Adverse childhood experiences and risk of non-mental medical diseases in adulthood: an umbrella review.
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BACKGROUND: This umbrella review evaluates adverse childhood experiences (ACEs) as etiological risk factors for non-mental medical diseases. METHODS: We systematically searched PubMed, EMBASE and WoS up to 30 April 2025, following PRISMA, PRIOR and MOOSE guidelines. Eligible studies were meta-analyses or systematic reviews investigating associations between ACEs and non-mental medical disease, with control groups and adequate data for extraction. Studies on congenital disorders or without relevant data were excluded. Methodological quality was assessed using AMSTAR. The protocol was registered in PROSPERO (CRD42022384104). Meta-analytic data were synthesised with random-effects models to calculate odds ratios (OR) with confidence intervals and p-values. Heterogeneity was assessed with I2, small-study effects with the Egger test, and 95% prediction intervals were calculated. Evidence credibility was graded according to Ioannidis' criteria. FINDINGS: We included 36 reviews/meta-analyses covering 250 non-duplicated studies with 6,064,006 participants (412,760 cases and 5,651,246 controls). There was highly suggestive evidence (Class II) linking any ACE to any non-mental medical disease (OR = 1.57; 95% CI: 1.49, 1.66). Strong associations were found between any non-mental medical disease and abuse of any type (OR = 1.61), physical abuse (OR = 1.59), sexual abuse (OR = 1.58) and bullying (OR = 2.04). Regarding specific diseases, highly suggestive associations were identified for headache (OR = 1.91), irritable bowel syndrome (OR = 1.79), diabetes (OR = 1.67), and cardiovascular disease (OR = 1.46). Convincing evidence emerged for a modest association between ACEs and cardiovascular disease (OR = 1.19) and endocrine/metabolic disorders (OR = 1.62) in prospective studies. INTERPRETATION: ACEs are significant risk factors for adult non-mental medical diseases, underscoring the importance of early intervention and prevention for vulnerable groups. Early stressors have lasting physical health impacts. Limitations include reliance on self-reported trauma and heterogeneous study designs; prospective data showed lower bias, reinforcing the need for rigorous research. Future studies should explore genetic, environmental, and resilience factors that may moderate medical risks among individuals exposed to ACEs. FUNDING: No funding was received.