Pediatric Weight Management

PWM: Foods and Nutrients (2006)


Francis CC, Bope AA, MaWhinney, Czaijka-Marins D, Alford BB. Body composition, dietary intake, and energy expenditure in nonobese, prepubertal children of obese and nonobese biological mothers. Journal of the American Dietetic Association 1999; 99: 58-66.

Worksheet created prior to Spring 2004 using earlier ADA research analysis template.
PubMed ID: 9917733
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
To determine differences in dietary intake, resting energy expenditure, activity level, fat-free mass, and percentage body and abdominal fat in nonobese children of obese mothers compared with nonobese children of nonobese mothers.
Inclusion Criteria:
  • Mothers who had remained in the same BMI classification for the past 2 years
  • Children with weight between the 10th and 90th percentiles
Exclusion Criteria:
Not meeting inclusion criteria
Description of Study Protocol:


Subjects were recruited through advertisements and were classified as nonobese (BMI=20 to 25) or obese (BMI >=30). Offspring included in the study were prepubertal and nonobese (10th to 90th percentile of weight for height by gender). Twelve pairs of children could be matched for weight, gender, and age.

Study Design

Cross-sectional comparison study.

12 pairs of white, prepubertal, nonobese children (12 with an obese mother (BMI > 30), 12 with a nonobese mother (BMI 20-25)) matched for age, gender & weight.

Children's food diaries were analyzed to determine average energy and nutrient content. Resting energy expenditure of children was measured by means of indirect calorimetry. Children's activity levels were estimated through questionnaires administered during interviews. Body composition wsa estimated using dual-energy x-ray absorptiometry was used to estimate body composition of children.

Data Collection Summary:

Dependent: Children predisposition to overweight (biological mother with BMI> 30 or  biological mother with BMI bt 20 & 25)


Dietary Intake: total energy, protein, carbohydrate, fat, sat.fat, monounsaturated fat, polyunsaturated fat (7-d food diaries), REE (indirect calorimetry), Activity Level (questionnaires & interviews), Body Composition (dual-energy a-ray absorptiometer)

Statistical analyses:

Matched-pair analysis/ nonparametric Wilcoxon signed rank test 

Description of Actual Data Sample:

N: 49 children initially recruited

Attrition: 30 children did not have obese mothers and were excluded.

Final N: 10 prepubertal boys (5 matched pairs) 14 prepubertal  girls (7 matched pairs) were included in the final sample

Age: 6-10 years

Race/Ethnicity: white

SES: not indicated

Location:  Texas, USA

Summary of Results:

Dietary Intake

No stat. sig. differences bt the two groups were found for dietary intake (p =0.06)

Energy Expenditure

There was no statisticallly significant difference between groups.

Adiposity in Children

  • Percentage abdominal fat was greater (p=0.001) and fat-free mass was lower (P=0.04) in children of obese mothers compared with children of nonobese mothers.
  • There was no statistically significant difference between children or obese versus non-obese mothers in terms of percent body fat.


Author Conclusion:
The lack of stat. sig. differences in dietary intake may be related to the small sample size rather than a true lack of clinical differences between children of nonobese and obese mothers.
Funding Source:
Government: NIH
National Dairy Council
Commodity Group:
Reviewer Comments:
This study differs from others in that the only measure of adiposity is in regards to the child’s predisposition to overweight –Mother’s BMI.
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? N/A
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? No
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? No
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? No
  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? 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%.) 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? 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? No
  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? No
  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? 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)? N/A
  8.6. Was clinical significance as well as statistical significance reported? No
  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? N/A
  10.2. Was the study free from apparent conflict of interest? Yes
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? N/A
  2. Is the outcome or topic something that patients/clients/population groups would care about? N/A
  3. Is the problem addressed in the review one that is relevant to dietetics practice? N/A
  4. Will the information, if true, require a change in practice? N/A
Validity Questions
  1. Was the question for the review clearly focused and appropriate? N/A
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? N/A
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? N/A
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? N/A
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? N/A
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? N/A
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? N/A
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? N/A
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? N/A
  10. Was bias due to the review's funding or sponsorship unlikely? N/A