AWM: Eating Frequency and Patterns (2013)


Grujic V, Cvejin MM, Nikolic EA, Dragnic N, Jovanovic VM, Kvrgic S, Travar S. Association between obesity and socioeconomic factors and lifestyle. Vojnosanit Pregl 2009; 66 (9): 705-710.

PubMed ID: 19877548
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

The aim of this study was to determine the prevalence of overweight and obesity in a province of Serbia and to examine the association between obesity and socioeconomic and lifestyle factors in 2006 and to compare these data to data obtained in 2000 which also examined obesity prevalence and causes in a Serbian population.

Inclusion Criteria:

The Ministry of Health of the Republic of Serbia carried out "The 2006 National Survey for the population of Serbia". The survey conducted in the Province of Vojvodina covered 1,810 households (1,060 in towns and 750 in other settlements) and 3,854 adults were examined.

Exclusion Criteria:
  • Persons less than 20 years old
  • Persons not living in Vojvodina.
Description of Study Protocol:


The Ministry of Health of the Republic of Serbia recruited and surveyed persons 20 years and older in urban and rural areas of the country in 2000 and 2006. 


Cross-sectional study 


Not applicable

Statistical Analysis

  • A sample of survey data was chosen to provide reliable statistical evaluation for all persons whose frequency of appearance was above 5%
  • Data were analyzed using SPSS version 14.0 
  • Statistical analysis was done using descriptive and inferential statistics 
  • The results were given as mean ±SD 
  • Differences in frequency were tested by Χ² test and differences between two samples were tested using Student's t-test(for both, P values <0.05 were considered statistically significant).


Data Collection Summary:

Timing of Measurements: A stratified two-stage sample of the population was surveyed and analyzed by The Ministry of Health in 2006 and compared to corresponding data obtained by this Ministry in 2000. 

Dependent Variables

  • BMI was calculated by using standard methodology for weight and height measurements. 
  • Obesity and overweight classifications were made based on BMI data. 

Independent Variables:

  • Sociodemographic information:  age, sex, education, marital status, and household income
  • Lifestyle and nutrition habits, including whether or not breakfast was eaten, and time spent watching TV were obtained by questionnaire.



Description of Actual Data Sample:
  • Initial N: 3,854 adults
    • 1,831 males and 2,023 females
  • Attrition: Apparently data from all 3,854 adults was used in the study
  • Age: 20-70+ years
  • Ethnicity: Serbian
  • Other relevant demographics: From the Serbian province of Vojvodina, evidently different enough from the other Serbian provinces to be surveyed separately
  • Anthropometrics:
  • Location: Vojvodina, Serbia.


Summary of Results:

Key Findings

  • The prevalence rate for overweight was 35.7% (95%CI:34.1-37.2) and for obesity was 21.7% (95%CI:20.4-23.0) in the 2006 population survey. The prevalence of overweight was higher in men (41.1%) than in women (30.9%, P<0.001) while obesity was higher in women than men (P<0.035).
  • For both sexes overweight rates peaked at age 60-69, obesity peaked at 50-59 years for men and 60-69 years for women
  • There were no statistically significant differences in the prevalence of overweight or obesity in adult population of Province of Vojvodina in 2000 and 2006 nor were there statistically significant differences in the three BMI classes measured in 2000 and 2006
  • Statistically important decreases in overweight in 2006 compared to 2000 were found in women aged 20-29 years as well as decreases in obesity in women aged 50-59 years and those 70 years and older
  • The authors noted that their results confirmed the following findings from other studies: Overweight and obesity were lower in women than men and increased with aging, lower educational levels, marriage, omission of breakfast and TV-watching 
  • Village dwellers had higher prevalence of overweight and obesity.
Author Conclusion:

Healthy lifestyles combined with balanced nutrition with low energy intake and increased physical activity have to be promoted to decrease and prevent the prevalence of overweight and obesity such as that found in Vojvodina and society in general. Health services, community organizations, food industries, mass media, etc., have crucial roles in preventing weight gain and should undertake activities which will promote healthy lifestyles. 

Funding Source:
Government: Institute of Public Health of Vojvodina, Novi Sad, Serbia
Reviewer Comments:
  • Inclusion/exclusion criteria not well described 
  • Questionnaire not well described. 
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? N/A
  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? ???
  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? No
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
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? 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? ???
  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.) N/A
  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? 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? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  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? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? ???
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? ???
  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? No
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