Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 21;23(1):2301.
doi: 10.1186/s12889-023-17179-1.

Mediation of the association between social environmental characteristics of family childcare home and weight status in children by diet quality

Qianxia Jiang  1 , Patricia Markham Risica  2   3 , Alison Tovar  2   3 , Kristen Cooksey Stowers  4 , Marlene B Schwartz  5   6 , Caitlin Lombardi  5 , Kim M Gans  2   3   4
Affiliations

Mediation of the association between social environmental characteristics of family childcare home and weight status in children by diet quality

Qianxia Jiang et al. BMC Public Health. .

Abstract

Background: The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status.

Methods: Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N = 370) in FCCHs (N = 120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status.

Results: Children's total HEI scores significantly mediated the relationship between the EPAO subscale Food Provided and children's BMI z-scores (B=-0.01, p < .05, 95% CI = [-0.03, - 0.002]). Further, the EPAO subscale Food Provided was positively associated with the total HEI score (B = 0.75, p < .01, 95% CI = [0.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-0.01, p < .05, 95% CI = [-0.02, - 0.001]).

Conclusion: Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.

Keywords: Childhood obesity; Diet quality; Early childcare; Family childcare homes.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Illustration of a 2-1-1 multilevel mediation model.  Path a represents the effect of the FCCH food environment on child diet quality. Path b represents the effect of child diet quality on child weight status controlling for the FCCH environment characteristics. Path c’ represents the direct effect of Food Provided and Beverages Provided in FCCH on child weight status. All paths represent between-group effects
Fig. 2
Fig. 2
Multilevel mediation models of diet quality in relationships between Food Provided and Weight Status
Fig. 3
Fig. 3
Multilevel mediation models of diet quality in relationships between Beverages Provided and weight status
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

References

    1. Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA - J Am Med Assoc. 2016;315:2292–9. doi: 10.1001/jama.2016.6361. - DOI - PMC - PubMed
    1. Ogden CL, Fryar CD, Martin CB, Freedman DS, Carroll MD, Gu Q, Hales CM. Trends in obesity prevalence by race and Hispanic origin—1999-2000 to 2017-2018. JAMA. 2020;324(12):1208–10. - PMC - PubMed
    1. Singh AS, Mulder C, Twisk JWR, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474–88. doi: 10.1111/j.1467-789X.2008.00475.x. - DOI - PubMed
    1. Ayer J, Charakida M, Deanfield JE, et al. Lifetime risk: Childhood obesity and cardiovascular risk. Eur Heart J. 2015;36:1371–6. doi: 10.1093/eurheartj/ehv089. - DOI - PubMed
    1. Sanders RH, Han A, Baker JS, et al. Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr. 2015;174:715–46. doi: 10.1007/s00431-015-2551-3. - DOI - PubMed

Publication types