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Women who experienced sexual or physical abuse in childhood and adolescence-whether moderate or severe-run a higher risk of type 2 diabetes than women who were not abused, according to results from a study recently reported online in the American Journal of Preventive Medicine.
Physical abuse that did not involve sexual molestation increased women's chances of developing type 2 diabetes in adulthood by 26 to 54 percent, depending on the frequency and severity of the abuse. In the case of sexual abuse, even one incident increased the likelihood of acquiring type 2 by 34 percent, while multiple incidences increased the likelihood by 69 percent.
Researchers from Brigham and Women's Hospital/Harvard Medical School and Harvard School of Public Health in Boston analyzed data from 68,376 women who are part of an ongoing nationwide study, "Nurses Health Study II." The study, which began in 1989, initially enrolled 116,430 nurses 25 to 42 years of age. Since that time, the study cohort has been tracked by questionnaires mailed out every two years that ask about risk factors and disease.
One theory about why women who were abused in their youth run a higher risk of type 2 diabetes centers on overeating as a form of consolation and self-medication for traumas brought on by mistreatment. As the women gain weight or eat unhealthy foods, they run an increased risk of obesity and other factors, such as high blood sugar, that can eventually morph into diabetes.
The study found that even when abused women did not have a high body mass index, there remained a 10 to 30 percent increased risk of type 2.
Questionnaire Unveils Pattern
Statistics about the relationship between abuse and the development of type 2 began emerging in 2001, after a questionnaire on violence was added to NHS II's regular follow-ups. Study managers received 68,376 responses, which became the basis for the percentages reported here.
The questionnaire covered three age periods and categorized physical abuse in four ways:
● Childhood-up to age 11
● Adolescence-11 to 17 years
● Adulthood-18 and over
Physical Abuse Levels:
● Mild-being pushed, grabbed or shoved at any frequency; being kicked, bitten, punched or hit with something once
● Moderate-being hit with something or physically attacked more than once
● Severe-being kicked, bitten, punched or physically attacked more than once, or ever choked or burned, even if only once
Spanking was not included in the definition.
Sexual Abuse Levels:
● Unwanted sexual touching only
● Forced sexual activity once
● Forced sexual activity more than once
In all, 65 percent of respondents reported some degree of physical or sexual abuse before adulthood. Even after adjusting for such factors as age, ethnicity, body type at age five,* family history of diabetes, and parents' educational levels, those respondents' still ran a 24 percent greater risk of acquiring type 2 than respondents who reported no abuse.
*There was little difference in body type at age five between the women who reported childhood abuse and those who did not. By age 18, however, their body mass indexes began to diverge, with abused respondents reporting higher body weight.
Lead researcher, Dr. Janet W. Rich-Edwards, director of developmental epidemiology at the Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital, says the that while an association between childhood abuse and adult obesity has long been noted, the study by her and her colleagues is the first large-scale examination of a link between abuse and diabetes.
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