Mothers' perceptions about the nutritional status of their
               overweight children: a systematic review

Francescatto, Caliandra; Santos, Natalia S.; Coutinho, Vanessa F.; Costa, Roberto F.

doi:10.1016/j.jped.2014.01.009

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Review Articles • J. Pediatr. (Rio J.) 90 (4) • Jul-Aug 2014 • https://doi.org/10.1016/j.jped.2014.01.009 copy

Mothers' perceptions about the nutritional status of their overweight children: a systematic review ^☆ ☆ Please cite this article as: Francescatto C, Santos NS, Coutinho VF, Costa RF. Mothers' perceptions about the nutritional status of their overweight children: a systematic review. J Pediatr (Rio J). 2014;90:332-43. ^☆☆ ☆☆ Study conducted at the institution Universidade Gama Filho (UGF), Rio de Janeiro, RJ, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

this systematic review aims to explore and describe the studies that have as a primary outcome the identification of mothers' perception of the nutritional status of their children.

SOURCES:

the PubMed, Embase, LILACS, and SciELO databases were researched, regardless of language or publication date. The terms used for the search, with its variants, were: Nutritional Status, Perception, Mother, Maternal, Parents, Parental.

SUMMARY OF THE FINDINGS:

after screening of 167 articles, 41 were selected for full text reading, of which 17 were included in the review and involved the evaluation of the perception of mothers on the nutritional status of 57,700 children and adolescents. The methodological quality of the studies ranged from low to excellent. The proportion of mothers who inadequately perceived the nutritional status of their children was high, and was the most common underestimation for children with overweight or obesity.

CONCLUSION:

despite the increasing prevalence of obesity in pediatric age, mothers have difficulty in properly perceiving the nutritional status of their children, which may compromise referral to treatment programs.

Nutritional status; Perception; Mother; Maternal; Parents; Parental

	Selection bias		Blinding	Methods and data collection			Non- respondents	Quality
Study	Selection not based on nutritional status	Description of characteristics, representative sample	The mother was not aware of the nutritional status before being asked	Mentioned types of equipment, the same equipment for all subjects	In case of image scale use, the scale was validated	Mentioned diagnostic criteria for nutritional status	Non-respondents were mentioned	Classification of study quality
Aparício et al.¹⁸	+	+	+	-	+	+	?	Good
Baughcum et al.²³	+	?	?	+	n.a.	+	+	Moderate
Binkin et al.³⁰	+	+	+	+	n.a.	+	+	Excellent
Boa-Sorte et al.¹⁶	+	+	+	+	n.a.	+	+	Excellent
Boutelle et al.⁴²	+	+	?	-	n.a.	+	+	Moderate
Bracho & Ramos⁴³	+	+	?	?	n.a.	+	+	Moderate
Carnell et al.³³	+	?	?	-	n.a.	+	+	Moderate
Genovesi et al.⁵²	+	+	+	-	n.a.	+	+	Good
Guevara-Cruz et al.³¹	+	+	+	+	n.a.	+	?	Good
Hackie & Bowles⁴⁵	-	-	+	-	n.a.	-	-	Low
Hirschler et al.⁴⁶	+	+	?	-	n.a.	+	+	Moderate
de Hoog et al.⁴⁴	-	+	+	+	n.a.	+	+	Good
Lazzeri et al.⁴⁷	+	+	?	-	+	+	+	Good
Manios et al.⁴⁸	+	+	?	+	n.a.	+	+	Good
Maynard et al.⁴⁹	+	+	?	+	n.a.	+	+	Good
Molina et al.⁵⁰	+	+	?	-	n.a.	+	+	Moderate
Rosas et al.³²	+	+	+	-	+	+	+	Good

Study	Country	Objective	Adequate number of participants for this study	Male (%)	Age range or mean age	Diagnostic criterion of nutritional status	Main findings
Aparício et al.¹⁸	Portugal	To identify maternal perception of preschoolers’ body image	1,424	52.4	3-6 years	CDC	67.2% of mothers had a good perception of their children's NS, but only 0.6% of them perceived their children as obese, while 17.4% of them had this condition.
Baughcum et al.²³	United States	To verify factors associated with misperception of overweight of preschool children.	622	n.a.	2-5 years	BMI > P90 – overweight	79% of the mothers did not perceive their overweight children as overweight. Association with low educational level.
Binkin et al.³⁰	Italy	To investigate how much the prevalence of obesity influences the perception of the mother regarding the NS of their children.	37,161	51.0	8-9 years	IOTF	Mothers correctly perceived the NS in 84% of normal weight, 52% of overweight, and 14% of obese children. Association with areas of high prevalence of obesity.
Boa-Sorte et al.¹⁶	Brazil	Describe maternal perception and self-perception of NS of schoolchildren, and identify factors associated with the error.	827	46	6-19 years	CDC	The overall concordance was 75.3%, but 45.4% of the mothers underestimated the NS of the children with excess weight.
Boutelle et al.⁴²	United States	To evaluate the accuracy of maternal perception about the NS of their adolescent children.	675	53	14.6 ± 1.7 years	CDC	Correct perception in 60% of mothers, 70.5% underestimation for overweight and 86.2% for obese adolescents.
Bracho & Ramos⁴³	Chile	To evaluate maternal perception about the NS of their children.	270	51	2-6 years	WHO	Correct perception in 54.1% of mothers; 71.25% underestimation for overweight and 86.49% for obese children.
Carnell et al.³³	United Kingdom	To evaluate the accuracy of parents’ perception about their children's NS.	533	n.a.	3-5 years	IOTF	Of the 145 children classified as overweight, only 6% were perceived as such.
Genovesi et al.⁵²	Italy	Verify whether maternal perception of NS and food intake of children is related to the mother's level of education.	569	47.1	4-10 years	IOTF	28.3% of mothers underestimated the NS; 15.2% of mothers had low and 34.9% high level of schooling.
Guevara-Cruz et al.³¹	Mexico	To evaluate maternal perception of their children's NS.	273	56.8	8.52 ± 4.12 years	CDC	78% of mothers correctly classified their children's NS; 37.8% of mothers of children with excess weight classified them as having normal weight.
Hackie & Bowles⁴⁵	United States	To evaluate maternal perception of NS in obese preschoolers.	38	53	2-5 years	CDC	61% of mothers did not perceive their obese children as such.
Hirschler et al.⁴⁶	Argentina	Determine the association between overweight and: age, gender and maternal perception.	321	49.8	2-6 years	CDC	80% of mothers of children with excess weight did not perceive their children as such.
de Hoog et al.⁴⁴	Netherlands	Determine the ethnic variation in maternal underestimation of NS in children.	2,769	49.5	5-7 years	IOTF	79.1 of mothers of children with excess weight underestimated their NS, with differences between the ethnic groups studied.
Lazzeri et al.⁴⁷	Italy	To evaluate the accuracy of maternal perception of NS of schoolchildren.	2,835	51	8-9 years	IOTF	35% of the mothers underestimated the body habitus of their overweight children and 53% of the obese children. For NS, the underestimation was 59% and 87%, respectively.
Manios et al.⁴⁸	Greece	To quantify classification errors of NS in preschoolers by their mothers and to determine the factors associated with the error.	2,287	54	2-5 years	CDC	88.3% of the mothers underestimated the NS of their overweight children and 54.5% of obese ones. The results were worse for the male gender, participants in exercise programs, and low maternal schooling.
Maynard et al.⁴⁹	United States	To quantify classification errors of NS in children by their mothers and to determine the factors associated with the error.	5,500	50	2-11 years	CDC	Mothers underestimated obesity in 35% of males and 29.2% of females; the results for overweight underestimation were, respectively, 84.7% and 70.4%.
Molina et al.⁵⁰	Brazil	To verify the correspondence between the nutritional status of children and maternal perceptions.	1,282	42	7-10 years	IOTF	89.5% of mothers underestimated the NS of obese children and 65.9% of overweight children. Gender and ethnicity were associated with poor perception.
Rosas et al.³²	Mexico and United States	Compare the perception of mothers about the NS of Mexican children and from immigrant communities in California.	314	Mexico = 45 California = 47.5	5 years	CDC	Only 10% of Californian mothers correctly classified their children who were overweight, and 82% of the Mexican mothers correctly classified their children's NS.

Study	Criteria	TP	FP	TN	FN	Sensitivity (95% CI)	Specificity (95% CI)	PPV	NPV
Baughcum et al.²³	BMI > P90	21	3	78	202	21.2% (17.0%-25.4%)	98.5% (97.3%-99.8%)	87.5%	72.1%
Boa-Sorte et al.¹⁶	CDC	83	41	69	634	54.6% (49.5%-59.7%)	93.9% (91.5%-96.4%)	66.9%	90.2%
Boutelle et al.⁴²	CDC	61	30	209	442	22.6% (18.3%-26.9%)	93.6% (91.1%-96.2%)	67.0%	67.9%
Bracho & Ramos⁴³	WHO	28	4	89	149	23.9% (19.5%-28.3%)	97.4% (95.7%-99.0%)	87.5%	62.6%
Carnell et al.³³	IOTF	9	3	136	416	6.2% (3.7%-8.7%)	99.3% (98.4%-100.0%)	75.0%	75.4%
Guevara-Cruz et al.³¹	CDC	19	6	53	195	26.4% (21.9%-30.9%)	97.3% (95.3%-98.8%)	76.0%	78.6%
Hirschler et al.⁴⁶	CDC	97	9	106	409	47.8% (42.6%-52.9%)	97.8% (96.4%-99.3%)	91.5%	79.4%
Manios et al.⁴⁸	CDC	165	22	472	1100	25.9% (21.4%-30.4%)	98.0% (96.6%-99.5%)	88.2%	70.0%
Maynard et al.⁴⁹	CDC	527	75	725	4173	42.1% (37.0%-47.2%)	98.2% (96.9%-99.6%)	87.5%	85.2%
Molina et al.⁵⁰	IOTF	125	286	245	616	33.8% (28.9%-38.6%)	68.3% (63.5%-73.1%)	30.4%	71.5%

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E-mail: assessoria@jped.com.br

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[1] * Corresponding author. E-mail: roberto@robertocosta.com.br (R.F. Costa).