |
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| SubjectTerms | 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 |
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| Title | Childhood maltreatment and adult diseases in the general population: the mediating role of smoking and overweight in a time-sequence design |
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