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  • The potential of intervening on childhood adversity to reduce socioeconomic inequities in body mass index and inflammation among Australian and UK children: A causal mediation analysis

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The potential of intervening on childhood adversity to reduce socioeconomic inequities in body mass index and inflammation among Australian and UK children: A causal mediation analysis
  1. Naomi Priest1,2,
  2. Shuaijun Guo2,3,
  3. Dawid Gondek4,
  4. Meredith O'Connor3,5,6,
  5. Margarita Moreno-Betancur3,7,
  6. Sarah Gray2,3,
  7. Rebecca Lacey4,
  8. David P Burgner3,8,9,10,
  9. Sue Woolfenden11,12,
  10. Hannah Badland13,
  11. Gerry Redmond14,
  12. Markus Juonala15,16,
  13. Katherine Lange3,17,
  14. Sharon Goldfeld2,3
  1. 1 Centre for Social Research and Methods, Australian National University, Canberra, Australian Capital Territory, Australia
  2. 2 Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  3. 3 Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Research Department of Epidemiology and Public Health, University College London, London, UK
  5. 5 Melbourne Children’s LifeCourse Initiative, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  6. 6 Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Victoria, Australia
  7. 7 Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  8. 8 Inflammatory Origins Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
  9. 9 Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
  10. 10 Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
  11. 11 Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
  12. 12 Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
  13. 13 Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
  14. 14 College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
  15. 15 Department of Medicine, University of Turku, Turku, Finland
  16. 16 Division of Medicine, TYKS Turku University Hospital, Turku, Finland
  17. 17 Molecular Immunity Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
  1. Correspondence to Professor Naomi Priest, Centre for Social Research and Methods, Australian National University, Canberra, Australian Capital Territory, 2601, Australia; naomi.priest{at}anu.edu.au

Abstract

Background Lower maternal education is associated with higher body mass index (BMI) and higher chronic inflammation in offspring. Childhood adversity potentially mediates these associations. We examined the extent to which addressing childhood adversity could reduce socioeconomic inequities in these outcomes.

Methods We analysed data from two early-life longitudinal cohorts: the Longitudinal Study of Australian Children (LSAC; n=1873) and the UK Avon Longitudinal Study of Parents and Children (ALSPAC; n=7085). Exposure: low/medium (below university degree) versus high maternal education, as a key indicator of family socioeconomic position (0–1 year). Outcomes: BMI and log-transformed glycoprotein acetyls (GlycA) (LSAC: 11–12 years; ALSPAC: 15.5 years). Mediator: multiple adversities (≥2/<2) indicated by family violence, mental illness, substance abuse and harsh parenting (LSAC: 2–11 years; ALSPAC: 1–12 years). A causal mediation analysis was conducted.

Results Low/medium maternal education was associated with up to 1.03 kg/m2 higher BMI (95% CI: 0.95 to 1.10) and up to 1.69% higher GlycA (95% CI: 1.68 to 1.71) compared with high maternal education, adjusting for confounders. Causal mediation analysis estimated that decreasing the levels of multiple adversities in children with low/medium maternal education to be like their high maternal education peers could reduce BMI inequalities by up to 1.8% and up to 3.3% in GlycA.

Conclusions Our findings in both cohorts suggest that slight reductions in socioeconomic inequities in children’s BMI and inflammation could be achieved by addressing childhood adversities. Public health and social policy efforts should help those affected by childhood adversity, but also consider underlying socioeconomic conditions that drive health inequities.

  • CHILD HEALTH
  • Health inequalities
  • LONGITUDINAL STUDIES
  • PUBLIC HEALTH
  • CARDIOVASCULAR DISEASES

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jech-2022-219617

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @WoolfendenSusan

    • Contributors NP conceptualised and designed the study, drafted the initial manuscript, critically reviewed the manuscript for important intellectual content and obtained funding. MOC, SGr, MMB, DPB and RL conceptualised the study, drafted the initial manuscript and critically reviewed the manuscript for important intellectual content. SGu and DG conceptualised the study, conducted analysis, drafted the initial manuscript and critically reviewed the manuscript for important intellectual content. SGo obtained funding, conceptualised and designed the study, and critically reviewed the manuscript for important intellectual content. SW, HB, GR, MJ and KL conceptualised the study and critically reviewed the manuscript for important intellectual content. NP is responsible for the overall content as the guarantor. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding The UK Medical Research Council (MRC) and Wellcome (Grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors and NP and RL will serve as guarantors for the contents of this paper. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/Alspac/external/documents/grant-acknowledgements.pdf). This research was specifically funded by the National Institute of Health (NIH) (Grant ref: DK077659), Wellcome Trust and MRC (Grant ref: 07467/Z/05/Z). Access to ALSPAC data was supported by a University College London Global Engagement Award. This work was also supported by Australian Research Council Discovery Grant (grant number DP160101735) and was supported by the Victorian Government’s Operational Infrastructure Support Program. MOC is supported by the Melbourne Children’s LifeCourse initiative, funded by a Royal Children’s Hospital Foundation Grant (2018-984). MMB is supported by Australian Research Council Discovery Early Career Award (DE190101326) and Australian National Health and Medical Research Council (NHMRC) Investigator Grant Emerging Leadership Level 2 (ID 2009572). SGo is supported by an NHMRC Practitioner Fellowship (APP1155290). HB is supported by an RMIT University VC Senior Research Fellowship. NP was supported by a NHMRC Career Development Fellowship (APP1123677). DB is supported by an NHMRC Investigator Grant (APP1175744). RL and DG’s time on this study was supported by a UK Economic and Social Research Council grant (Grant ref: ES/P010229/1).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Author note The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.