PONE-D-23-29554The association of parental psychosocial status with children’s Body Mass Index and the mediating role of children’s energy balance behaviors - the ABCD StudyPLOS ONE

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PLOS ONE

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Additional Editor Comments:

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear PLOS ONE editor and authors

I've commented on the manuscript for improving readability.

General comments

The main issue with this manuscript is that statistical analyses do not match the study's aim, and the results do not support the authors' conclusion. I've described the reasons below.

Title

1. I prefer using "The cross-sectional association of ..." instead of " The association of ...".

Abstract

2. Please indicate the results of mediation analyses on children’s diet, physical activity, and sleep.

Introduction

3. I disagree that educational level serves as a potential mediator. Parent educational levels are just a confounder, not a mediator. Current psychological stress never causes low socio-economic status.

4. In addition to the above comment, the authors appear to confuse mediation with effect modification. Please revise sentences in the introduction section distinguishing these concepts.

Materials and methods

5. If the dietary quality score has been validated, please refer to a corresponding paper. If not, please describe the limitation of nonvalidating in the discussion section.

6. Please explain why children's age and sex were not included as covariates.

7. In addition to comment 6, there can be other potential confounders. Referring to previous studies, please confirm covariates in this study are sufficient for analyses.

8. Paternal and maternal psychosocial status should be adjusted simultaneously. This is because mothers whose partners have poorer psychosocial status tend to exhibit worse psychosocial status, the effect of paternal psychosocial status can include maternal ones, and vice versa.

9. The authors have a typo, misspelling "SPSS" as "SPS."

Results

10. Because the main exposures were not significantly associated with the outcome, the interpretation of the subsequent mediator analyses is questionable. If such interpretation is permissible, the authors must cite supporting literature.

Discussion

11. The argument of this paper seems inconsistent with the results. Considering the lack of a significant association and the small beta from linear regression models, it would be accurate to conclude that there was no association between parental psychosocial status and children's Body Mass Index.

Reviewer #2: The authors investigated if there is an association between parental depression, anxiety, or stress symptoms are associated with their children’s (aged 10 - 12 years) body mass index (adjusted for age and sex). The study was performed using data from 1,315 children and their parents participating in the Amsterdam Born Children and their Development (ABCD) study.

Unfortunately, I cannot recommend this manuscript for publication as I firmly believe there are fundamental issues with the study measures used to assess diet quality and physical activity and the statistical analyses performed. Furthermore, the small sample size and lack of replication mean that the publication of these results would only contribute to the reproducibility problem and further erode the public’s trust in scientific research, without providing any positive impacts to the ABCD Study participants, the general public, or the medical and scientific communities.

Below I have provided a few general comments before listing my concerns with the study.

General comments:

• BMI is a different measurement to weight and using these terms interchangeably (for example in the short title) is both factually incorrect and misleading.

• The use of very long sentences throughout makes this manuscript hard to read.

• There are grammatical, nomenclature, and English language mistakes throughout the manuscript.

• It was not mentioned if adjustment for multiple testing was performed.

Concerns:

• The BMI mathematical formula was devised based on the average Western European man’s physical characteristics and does not (1) distinguish between excess body fat, bone mass, or musculature, (2) interpret the distribution of fat (which is a predictor of negative health outcomes such as type 2 diabetes and heart disease), and (3) cannot distinguish between sex, age, or ethnicity.

o The authors highlight that this is a muti-ethnic study, however, the BMI formula’s inability to distinguish between ethnicities has not been addressed in the study. Also age and sex adjusted reference tables were used to create the z-scores for the children, however, this was not done for the parents.

o Furthermore, there is an ever-growing body of evidence showing that BMI should not be used as a standalone tool for categorising individuals as overweight or obese (or getting a full overview of an individual’s overall health). Rather, multiple measures should be considered, including: body adiposity index, waist circumference, and waist-to-hip index.

• The dietary quality score used in the study does not include the five standard food groups. Therefore, a comprehensive overview of the child’s diet is not used by the study.

• The study only included sports participation as a measure of physical activity. This oversimplifies the possible physical activities the child could be performing on a regular basis, such as riding their bicycle or running. Furthermore, the parents’ diet or activity levels were not included, which is a massive limitation as shared family dynamic was not investigated.

• Although the study has data on full mother-father-child trios the analyses were performed on parent-child dyads. The authors state that: “We included all parents who filled in the mother and father’s questionnaire, regardless of whether they were the biological parent or not. Our study does not include children with same sex parents or from single households.”. I have concerns about the authors choice to conduct analyses separately for each parent, rather than looking at the complete family. Furthermore, sensitivity analyses should have been performed for non-biological relationships to disentangle the direct and indirect familial effects. Finally, the exclusion of children from households with single parents and same-sex couples prevents the results to be generalisable to the general population.

• The authors state “Another major strength is the considerable sample size.”, however, the study included only 1,315 mother-father-child trios. Given this small sample size, I have considerable concerns about the statistical power the study has to identify a true effect of parental psychosocial status with children’s BMI (or the potential study mediators: children’s diet, sports participation, time in bed, and screen time). Furthermore, no replication analyses were performed, therefore, no evidence that the findings are reliable and applicable to the population as a whole were provided.

Reviewer Confidential Comments to Editor

Unfortunately, I do not recommend this manuscript for publication as I believe there are fundamental issues with the study measures and statistical analyses. Furthermore, the sample size and lack of replication mean that the publication of these results would only contribute to the reproducibility problem and further erode the public’s trust in scientific research, without providing any positive impact to the ABCD Study participants, the general public, or the medical and scientific communities.

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Reviewer #1: No

Reviewer #2: No

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The cross-sectional association of parental psychosocial status with children’s Body Mass Index z-score and the mediating role of children’s energy balance behaviors - the ABCD Study

PONE-D-23-29554R1

Dear Dr. Overman,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Henri Tilga, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear PLOS ONE editor and authors

My apologies, it appears I have made several misreadings.

The authors have improved their manuscript, so I have no further comments.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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