Nutrition for children and adolescents

Cancer treatment

Nutritional Assessment and Management of Paediatric Cancer Patients during treatment

The aims of this project are to investigate the prevalence of malnutrition, patterns of change in nutritional status and factors contributing to malnutrition in children and young people diagnosed and treated for cancer. 

This will help identify what group of patients have malnutrition and when it occurs, to help develop nutrition screening and nutritional interventions.

Funding bodies

• Fergus Maclay Leukaemia Trust
• Cancer and Leukaemia Fund and GI-Research Fund
• Queen Margaret University

Collaborators

• Dr Mark Brougham (Dept. Paediatric Haematology and Oncology, Royal Hospital for Children and Young People, Edinburgh)
• Prof David Wilson (Child Life and Health, University of Edinburgh; Dept. of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh)

Childhood cancer survivors

The role of diet and physical activity on cardiovascular health in childhood cancer survivors (CCSs)

Cardiovascular disease (CVD) is the leading non-malignant cause of death in CCSs, and the risk of mortality in CCSs is 7- fold higher than in age-matched peers. Some studies consistently show the heightened risk and early onset (younger than 30 years) of cardiovascular events, cardiac dysfunction and CVD risk factors in CCSs.

Diet and physical activity (PA) play a significant role in preventing the occurrence of CVD risk factors, as well as the development of cardiac dysfunction and CVD. While the impact of diet and PA on cardiovascular health has been extensively studied in the general population, their role in the cardiovascular health of CCSs is not well-established. There are no specific diet and PA guidelines for CCSs in any country. The diet and PA recommendations for general populations may provide some guidance; however, these guidelines may not fully address the unique needs of CCSs.

Consequently, there is a gap in understanding the association between diet and physical activity and cardiovascular health in CCSs.

The overarching aim of this project is to fill the knowledge gap in this field, investigate the role of diet and PA in cardiovascular health of CCSs.

Funding

Chinese Scholarship

PhD student

Ruijie Li

Research Centre

Children’s Health and Exercise Research Centre (CHERC)

Collaborators

• Professor Alan Barker
• Dr Dimitris Vlachopoulos

Partners

Dr Fabien Belle and Prof Christina Schindera (Institute of Social and Preventive Medicine), University of Bern, Switzerland

Autism Spectrum Disorders

Nutrition in children and teenagers diagnosed with Autism Spectrum Disorders 

Children with Autistic Spectrum Disorders (ASDs) may be nutritionally vulnerable due to their selective eating patterns, food neophobia, limited food repertoire, and sensory sensitivity, which predisposes them to nutrient deficiencies and may lead to malnutrition (undernutrition and obesity), poor growth and development.

In some cases, this may be worsened by implementing unnecessary restrictive diets, such as casein-free and gluten-free, intending to reduce ASD symptoms.

In order to perform nutritional interventions in the future, it is first necessary to identify the dietary needs and deficiencies of this population and how these could be implemented in practice.

Using a mixed-method approach, the aim of this project is to explore the dietary intake of children diagnosed with Autism Spectrum Disorder (ASD), challenges experienced by parents and caregivers, and potential enablers that could facilitate nutritional interventions in the future. 

PhD student

Afnan Alhrbi

Research Centre

Children’s Health and Exercise Research Centre (CHERC)

Collaborators

• Professor Chris Morris
• Dr Dimitris Vlachopoulos

Cystic Fibrosis

Nutrition in children and adolescents with Cystic Fibrosis

Cystic Fibrosis (CF) is an autosomal-recessively inherited multisystem disorder that affects 1 in 3000 newborn Caucasian children, with slightly lower prevalence noted in other ethnic groups. CF affects a number of body systems and is associated with gastrointestinal, hepatobiliary, sinopulmonary and bone disease.

Higher morbidity and mortality rates are principally due to unresolving and unremitting infections that cause progressive lung disease. Malabsorption as a result of pancreatic insufficiency may impair growth velocity and lead to a reduction in fat-soluble vitamins levels (vitamins A, D, E & K). 

Traditionally, the cornerstone of nutrition in patients with CF was a diet high in calories, salt and supplementation of fat-soluble vitamins. This is in conjunction with pancreatic enzyme replacement therapy due to malabsorption. When the oral caloric intake is not enough to reach the anthropometric nutritional goals, enteral feeding is often initiated to improve nutritional status (growth). The recent introduction of CFTR modulators have significantly improved pulmonary function and reduced exacerbations and is leading to higher obesity (high Z-BMI) rates and alterations in body composition.

This has led to new and exciting areas of research: 

• To develop energy requirements equations tailored to new clinical needs
• To investigate the relationship of nutrient intake and status and their impact on body composition and lung function in children and young people with CF
• Control trials and mechanistic studies in which the role of nutrients on pulmonary health in children and young people with CF is studied 

Research centre

Children’s Health and Exercise Research Centre (CHERC)

Researchers

• Prof Craig Williams
• Dr Raquel Revuelta Iniesta
• Dr Dimitris Vlachopoulos

Partners

Royal Devon and Exeter NHS Foundation Trust 

Sports nutrition 

Children and adolescents’ sports nutrition

Good nutritional practices are important for exercise performance and health during all ages. Athletes and especially growing children engaged in heavy training may have higher energy and nutrient requirements compared to their non-active counterparts.

Scientific understanding of sports nutrition for the young athlete and highly active children and adolescents is lacking behind the growing number of young athletes engaged in sports.

Most of the sports nutrition recommendations given to this cohort are based on adult findings due to a lack of age-specific information and research. Thus, research looking into this field is warranted, specifically:

1. The impact of food and nutrition on exercise performance, growth (and nutritional status), metabolism and development of children and adolescents playing different sports at a high level
2. To identify “what, when and how much” food and nutrition children and adolescents, who engage in heavy training, should have in order to lead to optimal growth, development, and wellbeing as well as higher performance

Research centre

Children’s Health and Exercise Research Centre (CHERC)

Collaborators

• Associate Prof Alan Barker
• Dr Bert Bond
• Dr Raquel Revuelta Iniesta
• Dr Dimitris Vlachopoulos
• Prof Craig Williams

Cardiometabolic effects of sugar

Cardiometabolic effects of different types of sugar

Clinically, cardiovascular disease (CVD) presents in adulthood; however, subclinical risk factors start to become apparent in childhood. Children and adolescents who present with CVD risk factors have impaired micro- and macro-cerebrovascular function, which may have implications for future cardiovascular and cerebrovascular health.

The consumption of sugar-sweetened beverages in adolescents has received interest for their potential role in elevating future CVD risk, independently of weight status. It is well known that adolescents consume the highest amounts of sugar-sweetened beverages; however, its effects on CVD and cerebrovascular function is largely unexplored.

Contrary to evidence from adults, a study performed in CHERC using state-of-the-art micro- and macro-cerebrovascular function techniques found that glucose consumption acutely increased peripheral vascular function in healthy adolescents and acute sugar-sweetened beverage consumption (sucrose) did not result in adverse vascular outcomes; however, elevations in uric acid were observed with fructose consumption, which may have implications over repeated exposure.

Future research projects should investigate the chronic effects of different sugars on micro- and macro-cerebrovascular function  

Research centre

Children’s Health and Exercise Research Centre (CHERC)

Researchers

• Jodie Koep
• Rhys Banks
• Rohit Banger
• Alice Lester
• Kate Sansum
• Max Weston

Supervisors

• Dr Bert Bond
• Associate Prof Alan Barker