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 | Research Programs |  |
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| An Examination of Families Attitudes and Beliefs about Obesity and Type 2 Diabetes and Body Composition in Children with Obesity |
| | The prevalence of obesity in Australia has reached epidemic proportions with nearly 30% of children considered overweight or obese, and this is not static with the prevalence accelerating. Although at present there is not a huge population of children with type 2 diabetes, due to the ramifications associated with the obesity epidemic this will soon change. Currently there is little to offer these children in terms of an effective dietary treatment and exercise regime in treating the co-morbidities associated with type 2 diabetes. Indeed, we know little about how families cope with the condition or what they expect of treatment and also, from the perspective of the health care system, there is currently little to offer children in terms of effective treatments.
A Qualitative research approach will be taken to explore the families attitudes and beliefs about treatment of type 2 diabetes. This is a two stream approach consisting of focus groups to obtain qualitative data from young people and a subsequent questionnaire-based data collection to obtain quantitative data from both parent(s) and a diet record to ascertain the current diet of the young person.
This study will also attempt to validate non-invasive measures of body composition in children with obesity and/or type 2 diabetes using air displacement plethysmography (BodPod™), total body potassium (which measures lean tissue) and total body water using deuterium dilution techniques. This study will be run in conjunction with a larger investigation that is underway that examines energy expenditure and body composition change in children under going treatment for obesity.
These studies will combine to increase the evidence base for treatment of type 2 diabetes in children. First by elucidating the specific barriers and benefits to the provision of a healthy diet for children with type 2 diabetes that are perceived by parents to enable more effective interventions to be developed. In addition to explore the reasons why families seek treatment for their overweight child and the extent and nature of their expectations for treatment. The second part of the study will evaluate different methodologies to measure body composition in obesity and assist in the development of suitable measures that can be used in the future to assess the effectiveness of interventions. | | |
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| Body Composition, Energy Balance and Appetite Control in Children with Acute Lymphoblastic Leukaemia |
| | Optimal nutritional status is an essential factor in the clinical management of children undergoing treatment for Acute Lymphoblastic Leukaemia (ALL). However, there is a lack of longitudinal studies that comprehensively monitor nutritional status throughout the treatment protocols. This information could be used to identify specific treatment time points within ALL treatment protocols when nutrition intervention is required to achieve optimal nutritional status. Although hypothesised, the link between nutritional status and clinical outcome parameters has also not been well documented in paediatric oncology. This study aims to evaluate the effect of two drugs, AALL0232 and AALL0331 on nutritional status (body composition, appetite, energy intake, expenditure) in children newly diagnosed with ALL and to determine if there is a relationship between nutritional status and clinical outcome parameters.
Patients being treated with AALL0232 and AALL0331 between the ages of 1.00 and 17.99 years will be recruited for the study. The children will be tested longitudinally from the start of the treatment protocol until 2-3 years post diagnosis. The children will have measures of height and weight, total body potassium, Air Displacement Plethysmography, Total body water, Resting energy expenditure and information on wellness, appetite, physical activity, dietary behaviour, nutritional supplementation will be collected by questionnaire. This study will give us the knowledge to change clinical practice, and thereby significantly influence treatment outcomes for children with ALL. | | |
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| Body Composition and Energy Expenditure in Inflammatory Bowel Disease |
| | The number of children diagnosed with Inflammatory Bowel Disease (IBD) (Crohn’s disease and Ulcerative Colitis) has increased in recent years. Many children with IBD suffer diarrhoea, abdominal pain, have impaired linear growth, fail to gain weight appropriately for age and present with poor nutritional status.
The CNRC has been running a long term study investigating the link between nutritional status and disease activity in children with IBD. At 6-monthly intervals children have several anthropometric, body composition and disease activity measures performed. These include height and weight, total body potassium (TBK), resting energy expenditure, self-assessed pubertal status, inflammatory markers, quality of life and the Pediatric Crohn’s Disease Activity Index. This study provides valuable information for the clinical management of the individual children participating in this research and has made important contributions to the body of literature investigating IBD, including the areas of resting energy expenditure, bone health and nutritional status. This research is due to complete in June 2009.
New research investigating the probiotic VSL#3 as an adjunct to standard therapy in children with Crohn’s disease has just commenced. This research involves two studies. One is aimed at bringing children with active disease into remission; the second is aimed at maintaining remission long term in children with inactive disease. The addition of VSL#3 to the range of therapies available for the management of children with CD may lead to improved care, avoidance of side-effects related to other treatment options and prevention of long term complications.
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| Bone Strength Parameters in Cystic Fibrosis |
| | Low bone mineral density (BMD) is recognised in individuals with cystic fibrosis (CF). It is suggested that suboptimal bone mineral accrual may occur during adolescence that leads to low levels of bone mineral density (BMD) in adults with CF. However, the evidence is unclear because of the poor understanding of the individual and combined effects of the CF disease and treatment on bone health and the limitations of using current standard densitometry techniques (DXA) to assess bone health in this population. The main aim of this cross sectional study is to investigate bone parameters using state of the art densitometry (pQCT) to present a more comprehensive assessment of the bone health of children and adolescents with CF compared to healthy controls. | | |
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| Childhood Obesity and Asthma; Is Leptin The Link? |
| | The incidence and prevalence of both obesity and asthma has increased in parallel in recent years, however a linking mechanism has not yet been established. Australia ranks highly in the world for both asthma and obesity in children.
The aim of this project is to document the potential contributing role of obesity in childhood asthma.
Children in the study will have several anthropometric, body composition and disease activity measures performed. These include height and weight, fat mass (FM), physical activity (PA), self-assessed pubertal status, inflammatory markers both in blood circulation and respiratory airways.
This study, by proposing a novel theory linking obesity to asthma, provides valuable clinical information for health professionals to develop better interventions for the prevention and treatment of asthma, the most common chronic disease of childhood.
Future research in this area includes investigations in efficacy of reduction of FM in asthma treatment and asthma improvement in children. | | |
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| Dietary Interventions in Obese Young People - The 'Eat Smart' Study |
| | Dietary change is one of the cornerstones of obesity treatment yet there is a lack of good evidence for optimal dietary approaches particularly in children and young people.
Eat Smart is a novel research study in which 2 dietary approaches to treat childhood obesity will be tested. The study is a collaboration between Professor Jenny Batch, Consultant Endocrinologist at the Royal Children’s Hospital and the Children’s Nutrition Research Centre at the University of Queensland, and will commence in January 2007. Families will initially undertake a short course in life skills called FRIENDS for Life, which focuses on emotional resilience building and self esteem. Families will then be randomly allocated to one of three groups:
• A reduced carbohydrate eating plan
• A structured low fat meal plan system
• Or a wait listed control group
For those families allocated to one of the dietary groups, this will include 6 months of support with 8 appointments at the Royal Children’s Hospital over that time. For families allocated to the control group, this will involve a 12 week monitoring (waiting) period after which they may under the dietary program of their choice. Eat Smart is supported by an experienced weight management dietitian and includes measures of energy expenditure, body composition and biochemical markers of inflammation.
For more information on this research please contact Ms Kim Cojean on 3365 5476 or k.cojean@uq.edu.au
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| Energy Metabolism, Body Composition and Diet Induced Thermogenesis in Anorexia Nervosa |
| | Anorexia Nervosa (AN) is a serious psychiatric illness with a high morbidity and significant lifetime mortality.
In 2002 the Body Composition Laboratory of the CNRC carried out a significant number of measurements of total body potassium (TBK) as a measure of body composition in such patients. These measurements are used clinically to assess re-feeding strategies, nutritional status and are also used as a guide for discharge. As nutritional concerns are the focus in AN patients and there are still many areas of body composition and energy expenditure poorly understood, there is a vital need for research in this area to assist the clinical management of these subjects.
This study aims to (1) determine the body composition of children with AN using a reference model, (2) assess the validity of body composition techniques in children with AN and (3) investigate the relationship between resting metabolic rate and fat free mass in children with AN.
This research involves measurements of height and weight, body volume (using air displacement plethysmography - BodPod®), total body water (using deuterium oxide and bioelectrical impedance) bone mineral content (using DEXA), body cell mass (using TBK) and resting energy expenditure (using indirect calorimetry).
This study will allow the body composition and energy expenditure of AN patients to be clinically evaluated more accurately and for treatment to be better tailored to their actual compositional needs.
Future research will investigate the role of diet induced thermogenesis in the re-feeding strategies of patients with AN. | | |
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| Feeding Patterns and Growth of Preterm Infants |
| | The feeding patterns and growth of preterm infants have recently been studied as part of a combined project between the Discipline of Paediatrics & Child Health, University of Queensland, the Children’s Nutrition Research Centre, and the Neonatology Department of the Royal Brisbane & Women’s Hospital.
A number of investigations were completed with infants at term age, 4, 8, and 12 months corrected age. These included: a growth measurement, a parent-completed 3 day diet record, a parent-completed feeding questionnaire, a clinical assessment of oral feeding skills, and a parent-completed feeding stress questionnaire. The results of these studies demonstrated that, overall, preterm infants displayed delayed feeding patterns and reduced growth throughout their first year.
In addition, infants who were born more prematurely and/or who had a greater number of medical conditions as neonates displayed slower growth and more delayed feeding skills during infancy. Parents of preterm infants generally reported many concerns relating to feeding their infant, and reported wanting more information and assistance relating to infant feeding. Future research projects will compare the dietary intake and body composition of preterm and full-term infants, and will assess the efficacy of certain interventions aimed at improving feeding skills and growth in preterm infants. | | |
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| Optimising Micronutrient Status |
| | Optimising Micronutrient Status
‘Micronutrient status in children with cerebral palsy and the impact of a major orthopaedic surgical intervention.’
The natural healing processes of the body are required to be functioning optimally, in trauma or surgery, in order to prevent delays, impediments or complications which result in poor outcomes and prolonged hospitalization. The prolonged disease, stress and trauma associated with surgery, lead to a depletion of nutritional stores in the body, which is accelerated by a hypermetabolic state.
A study is currently being conducted looking at vitamin and mineral status in children with cerebral palsy and comparing this to typically developing children aged 4-12 years. Three baseline measures 6 weeks apart are being collected from all groups, with the third measure being at the time of surgery in the surgical group. These children will undergo a further 2 measures post-surgery, also 6 weeks apart, in order to compare this data with not only there own pre-measure data, but also with all of the other children’s baseline measures. Due to the potential presence of an acute phase response, a variety of functional and other novel biochemical markers are being utilised as measures of each individual vitamin or mineral.
Collaborations have also been formed with the Oxidative Stress Laboratory which will perform antioxidant, inflammation and oxidative stress measures, as well as with the Trace Element Laboratory which will be analysing 3-day food composites for trace element, mineral and protein content.
This study will provide valuable information relating to a wide range of nutritional parameters, not normally accessible to families. The necessity of adequate vitamin and mineral status for optimum physiological function and the prevention of disease cannot be overstated and is often underestimated. All results will be made available to clinicians and families at the conclusion of the study, should they desire.
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| OZGROW |
| | The Children’s Nutrition Research Centre hosts the Ozgrow study that receives data on every child in Australia and New Zealand that receives growth hormone therapy as a pharmaceutical benefit. By holding such data research can be undertaken on best dosage regimes as well as other clinically relevant analyses.
In Australia children can receive growth hormone as a pharmaceutical benefit for a number of reasons, including being below the 1st centile for height at any age, having been diagnosed with Turner’s syndrome or having neonatal hypoglycaemia. The Ozgrow research team have also been very much involved in the development of new growth charts for use in Australia which are based primarily upon the “CDC 2000” dataset.
For more information and to view and print the latest growth charts click into the Ozgrow link. | | |
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| Pathogenesis of the Metabolic Syndrome: Influence of Abdominal Adipose Depots and Skeletal Muscle Lipids, and Effect of Physical |
| | The Metabolic Syndrome is a complex medical disorder characterised by impaired insulin function (this controls blood sugar levels), unhealthy blood lipids and cholesterol, high blood pressure and obesity (especially excess abdominal fat). The condition is highly prevalent in the Australian population and is a strong risk factor for the development of cardiovascular disease and Type 2 diabetes mellitus. Recent evidence shows that the early stages of Metabolic Syndrome can begin in children and adolescents who are overweight or obese. As childhood obesity is increasing at an alarming rate in many countries, including Australia, it is important to understand more about the condition and how it can be treated or prevented.
This project included an observational study and an experimental study in a sample of 5-11 year old boys and girls. A comprehensive range of physiological tests were conducted on the participating children to investigate how the Metabolic Syndrome develops. These tests included measures of insulin sensitivity, blood biochemistry (lipid, haemostatic and adipocyte activity biomarkers), blood pressure, two-compartment body composition, abdominal adipose depots, liver fat and skeletal intramyocellular lipids. Each child’s habitual nutrition and physical activity were also analysed to determine how these environmental factors may contribute to the Metabolic Syndrome.
The children then took part in a 12-week exercise programme that was individually designed for them by an Exercise Physiologist. Following completion of this intervention, all of the physiological tests were repeated to ascertain how physical activity may affect the development of the early stages of Metabolic Syndrome.
The results of this project will help guide treatment for overweight and obese children who have, or are at risk for, the Metabolic Syndrome. It also provides important information about how the Metabolic Syndrome begins in a child’s body and directs future research into targeted prevention strategies. | | |
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| Qualitative Study of Food Choices in Young People with Type 2 Diabetes |
| | Type 2 diabetes is a recent phenomenon in young people and is usually linked to being overweight. Using focus groups, this qualitative study seeks to understand what shapes and influences these young peoples’ food and health behaviour. Parents’ attitudes and knowledge about their child’s diabetes will be assessed by a questionnaire. Families will also be asked about their expectations of treatment and their experiences to date. It is hoped that the outcome of this study will guide health professionals in their approach to these young people and hence improve the management provided. | | |
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| Relationships between Diet Quality and Body Composition in Childhood and Risk Factors of Future Disease |
| | In Australia 25 – 30% of children are now classed as overweight or obese, a figure that continues to rise. Consequently children are now more frequently diagnosed with the metabolic syndrome (TMS), a cluster of risk factors for non-insulin-dependant diabetes mellitus (NIDDM) and cardiovascular disease (CVD).
Dietary composition is an important contributor to the development of overweight and obesity and TMS, however, the role of diet in this disease process during childhood is not completely understood. Studies in adults indicate that diets low in glycemic index (GI) and glycemic load (GL) and also diets lower in saturated fats and higher in unsaturated fats are beneficial for weight loss and maintenance and reduction of TMS. Unfortunately, there are few similar studies in children.
This study explores the relationships between dietary GI and GL, saturated, monounsaturated and polyunsaturated fatty acids with adiposity and TMS in girls aged 5 – 10 years. This research will help to better understand the potential role of diet quality in development of overweight and obesity and TMS during childhood and is a crucial step in developing successful dietary strategies aimed at prevention and treatment of these health outcomes. | | |
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