Pediatric Weight Management

PWM: Foods and Nutrients (2006)


Lluch A, Herbeth B, Mejean L, Siest G. Dietary intakes, eating style and overweight in the Stanislas Family Study. International Journal of Obesity 2000; 24: 1493-1499.

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 describe the eating patterns of members of French families & assess the relationships between dietary intakes, eating styles & overweight.

Inclusion Criteria:

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.

  • Overweight = BMI between 25 & 30 (for adults) & Relative weight between 110 & 120 (for children).
  • Obese = BMI > 30 (for adults) & Relative weight > 120 (for children).
Exclusion Criteria:

Families were excluded from participation if on member had a disease that could influence their eating behavior (diabetes, food allergy, hyperlipaemia).

Description of Study Protocol:

A French familial and longitudinal cohort designed to investigate the family factors related to CVD was recruited between 1994 & 1995. During the first yr of the study, detailed dietary data from 387 families were collected.

Data Collection Summary:

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.

Statistical Analysis:  ANOVA & Pearson correlation analyses.

Description of Actual Data Sample:

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:  not specified

SES:  not specified

Age:  11-65 y

Summary of Results:

Total Energy:

  • A negative association between energy intake & overweight (relative weight) was found in girls only (P<0.001).
  • No sig. correlation was noted between total energy & overweight in men, women or boys.


% total energy from protein was positively associated (correlated) with  BMI in men (0.18, P< 0.001), women (0.13, P<0.05), boys (0.17, P<0.01) & girls (0.16, P<0.01).


% total kcal from fat was sig. associated with BMI in men only (0.18, P<0.001). It was not associated with BMI and relative weight in women & boys & girls, respectively.


% total kcal from carbohydrate was negatively correlated with BMI and relative weight in men (-0.23, P<0.001), women (-0.15, P<0.01), boys (-0.16, P<0.01) & girls (-0.14, P<0.05).
Author Conclusion:

Results from this study showed clear patterns 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.

Funding Source:
University/Hospital: University of Leeds (UK), Centre de Medecine Preventive and INSERM (France)
Reviewer Comments:


Pilot test conducted to test methods of assessing food intake.


Not representative sample of the general population from the East of France.

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? ???