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Research
Current
Research Initiatives:
Canadian
Assessment of Physical Literacy
The purpose of this
project is to improve the quality of the surveillance and
monitoring of childhood physical activity, fitness, obesity and
motor behaviours in Canada. This surveillance information is
critical to better understand how well our current health and
education systems are working; only the type of information
provided from wide-scale surveillance will subsequently lead to
anyone being able to act in the right places to tackle obesity
in a more direct fashion.
Physical Literacy
is conceived to be the tools, from multiple domains
(social/cognitive, behavioural, and fitness related) that
children need to possess or develop in order to receive the
inherent health benefits of taking part in physical activity for
life-long enjoyment and success. Part of being physically
literate is to possess the skills necessary to partake in
lifelong physical activity. The aim of this project is to
develop a comprehensive tool to measure physical activity in
Canadian schools thus allowing education and health experts to
better understand the quality and effectiveness of current
physical education programming. The collection of high quality
surveillance data on childhood physical activity, fitness,
obesity, and motor behaviours in Canada will facilitate the
understanding around the moderators and mediators of physical
activity and how these relate to obesity. After assessing the
feasibility and validity of the Canadian Assessment of Physical
Literacy (CAPL) in Ontario schools, we plan to use this tool to
comprehensively, and where possible, objectively measure the
status of physical activity, fitness, obesity, motor skill
proficiency and related psychosocial mediators and moderators
(e.g. knowledge, attitudes, preferences) of Canadian
school-children on a nation-wide scale. Ontario schools will be
used to initially develop the tool due to the location of the
research team. Initially the CAPL will be designed for children
in grades 4-6; subsequent versions will assess the other grade
levels. In addition to large scale surveillance and monitoring
the tool will also facilitate the evaluation of future changes
and interventions in physical education. The tool will provide
critical information to both health and education specialists
about the state of the childhood inactivity and how this relates
to the obesity crisis in Canadian children and will ultimately
help direct future interventions. Childhood obesity is a
multi-dimensional problem and will take a comprehensive,
multi-disciplinary approach to fully understand and correct.
Despite attention and efforts to slow the childhood obesity
epidemic, very little progress has been realized. Part of the
problem is a lack of well-measured data on the contributors to
obesity, in particular physical inactivity; a behaviour that is
affected by many factors including motor skills, fitness and
psycho-social characteristics.
Appetite Signaling Proteins and Energy Intake in Obese
Adolescents with Binge Eating Disorder: A Pilot Study
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Principal investigator;
Kristi Adamo
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Co-investigators; Hadjiyannakis/Goldfield/Doucet
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Funding Source; Children’s Hospital of Eastern Ontario
Research Institute (CHEO RI)
The
increasing prevalence of obesity in youth is due to positive
energy balance resulting from increased energy intake vs. energy
expenditure. Our “toxic environment” characterized by an
overabundance of palatable food rich in fat and sugar encourages
over-eating. Appetite regulation and the control of food intake
is thereby of great scientific interest and clinical relevance.
Feeding behaviour is the result of complex interactions between
genetic, biological, environmental and psychosocial factors.
From a biological perspective, food intake is controlled by
hunger and satiety signals. The signals are generated in
peripheral organs, such as the digestive tract and adipose
tissue, and in the brain itself. Hunger and satiety signals
generated by the GI tract, including ghrelin, PYY, and GLP-1,
have been implicated in the short-term regulation of food
intake. The primary objectives of this study are to assess
whether there are differences in the temporal patterns of
ghrelin, PYY, and GLP-1 and sensations of satiety following a
standardized test meal between obese adolescents with and
without binge eating disorder (BED). Secondary objectives are
to evaluate whether there are baseline differences between
fasting levels of ghrelin (hunger stimulating peptide) and PYY,
GLP-1 (satiety hormones) in obese adolescents with BED vs. obese
adolescents without BED; determine whether the levels of
signaling proteins released after a standard meal predict the
sensation of satiety and fullness and/or the amount of food the
adolescent will consume when provided with ad libitum access.
Physiological and psychological predictors
and determinants of metabolic complications of pediatric
obesity: A Cohort Study
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Principal investigator;
Kristi Adamo
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Co-investigators; Hadjiyannakis/Goldfield/Dagenais
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Funding Source; Canadian Diabetes
Association (CDA)
This study is intended to be an exploratory
2-year prospective, observational cohort feasibility study of
obese children attending the CHEO pediatric endocrinology
clinic. It is expected to generate data and hypotheses that will
be used to inform sample size calculations in future studies.
For this initial study, children will be recruited over 1 year
and followed for a period of one year after recruitment. The
initial plan is to gather clinical data obtained during a
comprehensive patient assessment protocol to determine the
feasibility of enrolling a larger group of patients into a
long-term study with the goal of answering important research
questions aimed at improving patient care in this population.
There will be 4 dimensions related to child obesity being
assessed bi-annually in the children visiting CHEO’s PEC. These
include: i) Biomarkers-plasma, serum and urine factors as well
as abdominal ultrasound and sleep study, ii) Body Composition-
height, weight, BMI, and body fat, iii) Physical Activity,
Fitness & Nutrition-7-day physical activity recall &
accelerometry, VO2 peak, and dietary intake, iv) Psychosocial &
Behavioural Factors- eating behaviour and food practices,
quality of life, depression, anxiety, stress, self-esteem, and
coping. Ultimately, it is our intent to systematically evaluate
the population visiting this clinic to determine the prevalence
of and predictors of various obesity related co-morbidities.
These data will aid us in developing an effective course of
action for the management of obesity and related co-morbidities
at the CHEO Pediatric Endocrinology Clinic.
Feasibility and Short-term Efficacy of the
GameBike to Increase Physical Activity in Obese Adolescents
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Principal investigators;
Gary Goldfield, Kristi Adamo
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Co-investigators; Hadjiyannakis/Bouchard/Lapierre
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Funding Source; Canadian Diabetes
Association (CDA)
The primary objective is to evaluate the feasibility of using
the GameBike to increase physical activity in obese youth aged
13-17 years. While quantitative measures of feasibility
including compliance, attrition, and safety/tolerability are
important and will be measured, the primary objective will be to
evaluate the degree to which the GameBike, a recumbent bicycle
interfaced with a PlayStation, increases energy expenditure
(kcal) during 2 weekly laboratory exercise sessions over a
10-week study period as compared to a standard cycling control
group. Additionally measured and compared in both groups before
and after the intervention will be aerobic fitness, body
composition, free living physical activity, sedentary behaviour,
diet, and psychosocial functioning.
Kenyan International Development Study -
Canadian Activity Needs (KIDS-CAN) Research Alliance
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Principal investigators;
Mark Tremblay,
Kristi Adamo, William Sheel
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Co-investigators; Onywera, Boit, Waudo
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Funding Source; Canadian Institutes of
Health Research (CIHR)-International Opportunities Partnership
The objective of this project is to establish a collaborative
partnership with the Department of Exercise and Sport Science,
at Kenyatta University in Nairobi, Kenya that will: i) promote
and facilitate research in the area of determinants/predictors
of child obesity, specifically using Kenya as a model to study
the physical activity and nutrition transition ii) facilitate
international research exchange thereby allowing for the
training and support of young researchers/trainees who are
interested in this area of study, increasing research capacity
in both countries (and perhaps others) iii) evolve into a
long-term international collaboration to promote the generation
of data, training opportunities, knowledge exchange and
knowledge translation on child obesity-related factors (physical
activity, eating behaviours, environmental and biological
determinants) including effective dissemination of findings and
iv) serve as a model (or nucleus) for expansion of the
international partnership to other countries.
Active Healthy Kids Canada Report Card (AHKC)
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Principal investigators;
Mark Tremblay,
Rachel Colley
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Funding Source; Active Healthy Kids Canada
(AHKC)
Active Healthy Kids Canada’s Report Card on Physical Activity
for Children and Youth (“Report Card”) is a research-based
communications and advocacy piece designed to provide insight
into Canada’s “state of the nation” each year on how, as a
country, we are being responsible in providing physical activity
opportunities for children and youth.
The development of each annual Report Card is largely supported
by the work of a Research Work Group. The Research Work Group
includes an interdisciplinary selection of experts that are
responsible for identifying and ranking Report Card indicators
based on available data, research and key issue areas that can
be graded nationally. As part of the development process the
Research Work Group also accesses additional experts/researchers
to fill issue specific gaps as applicable. Once gathered, the
raw report card data is organized into a detailed version (long
form) of the Report Card and condensed to produce a summary
(short form) Report Card. The Healthy Active Living and Obesity
Research Group at the CHEO-Research Institute has entered into a
strategic partnership agreement whereby the HALO research group
will serve as the knowledge and research engine for the Active
Healthy Kids Canada Report Card. HALO leads the development,
coordination, data gathering, evidence synthesis and expert
response related to the Report Card preparation and release.
Maternal, Infant, Child and Youth Research
Network (MICYRN)
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Principal investigators;
Mark Tremblay,
Team
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Funding Source; Children’s Hospital
Foundations, Canadian Institutes of Health Research (CIHR),
Canadian Foundation for Innovation (CFI)
The Maternal, Infant, Child and Youth Research Network (MICYRN)
is a multi-disciplinary initiative to support world-class health
research nationwide. The internationally unrivalled team
proposes to establish the requisite and comprehensive national
framework and infrastructure required to optimize the clinical
care of, and health outcomes in, Canadian mothers, infants,
children and youth. To achieve this goal, MICYRN has established
eight interrelated core initiatives addressing key research
needs: Training, Research Methods, Research Ethics and
Regulatory Affairs, Data Management, Biobanking, Research
Partnerships, Knowledge Translation and Funding Partnerships.
MICYRN has identified obesity as an emerging and poorly
understood problem in Canada requiring urgent coordination and
direction in its research efforts. The prevalence of obesity is
increasing worldwide at an alarming rate; in 2003, the World
Health Organization declared obesity as a global epidemic.
Childhood obesity in Canada has risen 3-fold over the last three
decades such that we now have one of the highest rates of
childhood obesity in the developed world. Canada is now faced
with a unique and timely opportunity to bring researchers and
clinicians together to increase the quality and strength of
research efforts in a way that could not be achieved through
independent initiatives.
MICYRN will undertake a comprehensive investigation of the
biological and environmental determinants of obesity-related
complications throughout the lifespan from the prenatal period
through to adolescence with a particular interest in the
development of innovative and effective interventions aimed at
the prevention and management of obesity. To achieve this
over-arching goal, MICYRN will build research infrastructure and
investigate obesity-related research hypotheses within the
Canadian context.
Prevalence of Markers of Insulin Resistance among Offspring
Exposed to Gestational Diabetes: A 13 to 17 Year Follow-Up Study
of a RCT Cohort (GDM)
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Principal investigators:
Dr. Stasia
Hadjiyannakis
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Co-investigators:
Teresa
Pinto, Kristi Adamo, Jane Rutherford, Janine Malcolm,
Erin Keely, Gary Goldfield, Isabelle Gaboury,
Margaret Lawson
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Funding Source: Children’s Hospital of Eastern Ontario
Research Institute
Gestational Diabetes Mellitus (GDM) is defined as “carbohydrate
intolerance of variable severity with first recognition during
pregnancy”. There is increasing evidence to suggest that
offspring of women with GDM are at an increased risk of
long-term consequences such as obesity and abnormalities of
glucose metabolism including Type 2 diabetes. This study aims
to determine whether differences in the prevalence of markers
of insulin resistance and body composition exist in a cohort of
offspring of women with GDM when compared to a control group
matched for age, sex, pubertal stage and BMI. Offspring (aged
12-17 years of age) of mothers with GDM will be examined for
markers of insulin resistance [increased waist circumference,
hypertension, hypertriglyceridemia, low HDL-cholesterol,
Impaired Glucose Tolerance,Impaired Fasting Glucose] and body
composition as measured by percent body fat (DEXA), abdominal
obesity (waist circumference) and compared to a matched control
group. The possibility of prenatal and postnatal interventions,
targeting known modifiable risk factors could play an integral
part in preventing or attenuating this epidemic of obesity and
Type 2 Diabetes
Think Tank:
Obesity and pregnancy – an opportune time for intervention to
prevent
long-term
sequelae
in mothers and their
offspring
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Principal investigators: Dr. Erin Keely (Ottawa
Hospital)
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Co-investigators: K Adamo, S Hadjiyannakis,
G Goldfield, M Walker, S Wen, J Malcolm, M Lawson
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Funding Source: Canadian Institutes of Health
Research (CIHIR) : Institute of Nutrition, Metabolism
and Diabetes (INMD)
Maternal pre-pregnancy BMI and gestational weight gain (GWG)
which, directly or indirectly modify the intrauterine
environment, are known to be important predictors of
growth/development trajectories and contributors to
overweight/obesity in children. Mean infant birth weight is
highest in women who are overweight/obese pre-pregnancy as well
as those with excessive weight gain during pregnancy. This
significantly increases the odds of overweight in pre-school,
adolescence and adulthood making fetal development a critical
period for preventative measures. Furthermore, high pregnancy
weight gain is also associated with higher postpartum weight
retention and higher risk of post-partum obesity leading to a
wide range of associated downstream health conditions for
mothers and offspring. Thus, maternal BMI and GWG may be
amongst the most important issues related to the short and
long-term risks for pediatric and maternal obesity and thus,
interventions targeted at decreasing maternal BMI and GWG have
the potential to significantly impact public health.
Researchers with expertise in this area were invited to attend a
one-day symposium to discuss the development of an exercise and
nutrition program for overweight/obese pregnant women that will
aim to reduce excessive weight gain during pregnancy. The
symposium served to inform the development of a lifestyle
intervention for women with an elevated pre-pregnancy BMI, with
the intent of applying to CIHR for funds to evaluate the
efficacy of the program at limiting excessive GWG, macrosomia,
post-partum weight retention and possibly obesity in early
childhood.
CIHR Team in Critical Periods of Body Weight Regulation: A
Women’s Health Perspective SOMET: Sherbrooke-Montréal-Ottawa
Emerging Team
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Principal Investigator: Denis Prud’homme
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Co-Investigators: K Adamo (Critical period of
Pregnancy/Maternal Obesity Team Leader)
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Funding Source: Canadian Institutes of Health Research (CIHR)
The proposed CIHR Team is a multidisciplinary research group
that will investigate the problem of body weight regulation in
women during three critical periods: gestation/post-partum,
peri-menopause and menopause years. The
objectives
are to; (1) understand the complex interactions between the
bio-psycho-social-cultural and environmental factors underlying
body weight regulation in overweight and obese women with and
without glucose intolerance (2) develop and evaluate
integrative obesity prevention and treatment approaches,
specific to these critical periods, with the combined expertise
of an inter-professional health team and institutional partners
using new multi-level intervention programs, (3) develop
practical planning tools to promote the adoption of new
knowledge into practice. The findings of this research program
will improve the health of Canadians and the Canadian health
care system.
The specific
aim of the gestation/postpartum piece is
to determine the effect of a structured physical activity and
nutritional intervention provided to overweight/obese pregnant
women on gestational weight gain, gestational diabetes, infant
birth weight, post-partum weight retention, and longitudinal
child BMI.
Champlain Healthy School-Aged Children: Parental Attitudinal
Survey
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Principal Investigators: Champlain Healthy School-Aged
Children Initiative working group (Dr. Kristi Adamo –
CHEO/HALO representative)
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Funding Sources: Eastern Ontario Health Unit, Leeds
Grenville & Lanark Health Unit, City of Ottawa, Heart &
Stroke Foundation Ontario, Champlain LHIN, University of
Ottawa Heart Institute Children’s Hospital of Eastern
Ontario
The Champlain Healthy School-Aged Children Initiative is
focused on addressing the cardiovascular health among children
and youth, the goal being to create environments that encourage
healthy eating and regular physical activity in school-aged
children, and to facilitate knowledge and skill development to
make healthy choices. The committee decided to undertake an
attitudinal survey of parents to better understand perceptions,
knowledge, and behaviours surrounding childhood
overweight/obesity and related physical activity and healthy
eating habits. The survey targeted 1940 parents of children aged
4 to 12 across the Champlain District and was conducted via
telephone. The information generated from this survey will be
used to inform next steps in our
Champlain Healthy School-aged Children initiative, including
development of a mass media communications campaign targeting
parents of school-aged children that is supportive of existing
healthy school programming in our region. The survey was
conducted jointly on behalf of several regional partners, namely
the University of Ottawa Heart Institute (UOHI), the 4 Champlain
District Public Health Units (City of Ottawa, Renfrew County &
District, Eastern Ontario, and Leeds, Grenville & Lanark), the
Heart and Stroke Foundation of Ontario (HSFO), and CHEO
Family-Based Behavioural Treatment of Childhood Obesity via
Internet A Randomized Controlled Trial.
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Principal Investigator: Dr. Gary Goldfield (CHEO/HALO)
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Co-Investigators: Dr. P. McGrath, Dr. S. Hadjiyannakis,
Dr. R. Sigal
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Funding Source: Heart & Stroke Foundation of Canada
Background: Because obese children are more likely to become
obese adults than lean children, and research shows that obesity
treatment in adults is largely ineffective in the long-term,
intervention during childhood is critical to prevent adult
obesity and related diseases. Family-based behavioural
treatment for childhood obesity has been proven to be the
treatment of choice, but this method of service delivery is
labor-intensive, designed for small numbers of families, and not
widely available. The deficits in service provision are
striking when one considers that 25% of children are overweight
or obese, yet there is only a few multidisciplinary childhood
obesity clinic in Ontario. This discrepancy between the supply
and demand for comprehensive child obesity treatment highlights
the need to explore alternative methods of service provision.
Rapid increases in access to the Internet make it a viable
medium of public health intervention, but no studies have used
this medium to deliver child obesity treatment.
Objectives: The primary objectives of this study are to
evaluate the feasibility as well as the effects of a
comprehensive family-based behavioural intervention for
childhood obesity delivered via Internet and an
education-control delivered by Internet on percent body fat
measured using BIA in 8-12 year old overweight or obese
children. Secondary objectives include evaluating the effects
of the intervention on children’s BMI, waist and hip
circumference, and quality of life in children and parents will
also be examined.
Study Design/Intervention: Parallel group randomized controlled
trial conducted at a single site (CHEO). Forty children (and
parents) will be randomized in equal numbers to family-based
behavioural intervention via Internet or Internet-based
education-control. The behavioural intervention will deliver
behaviour modification in eating and activity behaviours through
multiple forms of interactive media, including regular (3x/week)
contact and individualized feedback from a therapist and
dietician using email, chat rooms for social support/education,
videographic instruction on behaviour modification techniques,
and education modules in healthy eating and active living
available for downloading (in modular format) on our secure
website. The education-control group will just receive education
in healthy eating and active living available for downloading on
a separate secure website. The intervention period will last 3
months, with a follow-up assessment at 6-months
post-randomization.
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