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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (2): 308-313. doi: 10.19723/j.issn.1671-167X.2021.02.013

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Mediating effect of milk intake between family socioeconomic status and body mass index of children and adolescents

SHI Xin-ran,AN Mei-jing,CHEN Tian-jiao(),Ma jun   

  1. Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
  • Received:2019-04-23 Online:2021-04-18 Published:2021-04-21
  • Contact: Tian-jiao CHEN E-mail:tianjiao.chen@hsc.pku.edu.cn
  • Supported by:
    Specific Research Project of Health Project of Health Pro Bono Secters,Ministry of Health,China(201202010)

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Abstract:

Objective: To examine the association between family socioeconomic status (SES) and body mass index (BMI) z-score of children and adolescents, and the mediating effect of milk intake in this association. Methods: In the study, 2 496 students and their parents were selected from 16 schools (4 urban middle schools, 4 rural middle schools, 4 urban primary schools, and 4 rural primary schools) using a stratified cluster sampling method. The frequency and amount of weekly milk intake from the 7-day Food Records reported by the students were extracted. The parents’ education and household income were the indicators of family SES. The mediating effect of milk intake between family SES and BMI z-score of children and adolescents were tested using the PROCESS add-on SPSS software. Results: Parents’ education level and household income were positively correlated with BMI z-score of children and adolescents (P=0.001 and 0.038, respectively). The overall average daily intake of milk was (0.92±0.84) servings, and the frequency was (4.43±2.70) days per week. The students of primary school, in urban areas, with higher parents’ education level, with higher household income, and being non-obese were likely to have higher frequency and amount of milk intake. Milk intake was one of the mediating factors in the relationship between family SES and BMI z-score of children and adolescents. Specifically, the mediating effect of the frequency of milk intake accounted for -6.57% and -10.21% of the total effects of the association between the parents’ education and the household income with BMI z-score of children and adolescents, respectively. The mediating effect of the daily intake of milk accounted for -3.63% and -5.86% of the total effects of the association between the parents’ education and the household income with BMI z-score of children and adolescents, respectively. Conclusion: The milk intake of Chinese children and adolescents still needs to be improved. High family SES was found to contribute to high BMI z-score, mediated by the milk intake which was the protective factors of BMI z-score. Further research is needed to study other dietary or physical exercise behaviors that mediate the relationship between family SES and BMI z-score of children and adolescents in order to adopt more targeted interventions.

Key words: Family socioeconomic status, Body mass index, Milk intake

CLC Number: 

  • R151.3

Figure 1

Model of mediation"

Table 1

Association between family socioeconomic status and BMI z-score of children and adolescents"

Items β Standard error t 95%CI P
Parents’ education 0.13 0.04 3.26 0.05, 0.20 0.001
Household income 0.07 0.03 2.07 <0.01, 0.13 0.038

Table 2

Milk intake of different characteristic participants"

Characteristics n (%) Servings of daily milk intake,
$\bar{x} \pm s$		 Z/H P Weekly frequency
of milk intake, M (P25, P75)		 Z/H P
Total 2 496(100.00) 0.92±0.84 5(2, 7)
Gender
Boys 1 274(51.04) 0.94±0.84 -1.43 0.153 5(2, 7) -0.46 0.645
Girls 1 222(48.96) 0.89±0.84 5(2, 7)
Grade
Primary school 1 301(52.12) 0.97±0.88 -3.52 <0.001 6(3, 7) -3.98 <0.001
Junior high school 1 195(47.88) 0.86±0.79 5(1, 7)
Area
Urban 1 161(46.51) 1.01±0.77 -8.07 <0.001 6(3, 7) -8.21 <0.001
Rural 1 335(53.49) 0.83±0.89 4(1, 7)
Parents’ education
Junior high school and below 1 045(41.87) 0.83±0.87 62.76 <0.001 4(1, 7) 64.26 <0.001
Senior school 765(30.65) 0.92±0.83 5(2, 7)
Junior college and above 686(27.48) 1.05±0.79 6(4, 7)
Household income
≤2 000 yuan 446(17.87) 0.76±0.86 57.42 <0.001 4(0, 7) 55.23 <0.001
>2 000-<5 000 yuan 1 152(46.15) 0.90±0.84 5(2, 7)
≥5 000-<8 000 yuan 511(20.47) 1.03±0.86 6(3, 7)
≥8 000 yuan 387(15.50) 1.01±0.74 6(3, 7)
Obesity
Yes 441(17.67) 0.81±0.78 -2.71 0.007 5(1, 7) -2.30 0.021
No 2 055(82.33) 0.94±0.85 5(2, 7)

Table 3

Mediating effect of the weekly frequency of milk intake in the association between family SES and BMI z-score of children and adolescents"

Items a P b P c' P ab 95%CI ab/(c'+ab)
Parents’ education 0.31 <0.001 -0.03 0.010 0.14 0.001 -0.009 -0.019, -0.003 -6.57%
Household income 0.26 <0.001 -0.03 0.013 0.07 0.022 -0.007 -0.016, -0.002 -10.21%

Table 4

Mediating effect of the daily milk intake in the association between family SES and BMI z-score of children and adolescents"

Items a P b P c' P ab 95%CI ab/(c'+ab)
Parents’ education 0.07 0.003 -0.07 0.045 0.13 0.001 -0.005 -0.012, -0.001 -3.63%
Household income 0.06 0.002 -0.07 0.052 0.07 0.028 -0.004 -0.010, -0.001 -5.86%
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