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. 2025 Mar 27:16:1543923.
doi: 10.3389/fpsyt.2025.1543923. eCollection 2025.

The association between cumulative adverse childhood experiences and ultra-processed food addiction is moderated by substance use disorder history among adults seeking outpatient nutrition counseling

David A Wiss  1   2 , Celine D Tran  3 , Erica M LaFata  4
Affiliations

The association between cumulative adverse childhood experiences and ultra-processed food addiction is moderated by substance use disorder history among adults seeking outpatient nutrition counseling

David A Wiss et al. Front Psychiatry. .

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.

Keywords: adverse childhood experiences; eating disorder; food addiction; moderation; substance use disorder; ultra-processed food; weight suppression.

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Conflict of interest statement

Author DW was employed by the company Nutrition in Recovery LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Margins Plot from Adjusted Logistic Regression Interacting Adverse Childhood Experiences (ACEs) and Substance Use Disorder (SUD) on Ultra-Processed Food Addiction (UPFA) Among Adults (Ages 21+) Seeking Nutrition Counseling (N=287) (see Supplementary A for full output).
Figure 2
Figure 2
Margins Plot from Adjusted Logistic Regression Interacting Adverse Childhood Experiences (ACEs) and Weight Suppression on Eating Disorder (ED) Among Adults (Ages 21+) Seeking Nutrition Counseling (N=287) (see Supplementary B for full output).
See this image and copyright information in PMC

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