White Pär Andersson, Ludvigsson Johnny, Jones Michael P, Faresjö Tomas
Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Crown Princess Victoria Children's Hospital, Linköping University Hospital, Linköping, Sweden.
Front Public Health. 2025 May 19;13:1548949. doi: 10.3389/fpubh.2025.1548949. eCollection 2025.
Low socioeconomic status, measured by maternal education, increases the risk of obesity in children in high-income countries. This paper presents our hypothesis that self-control mediates the observed association.
Data from the All Babies in Southeast Sweden (ABIS) cohort, which includes children born 1st Oct 1997-1st Oct 1999 in southeast Sweden with data on BMI, were available for = 5,447 at age 19 out of the original cohort of = 17,055 participants (31.9%). We estimated maternal self-control through behaviors related to self-control, first using a latent variable constructed using the variables breastfeeding duration, maternal smoking during pregnancy, maternal smoking during the first year of the child's life, and participation with biological samples. In a second model, we also included maternal BMI. Child self-control was measured using the Hyperactivity/Inattention subscale of the Strength and Difficulties Questionnaire (SDQ).
We found that in the relationship between maternal education and BMI/obesity risk of the child at age 19, two indirect paths, maternal self-control and child self-control, mediated 85% of the effect on BMI (model 1) and 87.5% of the effect of obesity risk. Adding maternal BMI (model 2) to the latent maternal self-control variable increased the mediated indirect effect to 95% of the total effect for BMI and 94% of the total obesity risk.
We conclude that maternal self-control and child self-control may mediate most of the effect of low maternal education on BMI/obesity at age 19. The central role of self-control in health inequality, especially for the persistence of health inequalities in the welfare state, may have important implications and should be included when theories of health inequalities are constructed. However, future studies are needed to test the hypothesis described in this paper using additional measures of self-control and executive functions.
在高收入国家，以母亲教育程度衡量的低社会经济地位会增加儿童肥胖的风险。本文提出我们的假设，即自我控制在观察到的这种关联中起中介作用。
瑞典东南部所有婴儿（ABIS）队列的数据，包括1997年10月1日至1999年10月1日在瑞典东南部出生且有BMI数据的儿童，在最初的17055名参与者队列中，19岁时可获得数据的有5447名（31.9%）。我们通过与自我控制相关的行为来估计母亲的自我控制，首先使用由母乳喂养持续时间、孕期母亲吸烟、孩子出生后第一年母亲吸烟以及生物样本采集参与情况等变量构建的一个潜在变量。在第二个模型中，我们还纳入了母亲的BMI。儿童自我控制使用优势与困难问卷（SDQ）中的多动/注意力不集中分量表进行测量。
我们发现，在母亲教育程度与19岁儿童的BMI/肥胖风险之间的关系中，两条间接路径，即母亲自我控制和儿童自我控制，介导了对BMI影响的85%（模型1）以及肥胖风险影响的87.5%。将母亲BMI（模型2）添加到潜在的母亲自我控制变量中，使介导的间接效应对BMI的总效应增加到95%，对总肥胖风险的影响增加到94%。
我们得出结论，母亲自我控制和儿童自我控制可能介导了母亲低教育程度对19岁时BMI/肥胖的大部分影响。自我控制在健康不平等中的核心作用，特别是对于福利国家中健康不平等的持续存在，可能具有重要意义，并且在构建健康不平等理论时应予以考虑。然而，未来需要进行研究，使用自我控制和执行功能的其他测量方法来检验本文所述的假设。
