Inoue Kosuke, Seeman Teresa E, Nianogo Roch, Okubo Yusuke
Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Japan.
Hakubi Center, Kyoto University, Japan.
Lancet Reg Health Am. 2023 Jul 29;25:100565. doi: 10.1016/j.lana.2023.100565. eCollection 2023 Sep.
Although ample evidence has shown the link between childhood obesity and socioeconomic status including family income and household education levels, the mediating role of poverty in the association between household education levels and childhood obesity is unclear. This study aimed to quantify the extent to which family poverty levels contribute to the association between household education levels and obesity among US children and adolescents.
This cohort study used the nationally representative data of 21,754 US children and adolescents aged 6-17 years (National Health and Nutrition Examination Survey 1999-2018). We applied mediation analysis of the association between household education levels (less than high school, high school, and college or above) and obesity mediated through poverty (≤138% vs. >138% federal poverty level), adjusting for demographic characteristics of household head and their offspring. Obesity was defined as age- and sex-specific body mass index in the 95th percentile or greater using the 2000 Centers for Disease Control and Prevention growth charts.
Among 21,754 children and adolescents (weighted N = 43,544,684; mean age, 11.6 years; female, 49%), 9720 (weighted percentage, 33.0%) were classified as living in poverty and 4671 (weighted percentage, 19.1%) met the criteria for obesity. Low household education level (less than high school) showed increased risks of poverty (adjusted relative risk [95% CI], 5.82 [4.90-6.91]) and obesity (adjusted relative risk [95% CI], 1.94 [1.68-2.25]) compared to high household education level (college or above). We also quantified that poverty mediated 18.9% of the association between household education levels and obesity among children and adolescents. The mediation effect was consistently observed across age, gender, and race/ethnicity.
Poverty mediated the association between the low educational status of household heads and their offspring's obesity. Our findings highlight the importance of reducing obesity risk among the low-income population to minimize the burden of intergenerational health disparities due to socioeconomic status.
Japan Society for the Promotion of Sciences (22K17392).
尽管有充分证据表明儿童肥胖与社会经济地位（包括家庭收入和家庭教育水平）之间存在关联，但贫困在家庭教育水平与儿童肥胖之间的关联中所起的中介作用尚不清楚。本研究旨在量化家庭贫困水平在美国家童和青少年家庭教育水平与肥胖之间的关联中所起作用的程度。
这项队列研究使用了具有全国代表性的21754名6至17岁美国儿童和青少年的数据（1999 - 2018年国家健康与营养检查调查）。我们对家庭教育水平（高中以下、高中、大学及以上）与通过贫困（≤138%联邦贫困线与>138%联邦贫困线）介导的肥胖之间的关联进行了中介分析，并对户主及其子女的人口统计学特征进行了调整。肥胖的定义是使用2000年疾病控制和预防中心的生长图表，年龄和性别特异性体重指数处于第95百分位或更高。
在21754名儿童和青少年中（加权N = 43544684；平均年龄11.6岁；女性占49%），9720名（加权百分比33.0%）被归类为生活贫困，4671名（加权百分比19.1%）符合肥胖标准。与高家庭教育水平（大学及以上）相比，低家庭教育水平（高中以下）显示出贫困风险增加（调整后相对风险[95%置信区间]，5.82[4.90 - 6.91]）和肥胖风险增加（调整后相对风险[95%置信区间]，1.94[1.68 - 2.25]）。我们还量化了贫困在儿童和青少年家庭教育水平与肥胖之间的关联中起中介作用的比例为18.9%。在年龄、性别和种族/民族中均一致观察到这种中介效应。
贫困介导了户主低教育状况与其子女肥胖之间的关联。我们的研究结果凸显了降低低收入人群肥胖风险对于最小化因社会经济地位导致的代际健康差距负担的重要性。
日本学术振兴会（22K17392）。
