Editor's brief: In modern society, adolescents face more stress than their parents, accompanied by a spike in the incidence of certain physical and mental diseases, and worse, the effects of stress can last for life. Recently, a study published in the Journal of the American Heart Association found that young people with higher stress during their teenage years were more likely to have cardiometabolic diseases such as high blood pressure, obesity, and diabetes than their less stressed peers.
Stress is an important risk factor for cardiovascular disease
Cardiometabolic diseases, including cardiovascular diseases and diabetes, are one of the most common chronic diseases and the leading cause of death in middle-aged and elderly people. Although the disease appears in mid-to-late adulthood, studies have found that the pathological process can begin in adolescence and can persist for decades before clinical symptoms appear. Therefore, screening for risk factors and early intervention in adolescence can effectively prevent cardiometabolic diseases in adulthood.
Studies over the past few decades have found that stress is one of the important risk factors for cardiometabolic diseases. For example, one meta-analysis showed that in older adults, high stress levels were associated with an increased risk of coronary events. In young adults and adolescents with a low incidence of cardiovascular disease, preclinical markers such as blood pressure, body mass index (BMI), body composition, carotid intima-media thickness (CIMT), and glycosylated hemoglobin (HbA1c) are used to assess the risk of cardiometabolic disease. The study found that the higher the stress, the higher the values of these preclinical markers.
While much research has been done on stress and cardiometabolic disease, little is known about stress experienced in childhood and adolescence and its effects. To fill this gap, the researchers monitored stress levels from childhood to adulthood and analyzed the association between stress and seven cardiometabolic risk markers to assess the cardiovascular impact of stress in childhood.
The greater the stress in childhood, the higher the cardiometabolic risk
In this study, researchers analyzed health information from 276 children who participated in the Southern California Child Health Study (2003~2014). Stress assessments were performed in childhood (mean age about 6 years), adolescence (mean age 13 years), and adult years (mean age 24 years). The stress assessment uses a question-and-answer approach, conducted through a stress scale, and focuses primarily on feelings and thoughts from the previous month. Following the stress scale results, participants were divided into four groups: high stress that persisted over time, decreased stress over time, increased stress over time, and low stress that persisted over time. The investigators used 7 cardiometabolic risk markers to assess the cardiometabolic risk of the participants, namely: carotid intima-thickness, systolic blood pressure, diastolic blood pressure, body weight, body fat percentage, fat distribution, and glycosylated hemoglobin.
After an average follow-up of 18 years, the study found that:
Compared with the persistent low stress group, higher stress scale scores in adulthood were associated with higher levels of global cardiometabolic risk (β=0.12), carotid intima-media thickness (β=0.01), systolic blood pressure (β=1.27), and diastolic blood pressure (β=0.94).
Individuals with persistently high stress from adolescence to adulthood had a higher cardiometabolic risk (β=0.31), male/female ratio (β=0.07), body fat percentage (β=2.59), and adult obesity (OR: 5.57) compared with the persistent low stress group.
Overall, the study confirms that high stress in adulthood and persistent high stress through adolescence can lead to higher cardiometabolic risk. The difference is that high stress in adults may have an effect on carotid intimal thickness and blood pressure, while increased stress in adolescents may lead to a higher risk of obesity.
Managing cardiometabolic disease, starting with childhood
The study, the first to assess the relationship between stress levels in adolescence and cardiometabolic risk in adulthood, found that individuals with consistently higher perceived stress from adolescence to adulthood had a higher cardiometabolic risk and a soaring risk of obesity in adulthood.
The effects of stress in adolescence on cardiometabolism may be conspired through a combination of the following mechanisms:
First of all, children or adolescents who are more stressed are more likely to engage in a variety of behaviors that harm their health to relieve stress, such as eating a high calorie and high-fat diet, sitting for long periods of time and playing games, etc. These behaviors can increase cardiometabolic risk factors such as obesity and hypertension, and ultimately endanger heart health.
Secondly, it may be related to inflammation. Persistent chronic stress may lead to the release of stress hormones such as catecholamines and corticosteroids in adolescents, further depleting the vascular endothelium and inducing the development of atherosclerosis.
In addition, puberty is a critical period for the development and maturation of hormone signaling pathways. During this time, abnormal changes in stress hormone signaling, the hypothalamic-pituitary-adrenal axis, and cortisol may have long-lasting effects on cardiometabolic health in adolescents.
In conclusion, the mechanism of the effect of stress on cardiometabolism in adolescents is still being explored, but studies have found that obesity plays an important role in it. Therefore, people need to pay attention to their children's stress and help with stress management, which may help reduce the risk of cardiometabolic diseases in adulthood.
How can I help my child manage stress?
How to help children manage stress? Parents can support their children from seven aspects: nutrition, exercise, sleep, and social support.
01
Strengthen support
In addition to strengthening support within the family, such as making art, dancing, cooking, or reading together, children need to be encouraged to stay connected with their friends and participate in social activities.
02
Exercise regularly
It is recommended to do 30~60 minutes of exercise every day, including walking, running, yoga, push-ups, skipping rope, etc. These activities not only exercise your heart and lungs, but also relieve stress.
03
Get enough sleep
Getting enough and quality sleep can help relieve stress. Sleep regularity is also important, and going to bed and waking up at the same time every day can also help with stress management.
04
Eat a healthy diet
A healthy diet includes reducing the intake of refined carbohydrates, high-fat, and high-sugar foods, while ensuring 5~9 servings of fruits and vegetables per day, and eating more foods rich in dietary fiber and omega-3 fatty acids (including fish and nuts).
05
Mental and behavioral health support
Pay attention to your child's mental health and minimize certain unhealthy news or other social media content. If you find that your child is at risk, you should seek professional help promptly.
06
Mindfulness and meditation
Doing 20 minutes of mindfulness practice twice a day (e.g., meditation, yoga) can help relieve stress. Specialized courses for children of different ages can be found on the web.
07
Get in touch with nature
Participating in outdoor activities and exposure to nature can be a great way to relax and relieve stress. While it's not easy to find a suitable green space in a winter city, getting downstairs and getting a few minutes of fresh air is also great for your body and mind.
Bibliography:
1.Perceived Stress From Childhood to Adulthood and Cardiometabolic End Points in Young Adulthood: An 18-Year Prospective Study, Journal of the American Heart Association (2024). DOI: 10.1161/JAHA.123.0307411
2.https://osg.ca.gov/wp-content/uploads/sites/266/2023/03/Playbook_SC_HR.pdf