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@ARTICLE{KlingerKnig:281830,
      author       = {Klinger-König, Johanna and Streit, Fabian and Völker,
                      Maja P and Frank, Josef and Sekula, Peggy and Jaskulski,
                      Stefanie and Leitzmann, Michael and Meinke-Franze, Claudia
                      and Schmidt, Carsten O and Keil, Thomas and Willich, Stefan
                      N and Pischon, Tobias and Velásquez, Ilais M and Frost,
                      Jonas and Schmidt, Börge and Heise, Jana-Kristin and
                      Klett-Tammen, Carolina J and Koch-Gallenkamp, Lena and Obi,
                      Nadia and Harth, Volker and Mons, Ute and Berger, Klaus and
                      Greiser, Karin H and Mikolajczyk, Rafael and Schulze,
                      Matthias B and Grabe, Hans J},
      title        = {{C}hildhood maltreatment and adult diseases in the general
                      population: the mediating role of smoking and overweight in
                      a time-sequence design.},
      journal      = {BMC public health},
      volume       = {25},
      number       = {1},
      issn         = {1471-2458},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DZNE-2025-01211},
      pages        = {3613},
      year         = {2025},
      abstract     = {Childhood maltreatment is associated with an unhealthier
                      lifestyle in adulthood and an increased risk of mental and
                      somatic health problems, although the underlying pathways
                      remain unclear. This study examined whether smoking and
                      overweight mediate the association between childhood
                      abuse/neglect and frequent adult diseases, including cancer,
                      myocardial infarction, stroke, type 2 diabetes, chronic
                      obstructive pulmonary disease, depression, and
                      anxiety.Childhood maltreatment was assessed in 152,887
                      German National Cohort (NAKO) participants using the
                      Childhood Trauma Screener. Information on smoking initiation
                      age, weight history, and respective age at diagnosis was
                      incorporated to ensure that smoking and overweight preceded
                      the diagnosis. Mediation analyses were adjusted for age,
                      sex, study center, and education.For childhood abuse, larger
                      proportions of associations with adult somatic diseases were
                      mediated through preexisting smoking and overweight compared
                      to adult mental disorders. Smoking most strongly mediated
                      myocardial infarction $(36.88\%$ $[95\%$ confidence interval
                      (CI): $17.88\%;$ $55.89\%]),$ with more pronounced effects
                      in men $(48.62\%$ $[14.28\%;$ $82.97\%])$ than in women
                      $(20.82\%$ $[2.75\%;$ $38.89\%]).$ For overweight, a
                      substantial mediation was only found for type 2 diabetes
                      $(13.69\%$ $[9.85\%;$ $17.52\%]),$ with stronger effects in
                      women $(16.16\%$ $[8.92\%;$ $23.39\%])$ compared to men
                      $(8.43\%$ $[4.52\%;$ $12.35\%]).$ Comparable results were
                      found for childhood neglect.To smoke or be overweight before
                      the first diagnosis of myocardial infarction and type 2
                      diabetes mediated the association between childhood
                      abuse/neglect and these somatic diseases. However, while the
                      mediation through smoking and overweight contributed to the
                      disease risk linked to childhood maltreatment, strong direct
                      effects of childhood abuse/neglect persisted for both mental
                      and somatic health problems. These findings underscore the
                      need for further longitudinal studies to better understand
                      the pathways.The online version contains supplementary
                      material available at 10.1186/s12889-025-24854-y.},
      keywords     = {Age of onset (Other) / Childhood abuse (Other) / Childhood
                      neglect (Other) / Chronic non-communicable diseases (Other)
                      / Mental health (Other)},
      cin          = {AG Grabe},
      ddc          = {610},
      cid          = {I:(DE-2719)5000001},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41146110},
      pmc          = {pmc:PMC12560492},
      doi          = {10.1186/s12889-025-24854-y},
      url          = {https://pub.dzne.de/record/281830},
}