Rethinking cardiometabolic risk: The role of childhood neglect and biomarker decoupling

Purpose Childhood adversity, including neglect, affects over 60% of children globally and fundamentally alters developing biological systems, including the cardiometabolic system. While research has established links between early neglect and disease risk, how neglect might disrupt the coherence and organization of cardiometabolic indicators contributing to risk has been overlooked. Methods We examined whether early neglect alters how markers of metabolic functioning cohere and contribute to overall risk—operationalized as the metabolic syndrome (MetS)—among young adults from the Bucharest Early Intervention Project, the only randomized controlled trial of high-quality foster care as an alternative to institutional rearing, by investigating measurement invariance of MetS across groups with varying levels of exposure to neglect. Results In this hypothesis-generating study, results indicate that the strength of associations between metabolic indicators and underlying latent risk appear to differ by neglect history. Analyses reveal a progressive “decoupling” of cardiometabolic indicators as exposure to early neglect increases, with the strongest between-biomarker coherence observed among never-institutionalized individuals and the weakest among individuals who experienced prolonged early institutional care. Conclusions Findings suggest that early neglect may alter the organization of indicators within the cardiometabolic system, challenging the validity of MetS scoring approaches for individuals with neglect histories. Results underscore the importance of developing context-sensitive methods of assessing cardiometabolic risk in adversity-exposed populations. © 2026 Elsevier Inc.