Childhood adversity, physical activity, and cardiometabolic vulnerability among adolescents in climate-vulnerable coastal Bangladesh

Childhood adversity and physical activity are important determinants of adolescent health and may influence cardiometabolic vulnerability during adolescence, although evidence from climate-vulnerable low- and middle-income countries remains comparatively limited. Guided by the dimensional adversity framework, this study examined associations of threat-related and deprivation-related adversities and physical activity with cardiometabolic vulnerability among adolescents in coastal Bangladesh. Data were drawn from 1,625 adolescents in coastal Bangladesh. Threat-related adversity comprised childhood abuse, bullying, and violence exposure, whereas deprivation-related adversity comprised neglect and food insecurity. Cardiometabolic vulnerability was assessed using a composite index calculated as the unweighted mean of standardized body mass index, systolic blood pressure, diastolic blood pressure, and resting heart rate. Sequential multivariable linear regression was used as the primary analytical approach to examine associations with cardiometabolic vulnerability. Complementary exploratory analyses, including generalized additive models, quantile regression, and network analysis, were conducted to assess potential nonlinear associations, heterogeneity across the cardiometabolic vulnerability distribution, and the interrelationships among study variables. Neither threat-related adversity (β = −0.002, 95% CI: −0.053, 0.049) nor deprivation-related adversity (β = −0.020, 95% CI: −0.065, 0.025) was significantly associated with cardiometabolic vulnerability after adjustment for demographic, developmental, socioeconomic, and behavioral factors. In contrast, higher physical activity was associated with lower cardiometabolic vulnerability (β = −0.078, 95% CI: −0.134, − 0.023), lower systolic blood pressure (β = −0.146, 95% CI: −0.228, − 0.063), and lower resting heart rate (β = −0.102, 95% CI: −0.184, − 0.021). Generalized additive models indicated an approximately linear inverse association between physical activity and cardiometabolic vulnerability. Physical activity did not moderate associations between adversity and cardiometabolic vulnerability. Network analysis identified systolic and diastolic blood pressure as the most central nodes. Physical activity was consistently associated with cardiometabolic vulnerability, whereas childhood adversity demonstrated limited independent associations. These findings suggest that higher physical activity is associated with lower relative cardiometabolic vulnerability, as reflected by the composite physiological index, among adolescents in climate-vulnerable settings, although longitudinal studies are needed to determine causal relationships.