Research priorities in this area are obesity, hyperlipidemia, and insulin resistance in childhood and adolescence. Special emphasis is placed on developing methods for detecting potential diabetics in childhood and for developing successful techniques of immunomodulation to prevent or mitigate the body's immune attack on the pancreatic beta cell. Similarly, studies of obesity and hyperlipidemia focus on the etiology, consequences, and prevention of childhood obesity and hyperlipidemia. Studies of calcium intake during adolescence and the prevention of osteoporosis later in life are encouraged.
Obesity: The Branch has provided long-term support to scientists who are working to elucidate the genetic, environmental, and behavioral origins of obesity, including recent initiatives on prevention and treatment of childhood obesity in primary care settings, and school-based initiatives to prevent childhood obesity. The PGNB also leads an NICHD working group on obesity that recently developed a research initiative to address the origins and consequences of maternal obesity during pregnancy. The PGNB is a founding and active member of the NICHD Obesity Research Strategic Core.
Diabetes: Branch initiatives have successfully investigated continuous glucose monitoring devices and novel therapies contributing to hypoglycemia prevention in children with Type 1 Diabetes (T1DM). In an effort to prevent diabetes, the Branch has pioneered immunogenetic methods that stratify levels of risk for T1DM, also called juvenile diabetes. The Branch’s efforts include (but are not limited to) involvement in:
- Diabetes Research in Children Network (DirecNet)
- Trial to Reduce T1DM in the Genetically at Risk (TRIGR)
- The Hyperglycemia and Pregnancy Outcome (HAPO) Study
Osteoporosis: Osteoporosis is a major public health problem in the United States. 10 million Americans older than age 50 already have osteoporosis, by World Health Organization criteria, while 33 million more have osteopenia. The origins of osteoporosis begin in childhood as bone mass accrued during childhood and adolescence determine peak bone mass in young adulthood. The PGNB initiated the Bone Mineral Density (BMD) in Childhood Study (BMDCS), a longitudinal study of bone accretion to further understand this topic. The availability of normal reference bone mass measurements play a crucial role in the diagnosis of osteoporosis in adults and deficient bone accrual in children. The objective of this study was to establish normal values of bone mineral content and BMD in 2,000 healthy American children, between ages 5 and 19 years, by dual X-ray absorptiometry (DXA) in the lumbar spine, radius, and the proximal femur. To study the correlation between DXA and computed tomography (CT), results were compared in a subgroup of subjects using quantitative CT (QCT) in the lumbar spine, and peripheral quantitative computed tomography (pqCT) of the forearm.
The careful implementation of the longitudinal protocol with relatively few drop-outs in a large, diverse cohort of healthy children enabled the BMDCS investigators to collect valuable data on linear growth, the timing of puberty, bone age, nutrition and exercise over a 6-year period. BMDCS investigators have provided reference curves for bone accrual that are analogous to the Centers for Disease Control and Prevention linear growth and weight gain curves for children and adolescents. Height adjustment guidelines have been determined, and our understanding of bone accrual and how it relates to age, puberty and bone age, ethnicity and race has been established.
As the logical extension of this groundbreaking work, there is a need to develop preventive strategies and therapeutic agents for pediatric bone disorders. The long-term goal is to determine ways to maximize peak bone mass and thereby reduce the burden of osteoporosis later in life.