Early life adversity and cardiometabolic risk in adolescents: Comparison of dimensional and cumulative approaches to adversity.

Early life adversity (ELA) is associated with cardiometabolic risk over the lifespan. While cumulative risk models of ELA have provided insights into those most vulnerable, emerging evidence suggests that ELA dimensions of threat and deprivation have distinct consequences for neurodevelopment. However, these dimensions remain understudied in relation to cardiometabolic risk. We assessed associations between ELA-comparing cumulative risk and dimensional approaches-with a cardiometabolic risk composite in youth aged 9-19 (n=117). Using a multi-method approach, youth and caregivers reported on youths' ELA experiences at baseline and 2-year follow-up visits; reports were aggregated to reflect lifetime experiences of threat and deprivation at follow-up. In addition to threat and deprivation composites, a cumulative ELA composite was calculated by summing the number of threat- and deprivation-related experiences. At follow-up, youth provided measures of blood pressure, body mass index, and waist circumference; indicators were standardized and summed. Regression models revealed that the cumulative ELA composite was not significantly associated with cardiometabolic risk. However, threat-related ELA, but not deprivation-related ELA, was associated with greater cardiometabolic risk, adjusting for age and sex. Furthermore, age moderated the deprivation-cardiometabolic risk association, such that greater deprivation was linked to lower cardiometabolic risk in late childhood/early adolescence, but not in middle or late adolescence. Results indicate that dimensional models of ELA may offer more nuanced understanding of biological embedding of adversity and its relevance for cardiometabolic risk, with stronger risk associations observed for threat-related experiences in youth.