Pediatric Weight Management

Tami's Folder


Boulton TJC & Magarey AM. Effects of differences in dietary fat on growth, energy and nutrient intake from infancy to eight years of age. Acta Paediatrica 1995; 84: 146-50. Adelaide Nutrition Study.

PubMed ID: 7756798
Study Design:
Cohort study
B - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:
To investigate if there were differences in somatic growth and intake of energy and selected nutrients according to the percentage of dietary fat to food energy intakes.
Inclusion Criteria:
The details of selection have been published previously.
Exclusion Criteria:
not specified
Description of Study Protocol:

Data were used from the subjects who were seen at 3, 6 and 12 months and at 2, 4, 6 and 8 years. Before each visit the parents kept a record of the child’s diet. Up to 2 years of age a 7-day weighed record was kept, at 4 years a 3-day weighed food record & at 6 and 8 years a 4-day weighed food record. At each visit the diet record was checked and measurements made of length/height and mass.

Data Collection Summary:

Dependent Variables

Fatness (sum of four skinfold thickness measurements taken at mid-biceps, triceps, subscapular & suprailiac sites); Length/height and mass (measured) as the method to determine growth.

Independent Variables

High (> 35% fat), Median (20-34.9% fat) and Low Fat Groups (< 30% fat) (weighed food recorders); Energy & nutrient intakes – mean intake per day; Intakes of protein, fat & carbohydrate (sugars and starches) were expressed as % contribution to total daily energy intake (weighed food records – see study protocol).

Control Variables


Statistical Analysis

ANOVA was used for comparison of the 3 fat intake groups.  Pearson correlation was used to examine the association between the percentage energy as fat and calcium, iron, thiamin and vitamin C.

Description of Actual Data Sample:

Original Sample: not specified

Withdrawals/Drop-Outs: not specified

Final Sample: 140 children who had been randomly selected by birth order.

Location: suburban Adelaide, Australia

Race/Ethnicity: white

SES: middle-class?

Summary of Results:

All children grew normally, none caused concern because of low growth velocity.

There were no clinically significant differences in height, weight or skinfold thickness according to the proportions of fat in the diet, although the high fat intake group had a higher food energy intake at 2, 4 and 8 years of age.

There were no differences in height, weight, energy or nutrient intake at 8 and 15 years of age according to dietary fat intake at 1 year.

The boys who had been in the lowest fat intake group at 2 years were shorter and lighter than those in the other groups at age 15 (p<0.05) – methods only covered data collection up to age 8.

Author Conclusion:
The authors conclude that the contemporary shift to a lower fat diet in early childhood is unlikely to have deleterious effects on growth and nutrient intake if eaten in the context of a family eating pattern which meets current guidelines.
Funding Source:
Government: Australian National Health and Medical Research Council
Reviewer Comments:


Long study duration.


  • Article missing detail on inclusion criteria and original/final sample size.
  • Study’s aim quite different from FNPA hypothesis.
Quality Criteria Checklist: Primary Research
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? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? No
  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? No
  4.1. Were follow-up methods described and the same for all groups? Yes
  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%.) No
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? No
  4.4. Were reasons for withdrawals similar across groups? No
  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? Yes
  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.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? Yes
  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? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  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? Yes
  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? No
  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)? No
  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? N/A
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? No
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