National Institute of Dental and Craniofacial Research Awards R21 Grant for Children’s Health Study

Dr. Christie Custodio-Lumsden, assistant professor of nutrition sciences (in dental medicine) at Columbia University College of Dental Medicine, has received an R21 grant from the National Institute of Dental and Craniofacial Research (NIDCR) for "Adolescent Health and Early-life Dietary Exposome (AHEAD): Developing a Metabolomic-based Index of Healthy Eating to Predict Children’s Health Trajectories." The study will investigate how dietary exposures during childhood and adolescence may help shape both oral and systemic health over time.

Research on the relationship between oral and systemic health has not always produced clear answers. Studies examining dental caries and obesity, for example, have yielded mixed findings about whether the conditions are directly related. Custodio-Lumsden hypothesizes that diet may be an important factor connecting them.

The AHEAD study will investigate that possibility by examining oral and systemic health outcomes together in children and using metabolomics within an exposomics framework to understand the role of dietary exposures.

“It's a new approach. It hasn't yet been done, particularly looking at this population, looking at young kids and looking at these dual outcomes of both oral and systemic health and working within this framework of exposomics,” Custodio-Lumsden said.

The R21 mechanism is designed by the National Institutes of Health to support exploratory and developmental research in the early and conceptual stages of a project. For Custodio-Lumsden, the award will provide an opportunity to generate preliminary data that could ultimately support a larger study examining these relationships in greater depth.

“I've been really interested in understanding how oral health and systemic health really relate to one another and how diet may play a really important role in mediating that relationship,” she said.

Dental caries and periodontal disease are diet-related diseases, she explained, and many of the dietary behaviors targeted to prevent them overlap with those targeted to prevent conditions including obesity, diabetes, and heart disease. The foods promoted for a healthy mouth are likewise often those promoted for overall health. That overlap raises the possibility that studying diet could reveal more about what connects oral and systemic health.

Childhood and adolescence offer particularly important windows for examining these relationships. Dietary behaviors can become established during these stages of development and often continue across the life course. Oral disease, like many chronic diseases, can also take years to develop and progress, making early-life exposures potentially important to understanding later health trajectories.

To investigate those relationships, the AHEAD study will use metabolomics, a technique that examines small molecules known as metabolites in biological samples. For this study, researchers will analyze metabolites in blood, providing an objective biological measure that can complement self-reported information about dietary intake. The approach offers researchers a way to examine not only what a child has consumed but how those dietary exposures are processed by the body.

Custodio-Lumsden described metabolomics as a way to connect dietary exposures with their biological effects. “Metabolomics is a tool to really understand how what we eat and how we eat gets processed by the body and eventually leads to biologic impacts on the body.”

Researchers will combine that biological information with reported dietary data to develop an index that can characterize healthier and less healthy eating patterns. By examining dietary exposures and biological measures during childhood and adolescence, the team hopes to create a model that could ultimately be applied to other populations of children to predict health outcomes. The study will consider oral health experience, including reported experience with cavities, as well as systemic measures, with BMI-for-age percentile serving as the primary systemic health outcome measure.

The project is distinctive in part because researchers will be able to examine these factors over time in the same children. Custodio-Lumsden is leveraging data from a large longitudinal cohort through the Columbia Center for Children’s Environmental Health, which is one of the sites of the national ECHO study of children’s health outcomes and environmental exposures. The cohort includes extensive information about environmental and behavioral exposures, health outcomes, and blood samples collected from children.

For Custodio-Lumsden, the opportunity to bring an oral health perspective to the cohort is particularly significant. “It's super exciting to be doing something dental related with that cohort because it really hasn't been done.”

Another innovative element is the study’s use of exposomics, a research framework that examines how multiple environmental and behavioral exposures interact to affect health. Rather than isolating one exposure from everything surrounding it, the approach allows researchers to consider diet within the broader context of the factors that influence what people eat, how they eat, and how their bodies process those foods. The study will use untargeted metabolomics, allowing researchers to examine a broad range of metabolites rather than beginning with only a predetermined set.

That broader approach could eventually have important implications for prevention. Instead of developing interventions aimed solely at preventing one condition, the findings could help inform preventive approaches that support multiple dimensions of children’s health.

She sees that broader perspective as potentially changing how researchers think about prevention. “It can really help drive not only our interventions, but our preventive approaches, and potentially refocus on this long-term, multi-morbidity prevention approach where we are not just saying, ‘Let's build interventions to prevent dental caries,’ but rather, ‘Let's build interventions that keep kids healthy for caries, for obesity, for diabetes, for all of these other things.’”

The award is Custodio-Lumsden’s first independent NIH award as a principal investigator and represents an important milestone in her career as an early-stage investigator. The project also brings together researchers with complementary expertise at Columbia and Mount Sinai. Custodio-Lumsden is collaborating with Dr. Julie Herbstman, Dr. Gary Miller, and Randolph Singh of Columbia University Mailman School of Public Health on the project’s children’s environmental health, exposomics, and metabolomics components. A collaborator in environmental health sciences at Mount Sinai will contribute to the project’s statistical analyses. 

By examining diet alongside oral and systemic health outcomes, the AHEAD study is intended to lay the groundwork for understanding the factors that contribute to positive and adverse health outcomes and, over time, help inform more effective approaches to prevention.