Cumulative environmental stress and emerging cardiometabolic risk during childhood

Alicia S. Kunin-Batson, Jacob Haapala, A. Lauren Crain, Megan R. Gunnar, Elyse O. Kharbanda, Aaron S. Kelly, Elisabeth M. Seburg, Nancy E. Sherwood, Simone A. French

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To prospectively evaluate the relationship between cumulative environmental stress and cardiometabolic risk in middle childhood, and to examine whether hair cortisol, a measure of hypothalamic pituitary adrenal-axis activity, mediates this relationship.

METHODS: In a cohort of children from low-income households (n = 320; 59% Hispanic, 23% Black, body mass index (BMI) percentile >50th at enrollment), environmental stressors including family and neighbourhood factors representing disadvantage/deprivation, and cortisol concentrations from hair samples, were measured over five timepoints beginning when children were 2-4 years old. Cardiometabolic risk factors (i.e., BMI, blood pressure, lipids, blood sugar, C-reactive protein) were measured at the final timepoint when children were 7-11 years of age.

RESULTS: In adjusted logistic regression models, greater cumulative environmental stress was associated with a higher likelihood of elevated cardiometabolic risk in middle childhood (p = 0.01). Children from minoritized racial/ethnic groups had a higher prevalence of both stressors and cardiometabolic risk factors. Cumulative environmental stress was associated with higher hair cortisol concentrations (p < 0.01). However, hair cortisol was not directly associated with cardiometabolic risk factors and did not explain the association between environmental stress and cardiometabolic risk in causal mediation analysis.

CONCLUSIONS: The influence of cumulative stress on cardiometabolic health can be observed in middle childhood and may contribute to cardiometabolic health disparities, highlighting the importance of public health interventions to mitigate disadvantage.

Original languageEnglish (US)
Article numbere13116
Pages (from-to)e13116
JournalPediatric Obesity
Issue number6
Early online dateMar 28 2024
StateE-pub ahead of print - Mar 28 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.


  • childhood
  • health disparities
  • obesity
  • stress

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


Dive into the research topics of 'Cumulative environmental stress and emerging cardiometabolic risk during childhood'. Together they form a unique fingerprint.

Cite this