The Mediation Role of Health Behaviors in the Association between Self-Regulation and Weight Status among Preschool Children: A Sex-Specific Analysis

Abstract

Previous studies have supported the link between children’s self-regulation (CSR) and weight status, but the potential pathways have not been elucidated yet. We aimed to investigate whether and to what extent health behaviors mediate this association, as well as to explore the sex effect. For this study, we recruited 3740 preschoolers in Wuhan, China. The height and weight of children were measured, and a body mass index of the ≥85th percentile was defined as overweight/obesity (OWO). We used the Children’s Behavior Questionnaire, with measured domains including inhibitory control, impulsivity, anger, and attentional focusing, to assess CSR. The primary caregivers’ SR (PSR) was assessed with the Self-Control Scale. Information on lifestyles collected from questionnaires was utilized to construct the health behavior index (HBI). We found that Children’s HBI was associated with both CSR and PSR, inhibitory control (OR = 0.81, p < 0.001), anger (OR = 1.23, p < 0.001), attentional focusing (OR = 0.70, p < 0.001), impulsivity (OR = 1.23, p < 0.001), and PSR (OR = 0.73, p < 0.001). Children’s impulsivity was associated with their OWO (OR = 1.11, p = 0.013) which was partly mediated by the HBI (direct effect: β = 0.092, p = 0.026; indirect effect: β = 0.011, p = 0.007). The sex-specific analysis indicated that this mediation effect was only significant in boys. These results indicated that impulsivity is associated with childhood weight status, which is partially mediated by health behaviors, especially in boys.

Keywords: children; health behaviors; impulsivity; obesity; self-regulation.

Figure 1

Flowchart for the current study.

Figure 2

ORs and 95% CIs for the association of SR–HBI. Logistic regression models were used to calculate ORs and 95% CIs. All the models were adjusted children sex, age, current maternal BMI, maternal education, and household income. OR: odds ratio; HBI: health behavior index; CSR: children’s self-regulation; PSR: primary caregivers’ self-regulation. HBI values (≤ 2 vs. >2) were transformed into categorical variables.

Figure 3

ORs and 95% CIs for the association of SR–OWO. Logistic regression models were used to calculate ORs and 95% CIs. All the models were adjusted sex, age, birth weight-for-length Z scores, current maternal BMI, maternal education, household income, and secondhand smoke during pregnancy. OR: odds ratio; OWO: overweight/obesity; CSR: children’s self-regulation; PSR: primary caregivers’ self-regulation.