University of Groningen Adverse life events and overweight in childhood, adolescence and young adulthood Elsenburg, Leonie Koosje

Adverse life events and overweight in childhood, adolescence and young adulthood Elsenburg, Leonie Koosje

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Elsenburg, L. K. (2018). Adverse life events and overweight in childhood, adolescence and young adulthood. Rijksuniversiteit Groningen.

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Chapter(3(

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!

The(longitudinal(relation(between(accumulation(of(

adverse(life(events(and(body(mass(index((

from(early(adolescence(to(young(adulthood(

(

(

ABSTRACT

&

Objective(

Stressors,! such! as! adverse! life! events,! can! cause! weight! changes! through! behavioral! and! biological!mechanisms.!Whether!the!accumulation!of!adverse!life!events!is!related!to!body! mass!index!(BMI)!across!multiple!time!points!from!early!adolescence!to!young!adulthood!has! not!been!investigated!to!date.!! ! ! Methods( Data!are!from!2188!children!participating!at!T1!(10"12!years),!T3!(14"18!years)!and/or!T5!(21" 23! years)! of! the! prospective! TRAILS! (TRacking! Adolescents'! Individual! Lives! Survey)! cohort! study.!Adverse!events!before!T1!and!between!T1,!T3!and!T5!were!measured!with!a!parent! interview!at!T1!and!a!semi"structured!interview!(Event!History!Calendar)!with!the!adolescent! at! T3! and! T5.! An! adverse! events! score! was! calculated! per! wave.! BMI! z"scores! were! determined!from!objectively!measured!height!and!weight!using!the!reference!curves!of!the! International!Obesity!Task!Force!for!children!≤18!years.!Data!were!analyzed!using!a!modified! bivariate!autoregressive!cross"lagged!structural!equation!model.!

(

Results(

Adverse! events! before! T1! and! between! T3! and! T5! were! related! to! BMI! at! T5! (β=0.06,! p=0.001! and! β="0.04,! p=0.04,! respectively).! Specifically,! health! events! before! T1! were! associated! with! a! higher! BMI! at! T5! and! events! related! to! relationships! and! victimhood! events!between!T3!and!T5!were!associated!with!a!lower!BMI!at!T5.!!

(

Conclusions(

Adverse!relationship!and!victimhood!events!in!their!recent!past!were!related!to!a!lower!BMI! in!young!adults,!while!adverse!health!events!during!childhood!were!related!to!a!higher!BMI! in! young! adults.! No! relationships! were! found! between! adverse! life! events! with! BMI! in! children!and!adolescents.!

INTRODUCTION(

Over! the! last! 30! years,! there! has! been! an! alarming! global! increase! in! rates! of! childhood! overweight!and!obesity![1].!Children!with!a!higher!body!mass!index!(BMI)!have!an!elevated! risk!of!long"term!morbidity!and!mortality!from!diseases!such!as!coronary!heart!disease!and! type! 2! diabetes! [1–4].! Identifying! determinants! of! childhood! overweight! and! obesity! is! crucial!to!prevent!these!conditions!and!associated!disorders.( Recent!studies!into!possible!determinants!of!childhood!overweight!and!obesity!have! focused!on!the!potentially!crucial!role!of!stressors![5,6].!Stressors!are!suggested!to!influence! weight!via!two!mechanisms![7–9].!In!response!to!stressors,!children!may!change!their!health! behaviors,!e.g.!by!reducing!their!physical!activity!levels,!increasing!their!sedentary!behavior! or!increasing!their!(unhealthy)!food!intake.!Secondly,!stressors!can!cause!biological!changes! in!the!body![10].!Hormones!released!in!response!to!stress!can!influence!fat!deposition!in!the! body!or!influence!health!behaviors!related!to!weight!change![11,12].&Two!recent!reviews!on! the!relationship!between!stress(ors)!and!overweight!concluded!that!although!a!relationship! seems!to!exist,!the!literature!is!inconsistent!and!incomplete![5,6].!An!important!and!rather! easily!identifiable!set!of!stressors!that!might!impact!children’s!weight!status!are!adverse!life! events,!such!as!parental!divorce,!the!illness!or!death!of!a!family!member,!and!the!experience! of! being! bullied.! Studying! the! effect! of! isolated! adverse! events! on! medical! conditions! is,! however,! suggested! to! overestimate! the! effect! of! that! event! due! to! its! potential! interrelatedness!with!other!childhood!adversities![13–15].!Therefore,!it!is!important!to!study! the!effect!of!the!accumulation!of!adverse!childhood!events!on!BMI.!However,!most!studies! on! this! topic! have! been! cross"sectional! in! nature! [16–27].! No! studies! have! yet! examined! whether! accumulation! of! adverse! events! is! related! to! BMI! across! multiple! time! points! between!early!adolescence!and!young!adulthood.!!

Longitudinal! studies! to! date! did! not! focus! specifically! on! the! relation! between! accumulation!of!adverse!events!and!BMI,!but!instead!examined!the!relation!between!BMI! and! cumulative! risk,! a! composite! measure! that! combines! information! on! adverse! events! with!information!on!housing!problems,!behavioral!problems!and/or!living!in!a!single"parent! household.!No!relationship!between!cumulative!risk!and!BMI!was!found!in!children![28,29].! One! previous! longitudinal! study! in! adolescents! did! find! a! positive! relation! between! trajectories!of!cumulative!risk!and!trajectories!of!BMI![15].!Adolescence!is!a!period!marked! by! major! transitions! in! children’s! lives,! socially,! emotionally! as! well! as! physically,! making! adolescence!a!particularly!interesting!period!to!study!factors!associated!with!changes!in!BMI! [30].!In!the!current!study,!the!effect!of!accumulation!of!adverse!events!on!BMI!from!early! adolescence!to!young!adulthood!is!studied.!This!is!the!first!study!to!examine!this!relationship! across! multiple! time! points! in! this! age! group.! The! possible! bidirectionality! of! the! relation!

between! adverse! events! and! BMI! is! taken! into! account! [31].! These! relationships! are! examined!controlling!for!household!socio"economic!status!(SES)![32].!Whether!specific!types! of!events!account!for!the!relationship!between!accumulation!of!adverse!events!and!BMI!is! also!studied.! ! METHODS(

Subjects! were! participants! in! the! TRacking! Adolescents'! Individual! Lives! Survey! (TRAILS)! [33,34].!TRAILS!is!a!prospective!cohort!study!following!Dutch!adolescents,!aged!10"12,!into! young! adulthood.! At! the! start! of! the! study,! children! born! between! either! 1! October! 1989! and!30!September!1990!or!between!1!October!1990!and!30!September!1991!were!identified! in! five! municipalities! in! the! North! of! the! Netherlands! (n=3483).! These! children! were! approached!if!their!primary!school!agreed!to!participate!(n=3145).!Exclusion!criteria!of!the! study!were!no!parental!or!child!consent,!severe!physical!illness!or!mental!retardation!and!no! Dutch,!Turkish"!or!Moroccan"speaking!parent!or!parent!surrogate!available!(n=210).!A!total! of!2230!children!were!included!in!the!study!at!T1!(76.0%!of!eligible!children!in!participating! schools).!Five!waves!of!data!collection!were!conducted,!each!two!to!three!years!apart.!In!the! current!study,!data!from!T1,!T3!and!T5!are!used.!Data!were!collected!from!March!2001!to! July!2002!(T1),!September!2005!to!December!2007!(T3)!and!April!2012!to!November!2013! (T5).!Mean!age!of!the!children!at!these!waves!was!11.1,!16.3!and!22.4!years.! ! Adverse(events(measure( ( Adverse!event!occurrence!from!birth!to!T1!was!measured!using!a!parental!interview!at!T1.! The!occurrence!of!adverse!events!between!T1!and!T3!and!between!T3!and!T5!was!measured! with!a!semi"structured!interview,!the!Event!History!Calendar!(EHC),!with!the!adolescent!at! T3!and!T5![35].!!

Adverse! events! measured! at! T1! were! hospital! admission! of! the! child,! physical! or! mental!illness!of!father!or!mother,!death!of!a!family!member,!friend!or!loved!one,!parental! divorce!and!out"of"home!placement.!At!T3,!additionally!measured!events!were!suspension,! running!away!from!home,!physical!or!mental!illness!of!a!family!member,!friend!or!loved!one,! addiction!of!a!family!member,!friend!or!loved!one,!loss!of!friendships,!fights!with!friends!or! family!members,!breaking!up!with!a!boy"!or!girlfriend,!being!a!victim!of!bullying,!gossiping,! sexual!intimidation!or!violence!and!having!had!contact!with!the!police.!Due!to!the!older!age! of!the!participants!certain!events!were!no!longer!measured!at!T5,!but!several!new!adverse! events! were! added! to! the! interview,! such! as! miscarriage,! abortion,! unemployment,! disappointment!in!a!partner,!family!member,!friend!or!colleague,!financial!setback!and!being! a!victim!of!theft!(see!Table!S1!for!a!complete!list!of!assessed!events).!!

An! adverse! events! score! per! wave! was! calculated! by! summing! up! the! number! of! adverse!events!reported!at!T1,!T3!and!T5,!respectively.!Identical!events!that!occurred!more! than!once!before!T1,!in!between!T1!and!T3!or!in!between!T3!and!T5!were!counted!3!times!at! maximum.!! ! Body(mass(index(

Children’s! weight! and! height! were! measured! using! calibrated! scales! (Seca! 770,! Hamburg,! Germany! at! T1! and! T3,! Seca! 876,! Hamburg,! Germany! and! Besthome! EB813"SL! at! T5)! and! stadiometers/measuring!tapes!(Seca!214,!Hamburg,!Germany!at!T1!and!T3,!Seca!201/222,! Hamburg,!Germany!at!T5).!BMI!was!calculated!by!dividing!weight!by!height!squared!(kg/m2).! BMI!scores!were!standardized.!For!adolescents!≤18!years!of!age,!these!standardized!scores! were!determined!based!on!the!age"!and!gender"specific!skewness,!median!and!coefficient!of! variation!(LMS)!reference!curves!of!the!International!Obesity!Task!Force!(IOTF)!due!to!the! dependency!of!BMI!on!age!and!gender!in!childhood![36].!In!addition,!weight!status!of!the! respondents! was! determined.! For! adolescents,! weight! status! was! divided! into! thinness,! normal!weight,!overweight!and!obesity!using!the!SD!cut"offs!of!the!IOTF!corresponding!to,! respectively,!the!adult!cut"offs!of!<18.5!kg/m2_{,!18.5!–!<25!kg/m}2_{,!25!–!<30!kg/m}2_!and!≥30! kg/m2![36].! Young! adults! were! classified! as!underweight,! normal! weight,! overweight! or!

obese!using!the!adult!cut"offs![37].!

&

Covariates(

Information!on!children’s!age,!gender,!SES!and!ethnicity!was!obtained!from!parents!at!T1.! SES!was!measured!by!taking!the!mean!of!the!standardized!scores!for!maternal!and!paternal! education! (in! five! categories! from! elementary! to! University! education),! maternal! and! paternal! occupation! (using! the! International! Standard! Classification! of! Occupations! (ISCO)! [38])!and!household!income![39].!As!most!of!the!participants!were!Dutch,!ethnic!background! was!measured!by!a!categorical!variable!indicating!whether!both!parents!were!born!in!the! Netherlands!or!not.!!

Pubertal! status! at! T1! was! assessed! by! asking! parents! to! identify! the! stage! of! their! child’s!pubertal!development!using!schematic!drawings!of!the!five!Tanner!stages!of!pubertal! development![40,41].!At!T3,!adolescents!rated!their!own!level!of!physical!development!using! the! Physical! Development! Scale! questionnaire! [42].! Scores! on! this! questionnaire! were! converted!to!Tanner!stages![43].!

&

Statistical(analysis(

A!modified!bivariate!autoregressive!cross"lagged!structural!equation!model!was!estimated! to!test!the!hypothesized!relation!between!adverse!events!and!BMI!(Figure!1).!To!adjust!for! possible! confounding! by! age,! gender,! SES! and! ethnicity,! paths! from! these! variables! to! all! adverse! events! and! BMI! scores! were! added.! Additionally,! BMI! scores! at! T1! and! T3! were! adjusted!for!pubertal!status!at!T1!and!T3.!Paths!were!also!allowed!between!age!at!T1,!T3! and! T5! and! between! age! and! pubertal! status! at! both! T1! and! T3.! Differences! in! the! path! coefficients! of! the! final! model! between! boys! and! girls! were! tested! using! Wald! tests.! Furthermore,!the!model!was!tested!using!three!specific!types!of!accumulated!events.!These! three!types!were:!(I)!health!events,!(II)!relationship!events!and!(III)!victimhood!events!(for! the!division!of!events!into!types!see!Table!S1).!

Three! sensitivity! analyses! were! performed.! In! the! first! two! sensitivity! analyses,! the! cut"off!point!for!the!maximum!number!of!occurrences!of!the!same!event!in!between!waves! was!set!to!5!and!1,!respectively,!instead!of!3.!In!the!third!sensitivity!analysis,!BMI!z"scores! were! replaced! by! BMI! categories! (thinness/underweight,! normal! weight,! overweight! and! obesity).!! All!analyses!were!performed!in!MPlus!(version!7.3).!Models!were!run!using!maximum! likelihood!estimation!with!robust!standard!errors!(MLR).!Model!fit!was!considered!good!if! the!comparative!fit!index!(CFI)!and!the!Tucker!Lewis!Index!(TLI)!were!both!≥0.95!and!the!root! mean!square!error!of!approximation!(RMSEA)!was!≤0.06![44].!The!χ2_{!statistic!was!evaluated,!} but!due!to!the!relatively!large!sample!size!of!this!study,!the!statistical!significance!of!χ2!was! not!used!as!a!definitive!indicator!of!model!fit.!Full!information!maximum!likelihood!(FIML)! was!used!to!handle!missing!data.!As!level!of!significance!p<0.05!was!used.!! ! !!!!!!!!!!!!!!!!!!! ! Figure(1.!Modified!bivariate!autoregressive!cross"lagged!model!of!the!hypothesized!relation!between! adverse!events!and!body!mass!index!(BMI).!! ! RESULTS(

Descriptive! data! of! the! sample! (n=2188! at! T1)! are! presented! in! Table! 1.! The! sample! consisted! of! nearly! as! many! boys! as! girls! (49%! vs.! 51%! at! T1).! On! average,! children! experienced!2.4!adverse!events!before!T1!and!6.0!adverse!events!between!T1!and!T3!and!

between!T3!and!T5.!At!all!waves,!the!majority!of!children!had!normal!weight!(69"78%).!At!T1! and!T3,!approximately!12%!was!overweight!and!3%!was!obese.!At!T5,!these!numbers!were! 21%! and! 7%.! The! percentage! of! thin/underweight! participants! at! the! waves! was! 14%,! 7%! and!3%,!respectively.!

The! model! fit! of! the! initial! model! examining! the! autoregressive! and! cross"lagged! associations!between!adverse!events!with!BMI,!adjusted!for!age,!gender,!SES,!ethnicity!and! pubertal!status,!was!not!good!(RMSEA!=!0.050,!CFI!=!0.947!&!TLI!=!0.899).!To!establish!good! model! fit,! three! paths! were! added! to! this! model:! (I)! adverse! events! score! before! T1! to! adverse!events!score!between!T3!and!T5,!(II)!BMI!at!T1!to!BMI!at!T5!and!(III)!adverse!events! score! before! T1! to! BMI! at! T5! (Figure! 2).! In! addition,! ethnicity! and! pubertal! status! were! removed! from! the! model.! Removal! of! pubertal! status! from! the! model! resulted! in! improvement! of! the! model! fit! above! the! pre"established! criteria! for! good! model! fit.! Exclusion! hardly! changed! the! path! coefficients! of! the! core! model.! Model! fit! of! the! final! model!was!good:!RMSEA!=!0.019,!CFI!=!0.996!&!TLI!=!0.990.!The!χ2!statistic!was!significant! (χ2_{(19)=33.432,!p=0.021),!but!this!is!probably!due!to!sensitivity!of!the!chi"square!test!to!large!} samples.!!

The!bivariate!correlations!between!adverse!events!with!BMI!ranged!from!0.015!(ns)! to! 0.089! (p<0.01)! (see! Table! S2).! We! identified! significant! autoregressive! paths! of! both! adverse!events!and!BMI!from!T1!to!T3!and!T5!and!from!T3!to!T5.!We!identified!a!positive! relation!between!adverse!events!before!T1!and!BMI!at!T5!and!a!negative!relation!between! adverse!events!between!T3!and!T5!and!BMI!at!T5!(Figure!2!and!Table!2,!see!Table!S2!for!the! bivariate! correlation! matrix).! There! were! no! significant! indirect! effects,! except! for! the! indirect!effect!of!adverse!events!between!T1!and!T3!via!adverse!events!between!T3!and!T5! on! BMI! at! T5! (β="0.011,! p=0.041).! Running! the! model! stratified! for! gender! revealed! a! significant!difference!between!the!model!for!boys!and!the!model!for!girls!(p<0.001).!Testing! equality!of!all!path!coefficients!of!the!core!model!separately,!revealed!only!one!significant! difference.!The!autoregressive!path!of!BMI!from!T1!to!T3!was!stronger!for!boys!than!for!girls! (p=0.004),!although!the!difference!was!small!(βboys=0.788,!p<0.001!and!βgirls=0.751,!p<0.001).!!

Models! in! which! the! total! adverse! events! score! was! replaced! by! different! types! of! accumulated! events! showed! that! health! events! before! T1! (β=0.058,! p=0.001)! and! relationship!and!victimhood!events!between!T3!and!T5!were!related!to!BMI!at!wave!5!! (β="0.054,!p=0.003!&!β="0.045,!p=0.009).!Model!results!and!bivariate!correlation!matrices!of! these!models!can!be!found!in!Table!S3"S8.!

Table(1.!Descriptive!statistics!of!the!study!sample!at!the!different!study!waves.( ( T1( T3( T5( na( _{2188! 1633! 1455!} Age((years),(mean((SD)( 11.11!(0.55)! 16.25!(0.67)!! 22.44!(0.60)! Gender( ! ! ! Girls,!%! 51.0! 52.7! 55.0! SES(zPscoreb_{,(mean((SD)( ".05!(0.80)! 0.04!(0.79)! 0.11!(0.76)!} Ethnicity( ! ! ! Dutch,!%! 86.6! 88.4! 89.5! Non"Dutch,!%! 13.4! 11.6! 10.5! Pubertal(status((Tanner(stage),( mean((SD)( 1.87!(0.76)! 2.77!(0.67)! not!measured! Adverse(events(scorec,(mean((SD)( 2.38!(1.82)! 6.02!(3.71)! 5.99!(3.75)! 0!events,!%( 13.8! 2.2! 1.3! 1!event,!%( 21.8! 5.5! 4.9! 2!events,!%( 23.6! 8.1! 9.3! 3!events,!%( 18.0! 12.5! 11.0! ≥4!events,!%( 22.8! 71.6! 73.5! Relationship!events,!mean!(SD)! 0.26!(0.54)! 2.80!(2.43)! 3.21!(2.57)! Health!events,!mean!(SD)! 2.13!(1.71)! 1.71!(1.49)! 1.79!(1.58)! Victimhood!events,!mean!(SD)! not!measured! 1.22!(1.36)! 0.44!(0.71)! BMI(zPscored,(mean((SD)( 0.12!(1.04)! 0.28!(0.95)! 0.00!(0.99)! BMI(categoriese( ! ! ! Thinness/underweight,!%! 13.7! 7.4! 3.4! Normal!weight,!%! 71.7! 78.1! 68.7! Overweight,!%! 12.1! 11.7! 20.8! Obesity,!%! 2.4! 2.9! 7.1!

SES! =! socio"economic! status,! BMI! =! body! mass! index.!a_{Sample! size! per! variable! ranged! between!} 2114"2188,!1494"1633!and!1424"1455!at!T1,!T3!and!T5,!respectively.!b_{SES!z"score!is!the!mean!of!z"} scores!for!maternal!and!paternal!education,!maternal!and!paternal!occupation![38]!and!household! income![39].!c_{Adverse!events!were!measured!differently!at!T1!compared!to!T3!and!T5!and!therefore!} means!and!standard!deviations!of!T1!are!lower.!d_{BMI!z"scores!at!T1!and!T3!were!determined!based!} on!external!reference!curves,!while!BMI!z"scores!at!T5!were!derived!by!standardization!and!therefore! only!the!BMI!z"scores!at!T5!have!mean!‘0’!and!standard!deviation!‘1’.!e_{Differences!in!the!adequacy!of!} the!international!(SD)!cut"offs!of!the!BMI!categories!for!Dutch!children![36]!and!young!adults![37]!can! result!in!different!percentages!of!children!in!the!different!BMI!categories!between!the!waves.! ! ! !

Table(2.(Autoregressive!and!cross"lagged!associations!between!accumulated!adverse!events! and!BMI!from!childhood!to!adolescence!and!young!adulthood!(n=2188a_).((

Relationship( _{Path(coefficient((β)( Standard(error( pPvalue(}

Adverse!events!score!before!T1!to! ! ! ! adverse!events!score!T1"T3! 0.090! 0.025! <0.001( adverse!events!score!T3"T5! 0.079! 0.027! 0.004( BMI!z"score!T1! 0.002! 0.023! 0.932! BMI!z"score!T5! 0.059! 0.017! 0.001( Adverse!events!score!T1"T3!to! ! ! ! adverse!events!score!T3"T5! 0.288! 0.028! <0.001( BMI!z"score!T3! 0.026! 0.018! 0.138! Adverse!events!score!T3"T5!to! ! ! ! BMI!z"score!T5! "0.039! 0.019! 0.042( BMI!z"score!T1!to! ! ! ! BMI!z"score!T3! 0.766! 0.011! <0.001( BMI!z"score!T5! 0.117! 0.028! <0.001( adverse!events!score!T1"T3! 0.036! 0.026! 0.158! BMI!z"score!T3!to! ! ! ! BMI!z"score!T5! 0.676! 0.027! <0.001( adverse!events!score!T3"T5! 0.038! 0.028! 0.176! Age!T1!to! ! ! ! adverse!events!score!before!T1! 0.039! 0.021! 0.067! BMI!z"score!T1! "0.010! 0.021! 0.619! age!T3!! 0.492! 0.020! <0.001! age!T5! 0.356! 0.020! <0.001( Age!T3!to!! ! ! ! adverse!events!score!T1"T3! 0.188! 0.027! <0.001( BMI!z"score!T3! 0.003! 0.017! 0.883! age!T5! 0.483! 0.022! <0.001! Age!T5!to! ! ! ! adverse!events!score!T3"T5! 0.063! 0.026! 0.015( BMI!z"score!T5! 0.040! 0.018! 0.029( SES!to! ! ! ! adverse!events!score!before!T1! "0.128! 0.021! <0.001( adverse!events!score!T1"T3! "0.183! 0.028! <0.001( adverse!events!score!T3"T5! "0.031! 0.027! 0.255! BMI!z"score!T1! "0.122! 0.021! <0.001( BMI!z"score!T3! "0.049! 0.017! 0.003( BMI!z"score!T5! "0.041! 0.017! 0.019( Gender!(girls=0,!boys=1)!to! ! ! ! adverse!events!score!before!T1! 0.037! 0.021! 0.079! adverse!events!score!T1"T3! "0.044! 0.024! 0.068! adverse!events!score!T3"T5! "0.071! 0.024! 0.004( BMI!z"score!T1! "0.060! 0.021! 0.005( BMI!z"score!T3! "0.054! 0.016! 0.001( BMI!z"score!T5! 0.030! 0.017! 0.066! The!table!shows!standardized!path!coefficients,!standard!errors!and!p"values!of!the!final!adjusted! bivariate! autoregressive! cross"lagged! model! (see! Figure! 2).! BMI! =! body! mass! index,! SES! =! socio" economic! status.! Significant! p"values! are! shown! in! bold.!a_{Of! the! 2230! participants,! 42! have! been!} excluded!due!to!missing!data!on!SES.!!

!

!!!!!!!!!!!!!!!!!! !

Figure( 2.! Paths! and! standardized! path! coefficients! of! the! final! adjusted! bivariate! autoregressive!

cross"lagged!model!of!the!relation!between!adverse!events!and!body!mass!index!(BMI)!(n=2188).!The! model!is!adjusted!for!age,!gender!&!socio"economic!status!(SES).!Significant!paths!are!shown!in!bold,! *p<0.05,! **p<0.01,! ***p<0.001.! Model! fit! indices:! RMSEA! (Root! Mean! Square! Error! of! Approximation)!=!0.019,!CFI!(Comparative!Fit!Index)!=!0.996,!TLI!(Tucker!Lewis!Index)!=!0.990.! ! Sensitivity(analyses( Sensitivity!analyses!with!the!cut"off!for!the!maximum!number!of!included!occurrences!of!the! same!event!in!between!waves!set!to!1!and!5!rather!than!3!revealed!no!differences,!except! that!adverse!events!between!T3!and!T5!and!BMI!at!T5!were!no!longer!related!when!the!cut" off! was! set! to! 1! (β="0.027,! p=0.155).! In! this! model,! the! indirect! effect! of! adverse! events! between!T1!and!T3!via!adverse!events!between!T3!and!T5!was!also!non"significant.!Using! BMI! categories! as! the! outcome! instead! of! BMI! z"scores,! revealed! no! differences! in! the! identified!relationships.!In!Table!S9"S11,!we!have!listed!how!many!participants!changed!from! a! specific! BMI! category! at! T1! or! T3! to! another! BMI! category! at! T3! or! T5! and! how! many! participants!were!in!the!same!BMI!category!at!both!waves.!Furthermore,!we!provided!the! mean!number!of!adverse!events!the!participants!in!each!of!these!groups!experienced!and! we!provided!odds!ratios!of!being!in!any!of!these!groups!vs.!being!in!the!normal!weight!group! at!both!waves!after!experiencing!one!more!adverse!event.! ! DISCUSSION( In!the!current!study,!the!effect!of!accumulation!of!adverse!events!on!BMI!across!multiple! time!points!from!early!adolescence!to!young!adulthood!was!studied.!Evidence!was!found!for! a! small! negative! relationship! between! adverse! events! from! 16! to! 22! years! and! BMI! at! 22! years.!Adverse!events!from!11!to!16!years!were!also!negatively!related!to!BMI!at!22!years!via! adverse!events!from!16!to!22!years.!Further,!a!small!positive!relationship!between!adverse! events!before!age!11!and!BMI!at!age!22!was!found.!The!relationship!between!adverse!events! before! age! 11! and! BMI! at! age! 22! could! be! attributed! to! health! events,! while! adverse!

relationship! events! and! victimhood! events! explained! the! relation! between! adverse! events! from!16!to!22!years!and!BMI!at!22!years.!!

!

Comparison(to(previous(research(

No! longitudinal! relationships! between! adverse! events! and! BMI! in! children! were! found! in! previous! studies! [28,29].! Our! findings! corroborated! this,! as! we! observed! no! relationship! between!adverse!events!and!BMI!in!11"year"olds.!We!found!no!relationship!in!adolescents! either,!which!contrasts!with!an!earlier!longitudinal!study!in!adolescents!that!found!a!positive! association! between! cumulative! risk,! i.e.! adverse! events! together! with! housing! problems,! and!BMI!trajectories![15].!!

We! found! effects! of! adverse! events! on! BMI! in! early! young! adults,! though.! Most! remarkably,! we! observed! a! delayed! positive! effect! of! events! before! age! 11! on! BMI! at! 22! years.!This!effect!is!in!accordance!with!results!from!a!study!on!childhood!sexual!abuse!and! obesity!from!childhood!to!young!adulthood![45].!The!rate!of!obesity!between!abused!and! non"abused! females! in! that! study! was! not! significantly! different! until! young! adulthood.! Another!study!found!that!higher!childhood!stress!was!associated!with!a!more!rapid!gain!in! BMI! in! adult! women! [46].! Together,! these! studies! indicate! that! events! or! stressors! in! childhood!can!affect!weight!changes!later!in!life.!This!might!be!due!to!the!fact!that!children! do!not!always!cope!well!with!events!in!early!childhood.!Since!children!have!little!autonomy! over! their! health! behaviors,! such! as! eating! and! physical! activity,! the! expression! could! be! delayed!to!a!life!phase!characterized!by!increased!autonomy!over!these!behaviors,!such!as! young!adulthood![30,47].!If!so,!children!who!experienced!high!adversity!may!benefit!from! learning!about!methods!to!cope!with!adverse!experiences!at!a!relatively!early!age![28,48].!

We! also! found! a! negative! relation! between! adverse! events! and! BMI! in! young! adulthood.!This!result!was!unexpected,!as!a!cross"sectional!study!in!adolescents!and!young! adults!found!a!positive!association![26].!The!difference!in!findings!could!be!explained!by!the! fact!that!the!participants!in!this!previous!study,!who!had!a!family!history!of!cardiovascular! disease!and!a!high!average!BMI,!may!have!been!prone!to!react!to!adversity!by!increasing! their!(unhealthy)!food!intake,!whereas!young!adults!in!general!might!be!more!inclined!to!eat! less.! Accumulation! of! adverse! events! has! previously! been! related! to! both! binge! eating! as! well!as!to!extreme!weight!control!behaviors!in!older!adolescents!and!young!adults![49].!This! suggests! that! accumulation! of! adverse! events! can! indeed! result! in! both! increased! and! decreased! food! intake! and! as! such! in! over"! as! well! as! underweight.! The! idea! that! the! negative!relation!might!be!caused!by!an!overfitted!structural!equation!model!seems!to!be! unfounded!as!a!linear!regression!analysis!with!BMI!at!T5!as!dependent!variable!and!adverse!

events! between! T3! and! T5! as! independent! variable,! adjusted! for! age! at! T5,! gender,! SES,! ethnicity!and!BMI!at!T3,!generates!the!same!result.! The!positive!relationship!between!adverse!events!before!11!years!and!BMI!at!age!22! was!attributable!to!adverse!health!events.!An!earlier!study!found!a!relation!between!adverse! family!health!events!before!11!years!and!overweight!at!age!15,!while!finding!no!relationship! between!adverse!family!relationship!events!and!overweight![18].!Although!the!relation!was! detected! earlier! in! life! than! in! the! current! study,! the! relation! with! the! different! types! of! events! was! the! same.! The! negative! relation! between! adverse! events! between! 16! and! 22! years!and!BMI!at!22!years!in!this!study!was!explained!by!victimhood!and!relationship!events.! Mental! and! physical! abuse! have! previously! been! related! to! overweight! as! well! as! underweight,!dieting,!skipping!meals!and!vomiting!in!adolescents!and!young!adults![50–53].! The!effect!of!relationship!events!contrasts!with!studies!finding!a!positive!relation!between! family! conflict! and! BMI! in! children! and! with! studies! finding! a! higher! likelihood! of! a! meaningful!increase!in!BMI!after!exposure!to!greater!negative!aspects!of!social!relationships! in! adults! [54–56].! However,! studies! on! the! longitudinal! relation! between! adverse! relationship! events! and! BMI! in! early! young! adults! have! not! been! performed! to! our! knowledge.!!

! !

Strengths(and(limitations(

Strengths!of!the!current!research!are!its!longitudinal!design,!the!analytical!procedure,!the! large! sample! size! and! the! assessment! of! exposure! and! outcome.! The! exposure! was! measured!using!a!semi"structured!interview!asking!participants!to!recall!a!large!number!of! adverse! events! since! the! last! interview.! This! approach! allowed! incorporating! a! more! complete!set!of!events!than!included!in!most!questionnaires![57].!In!addition,!the!relatively! short! recall! period! reduced! the! risk! of! recall! bias.! The! objective! assessment! of! BMI! minimized!risk!of!information!bias.!

A!limitation!of!the!current!research!is!that!very!heterogeneous!events!were!assessed.! We! decided! not! to! correct! for! this! heterogeneity! by! applying! weights,! because! the! same! event!can!impact!different!children!very!differently!and!applying!weights!does!not!correct! for!this!heterogeneity.!We!did,!however,!provide!separate!results!for!groups!of!events!that! are!expected!to!have!a!similar!impact.!Another!limitation!of!the!current!research!is!that!the! assessment!of!events!relied!on!self"report!of!past!events!and!this!could!lead!to!under"!as! well!as!over"reporting!of!events.!This!is,!however,!inevitable!in!this!type!of!research!and!we! believe!that!the!method!used!to!measure!events!minimizes!the!risk!of!both!reporting!and! recall!bias.!! !

Mechanisms(and(future(research(

Stressors!are!suggested!to!influence!weight!via!changes!in!health!behaviors!or!via!biological! reactions!in!the!body![7–9].!An!important!question!that!remains!unanswered!in!the!current! research!is!how!accumulation!of!adverse!events!causes!weight!gain!or!weight!loss.!Physical! activity,! sedentary! time,! sweet! food! consumption! and! cortisol! have! been! shown! to! moderate!the!relation!between!stress!and!BMI!in!children![26,28],!but!whether!these!factors! also! serve! as! mediators,! or! whether! other! factors! mediate! this! relation,! has! not! been! investigated.!! ! Conclusion( In!the!current!study,!no!longitudinal!relation!was!found!between!accumulation!of!adverse! events!and!BMI!in!children!and!adolescents,!but!a!relationship!was!found!between!events!in! early!childhood!and!late!adolescence!and!BMI!in!young!adults.!These!findings!suggest!that! weight! changes! in! response! to! adverse! childhood! events! take! place! at! the! end! of! adolescence!or!beginning!of!young!adulthood!rather!than!earlier!in!children’s!lives.!It!further! suggests!that!the!effect!of!adverse!childhood!events!on!physical!health!may!take!some!time! to! develop.! The! exact! implications! of! these! findings! for! the! timing! and! content! of! obesity! prevention!programs!is!an!area!for!further!research.!!

! !

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Supplemental*Material*

Tab le&S 1.& As se ss ed %ad ve rs e% ev en ts %at% th e% di ffe re nt% w av es %d iv id ed %in to %ty pe s% (h eal th ,%r el ati on sh ip %an d% vi cti m ho od ).& Eve nt&c ate gor y& T1 & T3 & T5 & He alth & Ho sp ital izati on %p ar tic ip an t& Ho sp ital izati on %p ar tic ip an t& Ill ne ss %p ar tic ip an t& % Ill ne ss %m oth er % Ill ne ss %m oth er % Ill ne ss %m oth er % % Me ntal %il ln es s% m oth er % Ps yc ho lo gi cal %p ro bl em s% m oth er % % % Ill ne ss %fath er % Ill ne ss %fath er % Ill ne ss %fath er % % Me ntal %il ln es s% fath er % Ps yc ho lo gi cal %p ro bl em s% fath er % % % Ill ne ss %s ib lin g% Ill ne ss %b ro th er % Ill ne ss %b ro th er %% % % Ill ne ss %s is te r% Ill ne ss %s is te r% % Ill ne ss %fr ie nd %% % Ill ne ss %fr ie nd %% % % % Ill ne ss %p ar tn er % % % % Ill ne ss %c hi ld % % % % Ill ne ss %c ol le ag ue % % % Ill ne ss %g ran df ath er % Ill ne ss %g ran df ath er % % % Ill ne ss %g ran dm oth er % Ill ne ss %g ran dm oth er % % % Ill ne ss %u nc le % Ill ne ss %u nc le % % % Ill ne ss %au nt % Ill ne ss %au nt % % % Ill ne ss %m al e% co us in % Ill ne ss %m al e% co us in % % % Ill ne ss %fe m al e% co us in % Ill ne ss %fe m al e% co us in % % % Ill ne ss %s te pf ath er % Ill ne ss %p ar tn er %fath er % % % Ill ne ss %s te pm oth er % Ill ne ss %p ar tn er %m oth er % % % Ill ne ss %s te pb ro th er % Ill ne ss %s te pb ro th er % % % Ill ne ss %s te ps is te r% Ill ne ss %s te ps is te r% % % Ill ne ss %fo ste r%b ro th er % Ill ne ss %fo ste r%b ro th er % % % Ill ne ss %fo ste r%s is te r% Ill ne ss %fo ste r%s is te r% % % Ill ne ss %h al fAb ro th er % Ill ne ss %h al fAb ro th er % % % Ill ne ss %h al fAs is te r% Ill ne ss %h al fAs is te r% % % Ill ne ss %g re at% gr an dm oth er % % % % Ill ne ss %g re at% gr an df ath er % % % % % Ill ne ss %some one %e lse %

Tab le&S 1.& As se ss ed %ad ve rs e% ev en ts %at% th e% di ffe re nt% w av es %d iv id ed %in to %ty pe s% (h eal th ,%r el ati on sh ip %an d% vi cti m ho od ).& Eve nt&c ate gor y& T1 & T3 & T5 & He alth & % Me ntal %p ro bl em s% se lf% % & % Me ntal %p ro bl em s% br oth er % % % % Me ntal %p ro bl em s% si ste r% % % % Me ntal %p ro bl em s% ste pf ath er % % % % Me ntal %p ro bl em s% ste pm oth er % % % % Me ntal %p ro bl em s% ste pb ro th er % % % % Me ntal %p ro bl em s% ste ps is te r% % % % Me ntal %p ro bl em s% hal f;b ro th er % % % % Me ntal %p ro bl em s% hal f;s is te r% % % % Me ntal %p ro bl em s% fo ste r%b ro th er % % % % Me ntal %p ro bl em s% fo ste r%s is te r% % % % Me ntal %p ro bl em s% so m eo ne %e ls e% % % D eath %m oth er % D eath %m oth er % % % D eath %fath er % D eath %fath er % % % D eath %n on ;b io lo gi cal %m oth er % % % % D eath %n on ;b io lo gi cal %fath er % % % % D eath %s ib lin g% D eath %b ro th er % % % % D eath %s is te r% % % D eath %o th er %fam ily %m em be r% % % % D eath %g ran dp ar en t% D eath %g ran df ath er % D eath %g ran df ath er % % % D eath %g ran dm oth er % D eath %g ran dm oth er % % % % D eath %p ar tn er % % % % D eath %c hi ld % % D eath %fr ie nd % % D eath %fr ie nd % % D eath %o th er %lo ve d% one % D eath %o th er %lo ve d% on e% % % % D eath %u nc le % D eath %u nc le % % % D eath %au nt % D eath %au nt % % % D eath %m al e% co us in % D eath %m al e% co us in %

Tab le&S 1.& As se ss ed %ad ve rs e% ev en ts %at% th e% di ffe re nt% w av es %d iv id ed %in to %ty pe s% (h eal th ,%r el ati on sh ip %an d% vi cti m ho od ).& Eve nt&c ate gor y& T1 & T3 & T5 & He alth % % D eath %fe m al e% co us in % D eath %fe m al e% co us in % % % D eath %s te pf ath er % D eath %s te pf ath er % & % D eath %s te pm oth er % D eath %s te pm oth er % % % D eath %s te pb ro th er % D eath %s te pb ro th er % % % D eath %s te ps is te r% D eath %s te ps is te r% % % D eath %fo ste r%b ro th er % D eath %fo ste r%b ro th er % % % D eath %fo ste r%s is te r% D eath %fo ste r%s is te r% % % D eath %h al f<b ro th er % D eath %h al f<b ro th er % % % D eath %h al f<s is te r% D eath %h al f<s is te r% % % D eath %g re at% gr an dm oth er % % % % D eath %g re at% gr an df ath er % % % % D eath %o th er % D eath %o th er % % % Ad di cti on % % % % Ad di cti on %b ro th er % % % % Ad di cti on %s is te r% % % % Ad di cti on %s te pf ath er % % % % Ad di cti on %s te pm oth er % % % % Ad di cti on %s te pb ro th er % % % % Ad di cti on %s te ps is te r% % % % Ad di cti on %h al f<b ro th er % % % % Ad di cti on %h al f<s is te r% % % % Ad di cti on %fo ste r%b ro th er % % % % Ad di cti on %fo ste r%s is te r% % % % Ad di cti on %s om eo ne %e ls e% % % % % Mi sc ar riag e% % % % Ab or tio n% Re la tio ns hi p% D iv or ce %p ar en ts % D iv or ce %p ar en ts % D iv or ce %p ar en ts % & Div or ce %non <b io lo gi cal %p ar en ts % % %

Tab le&S 1.& As se ss ed %ad ve rs e% ev en ts %at% th e% di ffe re nt% w av es %d iv id ed %in to %ty pe s% (h eal th ,%r el ati on sh ip %an d% vi cti m ho od ).& Eve nt&c ate gor y& T1 & T3 & T5 & Re la tio ns hi p% % Br eak ;up % Br eak ;up % % % % D is ap po in te d% in %p ar tn er % % % % D is ap po in te d% in %fath er %% % % % D is ap po in te d% in %m oth er % % % % D is ap po in te d% in%c hild % % % % D is ap po in te d% in%fr ie nd % % % % D is ap po in te d% in %c ol le ag ue % % % % D is ap po in te d% in %b ro th er % % % % D is ap po in te d% in %s is te r% % % % D is ap po in te d% in %g ran dm oth er % % % % D is ap po in te d% in %g ran df ath er % % % % D is ap po in te d% in%unc le % % % % D is ap po in te d% in %au nt % % % % D is ap po in te d% in %m al e% co us in % % % % D is ap po in te d% in %fe m al e% co us in % % % % D is ap po in te d% in %s te pf ath er % % % % D is ap po in te d% in %s te pm oth er % % % % D is ap po in te d% in %s te pb ro th er % % % % D is ap po in te d% in %s te ps is te r% % % % D is ap po in te d% in %fo ste r%b ro th er % % % % D is ap po in te d% in %fo ste r%s is te r% % % % D is ap po in te d% in %h al f;b ro th er % % % % D is ap po in te d% in %h al f;s is te r% % % % D is ap po in te d% in%som eone %e lse % % % Lo ss %o f%a% fr ie nd % Lo ss %o f%a% fr ie nd % % Mo ve d% in %w ith %fam ily %% % % % Mo ve d% in %w ith %fo ste r%f am ily % % % % Mo ve d% in to %a% ch ild re n' s% ho m e% % %

Tab le&S 1.& As se ss ed %ad ve rs e% ev en ts %at% th e% di ffe re nt% w av es %d iv id ed %in to %ty pe s% (h eal th ,%r el ati on sh ip %an d% vi cti m ho od ).& Eve nt&c ate gor y& T1 & T3 & T5 & Re la tio ns hi p& Mo ve d% in to %a% yo uth %fac ili ty % % % % O th er %o ut <of <h om e% pl ac em en t% Out <of <h om e% pl ac em en t% Out <of <h om e% pl ac em en t% % % Ran %aw ay % Ran %aw ay % % % Suspe nde d% % % % Fi gh t%w ith %o r%b etw ee n% fam ily % memb ers % Co nf lic t%w ith %p ar tn er % % % % Co nf lic t%w ith %fath er % % % % Co nf lic t%w ith %m oth er % % % % Co nf lic t%w ith %c hi ld % % % % Conflict %w ith %fr ie nd % % % % Co nf lic t%w ith %c ol le ag ue % % % % Co nf lic t%w ith %b ro th er % % % % Co nf lic t%w ith %s is te r% % % % Co nf lic t%w ith %g ran dm oth er % % % % Co nf lic t%w ith %g ran df ath er % % % % Co nf lic t%w ith %u nc le % % % % Co nf lic t%w ith %au nt % % % % Co nf lic t%w ith %m al e% co us in % % % % Co nf lic t%w ith %fe m al e% co us in % % % % Co nf lic t%w ith %s te pf ath er % % % % Co nf lic t%w ith %s te pm oth er % % % % Co nf lic t%w ith %s te pb ro th er % % % % Conflict %w ith %s te ps is te r% % % % Co nf lic t%w ith %fo ste r%b ro th er % % % % Co nf lic t%w ith %fo ste r%s is te r% % % % Co nf lic t%w ith %h al f<b ro th er % % % % Co nf lic t%w ith %h al f<s is te r% % % % Co nf lic t%w ith %s om eo ne %e ls e%

! ! ! ( Tab le&S 1.& As se ss ed %ad ve rs e% ev en ts %at% th e% di ffe re nt% w av es %d iv id ed %in to %ty pe s% (h eal th ,%r el ati on sh ip %an d% vi cti m ho od ).& Eve nt&c ate gor y& T1 & T3 & T5 & Re la tio ns hi p& % G ot% in %to uc h% w ith %th e% po lic e% G ot% in %to uc h% w ith %th e% po lic e% % % Ti ck et% of fe ns e% Co nv ic tio n% % % Bei ng%p re se nt% at% polic e% co ntac t%o th er s% % Vi ct imh oo d&even ts % % Vi cti m %b ul ly in g% Vi cti m %b ul ly in g% % & Vi cti m %g os si pi ng & & % % Vi cti m %s er io us %p hy si cal %ab us e% Vi cti m %p hy si cal %ab us e% & % Vi cti m %m ild %p hy si cal %ab us e% % % % Vi cti m %s ex ual %in tim id ati on % Vi cti m %s ex ual %ab us e% % % Vi cti m %th ef t% Vi cti m %th ef t% Ot her % % O th er %n eg ati ve %e ve nt % % % % % Fi nan ci al %s etb ac k% & & & Un emp lo ymen t& % % % U ne m pl oy m en t%p ar tn er % % % % U ne m pl oy m en t%f ath er % % % % U ne m pl oy m en t%m oth er % %

( Tab le&S2 .&B iv ar iate (c or re lati on (c oe ff ic ie nts (b etw ee n( ad ve rs e( ev en ts (s co re s,( BMI( z6 scor es ,(ag e, (s ex (an d( SE S. & & Ad ve rs e& even ts && <T 1& Ad ve rs e& even ts & T1 3T3 & Ad ve rs e& even ts & T3 3T5 & zB MI &T 1& zB MI &T 3& zB MI &T 5& Ag e& T1 & Ag e& T3 & Ag e& T5 & Se x a & SES & Ad ve rs e& ev en ts &<T 1& 1. 000 ( ( ( ( ( ( ( ( ( ( ( Ad ve rs e& ev en ts &T 13 T3 & .1 16 ( 1. 000 ( ( ( ( ( ( ( ( ( ( Ad ve rs e& ev en ts &T 33 T5 & .1 16 ( .3 20 ( 1. 000 ( ( ( ( ( ( ( ( ( zB MI &T 1& .0 15 ( .0 64 ( .0 31 ( 1. 000 ( ( ( ( ( ( ( ( zB MI &T 3& .0 30 ( .0 87 ( .0 77 ( .7 76 ( 1. 000 ( ( ( ( ( ( ( zB MI &T 5& .0 84 ( .0 89 ( .0 28 ( .6 43 ( .7 67 ( 1. 000 ( ( ( ( ( ( Ag e& T1 & .0 45 ( .0 59 ( .0 64 ( 6.0 09 ( .0 11 ( .0 54 ( 1. 000 ( ( ( ( ( Ag e& T3 & .0 21 ( .2 01 ( .0 47 ( .0 00 ( .0 11 ( .0 43 ( .4 92 ( 1. 000 ( ( ( ( Ag e& T5 & .0 35 ( .1 51 ( .1 06 ( 6.0 11 ( .0 07 ( .0 46 ( .5 95 ( .6 58 ( 1. 000 ( ( ( Se x a& .0 42 ( 6.0 39 ( 6.0 77 ( 6.0 57 ( 6.0 98 ( 6.0 34 ( .0 37 ( 6.0 10 ( .0 36 ( 1. 000 ( ( SES & 6.1 30 ( 6.2 09 ( 6.1 10 ( 6.1 20 ( 6.1 45 ( 6.1 61 ( 6.0 33 ( 6.0 66 ( 6.0 86 ( 6.0 30 ( 1. 000 ( BMI( =( bo dy (m as s( in de x, (S ES (=( so ci o6 ec on om ic (s tatu s. ( a( G irl s( ar e( co de d( as (‘0 ’,( bo ys (as (‘1 ’. & !

Table(S3.(Autoregressive!and!cross"lagged!associations!between!accumulated!adverse! health!events!and!BMI!from!childhood!to!adolescence!and!young!adulthood!(n=2188a_).(

Relationship( _{Path(coefficient((β)( Standard(error( pPvalue(}

Adverse!health!events!score!before!T1!to! ! ! ! adverse!health!events!score!T1"T3! 0.079! 0.026! 0.002( adverse!health!events!score!T3"T5! 0.044! 0.028! 0.113! BMI!z"score!T1! 0.009! 0.023! 0.678! BMI!z"score!T5! 0.058! 0.017! 0.001( Adverse!health!events!score!T1"T3!to! ! ! ! adverse!health!events!score!T3"T5! 0.077! 0.032! 0.018( BMI!z"score!T3! 0.006! 0.018! 0.738! Adverse!health!events!score!T3"T5!to! ! ! ! BMI!z"score!T5! 0.009! 0.017! 0.587! BMI!z"score!T1!to! ! ! ! BMI!z"score!T3! 0.766! 0.011! <0.001( BMI!z"score!T5! 0.120! 0.028! <0.001( adverse!health!events!score!T1"T3! 0.044! 0.028! 0.116! BMI!z"score!T3!to! ! ! ! BMI!z"score!T5! 0.671! 0.027! <0.001( adverse!health!events!score!T3"T5! 0.031! 0.029! 0.284! Age!T1!to! ! ! ! adverse!health!events!score!before!T1! 0.022! 0.021! 0.304! BMI!z"score!T1! "0.010! 0.021! 0.615! age!T3!! 0.492! 0.020! <0.001! age!T5! 0.356! 0.020! <0.001( Age!T3!to!! ! ! ! adverse!health!events!score!T1"T3! 0.029! 0.026! 0.272! BMI!z"score!T3! 0.007! 0.017! 0.666! age!T5! 0.483! 0.022! <0.001! Age!T5!to! ! ! ! adverse!health!events!score!T3"T5! 0.031! 0.025! 0.224! BMI!z"score!T5! 0.038! 0.018! 0.040( SES!to! ! ! ! adverse!health!events!score!before!T1! "0.059! 0.021! 0.005( adverse!health!events!score!T1"T3! "0.090! 0.027! 0.001( adverse!health!events!score!T3"T5! "0.027! 0.028! 0.331! BMI!z"score!T1! "0.122! 0.021! <0.001( BMI!z"score!T3! "0.053! 0.016! 0.001( BMI!z"score!T5! "0.040! 0.017! 0.021( Gender!(girls=0,!boys=1)!to! ! ! ! adverse!health!events!score!before!T1! 0.046! 0.021! 0.031( adverse!health!events!score!T1"T3! "0.084! 0.025! 0.001( adverse!health!events!score!T3"T5! "0.069! 0.026! 0.008( BMI!z"score!T1! "0.060! 0.021! 0.005( BMI!z"score!T3! "0.054! 0.016! 0.001( BMI!z"score!T5! 0.032! 0.017! 0.051!

The! table! shows! standardized! path! coefficients,! standard! errors! and! p"values.! BMI! =! body! mass! index,! SES! =! socio"economic! status.! Significant! p"values! are! shown! in! bold.! a_{Of! the! 2230!} participants,!42!have!been!excluded!due!to!missing!data!on!SES.!

Tab le&S4.& Bi var iate (c or re lati on (c oe ffi ci en ts (b etw ee n( ad ve rs e( he al th (e ve nts (s co re s, (B MI( z7 scor es ,(ag e, (s ex (an d( SE S. ( & Ad ve rs e& he alth& even ts && <T 1& Ad ve rs e& he alth & even ts & T1 4T3 & Ad ve rs e& he alth& even ts & T3 4T5 & zB MI &T 1& zB MI &T 3& zB MI &T 5& Ag e& T1 & Ag e& T3 & Ag e& T5 & Se x a & SES & Ad ve rs e& he alth& ev en ts &<T 1& 1. 000 ( ( ( ( ( ( ( ( ( ( ( Ad ve rs e& he alth& even ts &T1 4T3 & .0 80 ( 1. 000 ( ( ( ( ( ( ( ( ( ( Ad ve rs e& he alth& even ts &T3 4T5 & .0 48 ( .0 92 ( 1. 000 ( ( ( ( ( ( ( ( ( zB MI &T 1& .0 13 ( .0 60 ( .0 39 ( 1. 000 ( ( ( ( ( ( ( ( zB MI &T 3& .0 32 ( .0 62 ( .0 47 ( .7 76 ( 1. 000 ( ( ( ( ( ( ( zB MI &T 5& .0 84 ( .0 95 ( .0 49 ( .6 43 ( .7 67 ( 1. 000 ( ( ( ( ( ( Ag e& T1 & .0 26 ( 7.0 25 ( .0 18 ( 7.0 09 ( .0 11 ( .0 54 ( 1. 000 ( ( ( ( ( Ag e& T3 & 7.0 15 ( .0 34 ( 7.0 25 ( .0 00 ( .0 10 ( .0 43 ( .4 92 ( 1. 000 ( ( ( ( Ag e& T5 & .0 00 ( .0 18 ( .0 31 ( 7.0 10 ( .0 08 ( .0 47 ( .5 95 ( .6 57 ( 1. 000 ( ( ( Se x a& .0 48 ( 7.0 80 ( 7.0 74 ( 7.0 57 ( 7.0 97 ( 7.0 36 ( .0 37 ( 7.0 10 ( .0 36 ( 1. 000 ( ( SES & 7.0 62 ( 7.0 98 ( 7.0 43 ( 7.1 20 ( 7.1 45 ( 7.1 60 ( 7.0 33 ( 7.0 66 ( 7.0 85 ( 7.0 30 ( 1. 000 ( BMI( =( bo dy (m as s( in de x, (S ES (=( so ci o7 ec on om ic (s tatu s. ( a G irl s( ar e( co de d( as (‘0 ’,( bo ys (as (‘1 ’. ( !

Table(S5.(Autoregressive!and!cross"lagged!associations!between!accumulated!adverse! relationship!events!and!BMI!from!childhood!to!adolescence!and!young!adulthood!(n=2188a_).(

Relationship( _{Path(coefficient((β)( Standard(error( pPvalue(}

Adverse!relationship!events!score!before!T1!to! ! ! ! adverse!relationship!events!score!T1"T3! 0.074! 0.030! 0.015( adverse!relationship!events!score!T3"T5! 0.069! 0.031! 0.027( BMI!z"score!T1! "0.025! 0.021! 0.232! BMI!z"score!T5! "0.009! 0.021! 0.647! Adverse!relationship!events!score!T1"T3!to! ! ! ! adverse!relationship!events!score!T3"T5! 0.202! 0.028! <0.001( BMI!z"score!T3! 0.013! 0.018! 0.457! Adverse!relationship!events!score!T3"T5!to! ! ! ! BMI!z"score!T5! "0.054! 0.018! 0.003( BMI!z"score!T1!to! ! ! ! BMI!z"score!T3! 0.766! 0.011! <0.001( BMI!z"score!T5! 0.114! 0.028! <0.001( adverse!relationship!events!score!T1"T3! 0.033! 0.027! 0.221! BMI!z"score!T3!to! ! ! ! BMI!z"score!T5! 0.678! 0.027! <0.001( adverse!relationship!events!score!T3"T5! 0.022! 0.029! 0.438! Age!T1!to! ! ! ! adverse!relationship!events!score!before!T1! 0.062! 0.021! 0.004( BMI!z"score!T1! "0.009! 0.021! 0.670! age!T3!! 0.492! 0.020! <0.001! age!T5! 0.356! 0.020! <0.001( Age!T3!to!! ! ! ! adverse!relationship!events!score!T1"T3! 0.188! 0.027! <0.001( BMI!z"score!T3! 0.005! 0.017! 0.780! age!T5! 0.483! 0.022! <0.001! Age!T5!to! ! ! ! adverse!relationship!events!score!T3"T5! 0.052! 0.027! 0.056! BMI!z"score!T5! 0.043! 0.019! 0.021( SES!to! ! ! ! adverse!relationship!events!score!before!T1! "0.243! 0.020! <0.001( adverse!relationship!events!score!T1"T3! "0.133! 0.028! <0.001( adverse!relationship!events!score!T3"T5! "0.019! 0.028! 0.487! BMI!z"score!T1! "0.129! 0.022! <0.001( BMI!z"score!T3! "0.051! 0.016! 0.002( BMI!z"score!T5! "0.049! 0.018! 0.006( Gender!(girls=0,!boys=1)!to! ! ! ! adverse!relationship!events!score!before!T1! "0.021! 0.020! 0.309! adverse!relationship!events!score!T1"T3! 0.027! 0.025! 0.276! adverse!relationship!events!score!T3"T5! "0.049! 0.025! 0.053! BMI!z"score!T1! "0.061! 0.021! 0.004( BMI!z"score!T3! "0.056! 0.016! <0.001( BMI!z"score!T5! 0.033! 0.017! 0.052!

The! table! shows! standardized! path! coefficients,! standard! errors! and! p"values.! BMI! =! body! mass! index,! SES! =! socio"economic! status.! Significant! p"values! are! shown! in! bold.! a_{Of! the! 2230!} participants,!42!have!been!excluded!due!to!missing!data!on!SES.!

Tab le&S6 .&B iv ar iate (c or re lati on (c oe ffi ci en ts (b etw ee n( ad ve rs e( re lati on sh ip (e ve nts (s co re s, (B MI( z8 scor es ,(ag e, (se x( an d( SE S. &( & Ad ve rs e& rel at io ns hi p& even ts && <T 1& Ad ve rs e& rel at io ns hi p& even ts && T1 7T3 & Ad ve rs e& rel at io ns hi p& even ts && T3 7T5 & zB MI & T1 & zB MI & T3 & zB MI & T5 & Ag e& T1 & Ag e& T3 & Ag e& T5 & Se x a & SES & Ad ve rs e& rel at io ns hi p& ev en ts &<T 1& 1. 000 ( ( ( ( ( ( ( ( ( ( ( Ad ve rs e& rel at io ns hi p& even ts &T1 7T3 & .1 30 ( 1. 000 ( ( ( ( ( ( ( ( ( ( Ad ve rs e& rel at io ns hi p& even ts &T3 7T5 & .1 08 ( .2 23 ( 1. 000 ( ( ( ( ( ( ( ( ( zB MI &T 1& .0 07 ( .0 49 ( 8.0 09 ( 1. 000 ( ( ( ( ( ( ( ( zB MI &T 3& 8.0 01 ( .0 58 ( .0 42 ( .7 77 ( 1. 000 ( ( ( ( ( ( ( zB MI &T 5& .0 04 ( .0 43 ( 8.0 23 ( .6 44 ( .7 68 ( 1. 000 ( ( ( ( ( ( Ag e& T1 & .0 69 ( .0 65 ( .0 57 ( 8.0 09 ( .0 10 ( .0 54 ( 1. 000 ( ( ( ( ( Ag e& T3 & .1 25 ( .2 05 ( .0 46 ( .0 00 ( .0 10 ( .0 41 ( .4 93 ( 1. 000 ( ( ( ( Ag e& T5 & .1 25 ( .1 55 ( .0 89 ( 8.0 12 ( .0 06 ( .0 44 ( .5 95 ( .6 58 ( 1. 000 ( ( ( Se x a& 8.0 11 ( .0 27 ( 8.0 41 ( 8.0 57 ( 8.0 99 ( 8.0 35 ( .0 37 ( 8.0 10 ( .0 38 ( 1. 000 ( ( SES & 8.2 44 ( 8.1 68 ( 8.0 77 ( 8.1 20 ( 8.1 45 ( 8.1 60 ( 8.0 33 ( 8.0 65 ( 8.0 88 ( 8.0 30 ( 1. 000 ( BMI( =( bo dy (m as s( in de x, (S ES (=( so ci o8 ec on om ic (s tatu s. ( a G irl s( ar e( co de d( as (‘0 ’,( bo ys (as (‘1 ’. ( !

Table(S7.(Autoregressive!and!cross"lagged!associations!between!accumulated!adverse! victimhood!events!and!BMI!from!childhood!to!adolescence!and!young!adulthood!(n=2188a_).(

Relationship( _{Path(coefficient((β)( Standard(error( pPvalue(}

Adverse!events!score!before!T1b_!to! ! ! ! victimhood!events!score!T1"T3! 0.057! 0.027! 0.032( victimhood!events!score!T3"T5! 0.062! 0.028! 0.026( BMI!z"score!T1! 0.002! 0.023! 0.933! BMI!z"score!T5! 0.058! 0.017! 0.001( Victimhood!events!score!T1"T3!to! ! ! ! victimhood!events!score!T3"T5! 0.159! 0.034! <0.001( BMI!z"score!T3! 0.032! 0.017! 0.067! Victimhood!events!score!T3"T5!to! ! ! ! BMI!z"score!T5! "0.045! 0.018! 0.009( BMI!z"score!T1!to! ! ! ! BMI!z"score!T3! 0.767! 0.011! <0.001( BMI!z"score!T5! 0.119! 0.028! <0.001( victimhood!events!score!T1"T3! "0.013! 0.027! 0.633! BMI!z"score!T3!to! ! ! ! BMI!z"score!T5! 0.673! 0.026! <0.001( victimhood!events!score!T3"T5! 0.022! 0.026! 0.403! Age!T1!to! ! ! ! adverse!events!score!before!T1b! _{0.039! 0.021! 0.067!} BMI!z"score!T1! "0.010! 0.021! 0.623! age!T3!! 0.492! 0.020! <0.001! age!T5! 0.356! 0.020! <0.001( Age!T3!to!! ! ! ! victimhood!events!score!T1"T3! 0.117! 0.027! <0.001( BMI!z"score!T3! 0.003! 0.017! 0.838! age!T5! 0.483! 0.022! <0.001! Age!T5!to! ! ! ! victimhood!events!score!T3"T5! 0.023! 0.026! 0.369! BMI!z"score!T5! 0.039! 0.018! 0.035( SES!to! ! ! ! adverse!events!score!before!T1b! _{"0.128! 0.021! <0.001(} victimhood!events!score!T1"T3! "0.157! 0.027! <0.001( victimhood!events!score!T3"T5! 0.055! 0.029! 0.056! BMI!z"score!T1! "0.122! 0.021! <0.001( BMI!z"score!T3! "0.049! 0.016! 0.003( BMI!z"score!T5! "0.036! 0.017! 0.035( Gender!(girls=0,!boys=1)!to! ! ! ! adverse!events!score!before!T1b! _{0.037! 0.021! 0.079!} victimhood!events!score!T1"T3! "0.044! 0.024! 0.073! victimhood!events!score!T3"T5! "0.035! 0.026! 0.169! BMI!z"score!T1! "0.060! 0.021! 0.005( BMI!z"score!T3! "0.053! 0.016! 0.001( BMI!z"score!T5! 0.031! 0.017! 0.061!

The! table! shows! standardized! path! coefficients,! standard! errors! and! p"values.! BMI! =! body! mass! index,! SES! =! socio"economic! status.! Significant! p"values! are! shown! in! bold.! a_{Of! the! 2230!} participants,! 42! have! been! excluded! due! to! missing! data! on! SES.!b_{No! victimhood! events! were!} measured!at!T1,!therefore!the!total!adverse!events!score!before!T1!is!used!in!this!model.!

Tab le&S8.& Bi var iate (c or re lati on (c oe ffi ci en ts (b etw ee n( vi cti m ho od (e ve nts (s co re s, (B MI( z8 scor es ,(ag e, (s ex (an d( SE S. &( & Ad ve rs e& even ts && <T 1 a & Vi ct imh oo d& even ts && T1 9T3 & Vi ct imh oo d& even ts && T3 9T5 & zB MI & T1 & zB MI & T3 & zB MI & T5 & Ag e& T1 & Ag e& T3 & Ag e& T5 & Se x b & SES & Ad ve rs e& ev en ts &<T 1 a& 1. 000 ( ( ( ( ( ( ( ( ( ( ( Vi ct imh oo d& even ts &T1 9T3 & .0 78 ( 1. 000 ( ( ( ( ( ( ( ( ( ( Vi ct imh oo d& even ts &T3 9T5 & .0 67 ( .1 58 ( 1. 000 ( ( ( ( ( ( ( ( ( zB MI &T 1& .0 15 ( .0 09 ( .0 07 ( 1. 000 ( ( ( ( ( ( ( ( zB MI &T 3& .0 30 ( .0 49 ( .0 27 ( .7 76 ( 1. 000 ( ( ( ( ( ( ( zB MI &T 5& .0 84 ( .0 51 ( 8.0 23 ( .6 43 ( .7 67 ( 1. 000 ( ( ( ( ( ( Ag e& T1 & .0 45 ( .0 57 ( .0 21 ( 8.0 09 ( .0 11 ( .0 54 ( 1. 000 ( ( ( ( ( Ag e& T3 & .0 21 ( .1 29 ( .0 22 ( .0 00 ( .0 10 ( .0 44 ( .4 92 ( 1. 000 ( ( ( ( Ag e& T5 & .0 35 ( .0 94 ( .0 34 ( 8.0 10 ( .0 07 ( .0 47 ( .5 94 ( .6 58 ( 1. 000 ( ( ( Se x b& .0 42 ( 8.0 37 ( 8.0 41 ( 8.0 57 ( 8.0 97 ( 8.0 34 ( .0 37 ( 8.0 10 ( .0 36 ( 1. 000 ( ( SES & 8.1 30 ( 8.1 69 ( .0 16 ( 8.1 20 ( 8.1 45 ( 8.1 61 ( 8.0 33 ( 8.0 66 ( 8.0 85 ( 8.0 30 ( 1. 000 ( BMI( =( bo dy (m as s( in de x, (S ES (=( so ci o8 ec on om ic (s tatu s. ( a N o( vi cti m ho od (e ve nts (w er e( m eas ur ed (at( T1 ,(th er ef or e( th e( to tal (ad ve rs e( ev en ts (s co re ( be for e( T1 (is (u se d( in (th is (m od el .( b Gi rls (ar e( co de d( as (‘0 ’,( bo ys (as (‘1 ’.(

Table(S9.(Number!of!(A)!participants,!(B)!girls!and!(C)!boys!in!the!different!weight!categories! at! T1! and! T3,! the! mean! number! of! adverse! events! children! in! these! groups! experienced! between! T1! and! T3! and! odds! ratios! for! being! in! this! group! in! comparison! to! being! in! the! group!with!normal!weight!at!both!waves!after!experiencing!one!more!adverse!event.!!

! !

A.(All!participants( ( T3(

( ( ! _Underweight( Normal(

weight( Overweight/(obesity(

T1( Underweight! ! N! 71! 141! 1! Adverse!events!T1"T3! Odds!ratio! 0.975!5.63! 1.0086.02!a! _1.00811.00!a! Normal( weight( N! 42! 1004! 101! Adverse!events!T1"T3! Odds!ratio! 0.957!5.89! 5.96!ref! 1.000!6.40! Overweight/( obesity( N! 0! 76! 119! Adverse!events!T1"T3! Odds!ratio! "!"! 0.961!5.72! 1.021!6.67! ( B.(Girls( ( ! T3( ( ( ! _Underweight( Normal(

weight( Overweight/(obesity(

T1( Underweight! N! 30! 78! 1! Adverse!events!T1"T3! Odds!ratio! 6.08! 0.978! 6.19! 1.003a! _1.00311.00!a! Normal( weight( N! 19! 517! 58! Adverse!events!T1"T3! Odds!ratio! 0.988!6.56! 6.10!ref! 0.985!6.30! Overweight/( obesity( N! 0! 45! 67! Adverse!events!T1"T3! Odds!ratio! "! "! 5.84! 0.973! 7.13! 1.035! ( C.(Boys( ( ! T3( ( ( ! _Underweight( Normal(

weight( Overweight/(obesity(

T1( Underweight! N! 41! 63! 0! Adverse!events!T1"T3! Odds!ratio! 0.967!5.27! 1.014!5.78! "!"! Normal( weight( N! 23! 487! 43! Adverse!events!T1"T3! Odds!ratio! 5.18! 0.894! 5.79! ref! 6.54! 1.030! Overweight/( obesity( N! 0! 31! 52! Adverse!events!T1"T3! Odds!ratio! "!"! 0.937!5.54! 0.989!6.00! Sample!size!for!the!multinomial!logistic!regression!=!1398!(ngirls=764,!nboys=634).!Models!are!adjusted! for!age!at!T3,!age!at!T5,!socio"economic!status!and!sex.!a_{Due!to!the!small!number!of!participants!in!} one! of! the! groups,! this! group! is! combined! with! the! adjacent! group! for! the! multinomial! logistic! regression.!Therefore,!odds!ratios!for!both!groups!are!the!same.!*!p<0.05,!**!p<0.01,!***!p<0.001,! ref!=!reference!category.!