Does parenting help to explain socioeconomic inequalities in children's body mass index trajectories? Longitudinal analysis using the Growing Up in Scotland study

BACKGROUND Pathways leading to socioeconomic inequalities in young children's body mass index (BMI) are not well understood. This study examined whether parenting related to the physical and social context of children's food consumption helped to explain associations between maternal educational level and child BMI trajectory. METHODS The study used data from 2957 families in a nationally representative birth cohort study surveyed from 2004 to 2011, with child BMI z-score measured 3 times (46, 70 and 94 months). Latent growth curve models examined associations between maternal education and BMI z-score trajectory, exploring mediating effects of parenting (positive mealtime interaction, informal meal setting and child bedroom TV) and unhealthy child diet. RESULTS After adjusting for maternal BMI, maternal education predicted increased inequality in child BMI z-score trajectory slope over the study period. The slope index of inequality coefficient for maternal education, that is, the change in z-score associated with the lowest relative to the highest maternal education level, was 0.17, p<0.001. Indirect effects of lower maternal education on steeper BMI trajectory via parenting and/or unhealthy diet represented 89% of the total effect. Pathways via parenting and then unhealthy diet accounted for 68% of significant indirect pathways, with the remainder via unhealthy diet only. Bedroom TV was the most important parenting pathway, followed by informal meal setting. CONCLUSIONS Pathways via parenting helped to explain the emergence of inequalities in young children's BMI related to maternal education. Interventions targeting parental provision of child bedroom TV and informal meal setting might reduce these inequalities.