Early Life Adversity with Height Stunting Is Associated with Cardiometabolic Risk in Adolescents Independent of Body Mass Index

Brie M. Reid, Michelle M. Harbin, Jessica L. Arend, Aaron S Kelly, Donald R Dengel, Megan R Gunnar

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objective: To evaluate cardiovascular and metabolic function in youths adopted internationally from orphanages/institutions (postinstitutionalized) who were height-stunted at adoption. Study design: A total of 30 postinstitutionalized youths (age, 9-18 years; body mass index [BMI] percentile, 7.2-90.4) who were height-stunted at adoption were compared with age- and BMI percentile-matched youths (n = 90). Measurements included total body fat and visceral adipose tissue (dual radiograph absorptiometry), arterial stiffness (augmentation index and pulse wave velocity), cardiac autonomic function (heart rate variability), blood pressure, and fasting lipid, glucose, and insulin levels. Linear regression analyses were computed controlling for parent education, age, trunk tissue fat, height-for-age, sex, and race. Results: Compared with controls of the same age, sex, and BMI, the postinstitutionalized children had higher systolic blood pressure (P =.018), augmentation index (P =.033), total cholesterol (P =.047), low-density lipoprotein cholesterol (P =.03), triglycerides (P =.048), insulin (P =.005), and HOMA-IR (P =.01) values. The postinstitutionalized children had a lower low-frequency to high-frequency ratio (P =.008), indicating lower sympathetic tone, as well as a lower total lean mass (P =.016), a lower gynoid lean mass (P =.039), and a higher proportion of trunk tissue fat (P =.017). The postinstitutionalized and control children did not differ in any other body composition measures. Conclusions: Early life stress, as represented by height-stunted growth in institutional care, may be associated with early pathways to cardiovascular and metabolic risk in youths even after moving into well-resourced homes early in life and in the absence of increased adiposity. These findings suggest that postinstitutionalized youths with a history of height stunting may need to be closely monitored for emergent cardiometabolic risk factors.

Original languageEnglish (US)
Pages (from-to)143-149
Number of pages7
JournalJournal of Pediatrics
StatePublished - Nov 2018

Bibliographical note

Funding Information:
Funded by the National Heart, Lung, and Blood Institute (R01 HL110957, to A.K.), the National Center for Advancing Translational Sciences (UL1TR000114), the National Institute of Diabetes and Digestive and Kidney Diseases (NORC Grant P30 DK050456), and the Canadian Institute for Advanced Research Child and Brain Development program (to M.G.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This material is based on work supported by the National Science Foundation Graduate Research Fellowship (Grant 00039202, to B.R.). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors(s) and do not necessarily reflect the views of the National Science Foundation. A.K. serves as a consultant for Novo Nordisk, Orexigen, and Vivus Pharmaceuticals and receives research support from Astra Zeneca Pharmaceuticals in the form of drug/placebo. D.D. serves as a paid consultant for Hologic, Inc. The other authors declare no conflicts of interest.


  • adolescence
  • arterial stiffness
  • body composition
  • early adversity
  • heart rate variability
  • height stunting


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