Nutrition for children and adolescents
CHERC research in Nutrition is based on the concept of “nutritional status”, which refers to the “health and well‐being of individuals and populations as influenced by their intake and utilisation of nutrients.”
Our research covers five main themes:
- Childhood cancer
- Nutrition in children and teenagers with autism
- Nutrition and muscle health
- Children and adolescents' sports nutrition
- Cardiometabolic effects of different types of sugar
Current research projects:
Staying well-nourished throughout treatment for osteosarcoma can be challenging. Due to intensive, frequent chemotherapy that affects taste, appetite and the ability to digest and absorb nutrients, many children lose weight and strength.
This has been shown to be linked to their risk of catching infections, and to significantly impair their quality of life and ability to tolerate the effects of chemotherapy itself. Losing weight can also affect how much chemotherapy is given, sometimes resulting in reduced doses and therefore possibly less effective treatment.
Nutrition is supported differently across centres for children having osteosarcoma treatment, both within the UK and internationally. Some clinical teams recommend placing a surgical feeding tube (gastrostomy) into the stomach at diagnosis, whilst others adopt a ‘wait and see’ approach and, if nutrition deteriorates, then recommend a feeding tube is passed through the nose into the stomach (nasogastric tube).
There are potential benefits and disadvantages to both options: a gastrostomy gives a reliable route for nutrition to be given, but it can be an infection risk. Whereas nasogastric tubes are easily inserted at the bedside, but they are clearly visible, can be vomited out and the insertion procedure and sensation of the tube in the throat can be upsetting for some.
Unfortunately there is little evidence to show us which is more effective in supporting nutrition, and also most acceptable to children undergoing this treatment.
This project has two aims:
- To look back through medical notes to compare practice at two primary treatment centres to work out if nutritional support strategies used in these two centres influence nutritional status.
- To find out if there are differences in the time spent in hospital as a result of complications and the safety of both options.
Laura Sealy (Haematology, Oncology and Stem Cell Transplants), Department of Paediatric Nutrition and Dietetics, University Hospitals Bristol & Weston NHS Trust
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.
- Fergus Maclay Leukaemia Trust
- Cancer and Leukaemia Fund and GI-Research Fund
- Queen Margaret University
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.
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.
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
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:
- 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
- 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
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