PWM: Foods and Nutrients (2006)
To describe the eating patterns of members of French families & assess the relationships between dietary intakes, eating styles & overweight.
- A subgroup of 405 nuclear Caucasian families was eligible for the Eating Behaviour project and was recruited at the Centre for Preventive Medicine of Vandoeuvre-leÁs-Nancy (France) between January 1994 and May 1995 to have a free health check-up examination.
- Only volunteer families attending the Centre for Preventive Medicine, composed of two parents aged less than 65 y & tow biological children older than 7 y were included.
-
The current analysis uses data from the largest sample of men, women, boys and girls having completed both a 3-day diary record and the DEBQ, from the first 387 families who took part in the study
- Overweight = BMI between 25 & 30 (for adults) & Relative weight between 110 & 120 (for children).
- Obese = BMI > 30 (for adults) & Relative weight > 120 (for children).
- Families were excluded from participation if on member had a disease that could influence their eating behavior (diabetes, food allergy, hyperlipaemia).
- Families were excluded if the members did not record their food intakes (eg lack of motivation, familial circumstances) or because the collected data were not complete (eg. missing data).
-
Recruitment
A subgroup of 405 nuclear Caucasian families was eligible for the Eating Behaviour project and was recruited at the centre for Preventive medicine of Vandoeuvre-le-As-Nancy (France) between January 1994 and May 1995 to have a free health check-up examination. Only volunteer families composed of two parents aged less than 65 y and two biological children older than 7 y were included in the study.
Methods and Data Collection
Dietary data were collected from these French nuclear families.
Only family members older than 10 y completed an eating style questionnaire (the Dutch Eating Behaviour Questionnaire, DEBQ).
The protocol and the aim of the study were fully explained to the subjects who gave their written consent. The research protocol was approved by the Scienti®c Ethic Committee of Nancy.
Each individual's weight and height were measured and body mass index (BMI computed. An individual relative weight was also calculated using the Lorentz's index (ideal weight), taking into account the gender.Relative weight was preferred to BMI to assess the relationships between overweight, eating style and dietary intakes. The individual weight for height was divided by the standard weight for height for that age (reference data from a sample of 6902 boys and 6798 girls, from 4 to 20 y, examined in the Centre for Preventive Medicine in 1990, unpublished data). For participants older than 20 y, the Lorentz's index was used.
Dietary intakes : To estimate nutrient intake, participants completed a 3- day food consumption diary on two consecutive week days and one weekend day assigned at random. Parents and children were assigned the same 3 days.
Eating style : Eating style was assessed using a French validated analyses were carried out in a subsample of 443 individuals and confirmed the internal validity of the French version of the DEBQ questionnaire . This a 33 item self rating questionnaire. DEBQ assesses levels of restrained (10 items), emotional (13 items) and external (10 items) eating , with each scale having a range of mean scores from 1 to 5. A pilot study was conducted in a sample of 26 families in order to test three methods of assessment of food intake: the 24 h recall, the dietary history and the 3-day dietary record.
Blinding used (if applicable) No
Intervention : No
Statistical Analysis:
- BMDP software was used for the analyses. The means and standard deviations for scores of BMDP software was used for the analyses.
- The means and standard deviations for scores of DEBQ scales, daily intakes of energy and macronutrients were calculated for groups of men, women, boys and girsl. The distributions of all variables were tested for normality.
- Analysis of variance (ANOVA) were performed to examine differences in eating style data between the four groups (men, women, boys and girsl).
- Student ± Newman ± Keul's multiple-range test was used to analyse differences between pairs of means.
- Pearson correlation analyses were performed to assess the relationships between scores of DEBQ, BMI or relative weight and nutritional data. All correlation coefficients were adjusted for age.
Times of Measurement
Not reported
Dependent: BMI (measured ht & wt); (for subjects < 20y) Relative weight (calculated using Lorentz’s index (ideal weight), taking into account gender).
Independent: Dietary intake: (3-day dietary records – for young children, diaries were completed by the mother with help from the child); Eating Style (Dutch Eating Behavior Questionnaire).
Control Variables: Age; BMI
Original Sample: 405 nuclear families were eligible for the Eating Behavior project & were recruited at the Centre.
Withdrawals/Drop-Outs: 18 families were excluded either because members did not record their food intakes or because the collected data was not complete.
Final Sample: 1320 members of 387 families (age 11-65 y); 379 men (mean age 42.2 y), 381 women (mean age 40.4 y), 270 boys (mean age 15.2 y) & 290 girls (mean age 15.8 y).
Location: East of France
Race/Ethnicity: Caucasians
SES: not specified
Age: 11-65 y
- Energy intake was significantly different across the four groups (boys, girls, men and women).
- Boys having the highest consumption, women having the lowest.
- Protein and fat contributions in energy intake were significantly higher in adults than in children while carbohydrate contribution was lower, without any signficant difference between sexes in adults and children.
|
characteristics
|
Men
(n.379)
|
Women
(n.381)
|
Boys
(n.270)
|
Girls
(n.290)
|
P a
|
|
Age (y)
|
42.4 (5.1)A
|
40.4 (4.6)B
|
15.2 (2.9)C
|
15.8 (3.3)C
|
***
|
|
Height (cm)
|
174.3 (6.7) A
|
161.6 (5.9)B
|
167.5 (11.7)C
|
161.5 (7.2)B
|
***
|
|
Weight (kg)
|
77.7 (12.0) A
|
61.7 (10.9)B
|
57.1 (14.4)C
|
53.5 (9.7)D
|
***
|
|
Relative weight (%)
|
113.9 (15.6) A
|
108.4 (18.3)B
|
101.0 (13.2)C
|
102.0 (14.8)C
|
***
|
|
BMI (kg=m2)
|
25.6 (3.5) A
|
23.6 (4.0)B
|
20.0 (3.1)C
|
20.4 (3.0)C
|
***
|
|
Energy intake (EI) (kcal)
|
2332 (543) A
|
1782 (428)B
|
2520 (587)C
|
1921 (417)D
|
***
|
|
Protein (% EI)
|
17.8 (2.9) A
|
17.8 (3.4) A
|
15.6 (2.6)B
|
15.7 (2.9)B
|
***
|
|
Fat (% EI)
|
37.2 (6.0) A
|
37.5 (5.6) A
|
35.5 (4.9)B
|
36.3 (5.1)B
|
***
|
|
Carbohydrate (% EI)
|
45.0 (6.9) A
|
44.7 (6.6) A
|
48.9 (5.7)B
|
48.0 (5.7)B
|
***
|
|
Restrained eating
|
2.25 (0.85) A
|
2.76 (0.94)B
|
1.66 (0.68)C
|
2.34 (0.96) A
|
***
|
|
Emotional eating
|
1.72 (0.63) A
|
2.29 (0.87)B
|
1.93 (0.67) A
|
2.26 (0.81)B
|
***
|
|
External eating
|
2.82 (0.69)A
|
2.84 (0.72)A
|
3.18 (0.74)B
|
3.18 (0.63)B
|
***
|
Dietary restraint was positively correlated with the energy derived from protein in women and girls (p<0.001 and P<0.01, respectively) and negatively correlated the energy derived from carbohydrate in the women only (p<0.001).
There was no significant relationship between emotional eating and dietary intakes.
-
A positive correlation was found between extenal eating and energy intakes was observed in women, girsl and boys.
-
In women external eating was negatively correlated with relative protein intake.
Relationships between restrained eating scores and dietary intakes
|
Dietary intakes and DEBQ scores
|
Men
|
Women
|
Boys
|
Girls
|
|
r*
|
r*
|
r*
|
r*
|
|
|
Energy intake (EI)
|
70.16 **
|
70.33 ***
|
70.14 *
|
70.27 ***
|
|
Protein (% EI)
|
0.08
|
0.30 ***
|
0.10
|
0.18 **
|
|
Fat (% EI)
|
0.07
|
0.09
|
0.03
|
70.06
|
|
Carbohydrate (% EI)
|
70.09
|
70.23 ***
|
70.07
|
70.04
|
-
A positive correlation between overweight and fat intake was found in men only. In each of the four groups, ditary restraint was positively correlated to BMI in adults and relative weight in children.
-
A negative relationship between energy intakes and overweight was found in girls only and was almost significant in boys. In the four groups, the percent of energy derived from protein significantly increased with the degree of overweight, whereas it decreased for carbohydrate.
-
There was a positive correlation between BMI and scores of emotional eating in women only. There was no relationship between external eating scores and overweight except in grils where a negative correlation was found.
-
External eating was mainly a characteristic of children (P<0.001).
|
Dietary intakes and DEBQ scores
|
Men
|
Women
|
Boys
|
Girls
|
|
r*
|
r*
|
r*
|
r*
|
|
|
Energy intake (EI)
|
70.03
|
70.03
|
70.11
|
70.19 **
|
|
Protein (% EI)
|
0.18 ***
|
0.13 *
|
0.17 **
|
0.16 **
|
|
Fat (% EI)
|
0.18 ***
|
0.10
|
0.10
|
0.07
|
|
Carbohydrate (% EI)
|
70.23 ***
|
70.15 **
|
70.16 **
|
70.14 *
|
|
Restrained eating
|
0.26 ***
|
0.27 ***
|
0.48 ***
|
0.48 ***
|
|
Emotional eating
|
0.05
|
0.16 **
|
70.10
|
70.01
|
|
External eating
|
0.10
|
0.03
|
70.07
|
70.12 *
|
- 45.1% of the men, 19.7% of the women, 14.4% of the boys and 13.8% of the girls were overweight. 7.7% of the women, 8.1% of the boys and 12.8% of the girls were obese.
- DEBQ scores revealed significant differences between the four groups of men,
- Women, boys and girls. External eating scores were significantly higher in children than in adults .
- Age was negatively related to external eating in men only.
- There was no relationship between age and eating style scores in boys. Girls had higher scores of emotional eating and tended to be less external eaters.
- Results from this study showed clear relationships of dietary intake and eating styles according to sex, age and overweight.
- This first analysis at entrance was necessary to generate baseline data in adults & children.
- The study population will be followed up every 5 y for 10 y.
- In the long term, these results should have implications in the prevention of obesity and eating disorders and may provide additional justification for health promotion programs that target the family as the unit of intervention.
| University/Hospital: | University of Leeds (UK), Centre de Medecine Preventive and INSERM (France) |
- Differences in eating style data were found in the current study according to gender and age.
- Restrained and emotional eating scores were significantly higher in women and girls than in men and boys.
- Dietary intake is varied this was due to changes in food choice ( e.g. external eating).
- Not representative sample of the general population from the East of France and authors agreed that .people are more concerned about their health .
- Further studies are required in a controlled sample and a follow up of the eating styles and dietary intakes are required.
|
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) | ??? | |
| 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? | ??? | |
| 2. | Was the selection of study subjects/patients free from bias? | N/A | |
| 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? | 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) | ??? | |
| 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.) | No | |
| 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? | No | |
| 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%.) | ??? | |
| 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? | 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? | No | |
| 5.5. | In diagnostic study, were test results blinded to patient history and other test results? | ??? | |
| 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? | ??? | |
| 6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | ??? | |
| 6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | ??? | |
| 6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | ??? | |
| 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? | N/A | |
| 7.1. | Were primary and secondary endpoints described and relevant to the question? | ??? | |
| 7.2. | Were nutrition measures appropriate to question and outcomes of concern? | ??? | |
| 7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | ??? | |
| 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? | ??? | |
| 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)? | No | |
| 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? | ??? | |
| 9.1. | Is there a discussion of findings? | Yes | |
| 9.2. | Are biases and study limitations identified and discussed? | ??? | |
| 10. | Is bias due to study's funding or sponsorship unlikely? | ??? | |
| 10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
| 10.2. | Was the study free from apparent conflict of interest? | ??? | |