Healthy Life Trajectories Initiative: Featured research
The following articles highlight some of the research projects funded through the Healthy Life Trajectories Initiative (HeLTI).
HeLTI Linked International Intervention Cohorts (LIIC) Team Grants
The LIIC Team Grants are comprised of four separate but harmonized projects in Soweto (South Africa), Mysore (India), Shanghai (China), and two provinces in Canada (Alberta and Ontario). All projects are focused on developing evidence-based interventions that span from pre-conception across pregnancy and into the postnatal period with a goal of improving maternal, infant and child health.
Canada – Team Grant: Healthy Life Trajectories
Trajectories of healthy life using public health and primary care interventions in Canada
The HeLTI Canada study will: (1) develop a new DOHaD cohort, and (2) evaluate the effectiveness of a package of interventions on child obesity, cardiometabolic health and child development. The trial will take a ‘cumulative-impact’ approach, designed to improve health behaviours and reduce modifiable risk factors across the entire developmental period. Nulliparous and primiparous women, and their partners will be randomised, through public health and primary care settings in two provinces and evaluate a 4-phase intervention, from preconception to early childhood. Its innovative design allows for two concurrent randomized comparisons: a preconception-lifecourse intervention vs. usual care and an intervention in infancy and early childhood vs. usual care in children. This design will enable the collection of family-level data, by including fathers preconceptionally, and following more than one child within the family. While the influence of maternal factors on child health is recognized, the role of the fathers/partners has been relatively understudied, including genetic/epigenetic and environmental factors. We will address this limitation.
South Africa – Team Grant: Healthy Life Trajectories Initiative
BUilding Knowledge and a foundation for HeALthy lIfe trajectories: BUKHALI Trial
South Africa’s evolving burden of disease is complex due to: (i) persisting malnutrition (infant stunting of 20%); (ii) high prevalence of overweight and obesity, particularly among women; and (iii) rising rates of non-communicable diseases such as type 2 diabetes. Global initiatives to mitigate adversity during the first 2000 days have resulted in significant improvements in maternal and child survival. However, the longer-term impact of interventions delivered from preconception to early childhood on child growth and social/cognitive development has been less clear. Therefore, there is a need to begin laying the foundation for healthy trajectories by optimising women’s health prior to and during pregnancy and reinforcing optimal health in the infant to offset obesity and cardiometabolic risk and improve cognitive development.
To address this need, a multidisciplinary team from South Africa and Canada is implementing a longitudinal analysis of how early-life exposures in the preconception period and during pregnancy, infancy and childhood impact life-long trajectories of health and development of children in South Africa. The study population will be drawn from Soweto, a historically disadvantaged urban area of the City of Johannesburg. The study hypothesizes that an integrated intervention starting pre-conceptionally in women and at appropriate points across the lifecourse (pregnancy, infancy and early childhood) will improve cardiovascular and metabolic health, reduce childhood adiposity and improve child development outcomes; ultimately reducing the risk of non-communicable diseases.
Using an individual randomized design, the study will test the efficacy of interventions that address behavior change to improve diet and physical activity during preconception, and health during pregnancy; reduce perinatal depression, increase exclusive breastfeeding and improve parental nurturing care.
A comprehensive series of measures to track maternal and child growth/development will be included along with the collection of biospecimens that will support studies into the science of the developmental origins of health and disease.
India – Team Grant: Healthy Life Trajectories Initiative
Early INterventions to Support Trajectories for healthy lifE in India: The EINSTEIN
Non-communicable diseases including cardiometabolic disease and mental health disorders are rising in India. Low birth weight, poor infant nutrition, and rapid childhood weight gain are well-established risk factors for poor health trajectories and development of non-communicable diseases in later life. While undernutrition remains a significant problem in India, rates of overweight and obesity are increasing leading to a double burden of malnutrition.
The HeLTI programme follows a Developmental Origins of Health and Disease (DOHaD) approach; our overarching hypothesis is that integrated interventions administered pre-conceptionally and at appropriate points across the life-course (pregnancy, infancy and childhood) will reduce childhood adiposity, improve cardiovascular and metabolic health, and improve child neurodevelopmental outcomes. The EINSTEIN study is a community-based, cluster randomized intervention with three arms (pre-conception, pregnancy and control) set in rural Mysore, South India, with individual villages forming the basis for the cluster. Women of reproductive age will receive a longitudinal multi-faceted intervention delivered by community health workers comprising: a) measures to optimise nutrition through dietary modification including increased dietary diversity and multiple micronutrient supplements; b) a group parenting program integrated with cognitive behavior therapy to address maternal depression and improve child development; c) support women to achieve a diverse diet, exclusive breastfeeding for the first 6 months, timely introduction of diverse and nutritious infant weaning foods, full vaccinations, and adopt appropriate hygiene measures, particularly hand washing and d) the reduction of environmental pollution particularly indoor air pollution and advice on toxin avoidance, and hygiene measures. The interventions will be underpinned by a lifestyle behavior change strategy.
China – Team Grant: Healthy Life Trajectories Initiative
Sino-Canada HeLTI: A Multifaceted Community-Family-Mother-Child Intervention Study for the Prevention of Childhood Obesity
Childhood overweight and obesity (OWO) prevention is a public health priority in China. It has reached epidemic levels with a prevalence among children and adolescents in 2006–2010 estimated at 13.1% and 7.5% respectively, and is increasing. Greater adiposity in children has been linked to risk for metabolic syndrome, suboptimal neurocognitive functioning and socio-emotional development, as well as poorer school performance. Chinese culture and beliefs value higher gestational weight gain and heavier and faster-growing babies.
The goal of the Sino-Canada HeLTI study is to evaluate an innovative obesity prevention programme implemented in China which: 1) includes a life-course conceptual framework that highlights the need to focus on critical periods using a cumulative-impact approach with targeted interventions that change over time; 2) integrates a population-level approach to generate intersectoral and system-level changes in health care and educational settings with family-based interventions to reinforce a coordinated approach to childhood obesity; and 3) integrates an implementation strategy of professional education, audit and feedback.
This project aims to provide much needed evidence to support the effectiveness of a sustained, professionally mediated, integrated approach to the prevention of childhood obesity. The obesity prevention programme is being implemented with the support of district public health planners and hospital authorities in Shanghai, China to reduce childhood overweight and obesity rates in boys and girls from 1-5 years of age. The programme is a multifaceted community-family-mother-child (CFMC) intervention aiming to positively change woman and family behaviours regarding nutrition, physical activity, smoking, stress and physical health, sleep quality and breastfeeding. It is expected that this intervention will lead to measurable reductions in infant/child adiposity and changes in biomarkers related to obesity risk (epigenome, microbiome, and placental microRNA).
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