Sex-specific association of adverse childhood experiences with TG/HDL-C ratio in adolescents

Background: Adverse childhood experiences (ACEs) are strongly associated with cardiovascular diseases. However, limited research has examined the relationship between ACEs and specific metabolic indicators, particularly the triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C), in adolescents. This study explores the association between ACEs exposure patterns and TG/HDL-C levels in adolescents, providing evidence to inform public health policies and targeted interventions. Methods: We analyzed questionnaire data and biological samples from 2,131 adolescents. ACEs were assessed using the international version of the 22-item Adverse Childhood Experiences Questionnaire (ACE-IQ), categorized into threat-related ( e.g. , maltreatment, peer bullying) and deprivation-related ( e.g ., neglect, parental separation) dimensions, with cumulative scores of the 22 items further calculated. Latent class analysis (LCA) was employed to identify four distinct ACEs exposure patterns. The TG/HDL-C ratio was measured via standard biochemical assays, and its association with ACEs was analyzed using multivariate linear regression, with additional gender-stratified analyses. Results : Exposure to individual adversities, including emotional neglect, physical neglect, emotional abuse, physical abuse, and peer bullying, was significantly associated with elevated TG/HDL-C ratios in adolescents ( P <0.05). Both the threat and deprivation dimensions showed marked associations with the TG/HDL-C ratio ( P <0.05), while cumulative ACEs exhibited a stronger effect ( P <0.05). Adolescents in the high neglect/abuse/bullying group and high family dysfunction group demonstrated significantly higher TG/HDL-C ratios than the low ACEs group ( β =0.054, P =0.011; β =0.056, P <0.001). Sex-stratified analysis revealed that females had higher metabolic risks under emotional neglect ( P <0.05) and emotional abuse ( P <0.05), whereas males showed elevated risks with physical neglect ( P <0.05). Conclusion: Our findings underscore the significant impact of ACEs exposure patterns and sex-specific differences on adolescent metabolic health, supporting the need for tailored interventions and public health strategies.