Shea S, Basch CE, Stein AD, Contento IR, Irigoyen M, Zybert P. Is there a relationship between dietary fat and stature or growth in children three to five years of age? Pediatrics. 1993; 92: 579-586. Columbia University Study of Childhood Activity and Nutrition.PubMed ID: 8414831
To determine whether a moderately reduced fat diet affects the stature or growth of healthy pre-school children.
Families with a healthy child between three and four years of age at entry.
- Families were excluded if the mother was pregnant or post-partum by less than six months
- Children with major illness, including personality disorders adnd severe behavioral problems.
- Subjects were drawn from children participating in the Columbia University Study of Childhood Activity and Nutrition
- Families were recruited during 1985 and 1986, mainly through a pediatric practice at The Presbyterian Hospital
- Only one child per family was eligible.
- Stature: Height, weight and BMI at baseline, calculated as means of all measurements occurring between first and fourth diet recalls in the first year of the study (measured following standardized techniques)
- Growth: Change during follow-up in height, weight and BMI (computed by linear regression using all available data points for each child)
- The mean time between the first and last measurements of stature was 25.3 months.
- Fat: % of total kcal
- Saturated fat: % of total kcal
- Cholesterol: mg per 1,000kcal
*Determined by four 24-hour recalls (elicited orally from the mother of the study child) and three Willett semi-quantitative food frequency questionnaires (administered orally to mothers who were asked to recall the child’s habitual diet).
- Age in months at first 24-hour recall
- Total energy intake
*Change in height, weight and BMI were adjusted for baseline values of these variables.
- Analysis of Variance (ANOVA)
- Multiple linear regression analysis.
- Inital N: 238 children
- Final N: 215 children (105 males; 110 females)
- Withdrawals/Drop-outs: Not specified. 215 children (105 males; 110 females) were followed for at least 12 months, had at least five measures of height and weight and completed the first four 24-hour recalls and the first three Willett semi-quantitative food frequency questionnaires.
- Location: Northern Manhattan, New York City
- Race/Ethnicity: Predominately Hispanic group with small percent of African-American children
- SES: Predominately low-income
- Age: Children aged three to four years at baseline.
- Mean total fat intake was 32.5% of total calories based on 24-hour recalls and 33.4% of total calories based on the Willett semi-quantitative food frequency questionnaire (FFQ)
- Total fat intake expressed as a nutrient density varied by more than 40% from the lowest; highest quintile of intake
- Longitudinal results: There were no differences in stature or growth across quintiles of children defined by consumption of total fat (% total kcal from fat), saturated fat (% total kcal) or cholesterol (mg per 1000kcal)
- Based on the 24-hour recalls, there were no differences in stature or growth between the group of children consuming less than 30% of calories from total fat compared with the group consuming 30% or more
- Based on the semi-quantitative FFQ, there were no differences between these groups in height or weight or change in height, weight or body mass index
- Cross-sectional results: Baseline BMI was approximately 5% greater in the group consuming less than 30 calories from total fat (0.01<P<0.05). This difference was of small magnitude, was marginally significant, was in the opposite direction of the expected reduction of stature among children eating a reduced-fat diet and was one of many comparisons (17.5 vs. 16.6, P<0.05 using FFQ). No significance difference was noted using 24-hour recall.
- Children who consumed a diet lower in total fat density also consumed significantly less total calories, saturated fat, cholesterol, calcium and phosphorus. On the other hand, children who consumed a diet lower in total fat density consumed significantly more carbohydrates, iron, thiamine, niacin and vitamins A and C.
- Based on data from the 24-hour recalls, children in the lowest two quintiles of fat intake had mean calcium intakes below RDA.
These data support the safety of a moderately reduced fat diet in healthy pre-school children.
|University/Hospital:||Columbia Unviersity College of Physicians & Surgeons, Columbia University School of Public Health Columbia University|
- Use of both multiple 24-hour recalls and FFQ
- Mean follow-up time was 25 months
- Possibility that the effects on growth of a reduced-fat diet take longer to become apparent.
Quality Criteria Checklist: Primary Research
|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)||Yes|
|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)||Yes|
|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?||Yes|
|2.4.||Were the subjects/patients a representative sample of the relevant population?||Yes|
|3.||Were study groups comparable?||Yes|
|3.1.||Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)||Yes|
|3.2.||Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?||Yes|
|3.3.||Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)||Yes|
|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?||Yes|
|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?||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%.)||Yes|
|4.3.||Were all enrolled subjects/patients (in the original sample) accounted for?||Yes|
|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?||Yes|
|5.1.||In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?||Yes|
|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?||Yes|
|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?||Yes|
|6.5.||Were co-interventions (e.g., ancillary treatments, other therapies) described?||Yes|
|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?||Yes|
|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?||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)?||Yes|
|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?||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?||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|