Accentuating the Positive: The Role Childhood Assets May Play in Association with
Better Cardiometabolic Health
LewisFirst, MD, MS, Editor in Chief, Pediatrics
We are all aware of the effects of toxic stress on a child. What we don’t focus on
as much is the role of positive mental health and how that might be associated with
physical wellness. Thus this month we are sharing a study by Qureshi et al. (10.1542/peds.2018-2004) that looks at four childhood assets to see if having one or more of these assets
at age 9 is associated with improved cardiometabolic health when assessed in that
same child eight years later. The authors enrolled 3,074 children in a longitudinal
cohort and collected data on them looking at their executive functioning skill, their
prosocial behaviors, and their levels of externalizing or internalizing behavioral
problems. They also got baseline cardiometabolic data at the same time. These children
were then followed up when they turned 17 years old. Even after controlling for confounders,
the authors found that those who had even one of these four positive attributes (good
executive function, prosocial behaviors, and no externalizing or internalizing issues)
were more likely to show healthier cardiometabolic markers (such as cholesterol level,
blood pressure, BMI) than those who lacked any of these positive assets.
So what does this mean? Should we focus on promoting wellness rather than just trying
to prevent cardiometabolic disease to improve our cardiac health as we usually do?
To answer that question, we asked Drs. Nicole Bush and Kirsten Bibbins-Domingo from
UCSF, experts on the study of psychological factors contributing to physical illness
or wellbeing, to share their thoughts in an accompanying commentary (10.1542/peds.2018-4004). The authors point out some limitations in the study but at the same time raise
a number of hypotheses whereby the findings in this study might be a beacon for thinking
about next steps in the formal study of the interface of mental and physical health.
They also salute the investigators on coming at cardiometabolic health from a wellness
perspective rather than just a risk-factor perspective with the hope that new approaches
to prevention anchored in promoting wellness in mental and behavioral behaviors may
be just what the pediatrician should order. Take heart and promote your own wellness
as well as that of your patients by reading this study to learn more.