Abstract Background: Robust measurement of dietary intake in population studies of children is critical to better understand the diet-health nexus. It is unknown whether parent proxy-report of children’s dietary intake through online 24-hour recalls is feasible in large cohort studies. Objectives: The primary objective of this study was to describe the feasibility of the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) to measure parent proxy-reported child dietary intake. A secondary objective was to compare intake estimates with those from national surveillance. Methods: Parents of children aged 4-15 years participating in the TARGet Kids! research network in Toronto, Canada were invited by email to complete an online ASA24-Canada-2016 recall for their child, with a subsample prompted to complete a second recall about two weeks later. Descriptive statistics were reported for ASA24 completion characteristics and intake of several nutrients. Comparisons were made to the 2015 Canadian Community Health Survey (CCHS) 24-hour recall data. Results: A total of 163 parents completed the first recall and 46 completed the second, reflecting response rates of 35% and 59%, respectively. Seven (4%) first recalls and one (2%) second recall were excluded for ineligibility, missing data, or inadvertent parental self-report. The median number of foods reported on the first recall was 18.0 (interquartile range [IQR] 6.0) and median time to complete was 29.5 minutes (IQR 17.0). Nutrient intakes for energy, total fat, protein, carbohydrates, fiber, sodium, total sugars, and added sugars were similar across the two recalls and the CCHS. Conclusions: The ASA24 was found to be feasible for parent proxy-reporting of children’s intake and to yield intake estimates comparable to those from national surveillance, but strategies are needed to increase response rate and support completion to enhance generalizability.
Abstract Background Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0–17 years) and present, explain, substantiate, and discuss the final Consensus Statement. Methods The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada’s Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan. Results Evidence from the literature reviews provided substantial support for the importance of family on children’s movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important ( e.g. , child care, school, health care, community, governments) and can support families in this pursuit . Conclusion Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.
Iron deficiency (ID) is the most common micronutrient deficiency in the world. Pre-school age children are a well-known high risk group for ID. Children from immigrant families may be at risk for ID due to a greater burden of acute and chronic infections, difficulty accessing health services, and cultural dietary practices. Conversely, such children may have family and community supports or exposure to selection and settlement policies when immigrating to Canada that improve their health status. To assess serum ferritin levels (a measure of iron stores) in young children from immigrant versus non-immigrant families; and to evaluate the relationship between immigrant status and ID and iron deficiency anemia (IDA) and whether known dietary, environmental, or biologic determinants of low iron status influence this relationship. This was a cross-sectional study of healthy urban children (12 to 72 months of age), recruited as part of TARGet Kids!, a primary care practice-based research network in Toronto, Canada. Laboratory assessment of serum ferritin and hemoglobin (Hgb) and standardized parent-completed surveys were completed between December 2008 and February 2013 during routine health maintenance visits. Multiple regression analyses were used to evaluate the association between immigrant status (Canadian born, immigrant from non-industrialized regions, immigrant from industrialized regions) and serum ferritin, ID (serum ferritin <14 μg/L), and IDA (serum ferritin <14 ug/L and Hgb ≤110 g/L). Of 2614 children included in the analysis (median age of 37 months) 48.5% were non-immigrants. Median serum ferritin was 30 ug/L and 10.4% of children had ID and 1.9% had IDA. After adjusting for ethnicity, age, sex, education, income quintile, cow's milk intake, breastfeeding duration and bottle use, there were no significant associations between immigrant status and ferritin, ID or IDA. Significant predictors of low iron status included age, sex, cow's milk intake, and breastfeeding duration. We found no association between family immigrant status and iron status including serum ferritin, ID, and IDA. The relationships did not change when clinically and biologically important covariates were included in the models. These data suggest that children of immigrant families may not need enhanced screening for iron status or targeted interventions for iron supplementation.
Background: The etiology of Kawasaki disease (KD) is commonly described as an exaggerated immune response to an environmental or infectious trigger in developmentally, immunologically and genetically susceptible children. The trigger for KD has not yet been identified. Methods: Patients with newly diagnosed KD (n=73) were enrolled within 6 weeks of KD diagnosis. Control subjects (n=65) were enrolled during pediatric annual visits and from friends of enrolled KD patients. All participants completed an extensive questionnaire about medical history, family and environment. Geographic localisation software characterized the participants’ neighborhoods. A hypothetical scenario was used for control patients to simulate similar recall bias to that of the KD patients. Results: There were no differences in age, gender, allergies, child and family medical history or recent vaccination. Children with KD were more likely to be unwell prior to KD symptom onset than controls, including fever, stomach pain, lethargy, jaundice, loss of appetite and irritability, but not infectious disease symptoms (16% vs. 21%, p=0.49). Infectious symptomatology developed concurrently to classic KD symptoms. Children with KD had less exposure to environmental allergens and were more likely to be exposed to chemical irritants. Conclusions: The presence of symptoms for up to 1 month before onset of KD may suggest that a preceding illness/environmental agents may alter barriers to entry/exposure or prime an immunologic reaction to an etiologic trigger. Children with fewer allergen/infectious exposures and chronic chemical exposure may be immunologically more susceptible.
Summary Background Cardiometabolic risk (CMR) in young children has been measured using various approaches, including a continuous summary score that incorporates components such as adiposity, lipids, metabolic factors and blood pressure. Objectives The objective of this study was to comprehensively review definitions of continuous CMR scores in children <10 years of age. Methods A scoping review was conducted using a systematic search of four scientific databases up to June 2016. Inclusion criteria were children <10 years of age and report of a continuous CMR score. Results Ninety‐one articles were included. Most studies were published from 2007 to 2016 (96%). Nearly all continuous CMR scores (90%) were calculated using the sum or the mean of z ‐scores, and many articles age‐standardized and sex‐standardized components within their own population. The mean number of variables included in the risk scores was 5 with a range of 3–11. The most commonly included score components were waist circumference (52%), triglycerides (87%), high‐density lipoprotein cholesterol (67%), glucose (43%) and systolic blood pressure (52%). Importance Continuous CMR scores are emerging frequently in the child health literature and are calculated using numerous methods with diverse components. This heterogeneity limits comparability across studies. A harmonized definition of CMR in childhood is needed.
Summary Objective To summarize the literature on pharmacotherapy for managing paediatric obesity. Methods A systematic review and meta‐analysis were conducted of randomized controlled trials (RCTs) with <18‐year‐olds of pharmacotherapeutic agents published up to November 2022. Estimates of effect for outcomes were presented relative to minimal important differences and GRADE certainty of evidence. We examined data on patient/proxy‐reported outcome measures (PROMs), cardiometabolic risk factors, anthropometry and adverse events (AEs). Results Overall, 35 RCTs were included. Trials examined metformin ( n = 26), glucagon‐like peptide‐1 receptor agonists (GLP1RAs) ( n = 7) and a lipase inhibitor (orlistat; n = 2). Intervention duration varied (3−24 months). Metformin had little to no benefit on PROMs (e.g., health‐related quality of life [HRQoL]; 6 RCTs), moderate reductions in triglycerides, a moderate decline in insulin resistance, a small to moderate decline in BMI z‐score (BMIz) and a moderate increase in mild to moderate gastrointestinal AEs. Response to GLP1RAs was heterogeneous and results of subgroup analysis demonstrated variability of impact. Liraglutide (2 RCTs) resulted in a small reduction in HOMA‐IR and BMIz, but little to no benefit on other outcomes. Exenatide (4 RCTs) had a moderate reduction on blood pressure and a small decrease in BMIz with little to no benefit on other outcomes. Semaglutide (1 RCT) had a small benefit on HRQoL, a small reduction on SBP, a moderate reduction on total cholesterol and LDL‐cholesterol, a large reduction on triglyceride, and a very large decline in BMIz accompanied by a small increase in mild to moderate gastrointestinal AEs. Orlistat had a moderate reduction in DBP and little to no benefit in other outcomes measured, but had a very large increased risk of mild to moderate gastrointestinal AEs. Serious AEs were rare and for interventions with sufficent AE reporting, were considered not likely attributable to the interventions. Conclusion Few studies examined the impact of pharmacotherapy on PROMs. There is evidence that metformin and GLP1RAs lead to important improvements in cardiometabolic and anthropometric outcomes while accompanied by mild to moderate AEs. Long‐term effectiveness and safety of GLP1RAs remain to be evaluated.
Patients and clinicians may have different priorities than health researchers. Providing patients, parents and clinicians a voice in selecting and prioritizing research topics is important in setting the research agenda for child health. To identify the most important unanswered research questions in pediatric preventive care from the perspective of parents and clinicians, and to identify whether differences exist between questions submitted by parents and clinicians. Based on the James Lind Alliance's Priority Setting Partnerships protocol, an online questionnaire was circulated to parents of children aged 0 to 5 years enrolled in a primary care practice-based research network, and to pediatricians and family physicians in the Ontario Medical Association. The questionnaire used one open-ended question and eight questions about specific domains to ask respondents to submit the most important research questions in pediatric preventive care. Similar submissions were combined into indicative questions through a consensus-building process. Unanswered indicative questions were identified by reviewing existing guidelines and multiple databases to determine if a relevant systematic review or high-quality trial exists. Fisher's exact test was used to identify statistically significant differences between the responses of parents and clinicians. Respondents included 42 clinicians and 102 parents, who submitted a total of 239 and 765 questions about pediatric preventive care, respectively. Most submissions pertained to nutrition and obesity (20.1% for clinicians, 18.3% for parents), illness prevention (19.2% and 17.2%) and parenting and behaviour (16.3% and 15.2%). Parents were more likely to ask questions about screen time (8.0% of parent submissions vs 4.6% of clinician submissions, P<0.05) and sleep (8.7% vs 6.3%, P<0.05) than clinicians. Of the original questions, 148 clinician questions (61.9%) and 397 parent questions (51.9%) were unanswered. These were combined into 79 indicative questions. The most frequently endorsed questions included discipline strategies, the impact of electronic devices on development, and interventions to promote healthy sleep. There was general agreement between parent and clinician research priorities. The 79 indicative questions will go through final priority setting steps with parents and clinicians, using the nominal group technique to attain consensus on the top 10 unanswered research questions in pediatric preventive care. Identifying the research priorities of parents and clinicians is important in advancing the care of children.
Journal Article 61 Cow’s milk fat & child adiposity: a systematic review and meta-analysis Get access Shelley Vanderhout, Shelley Vanderhout Search for other works by this author on: Oxford Academic Google Scholar Mary Aglipay, Mary Aglipay Search for other works by this author on: Oxford Academic Google Scholar Jonathon Maguire, Jonathon Maguire Search for other works by this author on: Oxford Academic Google Scholar Catherine Birken, Catherine Birken Search for other works by this author on: Oxford Academic Google Scholar Kevin Thorpe, Kevin Thorpe Search for other works by this author on: Oxford Academic Google Scholar Deborah O’Connor, Deborah O’Connor Search for other works by this author on: Oxford Academic Google Scholar Naz Torabi Naz Torabi Search for other works by this author on: Oxford Academic Google Scholar Paediatrics & Child Health, Volume 24, Issue Supplement_2, June 2019, Page e24, https://doi.org/10.1093/pch/pxz066.060 Published: 31 May 2019
Vitamin D is important for bone health and may be protective against fracture risk. Few studies have evaluated the association between vitamin D and fracture risk in children and none have evaluated this association in early childhood. To evaluate if vitamin D exposures, including serum 25 hydroxyvitamin D (25[OH]D) concentration, vitamin D fortified cow's milk intake and vitamin D supplementation, were associated with fracture risk in children <6 years of age. A case-control study was conducted. Cases were recruited from a pediatric fracture clinic and matched controls were obtained from children enrolled in the TARGet Kids! primary-care research network. Controls were matched to cases on age, sex, height and season of blood draw. Serum 25(OH)D was measured using liquid chromatography tandem mass spectrometry. Typical daily cow's milk intake and vitamin D supplementation were obtained through a parent completed questionnaire. The odds of fracture risk was estimated using adjusted odds ratios (aOR) and 95% confidence intervals (CI) obtained from conditional logistic regression, with adjustment for skin type, waist circumference, outdoor free play time, neighbourhood income, soda consumption and child birth weight. A total of 206 cases were recruited from 2009-2013 and were matched to 343 controls. Serum 25(OH)D concentration was not significantly associated with fracture risk (per 10 nnmol/L increase, aOR=0.95 [95% CI 0.88 to 1.03]). Cow's milk was not associated with reduced odds of fracture (>2 cups vs. 2 cups per day aOR=1.39 [95% CI 0.86 to 2.23]). A statistically significant association was observed between child vitamin D supplementation and decreased odds of fracture (yes vs. no: aOR=0.42 [95% CI 0.27 to 0.63]). Serum 25(OH)D concentration was not associated with fracture risk among young children yet children's use of supplements containing vitamin D was associated with a 58% reduction in odds of fracture risk. Future studies are needed to understand the relationship between vitamin D supplementation and fracture risk.
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