By: Allison Currie
Dr. Leah Cahill is the principal investigator of the Nourish research team at Nova Scotia Health and Dalhousie University where she holds the Howard Webster Research Chair as an associate professor in the Department of Medicine.
The Nourish team includes a ten-person patient-public-partner panel, research staff, graduate students, medical students, medical residents and partnerships with clinicians, administrators and policy makers.
Can you tell us a little bit about your field of research?
My research team studies healthy aging and the prevention and treatment of cardiometabolic diseases, especially heart disease, type 2 diabetes and clinical malnutrition. I studied nutrition and became a registered dietitian before going to graduate school, so my work has a special focus on nutrition because it’s been a passion of mine since I have seen firsthand how healthy eating makes a valuable difference to people's health.
Our team uses several different research methods, depending on the question that we are working to answer. We do a lot of statistical analyses of observational data collected over many years. For example, we have analyzed the long-term (e.g., at least 10 years) effects of skipping meals, snacking and eating at different times throughout the day. We are currently working on a randomized controlled trial of blueberries, protein, and regular workouts with a trainer for a year in older Nova Scotians (it is called the STRONG study). We have also tested the implementation of malnutrition screening and assessment upon admission to Nova Scotian hospitals to identify people who should receive special nutrition care while in hospital to improve their nutritional status so that they heal faster.
Sometimes we do qualitative research such as holding interviews with people to learn about their experiences and perspectives. For example, we recently completed interviews with people living with type 2 diabetes to learn their perspectives on personalizing their blood sugar targets. One thing we always try to do is involve the patient and clinician (e.g., doctors, nurses, dietitians, pharmacists, etc.) perspectives because we want to find medical solutions that work well for the people using them.
What led you to this field/inspired you to do this work?
I have always been interested in the relationship between nature and nurture. Some things we cannot change such as our age and genetics (nature), but we can change other things such as our nutrition and therapies (nurture) and use these changes to optimize our nature for good health and high quality of life. I am intrigued by how what works for one person may not work for another, which I think is due to the interplay between nature and nurture in our environment.
I have always been interested in food and nutrition because I love how delicious healthy food makes people feel good. Food is my favourite tool to use to improve health and the way that the nutrients in our food act once in our bodies is complex and fascinating. I want everyone to have healthy food and good nutritional status, and I am determined to help find ways to achieve this. Most people generally know what to eat to be healthy but face practical challenges within the many steps (e.g., planning, procuring, preparing, cleaning up) required to eat the meals they would like to, so my team is starting to research the barriers to healthy eating that people face.
My focus on preventing and treating cardiometabolic disease really became a passion after my dad had a heart attack. Many of my students and staff came to join my team for similar reasons. When you see someone that you care about suffer, you want to do something to help. Research is a way to help on a large scale that can benefit not just your own family, but many other families as well.
How does your research translate into healthcare solutions for the patient/public?
Preventative research translates into recommendations and guidelines, but also into programs and policies. For example, we heard that our research that linked skipping breakfast to worse cardiovascular health outcomes was used to provide evidence to support breakfast programs.
Eating well is relevant to everyone; adequate nutrition reduces risk of many diseases and general healthcare system usage. While everyone agrees that prevention is key to healthy living, it can be hard to measure the official impact of preventative research. It is much easier to measure the number of lives adversely affected by a disease (deaths, hospitalizations) than to measure the people who never got the disease or experienced it mildly. But many clinicians tell us that many of the cases they see could be prevented, which would relieve the healthcare system as well as improve quality of life for people.
What is the biggest challenge/opportunity in your field of research?
I like how you ask this question, because the biggest challenges are often the largest opportunities to make a positive impact. In our field, the biggest challenge is collecting data long-term high-quality data in a feasible, affordable, and ethical way. The impact of preventative factors such nutrition can take years to show its effect, and it is difficult to conduct studies that last decades.
It is also unethical to assign people to eat unhealthy foods, tell people to omit meals or healthy foods, or give people unhealthy foods to eat, which limits the types of comparisons we can make between diets in clinical studies.
Therefore, we often rely on observational studies, which need to collect data as it happens over many years. These have been difficult to conduct, but the evolution to electronic health records means that in the future we will be able to gather data from people and then link it to their health outcomes for years, which will let us know what practices early on are linked to less disease, hospitalization, disability and early death later in life. Of course, this will all be anonymous and safe. Nova Scotia Health and the Research Ethics Board always help ensure that privacy is protected in research
Why is research and participation in research important?
Research provides data, data is evidence, and evidence means informed decision making, which leads to much better outcomes for people. Research is how societies learn, grow and improve. Participation ensures that the research process is inclusive and impactful. We need a lot of people to participate in research to ensure that studies are diverse and representative of different groups. Without broad participation, findings may be skewed or not applicable to all populations, leading to unequal outcomes. All of the world’s most amazing medical breakthroughs are a large part thanks to the people who participated in studies.
What does the ideal future in your field of research look like to you?
Ideally all people will be able to eat well, and many preventative medical care options will be available to prevent people from developing malnutrition, type 2 diabetes, or heart disease, or if they do develop it, to help them experience it as mildly as possible. To achieve this, I think we will have large, patient-centered and community-centered studies to study the barriers and enablers to healthy living to design ways to provide more of the successful enablers for Nova Scotians. We will have engagement from the public and leverage technology to collect high quality data over years that will allow us to analyze the patterns in Nova Scotians that lead to long-term good health.
Research is care, and clinical studies help translate research into potentially life-changing therapies that can help you, your friends and your loved ones. Want to know more about how to get involved? Visit Nova Studies Connect today: novastudiesconnect.ca
