PWM: Family Influences (2006)
Johnson SL, Birch LL. Parents’ and children’s adiposity and eating style. Pediatrics 1994; 94: 653-661.PubMed ID: 7936891
To examine the data for any relations that might exist between the following:
- Children’s eating index and children’s anthropometric measures
- Parents’ weight status and parental dieting history
- Parents’ and children’s eating styles
- Parents’ child-feeding practices and children’s eating index.
Relations that might indicate the existence of parental influence on children’s eating styles and weight outcomes.
Age-eligible children who attended a university preschool setting (Urbana, IL) with parents born in the US.
- Children participated in one pair of calorie compensation trials during which they were asked to drink high- or low-calorie fruit-flavored drinks that differed only in carbohydrate and therefore calorie content
- After a short interval, children ate lunch ad libitum and their responsiveness to the energy density differences of the drinks was assessed by measuring energy consumption during lunch.
- Descriptive statistics: Means, standard errors, ranges, skewness, kurtosis and Wilk's test of nomality
- Gender differences were assessed using T-tests
- Correlation and multivariate regression analyses.
- Dependent variables: Children’s eating index (% compensation – COMPX)
- Independent variables:
- Children’s adiposity: Measured height and weight and skinfolds
- Parent’s dietary restraint, disinhibition, and perceived hunger: Stunkard and Messick’s Three-Factor Eating Questionnaire
- Parental control over child’s feeding: Child-Feeding Questionnaire
- Parental BMI (self-reported).
- Control variables: Gender.
- N: 77 (46 girls, 31 boys)
- Age: Three to five year old children
- SES: Predominantly middle class
- Ethnicity: Predominantly White (five African American, nine Asian)
- Location: Urbana, IL.
- Children who compensated poorly, that is, eat less lunch following the snack-drink were in fact significantly fatter (P<0.006)
- Girls’ COMPX was significantly negatively correlated with their anthropometric measures – fatter girls were less likely to compensate. For boys, only weight and weight/height correlated significantly and positively with COMPX. Boys overall compensated better than girls.
- Heavier parents reported a higher incidence of disinhibited eating, which refers to a tendency to eat uncontrollably even when not hungry
- Highly controlling parents had children who showed less evidence of self-regulation of caloric intake
- Parental disinhibition was negatively correlated to their children’s ability to regulate energy intake (r=-0.35, P<0.02)
- No correlation between parental dietary restraint and children’s COMPX emerged. However, mothers’ dietary restraint was marginally negatively correlated with girls’ COMPX (r=-0.37, P<0.08). Boys’ COMPX and mother’s restraint were significantly positively correlated (r=0.41, P<0.05).
- Multiple Linear Regression: Parental control index was negatively associated with children’s eating index. Gender was a significant covariate – reveals that girls and boys may be parented differently in the feeding context.
- The findings suggest that parental control in the feeding context is an important predictor of children’s responsiveness to energy density and of their weight outcome
- The optimal environment for children's development of self-control of energy intake is that in which parents provide healthy food choices, but allow children to assume control of how much they consume
- Sex differences in the control of food intake are present as early as the preschool period and that from a very early age, males and females are socialized differently regarding food and eating.
|University/Hospital:||University of Illinois|
- Investigators and classroom personnel were blinded to the experimental condition (high-calorie vs. low-calorie fruit drink)
- While the outcome measure was not a measure of child adiposity; child adiposity was measured and was indirectly explained by both parental dietary disinhibition and restraint as well as parental child feeding practices.
Quality Criteria Checklist: Primary Research
|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|
|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?||Yes|
|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)||???|
|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.)||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?||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?||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%.)||Yes|
|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?||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?||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?||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)?||???|
|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?||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?||Yes|
|10.2.||Was the study free from apparent conflict of interest?||Yes|