Plasma Multiomics Links Early‐Life Adversity to Disease and Cardiometabolic Health: A Population‐Based Cohort Study

BACKGROUND: Childhood adversity (CA) is associated with increased cardiovascular and cardiometabolic risk, but the molecular mechanisms remain unclear. We aimed to identify CA-related metabolomic and proteomic signatures and evaluate their roles in linking CA to incident diseases. METHODS: This prospective cohort study included 153 225 participants aged 48 to 64 years. CA was assessed using the Childhood Trauma Screener-5, capturing cumulative (0-5 domains) and individual adversity exposures. Plasma metabolomics and proteomics data were integrated to derive CA-related molecular signatures. Cox proportional hazards model was used to evaluate associations between CA, molecular signatures, and 58 incident diseases and mortality. Mediation analyses quantified the role of multiomics signatures. RESULTS: Each additional CA domain was associated with higher risk of 49 of 58 incident diseases (hazard ratios [HRs], 1.024-1.338) and a 7.3% higher all-cause mortality risk. Focusing on cardiometabolic health, the CA-related metabolic and proteomic signatures were independently associated with incident disease. Per 1-SD increase in the cumulative CA metabolic signature, the highest observed HR was 1.313 (95% CI, 1.278-1.349) for incident diabetes, and the risk for hypertension was also increased (HR, 1.136 95% CI, 1.114-1.159). Similarly, the proteomic signature was strongly associated with incident diabetes (HR, 1.645 95% CI, 1.489-1.818) and hypertension (HR, 1.223 95% CI, 1.155-1.295). The cumulative CA metabolic and proteomic signatures mediated up to 25.5% and 46.8% of the association with hypertension, respectively. CONCLUSIONS: CA is associated with a broad spectrum of diseases and mortality, with particularly strong links to cardiometabolic health. Multiomics signatures partially mediated these associations.