Measuring obesity & nutrition in preschool aged children in the primary care practice setting
The primary care network of HISTORY is known as TARGet Kids! (Toronto Area Research Group for Kids!). The TARGet Kids! investigators, Dr. Patricia Parkin and Dr. Catherine Birken, have strong and longstanding links with community primary care paediatricians, enabling the establishment of a Toronto-wide primary care research network.
In 2001, Dr. Parkin lead an initiative during her term as Head of the Division of Pediatric Medicine at the Hospital for Sick Children, to form a Section of Community Paediatrics, headed Dr. Mark Feldman. The section currently has 92 active members, all with University of Toronto appointments. The mandate of the section is to develop the academic activities of community-based part-time faculty, primarily through participation in education. A few members of the Section have initiated, most notably Dr. Moshe Ipp, or contributed, most notably Dr. Sheila Jacobson, Dr. Michael Peer, and Dr. Carolyn Taylor, to original research projects in collaboration with the HSC Pediatric Outcomes Research Team (PORT). These research collaborations have led to important contributions to knowledge and knowledge translation regarding care delivered in community settings, including more recently the identification and prevention of childhood overweight.
TARGet Kids! is a larger network of collaborating child health researchers and practitioners in the Greater Toronto Area (GTA) including: the Paediatric Outcomes Research Team (PORT, Hospital for Sick Children), and primary care providers from the Section of Community Paediatrics, and the Department of Family and Community Medicine, Faculty of Medicine at the University of Toronto. Under the mandate of “health research for every child”, this network is collecting longitudinal medical evidence on common nutrition and health problems affecting urban Canadian children. Unique to TARGet Kids! is the concept and capacity to embed research within primary care practice, providing a large, heterogeneous sample and providing opportunity for children from diverse socioeconomic and cultural backgrounds to participate in health research. Additionally, this framework is a powerful vehicle for knowledge translation for physicians and patients.
Presently, childhood overweight is not well addressed in the health care system, other than mangement of associated morbidities. Primary care providers have frequent contact with children and parents, and thus have a unique opportunity to prevent and manage childhood obesity. Therefore, through primary care providers TARGet Kids! aims to identify prevalence, predictors, outcomes, and effective strategies for prevention of overweight and obesity in children 1-5 years of age. Priority is to be placed on those topics clinically important and responsive to the intervention of the physician and may include targeting behaviours such as healthy nutrition, activity and outdoor play, limiting television and sugar sweetened beverage consumption.
Processes and Data Collection
Children 12 months to 5 years of age are being recruited through their physician at their well-child check up. A TARGet Kids research assistant works alongside the physician and is responsible for obtaining informed consent from the parent/guardian and for all data collection at the child’s appointment.
Nutritional risk is measured using the Nutrition Screening Tool for Every Preschooler (NutriSTEP™), which is a 17 item questionnaire, developed and validated for use in children 3-5 years of age by registered dietitians. NutriSTEP™ assesses nutritional risk based on physical growth, food and fluid intake, physical activity, and factors affecting food intake in this age group. Parents also complete a child behaviour questionnaire and a questionnaire to obtain details about the child’s health, feeding, activity, and screen time. Children have weight, height/length, BMI (%tile), blood pressure, and waist circumference measured and recorded. Parents have weight, height, and waist circumference measured and recorded. Measurements are repeated at yearly well-child check ups until a maximum of 5 years of age.
Through collaboration with CALIPER (Canadian Laboratory Initiative on Paediatric Reference Intervals Database), children have a small (3-5 ml) blood sample drawn at enrollment to the study for cross sectional measurement of insulin, glucose, triglycerides, total cholesterol, HDL and LDL cholesterol and other markers of nutritional status. Measurements are repeated at yearly well-child check ups until a maximum of 5 years of age.
Throughout the 5 year period of longitudinal data collection, knowledge translation activities and dissemination of results and progress is conducted with participating physicians.
Click here to view a more detailed look at the research objectives of Primary care arm.
Network & Progress to Date
Currently, there are over 19 physicians involved with TARGet Kids! Click this link to view the TARGet KIDS! physcian list.
The network will continue to expand to involve additional community and allied health professionals.