Paediatric Obesity Research in Early Childhood and the Primary Care Setting: The TARGet Kids! Research Network

Primary paediatric health care is the foundation for preventative child health. In light of the recent obesity epidemic, paediatricians find themselves at the frontline of identification and management of childhood obesity. However, it is well recognized that evidence based approaches to obesity prevention and subsequent translation of this evidence into practice are critically needed. This paper explores the role of primary care in obesity prevention and introduces a novel application and development of a primary care research network in Canada—TARGet Kids!—to develop and translate an evidence-base on effective screening and prevention of childhood obesity

Evaluating the accuracy of a geographic closed-ended approach to ethnicity measurement, a practical alternative

Purpose: Measuring ethnicity accurately is important for identifying ethnicity variations in disease risk. We evaluated the degree of agreement and accuracy of maternal ethnicity measured using the new standardized closed-ended geographically based ethnicity question and geographic reclassification of open-ended ethnicity questions from the Canadian census. Methods: A prospectively designed study of respondent agreement of mothers of healthy children age 1-5 years recruited through the TARGet Kids! practice based research network. For the primary analysis, the degree of agreement between geographic reclassification of the Canadian census maternal ethnicity variables and the new geographically based closed-ended maternal ethnicity variable completed by the same respondent was evaluated using a kappa analysis. Results: 862 mothers who completed both measures of ethnicity were included in the analysis. The kappa agreement statistic for the two definitions of maternal ethnicity was 0.87 (95% CI: 0.84-0.90) indicating good agreement. Overall accuracy of the measurement was 93%. Sensitivity and specificity ranged from 83-100% and 96-100% respectively. Conclusion: The new standardized closed-ended geographically based ethnicity question represents a practical alternative to widely used open-ended ethnicity questions. It may reduce risk of misinterpretation of ethnicity by respondents, simplify analysis and improve the accuracy of ethnicity measurement.This work was supported by the Canadian Institutes of Health Research [grant numbers 248319, 221549]

Evaluating the accuracy of a geographic closed-ended approach to ethnicity measurement, a practical alternative

Purpose: Measuring ethnicity accurately is important for identifying ethnicity variations in disease risk. We evaluated the degree of agreement and accuracy of maternal ethnicity measured using the new standardized closed-ended geographically based ethnicity question and geographic reclassification of open-ended ethnicity questions from the Canadian census.  Methods: A prospectively designed study of respondent agreement of mothers of healthy children age 1-5 years recruited through the TARGet Kids! practice based research network. For the primary analysis, the degree of agreement between geographic reclassification of the Canadian census maternal ethnicity variables and the new geographically based closed-ended maternal ethnicity variable completed by the same respondent was evaluated using a kappa analysis.  Results: 862 mothers who completed both measures of ethnicity were included in the analysis. The kappa agreement statistic for the two definitions of maternal ethnicity was 0.87 (95% CI: 0.84-0.90) indicating good agreement. Overall accuracy of the measurement was 93%. Sensitivity and specificity ranged from 83-100% and 96-100% respectively.  Conclusion: The new standardized closed-ended geographically based ethnicity question represents a practical alternative to widely used open-ended ethnicity questions. It may reduce risk of misinterpretation of ethnicity by respondents, simplify analysis and improve the accuracy of ethnicity measurement.</p

Non-Western immigrant children have lower 25-hydroxyvitamin D than children from Western families

Objective: To determine if children aged 1-6 years from non-Western immigrant families have lower serum 25-hydroxyvitamin D (25(OH)D) levels than children from Western-born families and examine which factors influence this relationship. Design: Cross-sectional study. Setting: Toronto, Canada. Subjects: Healthy children (n 1540) recruited through the TARGet Kids! practice-based research network. Serum 25(OH)D concentrations of non-Western immigrants were compared with those of children from Western-born families. Children from non-Western immigrant families were defined as those born, or their parents were born, outside a Western country. Univariate and multiple linear regression analyses were used to identify factors which might influence this relationship. Results: Median age was 36 months, 51 % were male, 86 % had 'light' skin pigmentation, 55 % took vitamin D supplements, mean cow's milk intake was 1·8 cups/d and 27 % were non-Western immigrants. Median serum 25(OH)D concentration was 83 nmol/l, with 5 % having 25(OH)D Conclusions: There is an association between non-Western immigration and lower 25(OH)D in early childhood. This difference appears related to known vitamin D determinants, primarily vitamin D supplementation, representing opportunities for intervention.</p

Unadjusted and Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-Fasting Serum Lipids (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.

<p>^aAdjusted for age, sex, season, vitamin D supplementation, daily volume of cow’s milk intake, daily minutes of outdoor play, daily minutes of screen time, zBMI, and skin pigmentation.</p><p>^bP-values for secondary objectives adjusted for multiple testing using a false discovery rate controlling procedure correction. Statistical significance is defined as an adjusted P-value <0.05.</p><p>^cTriglyceride values were log transformed for analysis and back transformed results are presented.</p><p>Unadjusted and Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-Fasting Serum Lipids (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.</p

Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-HDL (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.

<p>^aTo convert from mg/dL to SI units divide the results for non-HDL, Total Cholesterol, LDL and HDL by 38.6, and divide by 88.6 for triglycerides.</p><p>Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-HDL (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.</p