Ingram School of Nursing researchers Sonia Semenic, N, Ph.D, and Andrea Van Hulst, RN, PhD, are playing key roles in an international research consortium titled the Healthy Life Trajectories Initiative (HeLTI). The consortium oversees four separate but harmonized projects in South Africa, India, China, and Canada. All projects are focused on developing evidence-based interventions that span from pre-conception across pregnancy and into the postnatal and early childhood periods with a goal of improving maternal, infant and child health. Funded jointly by the Canadian Institutes of Health Research, and funding partners in each of the four site countries, in collaboration with the World Health Organization (WHO), the aim of this 10-year initiative is to generate evidence to reduce the global burden of non-communicable diseases (NCDs).
Obesity is a known risk factor for NCDs such as cancer, diabetes and heart disease. Given that infants who are breastfed have lower rates of obesity throughout their lifetimes, the promotion of breastfeeding has been recognized as a potentially promising obesity reduction strategy. Accordingly, Prof. Semenic has been invited to contribute her expertise in breastfeeding promotion and support, overseeing randomized HeLTI trials in both Canada and China testing the effectiveness of a multicomponent health promotion intervention including the promotion of breastfeeding as a means of reducing childhood obesity.
For optimal health and brain development, Health Canada recommends that infants be breastfed exclusively for the first 6 months, and that breastfeeding continues for up to 2 years and beyond. However, as Prof. Semenic notes, a variety of factors impact the prevalence and duration of breastfeeding, including education levels, skilled support for mothers who may encounter difficulties breastfeeding, and breastfeeding-friendly workplaces. “To be successful, breastfeeding promotion interventions also have to take cultural practices and beliefs into account,” she asserts. For example, while in Canada, the higher the education level, the more a mother is likely to breastfeed, in many developing countries, bottle-feeding is prized as a status symbol associated with wealth. The situation is more nuanced in China, explains Prof. Semenic. “While there is a high amount of bottle-feeding in China due in part to short maternity leaves, there is also growing recognition that breastfeeding is a healthier alternative. However, during the day time while parents are at work, babies and toddlers are often in the care of their grandparents, many of whom grew up with the notion that a heavy baby is a healthy one.”
As an expert in the study of strategies to reduce childhood obesity, Prof. Van Hulst serves as co principal investigator for the China site and has been a member of the study’s executive committee since 2022. As she reports, “In April 2023, I participated in a consortium meeting in Cape Town, South Africa, bringing together the WHO as well as funding agencies and partners from the four participating countries. After receiving an update on the study’s progress, we worked on the development of strategies and guidelines for international data storage and access, joint data analysis plans, and knowledge translation strategies.”
Prof. Van Hulst notes that unique features of HeLTI include its large sample size in four countries with very different contexts, studies that will follow mothers, partners and babies from pre-conception to five years old, a large number of variables harmonized across sites, and a massive biobank. To date, close to 17,000 people have been enrolled in ongoing HeLTI research projects.