PWM: Family Influences (2006)
Citation:
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
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.
Inclusion Criteria:
Age-eligible children who attended a university preschool setting (Urbana, IL) with parents born in the US.
Exclusion Criteria:
Children with inability to consume the entire drink load.
Description of Study Protocol:
- 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.
Statistical Analysis
- 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.
Data Collection Summary:
- 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.
Description of Actual Data Sample:
- 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.
Summary of Results:
- 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.
Parental Factors
- 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.
Author Conclusion:
- 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.
Funding Source:
Government: | NIH |
University/Hospital: | University of Illinois |
Reviewer Comments:
Strengths:
- 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
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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) | 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 | |
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? | 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 | |