Klesges 1995.
| Methods |
Study design: prospective cohort study. Analyses methods for cohorts: stepwise multiple regression analysis assessed whether baseline % energy from fat, change from baseline to 1 year, 1 year to 2 years, or baseline to 2 years (along with other variables) predicted change in BMI over 2 years. How were missing data handled? Missing data at baseline: 2 fathers were unavailable for baseline assessments (due to multiple scheduling conflicts), 6 families had some missing measures (no reasons given). Lost to follow‐up at 1 year: 35 families were unavailable after 1 year (20.8%); lost to follow‐up at 2 years: 57 (28.1%). Preliminary analyses investigated whether differences due to attrition were significant on baseline variables. 3 groups of families were formed: participants who did not return for the 1‐year follow‐up, participants not returning for the 2‐year follow‐up and participants who completed the study. No significant differences between groups on children's baseline body mass, energy intake, diet composition (percent of kilocalories from fat), physical activity, sex or familial risk of obesity (P > 0.15). Number of study contacts: 3 (baseline, 1 and 2 years). Period of follow‐up (total period of observation): 2 years. Periods of recruitment: NR. Sample size justification adequately described? No. Sampling method: convenience sample of 219 families with 3‐ to 5‐year‐old children recruited through local paediatricians, daycare centres and churches in Memphis, TN, USA. Study objective: to investigate the extent to which largely modifiable and non‐modifiable risk factors simultaneously predicted weight gain and to determine the precise dietary, physical activity and demographic predictors of weight change in preschool children over a 3‐year period. Additionally, changes in largely modifiable risk factors (e.g. increases or decreases in dietary intake) were evaluated to reflect the dynamic nature of body mass change. Study population: preschool children in Memphis, TN. |
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| Participants |
Baseline characteristics (reported for 1 overall group)
Included criteria: natural, biological offspring of his/her parents; no physical handicap or condition that could affect relative weight, dietary intake or physical activity; had parents who were married; had parents without CVD; and had a family who planned to stay in the metropolitan area in the coming year. Excluded criteria: NR. Brief description of participants: preschool children aged 3‐5 years. Total number completed in the cohort study: 146 children completed study; 73 children with some missing data (8 mothers pregnant, 2 fathers not available for baseline assessment, 35 families not available after 1 year, 22 not available at 2 years' follow‐up). Total number enrolled in cohort study: 219 children, including 3 sets of twins of whom only 1 was chosen randomly. |
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| Interventions |
Description of exposure for cohorts:
See Table 9; Table 10; Table 11; Table 12; Table 13; Table 14; Table 15; Table 16; Table 17; Table 18 for details of total fat intake exposure per outcome. |
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| Outcomes |
BMI
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| Identification |
Sponsorship source: National Blood, Heart and Lung Institute. Country: USA. Setting: community. Comments: NA. Author's name: Robert C Klesges. Institution: University Prevention Center, Department of Psychology, The University of Memphis, and the Department of Preventive Medicine, University of Tennessee, Memphis, TN, USA. Email: NR. Declaration of interests: no. Study ID: Klesges 1995. Type of record: journal article. |
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| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Were adequate outcome data for cohorts available? All outcomes | Low risk | Although attrition was high (33% over 2 years), authors demonstrated no significant differences (P > 0.05) in baseline BMI, energy intake and diet composition between participants completing the study and participants who did not. |
| Was there matching of less‐exposed and more‐exposed participants for prognostic factors associated with outcome or were relevant statistical adjustments done? All outcomes | Low risk | Child age, sex, baseline BMI, baseline energy intake, physical activity and parental BMI were adjusted using multiple regression analyses. Model was not adjusted for ethnicity or SES; however, authors report that participants were mostly white middle‐class children (data not provided). |
| Did the exposures between groups differ in components other than only total fat? All outcomes | Low risk | |
| Can we be confident in the assessment of outcomes? All outcomes | Low risk | Standard anthropometric methods used. |
| Can we be confident in the assessment of exposure? All outcomes | Low risk | Multiple dietary intake assessments completed by both parents and children using the Willett FFQ (baseline, 1 and 2 years). Questionnaire was validated, and assessed dietary intake over the previous 1‐year period. All questionnaires were checked for completeness while families were still present to correct missing data. |
| Can we be confident in the assessment of presence or absence of prognostic factors? All outcomes | Low risk | Child age, sex, baseline BMI, baseline energy intake, physical activity and parental BMI were adjusted using multiple regression analyses. |
| Was selection of less‐exposed and more‐exposed groups from the same population? All outcomes | Low risk | All participants in analysis were recruited through local paediatricians, daycare centres as participants of 1 cohort study |