Child Health CheckPoint series published in BMJ Open

The Child Health CheckPoint is part of the Growing Up in Australia study. It investigates childhood development of 1800 biological parent/child pairs with the aim of producing research that informs health policies.

BMJ Open has published a supplement of 15 research articles, including a methodological summary, along with a communication article presenting a broad overview of the project. We hope that this collection of research will stimulate discussion and make a positive contribution to healthcare practice.

Below is a summary of the research courtesy of the Murdoch Children’s Research Institute (MCRI).

You can view the article collection here.


Snapshot of 11 to 12 year olds to help experts determine what’s needed to keep Australians healthy 

A one-off health check of 1,800 Australian children, aged 11 to 12 years, has found most youngsters are healthy with the information to help governments, health workers and researchers come up with strategies to help keep it that way. 

Led by the Murdoch Children’s Research Institute, the Child Health CheckPoint study assessed the health of 1800 biological parent/child pairs with researchers travelling to 30 Australian cities and regional areas over a year. The results are published in the latest edition of BMJ Open. 

Paediatrician and researcher Professor Melissa Wake, from the Murdoch Children’s Research Institute, said the results would help the experts come up with strategies to keep Australians healthy in the future. 

“Most of the 11-12 year olds tested were healthy, however there were wide variations in their results,” Prof Wake said. 

“The aim of the Child Health CheckPoint was to examine how a child’s first decade of life impacts on their fitness before they enter their teenage years. 

“We noticed key differences in health measurements such as their weight, blood cholesterol and lung function. Come middle age and many Australians have heart and lung disease and diabetes. 

Prof Wake said researchers assessed the health of a child and one of their parents at the same time. 

“This provides us with some insight as to whether health issues are hereditary or influenced more by environmental factors – for example school, social pressures such as unhealthy food advertising, and peer groups,” she said. 

The CheckPoint team ran 20 health tests on the children – and one of their parents – over about three hours. Areas of research included sleep, physical activity, language development and hearing, snacking habits, body weight, bone health, and even the length of telomeres – the tiny caps on the end of chromosomes. Fourteen papers based on the findings appear in the latest issue of BMJ Open

The Child Health CheckPoint is part of the federally funded Growing Up in Australia study, which began in 2004 and looks at childhood development from the early years through to adulthood – with the focus on delivering research to guide future health policies. 

Prof Wake said children’s existing health problems, like asthma, obesity and poor vision, could also impact their health over their life course. 

“The ultimate aim of the ‘Child Health CheckPoint’ is that this data will go towards developing new methods of preventing and treating illness in Australia,” Prof Wake said. 

Led by the Murdoch Children’s Research Institute, Child Health CheckPoint brought together researchers from the University of Melbourne, The Royal Children’s Hospital, University of South Australia, Deakin University, Monash University, University of Auckland, University of Sydney, Australian National University, Burnet Institute, University of Tasmania, University of Adelaide, Adelaide Women’s and Children’s Health Network and University of Oxford. 

  • Funded by the Federal Government, the Child Health CheckPoint study is nested within the Growing Up in Australia study, which is run by the Department of Social Services, Australian Institute of Family Studies and Australian Bureau of Statistics. The Child Health CheckPoint was supported by the National Health and Medical Research Council (Project Grants 1041352, 1109355), Royal Children’s Hospital Foundation (2014-241), Murdoch Children’s Research Institute, National Heart Foundation of Australia (100660), Financial Markets Foundation for Children (2014-055, 2016-310) and the Victoria Deaf Education Institute. 

KEY FACTS ABOUT CHILD HEALTH CHECKPOINT 

  • 1874 families (child and a parent) participated, however not every family had every one of the 20 health tests. 
  • For many of the health tests, it was the largest study of children and their parents ever conducted in Australia. 
  • Children and parents attended Child Health CheckPoint ‘pop-up’ assessment centres in capital cities and larger cities for 3 1⁄2 hours. Most of the health tests were offered during 2 1⁄2 hour assessments in eight regional towns. If families were unable to attend an assessment centre, they were offered a 1 1⁄2 hour home visit. 
  • At the assessment centres, participants rotated through the health test stations every 15 minutes. 
  • The health tests involved a number of innovative technologies. Digital photos of eyes were taken to study delicate small blood vessels; pulse wave technology was used to test vascular function; and peripheral quantitative computer tomography (pQCT) delivered a more comprehensive picture of bone health than conventional density scans. Participants also wore a wrist accelerometer for a week to measure physical activity and sleep. 
  • The Child Health CheckPoint tests were carried out between February 2015 and March 2016. 
  • Child Health CheckPoint is a part of Australia’s only nationally-representative longitudinal child study, Growing Up in Australia. Ten percent of postcodes were randomly selected, then babies aged 0-1 years living in those postcodes were randomly chosen from the Medicare database and invited to participate. 
  • Growing Up in Australia is funded by the Australian Government and conducted in partnership between the Australian Government Department of Social Services, the 

Australian Institute of Family Studies and the Australian Bureau of Statistics, with advice provided by a consortium of leading researchers. 

  • The Child Health CheckPoint data are available for no cost under license to population health researchers around the world. 

SUMMARY OF FINDINGS FROM 14 CHILD HEALTH CHECKPOINT RESEARCH STUDIES PUBLISHED IN BMJ OPEN 

  1. The physical activity of children and their parents was measured using a physical activity monitor worn on the wrist. Children’s moderate or vigorous physical activity level was low – 32 minutes a day – while they were sedentary for more than 11 hours a day. The study indicates that Australian children are not sufficiently active. In contrast, most adults had the recommended amount of moderate and vigorous physical activity each day, and their sedentary time tended to be broken up into bouts of 30 minutes or less. 
  2. Sleep was measured by an accelerometer worn on the wrist for a week. The study found that while most children and parents had adequate sleep duration, poor quality sleep was common. 
  3. Food intake patterns or more particularly snacking habits were measured through a food choices study. Halfway through the Child Health CheckPoint visit, parents and children had a 15-minute break to visit the Food Stop station. They were given a box of snack food items, and researchers monitored what and how much they ate. The aim of the study was to determine connections between child and parent snack food consumption – the grams and calories eaten as well as the food’s nutrients (for example, macronutrients and sodium). The researchers concluded that teaching parents to snack less may be one way to improve children’s diets, but other influences (like peers, advertising and individual preferences) also influence food choices. 
  4. Children reported their health-related quality of life by completing the Child Health Utility questionnaire, which asked about key aspects of their lives: feeling worried, sad, in pain, tired, annoyed; and problems with school/work, sleep, daily routine and ability to join in activities. Parents also completed a health utility survey. The study found a small intergenerational concordance for health-related quality of life between parents and children. The researchers believe this is the first study of its kind to show evidence that children’s health-related quality of life is related to their parents’. The researchers call on health services to consider individuals as members of a wider family. 
  5. Hearing and language development was measured. Children and their parents underwent a hearing test (pure-tone audiometry). To measure language development, they were asked to recall sentences and link the meanings of words to pictures. The children had much better hearing than their parents, but similar levels of speech reception. 
  6. Children and parents’ height, weight, body composition and waist circumference were assessed at the Measure Up station. Approximately one-quarter of children and two-thirds of parents were overweight or obese. However, there was only modest concordance suggesting children are not bound to inherit their parent’s body shape or weight. 
  7. Bone health was measured by scanning the participant’s lower leg in a CT scanner. 

Osteoporosis and osteopenia can begin in childhood but are not usually diagnosed until a bone fracture occurs in later life. About half of all adult over 50 years around the world have osteoporosis and osteopenia. The study found that children’s bone size and shape was more strongly associated with their parents than other bone characteristics such as bone density and strength. 

  1. Urine samples were processed to detect albuminuria (protein in the urine), which can be an early sign of kidney and heart disease. The prevalence of albuminuria among Australians is increasing, consistent with rising body mass index. This study found 15 per cent of children and 14 per cent of adults had albuminuria. There was only a weak association between parents and children. 
  2. Blood samples were processed to measure telomeres, which are the ‘caps’ on the ends of chromosomes. They shorten every time a cells divides into two, and are a sign of cellular aging. Shortening of telomeres is associated with cardiovascular disease, hypertension and diabetes. The study found parents had shorter telomeres than their children, as expected because they were older. Researchers also found a modest association between the telomere length of children and their parent. 
  3. Lung capacity and function were measured by testing how hard and fast air could be exhaled from the lungs, using a spirometer device. The study found modest correlations between child and parent lung functioning. The researchers said further studies are needed to identify people at risk of developing lung disease, given the first indications of disease may appear in childhood. 
  4. Taking photographs through the pupil of the eye is a novel, non-invasive way to see the small blood vessels of the eye’s retina, and look for early indicators of cardiovascular disease. There were moderate parent-child parallels with retinal blood vessel size and shape. The researchers would like to see if these parallels strengthen by the time the children reach their parent’s age, to better understand the degree to which stiffness of arteries is inherited. 
  5. Researchers had a detailed look at the metabolomics (or chemistry) of the blood, measuring over 200 metabolic markers, such as lipids, fatty acids, amino acids and novel markers of inflammation and energy homeostasis (balance). Metabolomics is a powerful tool for better understanding genetic and environmental influences on health, and has the potential to identify biomarkers for the detection and monitoring of disease. Overall the study found a clear difference in metabolite profiles of children and adults. 
  6. Vascular health (including blood pressure and artery stiffness) was tested. A blood pressure cuff and ultrasound were used to measure blood pressure, and how quickly blood moves around the body. Nine per cent of parents and four per cent of children had hypertension (abnormally high blood pressure). There was a moderate association between children and their parents’ vascular function. 
  7. The thickness and elasticity of the wall of the large artery in the neck (supplying blood from the heart to the brain) were measured using ultrasound. Carotid artery wall thickness can predict future strokes and heart attacks. The study found a weak-to-moderate association between the arterial characteristics of children and their parent. This supports previous findings that the health of your arteries could be partially hereditary; however the full effect of genetic and other factors is not yet clear.

https://www.mcri.edu.au/research/projects/longitudinal-study-australian-childrens-child-health- checkpoint 

 

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