Setayeshgar 2017.

Methods	Study design: prospective cohort study. Analyses methods for cohorts: multivariable mixed‐effect analysis of each dietary component with the outcomes (WC, BMI, SBP and DBP) conducted. The model with WC was adjusted for age, sex and BMI‐for‐age z‐score, WC and physical activity at baseline. The model with BMI was adjusted for baseline BMI‐for‐age z‐score and physical activity. Models with SBP and DBP were adjusted for baseline BMI‐for‐age z‐score, physical activity and SBP or DBP. Model with SBP was also adjusted for year of study. Interaction analysis conducted for each model to identify significant sex‐specific difference in results. How were missing data handled? Authors reported no statistically significant differences in the SBP z‐scores, DBP z‐scores, BMI‐for‐age z‐scores and WC between the 448 students enrolled and 127 (28.3%) students with missing or incomplete information (data not shown). Number of study contacts: 3 (baseline, 1 and 2 years' follow‐up). Period of follow‐up (total period of observation): 2 years (2009‐2010; 2010‐2011). Periods of recruitment: 2007‐2008. Sample size justification adequately described? No. Sampling method: convenience sample of children in grades 5‐10 from 14 secondary schools, Black Gold School District, Alberta. Of approximately 7000 students, 2189 consented to participate in cohort; 774 students completed baseline dietary questionnaire (Forbes 2013). Of these, 448 students had complete data on dietary intake, physical activity and at ≥ 1 cardiometabolic risk factor at baseline and 1 follow‐up visit. Study objective: to investigate whether specific aspects of dietary intake were associated with prospective changes in cardiometabolic risk factors in children and youths. Study population: school children in grades 5‐10, Black Gold School District, Edmonton, Alberta, Canada.
Participants	Baseline characteristics (reported for 1 overall group) Age (mean in years): 12.53 (SD 1.58). Sex: 60% girls. Ethnicity: NR. Education: NR. Income: NR. Pubertal stage: NR. Parental BMI: NR. Child total energy (kJ): 7861.74 (SD 3284.44). Child total fat: in g: 67.43 (SD 37.78); %TE: 32.3 (SD 0.43). Child total protein: NR. Child total CHO: NR. Child physical activity: moderate‐to‐vigorous activity (minutes/day): 55.8 (SD 22.9). Child physical inactivity or screen time or both: NR. Child CVD risk (excluding fatness): SBP z‐score: 0.31 (SD 0.73); DBP z‐score: ‐0.56 (SD 0.51). Child body fatness: BMI‐for‐age z‐score: 0.39 (SD 0.88); WC (cm): 70.85 (SD 10.08). Included criteria: students with complete data on dietary intake, physical activity and ≥ 1 cardiometabolic risk factor at baseline and ≥ 1 follow‐up. Excluded criteria: energy intake of 500 or ≥ 5000 kcal/day. Brief description of participants: students in grades 5‐10 from rural and urban secondary schools of the Black Gold School District, Edmonton, Alberta, Canada participating in the Healthy Hearts study. Total number completed in cohort study: 321. Total number enrolled in cohort study: 448.
Interventions	Description of exposure for cohorts Time span: 2 years. Dietary assessment method used: validated 24‐hour diet recall (Web‐SPAN) to measure week day dietary intake. Frequency: single 24‐hour dietary recall at baseline. 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.
Outcomes	BMI BMI‐for‐age z‐score. WC WC (cm). SBP SBP z‐score. DBP DBP z‐score.
Identification	Sponsorship source: Collaborative Research and Innovation Opportunity (CRIO) Team Grant; Alberta Innovates Health Solutions. Country: Canada. Setting: rural and urban schools, Black Gold School District, Alberta. Comments: Healthy Hearts Study. Author's name: Solmaz Setayeshgar. Institution: School of Public Health, population Health Intervention Research Unit, University of Alberta, Canada. Email: paul.veugelers@ualberta.ca. Declaration of Interests: yes. "The authors declare that they have no competing interests." Study ID: Setayeshgar 2017. Type of record: journal article.
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Were adequate outcome data for cohorts available? All outcomes	High risk	Proportion of students with incomplete data was high (28.3%). Authors reported no statistically significant differences in outcome variables at baseline between children who were enrolled (n = 448) and children with incomplete information (n = 127) (data not shown). They did not compare children who had incomplete data with children who had complete data (n = 321).
Was there matching of less‐exposed and more‐exposed participants for prognostic factors associated with outcome or were relevant statistical adjustments done? All outcomes	High risk	No adjustment for total energy intake, parental BMI, pubertal stage or SES.
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	Standardised methods used to assess weight, height, WC and BP.
Can we be confident in the assessment of exposure? All outcomes	High risk	Single dietary assessment (validated 24‐hour recall) at baseline.
Can we be confident in the assessment of presence or absence of prognostic factors? All outcomes	High risk	Single assessment of physical activity using a validated method (accelerometer) at baseline.
Was selection of less‐exposed and more‐exposed groups from the same population? All outcomes	Low risk	Children and adolescents were all participants of the Healthy Hearts cohort study.