research analysis worksheet
TRANSCRIPT
USU RESEARCH ANALYSIS WORKSHEET EXAMPLE
RESEARCH ANALYSIS WORKSHEET Instructions: 1. It is important for dietitians to be critical when analyzing research and determining if the results were
reached using appropriate methods, and are reported accurately.
2. Find two current Primary Research articles (not found in the AND Evidence Analysis Library) related
to your controversial topic: one for each side of the controversy. They must be primary research
articles, meaning they are studies that did original research rather than reviewing other research.
3. Complete the Research Analysis Summary below for each study
4. For each question, first summarize that section from the study you read. Then, answer YES, NO, or
N/A (not applicable) for each question. Answer the questions to the best of your knowledge. If you
are not sure what terms mean, you can review your notes from your undergraduate research methods
class or look them up online. This will be a good review and preparation for the RD exam.
5. See the example available on Canvas and the website for help.
Research Analysis: Controversy Side #1
Citation (AMA style): Van Dommelen P. The effect of early catch-up growth on health and well-being in young
adults. Ann Nutr Metab. 2014;65(2-3):220-226.doi:10.1159/000364884.
1. Research Purpose Summarize the purpose of the study you read: The researcher’s aim was to study the effects
of catch-up growth in weight/length/HC in the first year of life on cognition, health related quality of life, problem behavior, height and weight status in young adults.
1.1 Was the research purpose clearly stated? Yes No N/A
1.2 Was the specific intervention(s) or procedure (independent variable(s)) identified? Yes No N/A
1.3 Was the outcome(s) (dependent variable(s)) clearly indicated? Yes No N/A
2. Population Studied Summarize the population studied in the study you read: The population that they used was
individuals that were a part of the Collaborative Project on Preterm and SGA infants in The Netherlands. In more detail they were newborn infants born alive in the Netherlands in 1983 with a GA off <32 weeks and/or a birth weight of <1,500g
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 No N/A
2.2 Were the subjects/patients a representative sample of the relevant population? Yes No N/A
2.3 Was the method of assignment subjects/patients to groups described and
unbiased? Or was the method of randomization identified if it’s a randomized control
trial?
Yes No N/A
3. Study Protocol
Study Design Summarize the study design in the study you read: After the 19th birthday, individuals were invited to
participate in the study by going to one of the multiple centers and completion of a questionnaire.
3.1 Was the study design clearly identified? Yes No N/A
Blinding Summarize the blinding methods in the study you read: There was no blinding method used in this study.
USU RESEARCH ANALYSIS WORKSHEET EXAMPLE
3.2 For an intervention study: Were subjects, clinicians/practitioners, and
investigators blinded to the treatment group, as appropriate?
Yes No N/A
3.3 For a cohort or cross-sectional study: Were measurements of outcomes and risk
factors blinded?
Yes No N/A
3.4 For a case control study: Was case definition explicit and case ascertainment not
influenced by exposure status?
Yes No N/A
3.5 For a diagnostic study: Were test results blinded to patient history and other test
results?
Yes No N/A
Interventions Summarize the interventions used in the study you read: There wasn’t an intervention completed
other than the tests/questionnaire that the participant completed. Assessments were facilitated by trained RN and med staff.
3.6 For a randomized control trial (RCT) or other intervention trial: Were protocols
described for all regiments studied?
Yes No N/A
3.7 For an observational study: Were interventions, study settings, and
clinicians/providers described?
Yes No N/A
3.8 Was the intensity and duration of the intervention or exposure factor sufficient to
produce a meaningful effect?
Yes No N/A
3.9 For a diagnostic study: Were details of test administration and replication
sufficient?
Yes No N/A
4. Results Summarize the results fro the study you read: Results summarized the environmental and personal factors,
neonatal factors, postnatal factors, and outcome measures at 19 years of age.
Outcomes Summarize the outcomes in the study you read: The researchers found that higher catch-up growth in
the first year was associated with better cognition, fewer disabilities, and higher final heights in young adults.
4.1 Was the period of follow-up long enough for important outcomes to occur? Yes No N/A
4.2 Were the observations and measurements based on standard, valid, and reliable
data collection instruments/tests/procedures?
Yes No N/A
4.3 Were other factors that could affect the outcome accounted for and measured? Yes No N/A
Statistical Analysis Summarize the statistical analysis used in the study you read: The statistician imputed
multiple adjustments for missing values. The process used filled in plausible values for missing data. They pooled results from the completed data set and used multivariate inputs. The analysis used regression and all stat analyses were performed in SPSS version 20.0 for windows.
4.4 Were statistical analyses adequately described and the results reported
appropriately?
Yes No N/A
4.5 Were statistics reported with levels of significance and/or confidence intervals? Yes No N/A
4.6 Were adequate adjustments made for effect of cofounding factors that might have
affecting the outcomes (e.g. multivariate analyses)?
Yes No N/A
4.7 Was clinical significance as well as statistical significance reported? Yes No N/A
5. Discussion/Author’s Conclusion Summarize the discussion and conclusion in the study you read: The authors
discussed their findings and also discussed another study that concluded similarly to theirs. They went on to say how
USU RESEARCH ANALYSIS WORKSHEET EXAMPLE
more research is needed to detail what is an appropriate catch up growth.
5.1 Is there a discussion of findings? Yes No N/A
5.2 Are biases and study limitations identified and discussed? Yes No N/A
6. Funding Sources Summarize the funding sources of the study you read: No funding is noted nor conflict
disclosure.
6.1 Were sources of funding and investigators’ affiliations described? Yes No N/A
6.2 Was the study free from apparent conflict of interest? Yes No N/A
7. Your Comments Do you consider this article’s conclusions to be accurate and reliable? Would you feel good using these recommendations in everyday practice? Why or Why not? Be specific in your comments.
I think that the researchers did a good job with what they were using. They were limited by the participants in the study group and those who volunteered to participate in the study at age 19. I think that they have solid methods that had many different factors that were used to account for multiple situations. I would feel comfortable using this article in everyday practice WITH other research/comparative standards that are in place.
USU RESEARCH ANALYSIS WORKSHEET EXAMPLE
RESEARCH ANALYSIS WORKSHEET Instructions: 1. It is important for dietitians to be critical when analyzing research and determining if the results were
reached using appropriate methods, and are reported accurately.
2. Find two current Primary Research articles (not found in the AND Evidence Analysis Library) related
to your controversial topic: one for each side of the controversy. They must be primary research
articles, meaning they are studies that did original research rather than reviewing other research.
3. Complete the Research Analysis Summary below for each study
4. For each question, first summarize that section from the study you read. Then, answer YES, NO, or
N/A (not applicable) for each question. Answer the questions to the best of your knowledge. If you
are not sure what terms mean, you can review your notes from your undergraduate research methods
class or look them up online. This will be a good review and preparation for the RD exam.
5. See the example available on Canvas and the website for help.
Research Analysis: Controversy Side #1
Citation (AMA style): Embleton ND, Korada M, Wood CL, Pearce MS, Swamy R, Cheetham TD. Catch-
up growth and metabolic outcomes in adolescents born preterm. Archives of Disease
in Childhood. June 2016:archdischild–2015–310190. doi:10.1136/archdischild-2015-
310190.
1. Research Purpose Summarize the purpose of the study you read: The purpose of this study was to determine
whether growth patterns in the neonatal period, infancy and childhood are associated with markers for the metabolic syndrome in adolescents who were born preterm. They wanted to compare the metabolic impact of weight gain pre discharge and in early infancy, when growth is strongly influenced by nutritional management with the impact of childhood growth when the determinants of weight gain are more closely correlated to lifestyle factors.
1.1 Was the research purpose clearly stated? Yes No N/A
1.2 Was the specific intervention(s) or procedure (independent variable(s)) identified? Yes No N/A
1.3 Was the outcome(s) (dependent variable(s)) clearly indicated? Yes No N/A
2. Population Studied Summarize the population studied in the study you read: Children born preterm from 1993-
1998. Preterm at <34 weeks.
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 No N/A
2.2 Were the subjects/patients a representative sample of the relevant population? Yes No N/A
2.3 Was the method of assignment subjects/patients to groups described and
unbiased? Or was the method of randomization identified if it’s a randomized control
trial?
Yes No N/A
3. Study Protocol
Study Design Summarize the study design in the study you read: longitudinal cohort study
3.1 Was the study design clearly identified? Yes No N/A
Blinding Summarize the blinding methods in the study you read: there was no blinding stated.
USU RESEARCH ANALYSIS WORKSHEET EXAMPLE
3.2 For an intervention study: Were subjects, clinicians/practitioners, and
investigators blinded to the treatment group, as appropriate?
Yes No N/A
3.3 For a cohort or cross-sectional study: Were measurements of outcomes and risk
factors blinded?
Yes No N/A
3.4 For a case control study: Was case definition explicit and case ascertainment not
influenced by exposure status?
Yes No N/A
3.5 For a diagnostic study: Were test results blinded to patient history and other test
results?
Yes No N/A
Interventions Summarize the interventions used in the study you read: Regular assessments of infant growth,
body composition, blood pressure, insulin sensitivity and lipid profile.
3.6 For a randomized control trial (RCT) or other intervention trial: Were protocols
described for all regiments studied?
Yes No N/A
3.7 For an observational study: Were interventions, study settings, and
clinicians/providers described?
Yes No N/A
3.8 Was the intensity and duration of the intervention or exposure factor sufficient to
produce a meaningful effect?
Yes No N/A
3.9 For a diagnostic study: Were details of test administration and replication
sufficient?
Yes No N/A
4. Results Summarize the results fro the study you read: of the 153 children they reviewed 102 as adolescents. Catch
up between term and 12 weeks corrected age height and wt were similar to population averages and didn’t differ between catch up groups. Those with rapid catch up had lower LDL, higher fasting log-insulin, compared to no catch up group. Weight gain in infancy and childhood- in infancy there were no significant t associations between wt and later outcomes. During the age of 1yr and older there was a ‘strong’ association between gain in weight and waist circumference, fasting glucose, insulin sensitivity, blood pressure, and HDL and cholesterol.
Outcomes Summarize the outcomes in the study you read: The outcomes that were seen in this study was the
waist circumference, fasting glucose, fasting insulin, systolic, diastolic blood pressure, total cholesterol, HDL, LDL, triglycerides, and total cholesterol/HDL ratio.
4.1 Was the period of follow-up long enough for important outcomes to occur? Yes No N/A
4.2 Were the observations and measurements based on standard, valid, and reliable
data collection instruments/tests/procedures?
Yes No N/A
4.3 Were other factors that could affect the outcome accounted for and measured? Yes No N/A
Statistical Analysis Summarize the statistical analysis used in the study you read: Linear regression models were
used to estimate relationships between weight gain and metabolic outcomes after adjusted for potential confounding factors. The association of catch up in weight postdischarge between term and 12 weeks on later outcomes was determined by categorizing the patterns of catch up in weight using the change in weight SDS. The analysis did not analyze the nutritional factors such as formula fed, parenteral nutrition duration, and breast feeding due to there being 7+ groups. Statistical analysis was performed using STATA V.11.0.
4.4 Were statistical analyses adequately described and the results reported
appropriately?
Yes No N/A
4.5 Were statistics reported with levels of significance and/or confidence intervals? Yes No N/A
USU RESEARCH ANALYSIS WORKSHEET EXAMPLE
4.6 Were adequate adjustments made for effect of cofounding factors that might have
affecting the outcomes (e.g. multivariate analyses)?
Yes No N/A
4.7 Was clinical significance as well as statistical significance reported? Yes No N/A
5. Discussion/Author’s Conclusion Summarize the discussion and conclusion in the study you read: The study
concluded that there was no significant difference in outcomes in children preterm with catch up growth before age 1. However, those who did have continued catch up growth past age one did have negative outcomes. The discussion made some good points about limitations due to the small group size and how they were not able to exam in the cohort for a longer period of time. Their study did differ from a recent study that showed that there were negative outcomes in bout study groups. The main difference between the two studies was the age at which the follow up occurred. The author speculates that maybe the time period that they performed the study was too early to see the effects from infant weight gain.
5.1 Is there a discussion of findings? Yes No N/A
5.2 Are biases and study limitations identified and discussed? Yes No N/A
6. Funding Sources Summarize the funding sources of the study you read: Nutricia UK provided funding for the
initial controlled trials in infancy. Support for subsequent follow-up studies was provided by Novo
Nordisk, Nutricia UK, and the Special Trustees Newcastle Healthcare Charity.
6.1 Were sources of funding and investigators’ affiliations described? Yes No N/A
6.2 Was the study free from apparent conflict of interest? Yes No N/A
7. Your Comments Do you consider this article’s conclusions to be accurate and reliable? Would you feel good using these recommendations in everyday practice? Why or Why not? Be specific in your comments.
I would consider this to be a good study. I agree with their conclusion/recommendation to continue to
facilitate postdischarge growth of preterm infants but limit it to one year of age.
A M B E R R I C H A R D S
O G D E N , U T A H
Feeding LBW/SGA infants. The catch-up growth dilemma.
Presentation Overview
The developmental consequences of poor early growth
Metabolic consequences of early growth
Topic Introduction
Why this topic
Experience as NICU diet tech
The controversy
In the neonatal field there is a debate over catch-up growth in LBW/SGA infants
RDN’s role in the process
NICU RDN monitors intake of infants and recommends fortification of formulas or breast milk.
Outpatient RDN does the same for failure to thrive or under weight infants/children.
Background Information
Definitions
LBW: Babies who are born weighing less than 2,500 grams (5 pounds, 8 ounces) Average baby weighs 8lbs.1
SGA: Variably set at the 3rd or 10th percentile, or at less than -2 standard deviations from the mean2
Catch-up growth: returning toward the original size that existed before growth restriction occurred. Restoration of lean body mass.3
Background Information Cont.
Causes of SGA
The exact etiology is unknown. Maternal factors include poor nutrition, chronic disease and infections, smoking and alcohol consumption. Parental factors including DM may also contribute to being born SGA. The primary cause of reduced fetal growth is believed to be the lack of nutritional supply to the fetus.2
Background Information Cont.
Why is it needed?
Because of the higher metabolic rate of the lean body mass, and also as a consequence of the reduced fat mass relative to lean mass, resting energy expenditure per unit of body mass is higher in growth-restricted infants than in normally grown infants, as has been documented in a number of studies.3
Recommended Weight Gain for Healthy Children
g/d = grams per day
Review of Research – Side 1
Advantages of proper catch-up growth in SGA infants
Optimized growth
Improved final adult height
Enhanced immune function
Improved neurodevelopment
Optimized growth Improved final adult height8
Feeding for catch up growth optimizes postnatal growth allowing infants to reach the size they ideally would have achieved in an optimal in utero state.
If catch-up growth doesn’t occur in early years, about half of SGA infants will remain short into adulthood.4-5
Review of Research – Side 1
Enhanced immune function2 Improved neurodevelopment2,8
Insufficient catch-up growth can lead to chronic health problems such as: cerebral palsy, visual & hearing impairment, and respiratory problems such as asthma.6
In 2001, a large study of 254,426 males from Sweden described a significantly increased risk of subnormal intellectual and psychological performance in SGA born adults; the most important predictor was the absence of catch-up growth.4
Review of Research – Side 1
Review of Research – Side 2
Consequences of early growth
Cardiovascular disease
Obesity
Diabetes/insulin resistance
Cardiovascular disease2,8 Obesity/increased fat mass/DM2,8
Formula feeding/fortified mom’s milk are sometimes required for catch up growth. A study of infant and adult deaths concluded that the increase of serum cholesterol related to formulas when compared to breast milk increased the risk of adult mortality related to heart disease.7
In a study on mice, forced catch-up growth after fetal protein restriction was reported to influence the adipose gene expression program.6
Catch up growth that occurs later than 1 year of age influences a greater adult BMI.6
Insulin resistance related to aforementioned phenomenon.8
Review of Research – Side 2
Benefits Consequences
Optimized growth
Improved final adult height
Enhanced immune function
Improved neurodevelopment
Cardiovascular disease
Obesity
Diabetes/insulin resistance
Summary of Research
Figure A4
My Recommendations
Though I did find many studies finding correlations between early growth and metabolic consequences, I conclude that none of these studies showed more than a correlation. Thus, I would continue to recommend healthy catch-up growth for LBW/SGA infants to promote proper growth and cognitive function.
The concept of 'healthy catch-up growth' should be the goal of future research to provided more guidelines for catch-up growth.
Questions
References
1. Stanford Children’s Health. Lucile Packard Children’s Hospital Stanford. Low Birthweight. http://www.stanfordchildrens.org/en/topic/default?id=low-birthweight-90-P02382. Accessed August 9, 2016.
2. Cho W, Suh B. Catch-up growth and catch-up fat in children born small for gestational age. Korean J Pediatr. 2016;59(1):1-7. http://dx.doi.org/10.3345/ kjp.2016.59.1.1. Accessed August 3, 2016.
3. Ziegler E. Nutrient needs for catch-up growth in low-birthweight infants. Nestle Nutrition Workshop Series. 2015;81:135-143
4. Ong K. Catchup growth in small for gestational age babies: good or bad? Curr Opin Endocrinol Diabetes Obes. 2007;14(1):30-34. doi:0.1097/MED.0b013e328013da6c
5. Dahlgren J, Wikland K. Final height in short children born small for gestational age treated with growth hormone. Pediatr Res. 2005;57:216-222.
6. Brisbois T, Farmer A, McCargar L. Early markers of adult obesity a review. Obesity Reviews. 2012;13:347-367.doi:10.1111/j.1467-789X.2011.00965.x
7. Barker. Infant mortaility, childhood nutrition, and ischaemic heart disease in england and wales. The Lancet. 1986;327(8489):1077-1081.
8. Van Dommelen P. The effect of early catch-up growth on health and well-being in young adults. Ann Nutr Metab. 2014;65(2-3):220-226.doi:10.1159/000364884.
