AWM: Eating Frequency and Patterns (2013)
Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C. Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. Eur J Clin Nutr. 1996;50:513-519.
Recruitment Not stated.
Design 7-day weighed records and BMI were gathered from 4 age groups. 3 age groups used in the current study had been gathered previously: 88 elderly (24 M, 64 F; 65-91 years); 44 middle-aged (6 M, 34 F; 39-59 years); and 59 working age (29M, 30 F; 17-60 years). 33 adolescents (12 M, 21 F; 13-14 years) were gathered in the current study. Subjects were instructed in recording their dietary intake. Intake was divided into 6 feeding periods, with the first feeding occasion classified as breakfast. A feeding period was defined as the consumption of any food or drink which provided energy. 2 consecutive feeding periods were considered separate if the time interval between them was greater or equal to 1 hour. The validity of the 7-day records was assessed by calculating the mean physical activity level (PAL=reported energy intake/estimated basal metabolic rate(BMR)) for each subject where BMR was calucated using age, sex, weight and height (Schofield, Schofield & James, 1985). For this study values < 1.10 were considered invalid (underreported).
Blinding used (if applicable) NA
Intervention (if applicable) NA
Statistical Analysis One-way ANOVA, Scheffe's multiple comparison tests, correlation coefficients, linear regression equations, and un-paired t-tests.
Timing of Measurements Each group completed 7 days of continuous recording, weight and height were gathered concurrently and used to determine BMI.
- feeding variability index: each feeding occasion was calculated as percent of total days intake (%MPEI); the variability index is the standard deviation around the mean of the 6 consecutive %MPEIs.**
- feeding frequency index: calculated as the number of %MPEIs which individually exceeded 10%**
- energy intake at breakfast: percentage of mean total daily energy intake
- energy intake in evening: percentage of mean total daily energy intake
** For example, a 'gorging' feeding pattern would produce a high variability index and a low frequency index, whereas a 'nibbling' feeding pattern would produce a low variability index and a high frequency index.
Control Variables none stated
Initial N: 71 M, 149 F
Attrition (final N):not stated
Age: 13-14 years: 12 M, 21 F
17-60 years: 29 M, 30 F
39-59 years: 6 M, 34 F
65-91 years: 24 M, 64 F
Ethnicity: not stated
Other relevant demographics: none reported
Anthropometrics BMI, all group means (by age and gender) are under 25.O except for the middle-aged group where males = 25.0 (+/-4.2) and females = 25.2 (+/-4.6)
Results are presented with the entire sample and with individuals excluded whose mean energy intake < a PAL of 1.10.
- In adolescents-a high BMI was associated with lower energy intakes at breakfast (P<0.01), high feeding variability (P<0.05), and a low feeding frequency (P<0.05).
- In the middle-aged group-a high BMI was associated with lower energy intakes at breakfast (P<0.05), and higher energy intakes during the evening (P<0.05).
- Feeding pattern was not related to BMI in the working age or elderly groups.
When invalid records were removed:
- In adolescents-absolute energy intakes at breakfast remained inversely related to BMI (P<0.05).
- In the middle-aged group-higher energy intake during the evening remained directly related to BMI (P<0.05).
- In the working age group-absolute energy consumed during the evening was directly related to BMI (P<0.05).
|University/Hospital:||St Bartholomew's and the Royal London Hospital School of Medicine and Dentistry, Robert Gordon University, Southbank University, University of London (London UK)|
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)||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|
|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?||???|
|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?||???|
|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?||???|
|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)||N/A|
|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.)||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?||???|
|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.)||No|
|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%.)||???|
|4.3.||Were all enrolled subjects/patients (in the original sample) accounted for?||???|
|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?||N/A|
|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.)||N/A|
|5.3.||In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?||N/A|
|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?||No|
|6.3.||Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?||N/A|
|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?||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?||???|
|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)?||N/A|
|8.5.||Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?||N/A|
|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|