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The Consequences of Foster Care Versus Institutional Care in Early Childhood on Adolescent Cardiometabolic and Immune Markers

Results From a Randomized Controlled Trial

Slopen, Natalie, ScD; Tang, Alva, PhD; Nelson, Charles A., PhD; Zeanah, Charles H., MD; McDade, Thomas W., PhD; McLaughlin, Katie A., PhD; Fox, Nathan A., PhD

doi: 10.1097/PSY.0000000000000696

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

From the Department of Epidemiology and Biostatistics (Slopen), School of Public Health, University of Maryland; Department of Human Development and Quantitative Methodology (Tang, Fox), University of Maryland, College Park; Boston Children's Hospital (Nelson), Harvard Medical School, Boston; Harvard Graduate School of Education (Nelson), Cambridge, Massachusetts; Tulane University School of Medicine (Zeanah), New Orleans, Louisiana; Department of Anthropology and Institute for Policy Research (McDade), Northwestern University, Evanston, Illinois; and Department of Psychology (McLaughlin), Harvard University, Cambridge, Massachusetts.

Address correspondence to Natalie Slopen, ScD, Epidemiology and Biostatistics, University of Maryland, College Park, MD 20742. E-mail:

Supplemental Content

Received for publication April 26, 2018; revision received January 24, 2019.

Online date: April 19, 2019

Copyright © 2019 by American Psychosomatic Society
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