PWM: Foods and Nutrients (2006)
Bao W, Nicklas TA, Srinivasan SR, Berenson GS. Body composition and energy and nutritional intake in children. Journal of Advancement in Medicine 1996; 9: 101-112.
- To examine the association between dietary intake patterns and weight or body composition in a pediatric population
- To accomplish this, one 24-hour dietary recall was collected on each child who participated in one of six cross-sectional surveys.
- 10-year old children in Bogalusa, Louisiana
- Bi-racial (Caucasian and African-American).
Six cross-sectional surveys were conducted from 1973 to 1988. Within each cross-sectional survey, dietary intake information and anthropometric measurements were collected.
Study Protocol included:
- One 24-hour recall was collected from each child
- All interviewers participated in rigorous training sessions and pilot studies prior to data collection to minimize interviewer effects
- Quality controls included a standardized protocol, graduated food models for estimation of portion sizes, a product identification notebook for snack probing, school lunch and family recipe collection and the Moore Extended Nutrients (MENu), a database for nutrient composition
- Duplicate recalls were collected from 10% random sub-samples to assess inter-interviewer variability.
- Height and weight were measured twice using standardized protocol
- Triceps and subscapular skinfolds were measured three times using standardized protocol.
- Ponderal index (measured weight and height)
- Estimated body composition--FFM (weight - body fat), Body Fat (weight X %body fat)
- Triceps and subscapular skinfolds.
- Total energy intake
- % kcal from protein, fat, carbohydrates or saturated fat (24-hour recalls).
- Spearman correlation and multivariate stepwise regression
- P<0.05 was established as statistically significant.
- Original sample: Not specified
- Withdrawals/Drop-outs: Not specified
- Final Sample: 1,419 Black and White children; 50% female
- Age: 10 years of age
- Location: Bogalusa, Louisiana (semi-rural southern community)
- Race/Ethnicity: 35% Black and 65% White population
- SES: Not specified.
- Associations between energy intake and anthropometric measurements were weak.
- Energy intake was more associated with fat free mass (FFM) (r=0.13, P<0.0005) than with weight (r=0.07, P<0.006) and height (r=0.07, P<0.01) and NOT with skinfolds or body fat
- The only significant but weak correlation found was between FFM and percent of energy from protein (r=0.06, p=0.04), but not after controlling for energy intake.
Percent of Kcals from Macronutrients
No significant correlations were noted between % kcal from fat, saturated fat or carbohydrates and anthropometric measures.
- Observations from the current study suggest that at least in growing children dietary intake has significant influence on FFM, and may be more significant than its influence on body fat
- Therefore, other measures, perhaps exercise and behavior are needed to complement dietary management in approaches to prevent obesity in childhood.
- Dietary methodology--quality controls to mimimize interviewer effects and duplicate recalls to assess inter-interviewer variability
- Large sample size.
- Article did specify details of how the 24-hr recalls were collected.
- Fat-free mass (FFM) calculated in this study as an estimate of body composition utilized sex, but not race-specific equations. Subcucaneous and skeletal fat distribution differs between Blacks and Whites. Race-sex-specific equations may be more accurate in estimating FFM.
- One 24-hour dietary recall
- Lack of physical activity data
- Population was 10-year old children from a single city; generalizability?
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)||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|
|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?||???|
|2.4.||Were the subjects/patients a representative sample of the relevant population?||???|
|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)||N/A|
|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.)||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?||???|
|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?||???|
|4.4.||Were reasons for withdrawals similar across groups?||???|
|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?||Yes|
|6.4.||Was the amount of exposure and, if relevant, subject/patient compliance measured?||No|
|6.5.||Were co-interventions (e.g., ancillary treatments, other therapies) described?||No|
|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)?||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|