PWM: Eating Behaviors of Children (2006)
To evaluate:
- associations of type and number of eating occasions with nutrient intakes,
- influence of OW status and prior participation in intervention or control groups in CATCH on them,
- patterns and sources of meals and snacks by sex and race/ethnicity.
2,075 eligible as completed 24-hr recall in 3rd or 5th grades; 1,543 (74% of original cohort) completed addition 24-hr recall in 8th grade
50 excluded from analysis because portions beyond 99th percentile
Recruitment – Details reported elsewhere; drawn from 96 public schools in 4 locations (San Diego, CA, New Orleans, LA Minneapolis, MN, Austin, TX)
Design – Multicomponent (heart-healthy diet & PA) intervention in 3rd -5th graders (CATCH Main Trial, 1991-1994) with tracking through 8th grade (CATCH Cohort Study, 1997); 883 from intervention group, 610 from control group
Statistical Analysis – Multiple logistic regression analysis(no blinding)
Independent variables: (24-hr recall – from 8th grade?)
- Meals (breakfast, lunch, dinner; defined by students’ self-reports)
- Snacks (defined by students’ self-reports)
- Total eating occasions
Dependent variables:
- BMI (measured) classification: Not OW (<85th%; n=991), OW (>85th%, n=502) using NHANES I cut-off points
Other variables:
- Nutrient intake (24-hr recall)
- Energy
- Total & saturated fat
- Protein
- Total CHO
- Sugar
- Sodium (not including discretionary salt)
Control variables:
- Gender
- Site
- CATCH intervention group
- Random inter-school variation
N –1,493 (736 boys, 757 girls)
Age – Mean 14.1 y (13.1-16.4 y)
Ethnicity – 70% white, 12% black, 14% Hispanic, 4% other
Other demographics – not provided (SES measure not available)
Eating Meals & Snacks
- Breakfast eating – inversely related to OW status (70% OW, 80% not OW, p =.0004)
- Lunch – NS
- Dinner – NS
- Snacks – trend toward being inversely related to OW status (85% OW, 89% not OW, p=.07)
- OW had lower energy, fat, protein, CHO, sugar intakes and higher Na intakes than not OW
- As number of eating occasions increased, so did intake of energy, CHO, & sugar; Na intake decreased (confusing for others due to difference in results and discussion section)
Other Results
- 77% ate breakfast (most likely meal to be skipped)
- 69% ate 3 meals/day
- 87% ate snacks (average 2/day)
- Fewer meals associated with more snacks (p=<.003)
- Nutrient content of meals and snacks provided (Table 2 & Figure)
- Some maintenance of intervention effects (lower total and saturated fat and Na, higher CHO and sugar in intervention vs. control group; no difference in meal or snack patterns between groups)
- Most lunches eaten at school, breakfast & dinner at home
Both eating patterns and eating occasions should be considered in promoting healthy eating behaviors.
University/Hospital: | Tufts University |
Strengths: Large sample size, ethnically diverse sample.
Weaknesses: Did not control for SES, PA or other diet measures in eating breakfast analysis
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | N/A | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | N/A | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | Yes | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | Yes | |
2.2. | Were criteria applied equally to all study groups? | ??? | |
2.3. | Were health, demographics, and other characteristics of subjects described? | Yes | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | Yes | |
3. | Were study groups comparable? | N/A | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | N/A | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | N/A | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | N/A | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | N/A | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | N/A | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | Yes | |
4.1. | Were follow-up methods described and the same for all groups? | N/A | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | N/A | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | N/A | |
4.4. | Were reasons for withdrawals similar across groups? | N/A | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | No | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | N/A | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | N/A | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | Yes | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | N/A | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | N/A | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | N/A | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | N/A | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | N/A | |
6.6. | Were extra or unplanned treatments described? | N/A | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | N/A | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | Yes | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | N/A | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | Yes | |
7.5. | Was the measurement of effect at an appropriate level of precision? | Yes | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | Yes | |
7.7. | Were the measurements conducted consistently across groups? | Yes | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | Yes | |
8.6. | Was clinical significance as well as statistical significance reported? | Yes | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | No | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | Yes | |
10. | Is bias due to study's funding or sponsorship unlikely? | Yes | |
10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
10.2. | Was the study free from apparent conflict of interest? | Yes | |