The origins of good health
Everyone knows that unfavourable childhood conditions can lead to life-long health problems. However, more evidence is needed to explain the connection, and this is what three physicians from the SickKids Department of Paediatrics are doing in the Toronto Applied Research Group or www.TARGetKids.ca which could become one of the largest child health studies in the world.
One aspect of the group’s work is to accumulate data for years to come and identify the link between early childhood and adult health. Another is ongoing collaboration with community paediatricians to implement solutions right away and conduct trials to identify the best preventive interventions.
Preventable medical conditions are a serious concern. It is estimated that by the end of childhood, 40 per cent of Canadian children are dealing with obesity, asthma, injury, behavioural problems or learning difficulties, all of which can affect them for the rest of their lives.
TARGetKids! will identify which of these and other childhood conditions are associated with the most common adult diseases – heart attacks, strokes, diabetes and cancer – and how such diseases can be prevented at an early age. The current focus of the research is obesity and vitamin D and iron deficiency, but it could include other conditions and more participants.
The project was developed with future expansion in mind. “We could broaden our research to include disorders of child development such as autism and cognitive difficulties, and we could extend the project to other cities or regions,” says Dr. Patricia Parkin, the lead investigator of the project. “This is the first initiative of its kind. There are no other primary care research networks like this in Canada.”
A similar study of adults, the Ontario Health Study, was launched by a group of government-supported organizations in September to study cancer and other diseases. It aims to recruit thousands of adult subjects, online and through advertisements in doctors’ offices and in the media. In comparison, TARGetKids! is embedded in primary care practice settings where research assistants recruit participants up to the age of six.
Drs. Parkin, Catherine Birken and Jonathon Maguire are project leaders of the initiative. In collaboration with six community clinics, they have already recruited 3,000 children who attend the clinics for annual check-ups. Parents answer questions about their child’s health, nutrition, lifestyle and behaviour. Both children and parents provide height, weight and waist circumference, and children give blood samples that are tested for cholesterol, glucose, iron and vitamin D levels.
The blood samples are sent to Mount Sinai Services for analysis, and results are entered in a database at the Applied Health Research Centre at St. Michael’s Hospital and shared with community physicians who otherwise wouldn’t have access to such information. The arrangement helps physicians to detect conditions earlier and threat them right away, and it allows them to monitor their patients’ progress in future blood tests.
“Our approach is novel,” Parkin says. “We are able to recruit subjects at doctors’ offices since they are doing a lot of the things we are looking for anyway, like measuring height and weight etc. By partnering with the primary physicians in the project, we will learn from them what is good and bad about our research so we can fix it, if necessary. The physicians benefit because they can immediately incorporate the findings from our collaborative work into their practice.”
Intervention or treatment by physicians won’t harm the scientific study, Parkin says.
“If there is an impact of these interventions it will only serve to modify the observed association – make the association seem smaller than it really might be. As researchers we are always happier if the associations are under-estimated rather than over-estimated.
“Separate from the longitudinal component of our study, we are doing intervention trials. In these trials, the interventions are planned and the outcomes are measured and compared in intervention and control groups. The results will be important for establishing evidence-based recommendations for primary prevention in the primary-care, physician-practice setting.”