PWM: Family Influences (2006)


Francis LA, Hofer SM, Birch LL. Predictors of maternal and child characteristics. Appetite 2001; 37: 231-243.

PubMed ID: 11895324
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:
To investigate the relationships among maternal and child characteristics, and two aspects of maternal child-feeding styles that may place daughters at risk for developing problems with energy balance.
Inclusion Criteria:
Age-eligible white girls living with both their biological parents.
Exclusion Criteria:

Girls with severe food allergies or chronic medical problems affecting food intake, or dietary restrictions involving animal products.

Description of Study Protocol:
  • Subjects were recruited for the study using flyers and newspaper advertisements
  • Families with age-eligible girls within a five-county radius received letters inviting them to participate; also received follow-up phone calls.
  • Girls were individually interviewed by a trained interviewer, parents completed a series of questionnaires and anthropometric measures were taken.


Data Collection Summary:

Dependent Variables 

  • Maternal Child-feeding practice-Maternal Restriction: Restriction subscale from the Child-Feeding questionnaire (CFQ)
  • Maternal Pressure to Eat: Pressure to Eat subscale from CFQ. 

Independent Variables  

  • Child adiposity: Daughters’ weight status and triceps and subscapular skinfold measurements
  • Maternal weight concern and eating style: Weight Concern Scale and Restraint Scale from the Eating Questionnaire
  • Perception of child weight: Perceived Child Overweight subscale from CFQ
  • Concern for child weight: Concerns about Child Overweight subscale.

Variables Controlled for:  

  • Maternal education: Self-report
  • Income: Self-report
  • Depression: Center for Epidemiological Studies-Depression Scale
  • General parenting style: Baumrind’s measure of general parental control

Statistical Analysis

Pearson’s zero-order correlations and Structural Equation Model (in order to examine multivariate relationships).

Description of Actual Data Sample:


  • Initial N: 196 girls and their mothers
  • Age: Five years old
  • Ethnicity: White.
Summary of Results:

Models of Maternal Restriction 

  • When all predictors and covariates were included in the predictive model the only variables that remained significant predictors of restriction were:
    • Maternal investment in weight and eating related issues
    • Mothers’ perceptions of daughters as overweight
  • Thus, mothers’ perception of daughters as overweight and mothers’ own investment in weight- and eating-related issues including her own weight concerns and eating style significantly contributed to the level of restriction that is placed on daughters’ intake, over and above the contribution of daughters’ actual weight status.

Models of Maternal Pressure to Eat  

  • When all predictors and covariates were included in the predictive model the only variable that remained a significant predictor of pressure to eat was Mothers’ perception of daughters as underweight
  • For overweight mothers, daughters’ adiposity (-0.31; P<0.05) and mothers’ concern for daughters’ weight were significant predictors of pressure to eat.
Author Conclusion:
  • Mothers response to daughters’ adiposity was thought to be a strong predictor of the use of restriction; however adiposity no longer remained a significant predictor of restriction once all predictors and covariates were included in the model
  • In predicting the use of pressure in child feeding, we found that daughters’ weight status was an important predictor, as was mothers’ perceptions of daughters’ weight deviance, specifically underweight
  • This provides evidence for the importance of mothers’ perceptions of daughters’ weight as a possible mediator in the relationship between daughters’ adiposity and child-feeding practices.
Funding Source:
University/Hospital: The Pennsylvania State University
Reviewer Comments:

This homogeneous sample precludes generalization of the findings to other SES, ethnic or racial groups.

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) 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? 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? 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? No
  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? No
  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? 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? No
  6.6. Were extra or unplanned treatments described? No
  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? 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? 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)? 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? 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? Yes
10. Is bias due to study's funding or sponsorship unlikely? ???
  10.1. Were sources of funding and investigators' affiliations described? No
  10.2. Was the study free from apparent conflict of interest? Yes