Trainee Research Day

Meeting ID: 844 2360 0192
Passcode: 505319

Presentations

Vitamin D Supplement Use in Healthy Toddlers Living in Metro Vancouver

Department of Pediatrics

Victoria Lampkemeyer, Undergraduate Student

ABSTRACT: Vitamin D is an essential micronutrient for optimum health in early childhood, as its deficiency can lead to rickets and possibly other poor health outcomes. Our objective was to determine vitamin D supplement use in healthy toddlers at ages 1 and 2 years. Methods: This is a secondary analysis of data from toddlers enrolled in a double-blind randomized controlled trial of arachidonic acid and docosahexaenoic acid supplementation between ages 1 and 2 years. Longitudinal data of toddlers in Metro Vancouver were collected at baseline (n = 133) and at 2 y (n = 112). Information about supplement use was collected by questionnaire from the toddler’s parent or caregiver. Results: At age 1 and 2 years, respectively, 40.6% (n = 54) and 42.9% (n = 48) of toddlers used vitamin D containing supplements; 25% (n = 28) were using supplements at both ages. The median daily vitamin D intake from supplements at age 1 y and 2 y respectively was 400 IU (range, 57.1 - 800 IU) and 257 IU (range, 57.1 – 2000 IU). Considering vitamin D intake from supplements alone, 74.1 % of supplement users at age 1 y and 41.7 % of supplement users at age 2 y met the Estimated Average Requirement (EAR) of 400 IU per day for toddlers (1-3 y) in North America. No toddler exceeded the Tolerable Upper Intake Level (UL) of 2500 IU per day (1-3 y). The most common reason for vitamin D supplement use was recommendation by a health practitioner (43.6 % at 1 y, 34.0 % at 2 y) followed by perceived general health benefits (25.5 % at 1 y, 32.0 % at 2 y). The supplements most frequently consumed were vitamin D drops (83.6 % of supplements at age 1 y, 51.0 % of supplements at age 2 y) followed by liquid multivitamin supplements at age 1 y (12.7 %) and multivitamin gummies at age 2 y (27.5 %). Conclusion: The use of supplements containing vitamin D was common in toddlers in Metro Vancouver. A large proportion of toddlers met vitamin D recommendations by supplement use alone. Ongoing studies are examining total vitamin D intake from foods, beverages, and supplements to evaluate the overall adequacy of vitamin D intake and to determine the relationship to vitamin D status.

Neonatal Intensive Care Unit Caregiver Participation in Research: A Qualitative Analysis

School of Nursing

Connie Ku, Masters Student

ABSTRACT: Investigate NICU parents’ interactions and experiences with research involving their child to explore factors that contribute to improved research participation. Methods: Parents who currently or previously had a(n) newborn/infant in the BCWH NICU in the past 15 years were invited to participate via direct contact or social media platforms. Qualitative description was employed using semi-structured interviews, verbatim transcription, and thematic analysis from September 2018 – September 2019. Results: 31 parents were interviewed; 23 mothers and 8 fathers. Data analysis revealed three main themes: 1) Adaptation to the NICU: Adjusting to the NICU required navigating the clinical environment by familiarizing with the foreign technologies, the roles of the healthcare providers, and finding a manageable routine. Parents who moved from emotions of stress and unfamiliarity to hopeful and acquaintance, described their increased receptibility to being approached for research and altruistic motives for participating in research. 2) Confidence in infant wellbeing: As the child’s health improved, parents transitioned from feelings of fear to feelings of optimism, resulting in more participation in the child’s care and became open to hearing about research opportunities. 3) Parent role establishment: Parents who transitioned from passive observer to active caregiver had decreased feelings of powerlessness and began feeling that they had a purpose and became emotionally ready to review research information. Conclusion: Understanding the experiences of families transitioning through their NICU journey will help inform how research can be presented in a supportive and trauma-informed manner and contribute to the development of a family-centred approach to research recruitment.

A Potential Retrospective Biomarker of Early-Life Stress: Steroid Profiling in Human Deciduous Teeth

Department of Psychology

Shorter Wu, Masters Student

ABSTRACT: The stress response is regulated by glucocorticoids, a class of steroid hormones released from the adrenal glands. Glucocorticoids promote processes that serve immediate energy needs, such as mobilization of glucose and oxygen, and inhibit processes that are costly and secondary to survival, such as growth and reproduction. Early-life exposure to stressors leads to hypersecretion of glucocorticoids and drastically increases the risk for developing various diseases later in life. However, there are currently no tools that can retrospectively measure long-term stress exposure in children. Here, we attempt to fill this gap using a non-invasive method of measuring glucocorticoids in deciduous (baby) teeth. During tooth formation (in utero to 2-3 years), glucocorticoids may become embedded in teeth. Thus, deciduous teeth may serve as biomarkers for early-life stress. We developed a protocol that measures multiple steroids through state-of-the-art liquid chromatography tandem mass spectrometry (LC-MS/MS). We validated our method with linearity and recovery tests, which demonstrated accuracy, precision, and sensitivity. We measured a panel of 16 steroids and consistently detected 9 steroids: cortisol (the main glucocorticoid in humans), cortisone, corticosterone, 11-dehydrocorticosterone, pregnenolone, progesterone, androstenedione, testosterone, and dehydroepiandrosterone. These novel data suggest that steroid hormones are embedded in human teeth. Future studies will investigate differences in dental steroid levels between sexes and among children of varying socioeconomic status.

The Double Burden of Malnutrition: early life epigenetic implications

Biochemistry and Molecular Biology

Karlie Edwards, Masters Student

ABSTRACT: Developing countries are facing an emerging health concern known as the double burden of malnutrition (DBM). Children are exposed to low nutrient malnutrition early in life and then as their society gains access to more food options that are typically processed and higher in fat, they are predisposed for obesity and early onset of non-communicable diseases. The dichotomy of malnourishment through wasting coupled with obesity can exist within an individual, household, and/or community and places a large burden both financially and on overall health outcomes. With the earlier onsets of non-communicable diseases such as diabetes and heart disease, there is evidence of immune system dysregulation. Using a mouse model, we will be looking at the changes that occur within immune cell populations and around the genome to better understand the effects of the DBM on immune system development and what is causing the observed disease phenotypes.

Early childhood poverty and immigration background predicting development and well-being of children in British Columbia

School of Population and Public Health

Randip Gill, PhD Student

ABSTRACT: In British Columbia (BC), about 1 in 5 children were growing up in poverty in 2018, with nearly half of recent immigrant children living in poverty. Childhood poverty is associated with a myriad of harmful conditions, including but not limited to exposure to greater crime and violence, nutritional deficits, and inadequate housing and living conditions. The present study uniquely examines the relationship between combinations of early life (ages 0 to 5) household (HH) and neighbourhood (NH) poverty with teacher-rated developmental and well-being outcomes of children in BC, and how this relationship may be modified by the immigration characteristics of the child’s family, and transitions into and out of poverty. METHOD: A population-based, linked dataset was utilized containing ratings of children’s cognitive development and well-being (from the Early Development Instrument; EDI), and children’s administrative birth characteristics data, health insurance registration and subsidy data, neighbourhood income data, and immigration records. The study cohort included children who resided within BC in 10 selected school districts and were born between 1990 to 2006, with data up to 2017. The analytic sample included 15,373 children. Multivariable linear and logistic regression were used to estimate the association between poverty experience, and poverty trajectory categories, to total EDI score and EDI developmental sub-domain outcomes. RESULTS: Preliminary analyses found that across both total EDI score and EDI sub-domains, experiencing combined poverty (both HH and NH poverty) early in life was associated with worse outcomes at kindergarten. In addition, the association between poverty experience to developmental outcomes differs based upon children’s migration backgrounds and the type and timing of poverty experienced. For example, non-migrant children scored higher in total EDI score and EDI domains (except for physical well-being) in comparison to second generation immigrant children when not experiencing poverty, but scored similarly when both groups of children had experienced combined poverty in infancy. CONCLUSION: Developmental outcomes of children at kindergarten differ based upon the type and timing of poverty experience, as well as migration characteristics of these children’s families. These findings at a population level can inform further inquiry into policy or practice to address inequities.

Positive Youth Development in a global context: A mixed-method project to examine assets in relation to positive development in children in Pakistan

School of Population and Public Health

Salima Kerai, PhD Student

ABSTRACT: Nearly 90% of the world’s children live and grow up in low- and middle-income countries (LMICs), where adverse socioeconomic conditions, heavier burden of disease and fewer opportunities (e.g., education, employment), jeopardize their healthy development (Patton et al., 2009). Scholars, WHO and UNICEF have stressed a need for research that informs action on the ground and supports the positive development of children and youth in LMICs. However, research examining strength-based assets that predicts positive child development has been conducted almost exclusively in Western countries; a global perspective that focuses on the voices of children is missing. Using principles of Positive Youth Development (Lerner et al., 2009) and Bronfenbrenner’s Bio-ecological context model of human development (Bronfenbrenner & Morris, 2006), the goal of this project is to understand current assets (e.g., nutrition, positive school climate, supportive relationships) in Pakistani school aged children (11- to 15 years) and how they are related to indicators of positive youth development (e.g., optimism, satisfaction with life, anxiety). Using a mixed-methods research design, our research team, composed of scholars from the University of British Columbia (UBC) and Aga Khan University (AKU, Pakistan), will translate, culturally adapt, implement and validate a widely used Canadian survey (i.e., the Middle Years Development Instrument; MDI) among children in Karachi, Pakistan. This presentation will specifically speak about the MDI translation and adaptation study from this project. The MDI is a population-level, child self-reporting tool, implemented in schools across British Columbia since 2013, to inform positive youth development in the Canadian context. Using the framework proposed by Geisinger and Hambleton, we have, so far, completed the translation, which was reviewed by an expert committee panel. We are now in process of conducting the focus group interviews to adapt and pretest the MDI among children in Karachi. The results from this study will inform the final tool implementation among N=1500 6th to 8th grade children in public schools in Karachi to support validation and regression analyses. Stakeholders, including educators, researchers, and children in Karachi, have been involved since the research outset, including all steps of translation. We expect adaptation study to be completed within the next 6 months with the entire project being concluded within 24 months.

DNA Methylation Differences in HIV-exposed newborns

Genome Science and Technology

Hannah-Ruth Engelbrecht, PhD Student

ABSTRACT: The number of children in Sub-Saharan Africa who are born HIV-exposed due to maternal HIV infection but who themselves are uninfected is growing every year – approximately 22% of infants born per annum in South Africa are HEU. These children are known as HIV-exposed uninfected (HEU), and display a range of health effects in early childhood, included impaired immune responses, increased susceptibility to infection, and neurodevelopmental delay. The mechanisms underlying these differences are unclear, and there is minimal investigation at present. DNA methylation, an epigenetic mark which can be an indicator of environmental exposure at any life stage as well a potential regulator of gene expression, was investigated in cord blood from South African infants (nTOTAL=268; nHEU= 68) who were either HEU or unexposed. Epigenetically-predicted age acceleration did not indicate a difference between the two groups, and no differences in cell type proportions were observed. However, a global increase in DNA methylation was observed in HEU infants according to detected probes from the Illumina 450K array. Single-site differences, reflecting both increases and decreases in methylation, were detected at 14 loci when comparing the exposed and unexposed groups of infants. Furthermore, within the HEU group, a further 5 sites were differentially methylated based on exposure to particular antiretrovirals in a variety of genes and genomic regions. The findings of this study indicate methylation differences with a high degree of statistical confidence that could be further investigated in larger cohorts, and form a foundation of knowledge to improve the care provided to HEU children by understanding the basis of their adverse health effects.

Early Life Adversity and the Cortisol Awakening Response in Depression: A Meta-Analysis

Department of Psychology

Ellen Jopling, PhD Student

ABSTRACT: Although cortisol-awakening-response (CAR) dysregulation is frequently documented among depressed individuals, there is conflicting evidence on the direction and degree of dysregulation, which impedes our ability to provide personalized and efficacious treatment. Early life adversity (ELA) is posited to explain variability within the CAR-depression literature, but the effect of ELA on CAR in depression has not yet been quantified. Methods: We meta-analyze 19 studies (n = 2,053) examining the association between ELA (broadly defined) and CAR amongst depressed individuals. Data were pooled using random-effects models for ELA overall, ELA characterized by threat, and ELA characterized by deprivation. Results: Among depressed individuals, greater exposure to ELA was associated with a steeper CAR (r = .18, 95% CI [.08, .27]). This effect was moderated by sample size and year of publication. Further, in line with hypotheses, among depressed individuals, greater exposure to ELA characterized by threat was associated with a steeper CAR (r = .15, 95% CI [.05, .24]), whereas ELA characterized by deprivation was not (r = .03, 95% CI [-.04, .09]). Conclusions: These results support the proposition that ELA, and in particular ELA characterized by threat, could lead to a distinct presentation of depression, potentially through a pathway characterized by dysregulated diurnal HPA-axis activity as evidenced by a steeper CAR. These findings suggest specificity in the associations between types of ELA and CAR and could inform growing efforts towards personalized medicine in the treatment of depression.

Effects of maternal high-sucrose consumption on fetal development

Department of Psychology

Desiree Seib, Post-doctoral Fellow

ABSTRACT: Sucrose (table sugar) consumption is high in most of the world. Moreover, low socioeconomic status is associated with higher sugar intake. The effects of a maternal diet high in sucrose on the placenta and fetal brain remain unknown. In rats, previous research has shown that a maternal high-sucrose diet (HSD) dramatically impacts the mother and the offspring. In dams, HSD increased liver lipids and adipose inflammation. In adult male offspring, maternal HSD increased preference for HSD and high-fat diet and increased motivation for sugar rewards. In adult female offspring, maternal HSD increased corticosterone levels in blood and brain. Here, we are investigating the effects of a maternal HSD, at a human-relevant level, on fetal brain development and to determine the underlying mechanisms of the previously observed behavioural and endocrine effects in the offspring. I want to examine whether a maternal HSD increases inflammation at the fetal stage to generate long-lasting effects on the offspring’s brain and behaviour. I am investigating where this increased inflammation occurs: in the mother, in the placenta, or in the fetus. This study will add to the knowledge of how sucrose affects the mother and the fetus during pregnancy.

School-aged Children in Vancouver do not meet dietary choline recommendations but do meet recommendations for folate and vitamin B12

Department of Pediatrics

Alejandra Wiedeman, Post-doctoral Fellow

ABSTRACT: Nutrients such as choline, betaine, folate, and vitamin B12 are required for proper growth and development, but little is known about these nutrients in children. Our objective was to determine intakes and biomarkers of these nutrients in school-aged children (5 to 6 years old). Methods: A cross-sectional study of healthy children (n=285) recruited from Metro Vancouver, Canada were assessed. Dietary information was collected using three 24-hour recalls. Nutrient intakes were estimated using the Canadian Nutrient File and USDA database for choline; supplement use was collected by questionnaire. Plasma biomarkers were quantified by mass spectrometry and immunoassay. Results: Daily dietary intakes were (mean ± SD) choline 250 ± 96 mg, betaine 88 ± 41 mg, folate 335 ± 126 µg DFE, and vitamin B12 3.78 ± 2.71 µg. Top food sources were dairy and eggs (42-57%) for choline and vitamin B12, and cereal and grains (41-60%) for betaine and folate. Only 40% of children met the choline adequate intake (AI) recommendation for North America (≥250 mg/d); 81.5% met the European AI (≥170 mg/d). Plasma free choline, betaine, and dimethylglycine concentrations were (mean ± SD) 8.62 ± 2.13 µmol/L, 45.3 ± 13.7 µmol/L, 3.34 ± 1.03 µmol/L, respectively. Dietary choline intake and plasma free choline were not related. However, dietary choline intake was positively associated with plasma dimethylglycine. Less than 5% of children had inadequate folate and vitamin B12 intakes. More than half of the children (59.4%) were consuming a supplement containing B-vitamins, but none included choline or betaine. Some children (5.26%) had total folic acid intakes above the North American upper limit (UL; >400 µg/d); 10.90% had intakes above the European UL (>300 µg/d). Vitamin B12 intake was positively associated with plasma total vitamin B12 (mean ± SD; 594 ± 158 pmol/L) in an adjusted model (sex, age, total energy intake, and supplement use; p <0.05). Conclusions: Our findings suggest that many school-aged children are not meeting dietary choline recommendations. Some children may have excessive folic acid intakes. The impact of imbalanced methyl nutrient intakes during this active period of growth and development needs to be determined in the future.