Pediatric Weight Management

PWM: Foods and Nutrients (2006)


Stewart KJ, Seemans C, McFarland LD, Weinhofer JJ, Brown CS. Dietary fat and cholesterol intake in young children compared with recommended levels. J Cardiopulmonary Rehabil 1999; 19: 112-117.

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 assess whether preadolescent children were following dietary guidelines based on the National Cholesterol Education Program (NCEP) in 1994 and to determine the relationship of diet to obesity.

Inclusion Criteria:
  • In grades 2 to 5     
  • Age 6 to 11 years old
  • Enrolled in one of 10 schools surrounding the Johns Hopkins Bayview Medical Center
  • Not previously enrolled in the FRESH study
Exclusion Criteria:
  • Not Described
Description of Study Protocol:


Participants of the Food Reeducation for Elementary School Health (FRESH) program.



Inside individual classrooms, subjects were instructed by a dietitian or healh educator to complete a 24-hour food log. Instruction included potion sizes. The children were told to consume their usual diets and record everything they ate for 24 hours on a nonweekend day. Food models were used to clarify portion sizes when reviewing for accuracy. Diets were analyzed using Nutritionist III.

Statistical Analysis

  • Pearson’s product moment (r) consumed/d (24-h weekday recall self-reported by child)
Data Collection Summary:

Timing of Measurements: 24-hour diet recall and review completed at one time.

Dependent Variables

  • BMI
  • Skinfold Thickness

Independent Variables

  • Dietary intake: Total energy, % energy from Fat, carbohydrates, protein, saturated fat, monounsaturated fat, milligrams of cholesterol

Control Variables: N/A

Description of Actual Data Sample:

Initial N: 468 children (48% males, 52% females)

Age: 6 to 11 years old (Grades 2 through 5 )

Ethnicity: 87% white, 12% African American, 3% Other

Other relevant demographics: Working class neighborhood

Anthropometrics: BMI: 18.5± 3.9; Sun of Skin folds:19.8± 9.5

Location: Southeast Baltimore, Maryland

Summary of Results:

Descriptive Statistics for Physical Characteristics and Dietary Measures

 Variables  Mean±SD
 Dietary Measures  
 Dietary cholesterol mg  1999.1±141.5
 Total daily energy  1731±476
 Fat % TDE  ±6.3
 Carb % TDE  ±7.8
 Protein % TDE  ±4.0
 SFA % TDE  ±3.3
 MFA % TDE  ±2.9
 PFA % TDE  ±2.1

 Percentil cutpoints for Total Daily Energy Intake from Dietary Fat and Cholesterol

Dietary Measure 10 25 50 75 90
Total Fat 24 27 31 35 40
Saturated Fat 7 9 11 13 15
Monounsaturated Fat
6 8 10 12 14
Polyunsaturated Fat 2 3 5 6 7
Cholesterol 77 110 158 237 377

The negative correlation for sum of skinfold measurements with Total Daily Energy (r=-0.14; P<0.05), suggesting that fatter children consume fewer calories than thinner children, was the only correlate among the dietary components and obesity.


Author Conclusion:
The present negative correlations of total energy intake and obesity are low and do NOT support a definitive conclusion about these relationships; however, obesity is not entirely dependent on energy intake.
Funding Source:
University/Hospital: Johns Hopkins Bayview Medical Center
Reviewer Comments:
  • Large population sample
  • Self reported height and weight
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? 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? N/A
  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? Yes
3. Were study groups comparable? N/A
  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? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  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? No
  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%.) No
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? No
  4.4. Were reasons for withdrawals similar across groups? N/A
  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.) Yes
  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? No
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  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? 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? N/A
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)? 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? 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? No
  10.2. Was the study free from apparent conflict of interest? Yes