Abstract
Adverse childhood experiences (ACEs), such as childhood maltreatment and household dysfunction, are positively linked to substance use disorders (SUD), weight loss efforts, and maladaptive eating behaviors, including ultra-processed food addiction (UPFA) and eating disorder (ED) symptoms. However, the differential association of ACEs with UPFA by lifetime SUD history and ACEs with EDs by weight suppression- the discrepancy between an individual's highest and current weight/BMI in adulthood- have not been examined. Using logistic regression and marginal effects analysis, this cross-sectional study aimed to assess (1) cumulative ACEs as a risk factor for screening positive for UPFA and EDs, (2) lifetime SUD history as a moderator of the ACE-UPFA relationship, and (3) weight suppression as a moderator of the ACE-ED relationship. Among 287 adults presenting to a private practice offering nutrition counseling for EDs and SUD recovery, the presence of 4 or more ACEs (compared to <4 ACEs) significantly increased the odds of UPFA-positive screens (OR=1.99; CI=1.19-3.35; p=0.01) but not ED-positive screens (OR=1.36; CI=0.80-2.30, p=0.25). Additionally, the interaction between ACEs and SUD was significant to the UPFA outcome (p<0.01). Those with a self-reported lifetime history of SUD exhibited an increased probability of UPFA-positive screens in the presence of 4 or more ACEs. Meanwhile, the probability of UPFA-positive screens remained unchanged among those who did not report a lifetime SUD history. Cumulative ACEs did not significantly predict ED-positive screens, and the ACE-weight suppression interaction did not meet the threshold for significance. Overall findings underscore the cross-vulnerability between addictive behaviors and the potential importance of integrating nutrition interventions in addiction treatment for those with ACEs.