The consequences of foster care versus institutional care in early childhood on adolescent cardiometabolic and immune markers: Results from a randomized controlled trial
Open accessAbstract
Objective: Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence. Methods: The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers. Results: Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (−0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = −0.07, p = .03). Conclusions: The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type. Clinical Trial Registration: NCT00747396
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The earlier BEIP study at age 16 found null results for cardiometabolic outcomes.
“While the latter results were null”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Slopen et al., 2019
The Results (Randomization to foster care) report no group differences in the biological measures except BMI z-score, which was higher in the foster-care group in the mean comparison. The age-16 cardiometabolic findings were therefore largely null, but calling them wholly null omits the BMI exception. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn an earlier study with the BEIP cohort, we investigated the effects of institutionalization and foster care interventions on cardiometabolic outcomes at age 16.
“In an earlier study with the BEIP cohort, we investigated the effects of institutionalization and foster care interventions on cardiometabolic outcomes at age 16.”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Slopen et al., 2019
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Flagged first, then by citations
Research works printed but not linked: 2
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- [72]Nelson CA. Romania’s abandoned children: Harvard University Press; 2014.
Cited by
Sorted by citations
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Self-citationResidential care as an alternative care option: A review of literature within a global context
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“Our results build upon a prior BEIP study using data from age 16 that investigated metabolic and immune markers (Slopen et al., 2019), along with BMI trajectories (Tang et al., 2018).”
Self-citation
- Authors
- Slopen, N., Tang, A., Nelson, C. A., Zeanah, C. H., McDade, T. W., McLaughlin, K. A., & Fox, N. A.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Slopen, Natalie
- ORCID
- Venue
- Psychosomatic Medicine
- Published
- 2019-04-19
- Volume
- 81
- Issue
- 5
- Pages
- 449-457
- ISSN
- 0033-3174 (ISSN-L)
- 1534-7796
- PMC
- PMC6544473
- OpenAlex
- W2937740589
- Cited by
- 18
- References
- 120
- Citations by year
- 2026: 3 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 2
- FWCI
- 6.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH091363, R01MH103291, R01MH106482)
- Topics
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- foster care, institutional care, cardiometabolic health, immune function, body mass index, blood pressure, C-reactive protein, interleukins, TNF-α, Epstein-Barr virus antibodies, Bucharest Early Intervention Project, age at placement
- MeSH terms
- Adolescent, Age Factors, Antibodies, Viral, Blood Pressure, C-Reactive Protein, Child, Institutionalized, Child, Preschool, Herpesvirus 4, Human, Female, Foster Home Care, Glycated Hemoglobin, Humans, Infant, Longitudinal Studies, Male, Biomarkers, Body Mass Index, Cytokines
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