PROMOTE: Preschoolers at Risk – Obesity and Cardiometabolic Risk Factors: Towards Early Identification

Dr. Catherine Birken, Hospital for Sick Children




Over the last decade, the relationships between the metabolic syndrome and important health outcomes such as type 2 diabetes mellitus and atherosclerotic cardiovascular disease have been well described in adults. There are conflicting data on the components of the metabolic syndrome in children and youth.


Until recently there have been no published normal values for waist circumference in childhood, a key component in many of the adult definitions. Further, critical gaps exist in accurate normal values of cardiometabolic laboratory tests performed in children, and prevalence varies by definitions developed through expert opinion. Consequently there are varying childhood conceptualizations, definitions, and prevalence of metabolic syndrome. Recently, the International Diabetes Federation (IDF) published its definition of the Metabolic syndrome in children and adolescents. Key components of this definition include obesity (using waist circumference), hypertriglyceridemia, hypertension, high glucose, and low high density lipoprotein (HDL). However, the IDF did not have enough data to publish recommendations for children less than 10 years of age. Given the importance of early childhood, this represents a critical gap in knowledge. The components of these cardiometabolic risk outcomes, namely blood pressure and laboratory tests (for example insulin, glucose, lipids) are the outcomes of interest for this proposed PROMOTE longitudinal study, and are referred to in this proposal, as ‘cardiometabolic risk factors’.



Objectives and Study Procedure


1.     To follow an existing cohort of n=2004 1-5 year old children prospectively for 4 additional years to determine if growth trajectories (BMI) in early childhood are associated with cardiometabolic risk, as defined by abnormal laboratory factors and blood pressure

2.     To characterize lifestyle patterns (diet, physical activity, sedentary behaviour, sleep) in early childhood

3.     To determine how lifestyle patterns (diet, physical activity, sedentary behaviour, sleep) influence growth trajectories (BMI, waist circumference) over time in early childhood

4.     To explore clustering of cardiometabolic risk (laboratory tests, and blood pressure) and growth factors (BMI and waist circumference) in early childhood


This will be a longitudinal observational study of children who are participating in the TARGet Kids! practice based resarch network. A total of 2004 children from 1 year of age through 5 years of age will be recruited to participate.



Importance of the Study


Early childhood has emerged as a critical period for assessing the origins of obesity and cardiometabolic disease and developing preventive interventions.  Providing preventive care during health supervision visits in early childhood is a defining component of pediatric primary care practice.  Given that primary care physicians see nearly all preschool children, they are in a unique position to screen children who are at risk of later-life cardiovascular disease and implement evidence based interventions – if only this evidence existed.


This study will further our understanding of cardiometabolic risk in young children, to aid the development of directed strategies for early identification of young children at risk, and to ultimately test interventions to advance the cardiovascular and metabolic health of Canadians.