Optimizing Child and Adolescent Nutrition and Health

A healthcare provider checks a teenager’s blood glucose by using a fingerprick on a monitor. Both are smiling, and a plate of fresh fruit is visible on the table.

Research on all aspects of child and adolescent health and development is central to the NICHD mission.

Investigators supported by NICHD explore the impact of nutrition on health from early childhood through adolescence. One group of researchers identified micronutrients that can potentially counteract the detrimental effects of toxic metals found in the environment. Children in underserved communities can be at greater risk for exposure to mercury, lead, and other metals that have well-known effects on the developing brain and, even at low levels, can also disrupt the body’s lipid metabolism and increase the risk of obesity. The study team found that adequate maternal selenium or folate levels during pregnancy could mitigate these effects on children, underscoring a potential nutritional intervention in these communities.

NICHD-supported researchers also evaluated whether consuming whole milk or 2% milk in early childhood was associated with obesity and risk of heart disease or diabetes in adolescence. Currently, pediatricians in the United States recommend that children ages 2 years or older drink low-fat milk, such as 1% milk or skim milk. However, the study team found no association  between consuming higher fat cow's milk in early childhood and obesity and adverse cardiometabolic health more than a decade later. These findings do not support current recommendations to consume lower fat milk in childhood.

Another NICHD-supported study evaluated whether nutrition assistance programs contribute to obesity. The Supplemental Nutrition Assistance Program, the Free/Reduced Priced Lunch Program, and the Special Supplemental Nutrition Program for Women, Infants, and Children have helped reduce food insecurity for millions of Americans with lower incomes. However, critics have questioned whether they also increase obesity. Researchers examined whether program participation was associated with obesity from kindergarten through fifth grade, and they found no associations between participation and BMI standard deviation scores, which are measures of weight adjusted for a child’s age and sex. The findings indicate that participation in these programs do not place children at higher risk for obesity.

The Best Pharmaceuticals for Children Act (BPCA) program at NICHD supports research to equip providers with details on a drug’s dose, safety, and efficacy in pediatric patients. Infants and children are often prescribed drugs “off-label” because many drugs lack pediatric safety and dosage guidelines. Furthermore, dosing can change based on many factors, including a child’s age, DNA coding for metabolism (called pharmacogenomics), and more. One study developed a dosing model for using opioids in children with obesity by assessing a patient’s variability in drug response. Fentanyl and methadone are commonly prescribed to treat pain and neonatal opioid withdrawal syndrome. However, under- and overdosing can cause serious adverse effects. The study highlights the importance of considering both age and obesity status when selecting a fentanyl dose, as well as a child’s metabolic rate when selecting a methadone dose.

NICHD-funded researchers reported long-term outcomes after bariatric surgery in adolescent patients with severe obesity that was not treatable with conventional therapies. Although long-term, post-surgical data are available for adults who undergo the same surgical procedure, long-term results in adolescents were unavailable. The study team contacted a group of 96 individuals who had bariatric surgery as adolescents, roughly 10 to 18 years earlier. The team found that the participants had significant and sustained reductions in weight, low rates of long-term complications, and reductions in other related health outcomes, such as high blood pressure and sleep apnea. The findings are important for adolescents who are considering bariatric surgery and the potential long-term impact on their health.

NICHD-supported researchers conducted a pilot study in adolescents to compare the standard care for type 1 diabetes with a more physiologic treatment—a hybrid insulin delivery and glucose monitoring system that is sometimes referred to as an “artificial pancreas.” This type of insulin delivery system (also called a hybrid closed-loop system) pairs an insulin pump with a glucose monitor to automatically manage blood sugar levels throughout the day and night. In contrast, the standard diabetes care involves periodic glucose monitoring and insulin injections that are initiated and done by the patient or a caregiver. Conventional therapy also includes the use of an insulin pump with no associated feedback from continued glucose monitoring. The study team found that the combined pump-monitoring system resulted in better management of blood glucose (i.e., avoidance of both low and high glucose levels), which translated to better neurodevelopment and cognitive outcomes. Compared with conventional therapy, teenagers using the combined pump-monitoring system had higher cognitive scores and functional brain activity consistent with typical adolescent brain development, as measured by MRI. These results suggest that changes to the developing brain caused by type 1 diabetes are likely preventable and possibly reversible with physiologic insulin delivery and rigorous glucose control.

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