Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project.

Abstract

Early psychological deprivation is associated with increased risk for cardiometabolic disorders, and rapid catch-up growth following improved care environments may further influence this risk. Using data from the Bucharest Early Intervention Project - a randomized longitudinal study of children institutionalized in infancy assigned to high-quality foster care, continued institutional care, or raised by biological families - we examined cardiometabolic outcomes in early adulthood. Participants were 81 women and 58 men (mean age 22.6 years), predominantly Romanian. We assessed associations between care type and cardiometabolic traits including blood pressure, lipid and glucose metabolism, and metabolic syndrome. Results indicated that adults with histories of institutionalization displayed poorer lipid metabolism compared to non-institutionalized controls. Notably, individuals randomized to foster care showed increased BMI and waist circumference in adulthood relative to those who remained in institutional care. Longitudinal latent class analyses revealed four distinct BMI trajectories from infancy to early adulthood. The accelerated BMI trajectory, predominantly comprising foster care participants, was associated with the greatest prevalence of metabolic syndrome. These findings suggest that both lipid dysregulation and persistent increases in BMI represent ongoing concerns for cardiometabolic risk following early psychosocial deprivation. Those exposed to early adverse care may benefit from ongoing cardiometabolic monitoring and lifestyle interventions.