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

Qianxia Jiang; Patricia Markham Risica; Alison Tovar; Kristen Cooksey Stowers; Marlene B Schwartz; Caitlin Lombardi; Kim M Gans

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

BMC Public Health. 2023 Nov 21;23(1):2301. doi: 10.1186/s12889-023-17179-1.

Authors

Qianxia Jiang¹, Patricia Markham Risica^{2

3}, Alison Tovar^{2

3}, Kristen Cooksey Stowers⁴, Marlene B Schwartz^{5

6}, Caitlin Lombardi⁵, Kim M Gans^{2

3

4}

Affiliations

¹ Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA. qjiang@cmh.edu.
² Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI, USA.
³ Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA.
⁴ Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
⁵ Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.
⁶ Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, USA.

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.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Body Mass Index
Child
Child Care* / methods
Child, Preschool
Diet
Humans
Multilevel Analysis
Pediatric Obesity* / epidemiology

Grants and funding

R01 HL123016/HL/NHLBI NIH HHS/United States