Adult Weight Management

AWM: Eating Frequency and Patterns (2013)

Citation:

Perusse-Lachance E, Tremblay A, Drapeau V. Lifestyle factors and other health measures in a Canadian university community. Appl Physiol Nutr Metab. 2010; 35(4): 498-506.

PubMed ID: 20725116
 
Study Design:
Cross-Sectional Study
Class:
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To describe lifestyle factors and other health measures in a Canadian university community. Student and staff samples were compared in order to identify factors associated with overweight and obesity.

Inclusion Criteria:
  • Member of the Laval University (Quebec City, Quebec) community
  • Provided written informed consent to participate in the study.
Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

Online questionnaire sent to the whole Laval University (Quebec City, Quebec) community in November 2008.

Design

Cross-sectional study.

Statistical Analysis

  • Data was analyzed using SAS version 9.1 (SAS Institute Inc., Cary, N.C.) with statistical significance set at P≤0.05
  • Descriptive statistics consisting of means, standard deviations, percentages and frequencies were calculated, and Student's T-test and x2 test were applied to verify statistical significance between genders (men vs. women) and university groups (students vs. staff members)
  • Shapiro-Wilk test was used to verify normality
  • Logistic regression analysis used to identify obesity-related factors and relative risks were adjusted for age and socioeconomic status (annual income).
Data Collection Summary:

Timing of Measurements

  • Participants completed an online questionnaire made up of three sections on physical activity (PA), food habits and other relevant lifestyle factors
  • Questionnaire was adapted from two questionnaires, one used by Health Canada in the Canadian Collectivity Health Survey Cycle 2.2 and one used by Health Quebec in the 1998 Quebec Health and Social Survey
  • Questions covered personal characteristics such as age, gender, socioeconomic status (annual income), personal status (students vs. staff members), height and weight.

 Dependent Variables

Overweight or obesity (BMI was calculated from self-reported height and weight).

Independent Variables

  • Physical activity (self-reported from questionnaire)
  • Food habits (self-reported from questionnaire)
  • Other relevant lifestyle factors (self-reported from questionnaire).

Control Variables

  • Age
  • Socioeconomic status (annual income).
Description of Actual Data Sample:
  • Initial N: 3,260 students and staff
  • Attrition (final N): 3,143 completed the questionnaire (2,490 students and 653 staff)
  • Age: Students age 24.1±5.4; staff members 42.6±10.7
  • Anthropometrics: BMI differed significantly between students and staff members and between men and women in both groups (23.8±4.2kg/m2 in male and 22.8±4.2kg/m2 in female students; 25.5±4.1kg/m2 in male and 24.0±4.5kg/m2 in female staff members, P≤ 0.0001)
  • Location: Laval University (Quebec City, Quebec) community.
Summary of Results:

Key Findings

  • The prevalence of overweight-obesity differed significantly between students and staff members (22.9% vs. 37.3% respectively P≤0.0001) as well as between men and women in both groups (29.3% in male and 20.9% in female students; 50.5% in male and 31.6% in female staff members, P≤0.0001)
  • Present and past dieting and disinhibition susceptibility were the two behaviors that were most strongly associated with overweight-obesity in both groups
  • Moderate-intensity physical activity was also significantly associated with overweight-obesity in staff members and students of both genders. Soft drink intake was significantly associated with overweight and obesity in the student sample only.
  • More than one half of the students and staff members did not meet the CFG recommendations for the consumption of vegetables and fruit [seven or more (women) and eight or more (men) per day] or MIPA participation (150 or more minutes per week)
  • Male students were more likely than female students to skip breakfast (14.3% vs. 9.6%, P≤0.001).

Other Findings

In staff members, more overweight-obese men had experienced past dieting, disinhibition and restriction susceptibility whereas the normal-weight group was less likely to report these behaviors.

Author Conclusion:

This study found a prevalence of overweight-obesity in a university community that was associated with many health-related lifestyle behaviors, such as dieting, eating behaviors and moderate-intensity physical activity categories (MIPA). These findings support the need to develop and evaluate health-promotion and obesity-prevention programs for university communities.

Funding Source:
University/Hospital: Universite Laval, Quebec City, Canada
Reviewer Comments:

The author noted some limitations to this study. First, it was based on self-reported data that are subject to social bias, especially since it is well known that weight is under-reported and height is over-estimated. Second, even though most of the health-related factors investigated are known to be implicated in body weight gain, the cross-sectional nature of the study does not justify a causal link between self-identified lifestyle patterns and obesity. Furthermore, the qualitative nature of the questionnaire did not enable an accurate evaluation of all the lifestyle factors and health measures.

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? ???
  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? No
  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? No
  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? No
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) Yes
  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.) 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? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  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? No
  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.) 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? 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? 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? ???
  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? 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)? N/A
  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