EAL

PWM: Foods and Nutrients (2006)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To relate food intake of children aged 3-7 years to selected parental and child mealtime behaviors.

Inclusion Criteria:

Families recruited from among families with children aged 1-9 years-old participating in a questionnaire study of parental mealtime behaviors (randomly selected from the local taxation register of Uppsala county).

Families selected to permit 10 children stratified among 4 age groups within 1-9 years of age.

Exclusion Criteria:

None specified.

Description of Study Protocol:

Family evening mealtimes were video taped 3 times. After the first video recording session the parents' and target child’s weight and height were measured. A previously used tool, BATMAN, was used to assess meal behaviors observed during the videos. Modification of BATMAN included Swedish specific meal time behaviors. BATMAN was used to score frequency of specific meal time behaviors.

7-day diet records were collected from a subset of the families to measure the target child's intake in each family.

Data Collection Summary:

Dependent: Child’s adiposity: divided into two groups overweight & normal weight (weight-length index).

Independent:

Child eating behaviour and parental behaviour occurring at mealtime (video version of BATMAN – Bob’s and Tom’s method for assessing nutrition)
Secondary Analysis (only 39 families participating in this analysis): Energy consumption and the intake of 10 nutrients including protein (g), Carbohydrates (g), Fat (g), Sucrose (g) (7-day dietary recording period).

Variables controlled for: Gender, age.

Statistical Analysis: Correlations & univariate analysis (using t-tests to test for significance).

Description of Actual Data Sample:

Initial N: 50 children (25 males & 25 females) and their parents

Age: 3-10 years

Other relevant demographics: Swedish

Summary of Results:

Parental Influences and meal time behaviors: Parental control over child’s intake & Parental encouragement.

51% of mealtime behavior for children was eating and drinking while approximatley 33% was verbal activity and 10% involved playing or other activities.
There were no age differences in child mealtime behavior.
No linear relationships between parental mealtime practices and child overweight were identified.
* This could either be due to the fact that the overweight children participating in the study were only moderately overweight.
Normal-weight children received more parental neutral statements about food than the overweight children.
Child eating was positively correlated with the child's relative weight (p<.01)
Mothers' BMI was positively correlated with the child bhavior identified as "taking food" (p<.05).
There were no correlations between BMI of parents and their children.

Total Energy & Dietary Fat: % total calories

Fat intakes of 4 - 10 year olds were higher than the recommended values as was the intake of sucrose for 4-6 years olds.
There was no significant difference in either energy or nutrient intake between the normal weight (n=24) and the overweight (n=15), even though the overweight children had higher energy and nutrient intakes when expressed in absolute figures.
There was no correlation between weight-length indices and energy or nutrient intakes.

Author Conclusion:

No linear relationship between parental mealtime practices and child overweight were found. Parental verbal behavior may be tied to child eating at a specific meal but not to child nutrient and enrgy intake over longer periods.

Funding Source:

Government:	The Swedish Council for Forestry and Agricultural Research
University/Hospital:	University of Uppsala (Sweden)

Reviewer Comments:

Limitations:

Mean interrater reliability was 80% for child behaviors and 63% for parental behaviors – low interrater reliability for the parental behaviors.
Small sample size & children in the study who were overweight were only mildly overweight.
Study took place in university town, with a large number of inhabitants with academic degrees. Not representative for the Swedish preschool population.
Only 106 of the 599 families initially participating in the questionnaire study were interested in further participation suggests that only families with greater interest in child food issues have participated in the present study.
7 day food records most likely lacked accuracy.

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?	Yes
2.	Was the selection of study subjects/patients free from bias?		No
	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?	No
	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?		???
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	No
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	???
	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?	???
	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.)	???
	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?		???
	4.1.	Were follow-up methods described and the same for all groups?	No
	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?	Yes
	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?		???
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	???
	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.)	???
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	???
	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?		N/A
	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?	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?		???
	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?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	???
	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?		???
	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?	N/A
	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?		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