Critical appraisal of a cohort studyHowe et al. Int J Obes 2010;34:1149-1159.

Ulla SovioCORGI Journal Club

22 Sept 2010

Introduction

• Motivation – why this paper?1. Public health importance; deals with inequalities 2. Recent key paper in paediatric obesity research3. Deals with methodological challenges that need

to be addressed in our own work• missing data and selection bias: multiple imputation• confounding: adjustments• effect modification: interactions and stratified analysis• mediation of effects: path analysis

Introduction

• Motivation – why this paper?4. Based on the prospective ALSPAC cohort, which

will be used in our project – this paper might • give important insights into the data• help us work on our own study questions • generate new ideas

Introduction

• Study questions1. Are there socioeconomic inequalities in

cardiovascular risk factors in childhood?2. If yes, are they mediated by adiposity?

Introduction

• What is already known? What this study adds?

Low childhood SEP Higher risk of adult CVD and T2D

known association but mechanism unclear

Childhood adiposity

known association in high-income countries

Adult adiposity

known association: tracking of obesity over time

known association

Q1: Low childhood SEP => Childhood CVD risk factors?Q2: Is the association (Q1) mediated by childhood adiposity?

Childhood CVD risk factors

known association

known association?

SEP = socioeconomic positionCVD = cardiovascular diseaseT2D = type 2 diabetes

?

AgeBirth 10 years Adulthood