Physical and sexual abuse interacted on an additive scale but not on a multiplicative scale, indicating that the absolute risk of diabetes was greater among women who had experienced both forms of abuse than would be expected from the risk of sexual or physical abuse alone, according to Dr. Rich-Edwards and her coauthors.
At age 5 years, little difference was found between the somatotypes of girls who did and did not report later abuse. By the age of 18 years, however, the BMI trajectories of abused girls had begun to diverge. By ages 25-42 years, a marked trend was found of increasing BMI with more severe abuse history.
Adjustment for adult smoking, alcohol use, and BMI weakened, but did not eliminate the dose-response associations of child and teen abuse with risk of adult diabetes. The attenuation was attributable almost entirely to adjustment for adult BMI, which accounted for 60% and 64% of the associations of physical and sexual abuse respectively with diabetes.
Despite adjustment, moderate physical abuse, severe physical abuse, and repeated forced sex remained independently associated with significantly increased risks of diabetes of 12%, 21%, and 28%, respectively.
Moderate and severe physical abuse were associated with 26%-54% higher risks of diabetes in maturity. Unwanted sexual touching was associated with 16% higher risk of diabetes, and forced sexual activity before adulthood carried a 34% greater risk when it occurred once and a 69% greater risk when it occurred more frequently. Child and teen abuse predicted later diabetes even among women who reported no adult physical or sexual abuse.
"The high prevalence of child abuse suggests that it is an important, if overlooked, contributor to type 2 diabetes ... A more precise description of the physiologic and psychological mechanisms through which abuse leads to overweight and obesity would help to focus prevention efforts. Weight-control interventions designed specifically for survivors of abuse may help to reduce the risk of diabetes," the investigators concluded.
Dr. Phillips agreed. "If an individual [with a history of abuse] is heavy or is gaining weight or is physically inactive, we need to try to intervene – recognizing that those kinds of changes in these individuals will predispose them to the development of diabetes more than perhaps the general population."
The authors reported no financial disclosures.