Pediatric Weight Management

PWM: Foods and Nutrients (2006)


Fisher JO and Birch LL. Fat preferences and fat consumption of 3- to 5- y-old children are related to parental adiposity. J Am Diet Assoc. 1995; 95: 759-764.

PubMed ID: 7797805
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:
  • The purpose of this study was to investigate whether preferences for high-fat foods predicted fat intakes of children aged three to five years
  • Researchers also examined the relationships between fat preferences, fat consumption and adiposity of the children and whether these factors were positively related to their parents' adiposity.
Inclusion Criteria:
  • Children were recruited from the University of Illinois Child Development Laboratory
  • Children's ages ranged from 36 to 67 months
  • All participants were apparently developing normally and were within the fifth and 95th percentiles for height and weight.
Exclusion Criteria:

Children with food allergies, food sensitivities, a history of gastrointestinal tract problems or chronic illnesses were excluded.

Description of Study Protocol:
  • Children's fat consumption was observed using weighed food intake data from one 30-hour period every week for six weeks. The period begain every Wednesday morning and concluded at lunch on the following Thursday. Children were served ad libitum portions of palatable and familiar foods using one set of menus across all observational periods. Anthropometric measurements were taken on week five and fat preference was assessed on week six.
  • Parent's dietary restraint and diet disinhibition were measured using the Three Factor Eating Questionnaire (TFEQ). Parent's height and weight were self-reported. Body mass index (BMI) was calculated from self-reported height and weight.


Data Collection Summary:

Dependent Variables

  • Children's weight-for-stature measurements
  • Children's percentile scores (National Center for Health Statistics reference data, 1986)
  • Children's triceps and subscapular skinfold measurements.

Independent Variables

  • Children’s fat consumption (using weighed food intake data from six 30-hour periods of observation)
  • Children’s fat preferences (using rank-order preference scores for foods served at lunch and dinner on day one)
  • Parent's dietary restriction and diet disinhibition (using Three Factor Eating Questionnaire)
  • Parent's body mass index (BMI) to assess parental adiposity (using self-reported height and weight).

Control Variables

Not discussed.

Statistical Analysis

  • Descriptive statistics were used to assess children's 30-hour energy and fat intakes, fat preferences and anthropometric measurements, and for parents' BMI
  • Logarthimic transformations were performed on mothers', fathers' and mean BMI scores to better approximate normal distribution
  • Pearson product-moment correlations were used to investiate relationships among parental adiposity and questionnaire responses, and childrens' fat preferences, 30-hour fat intake and skinfold measurements.
Description of Actual Data Sample:
  • Original sample: N=18 (10 girls, 8 boys)
  • Withdrawals/Drop-outs: One child refused to participate in the skinfold measurements. One child had triceps and subscapular skinfold scores greather than 95th percentile and was considered an outliner and subsequently excluded from data analysis.
  • Final sample: N=18; Children with weight-for-stature measurement; N=16 children with skinfold measurements
  • Age: 36 to 57 months (Mean age of 52±1.9 months)
  • Location: University of Illinois Child Development Laboratory
  • Ethnicity: Not discussed
  • Social economic standard: Not discussed.
Summary of Results:

Children’s Fat Preferences

  • Children who showed strong preferences for high-fat foods also had high total fat intakes (r=0.54; P<0.01)
  • Children’s fat preferences were also related to their triceps skinfold measurements, such that children with high-fat preferences also had the highest triceps skinfold measurements (r=0.61, P<0.01)
  • Children of heavier parents had stronger preferences for high-fat foods (r=0.75, P<0.01)

Children’s Percent Fat Intake

  • Using Pearson product-moment correlation analysis, no significant association between children’s percent fat intake and children’s weight-for-stature (%) was shown
  • Additionally, no significant association was noted between this variable and children’s tricep skinfold (%) or subscapular skinfold (%)
  • The percentage of childrens' energy consumed as fat was positively correlated with parental adiposity (r=0.67, P<0.01)
  • Children of heavier parents were more likely to have high total fat intakes than children of parents with lower BMI (P<0.05).

Parental Dietary Restraint and Disinhibition

Parents with higher BMIs reported high levels of cognitive control in self-regulating food intake (r=0.82, P<0.01) and higher difficulty in controlling their own eating once they began (r=0.70, P<0.01).

Author Conclusion:
  • The researchers suggest that parental adiposity is related to children's fat preferences and dietary fat intake
  • The findings also suggest that children's preferences for and consumption of dietary fat is likely influenced by familial factors, such as the access and exposure to high-fat foods
  • The authors suggest that parents possess the capacity to strongly influence children's preferences for high-fat foods through frequent high-fat food consumption and by making high-fat foods easily accessible to children.
Funding Source:
Government: National Institutes of Health grant ROI 1975-2
Kraft Foods Inc.
Food Company:
University/Hospital: University of Illinois College of Agriculture
Reviewer Comments:


  • Small sample size
  • Constraint of standard menu, all children were offered the same food however there was a range in dietary intakes.
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) 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
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? N/A
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.) Yes
  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? Yes
  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.) No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? No
  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? No
  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? 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? 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? No
  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)? No
  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? No
  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