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Parental education associations with children’s body composition: mediation effects of energy balance-related behaviors within the ENERGY-project

Juan M Fernández-Alvira12, Saskia J te Velde1*, Ilse De Bourdeaudhuij3, Elling Bere4, Yannis Manios5, Eva Kovacs6, Natasa Jan7, Johannes Brug1 and Luis A Moreno2

Author Affiliations

1 EMGO Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands

2 GENUD (Growth, Exercise, Nutrition and Development) Research Group. Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain

3 Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium

4 Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway

5 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

6 Department of Paediatrics, Pecs University, Pecs, Hungary

7 Slovenian Heart Foundation, Ljubljana, Slovenia

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International Journal of Behavioral Nutrition and Physical Activity 2013, 10:80  doi:10.1186/1479-5868-10-80

Published: 21 June 2013



It is well known that the prevalence of overweight and obesity is considerably higher among youth from lower socio-economic families, but there is little information about the role of some energy balance-related behaviors in the association between socio-economic status and childhood overweight and obesity. The objective of this paper was to assess the possible mediation role of energy balance-related behaviors in the association between parental education and children’s body composition.


Data were obtained from the cross sectional study of the “EuropeaN Energy balance Research to prevent excessive weight Gain among Youth” (ENERGY) project. 2121 boys and 2516 girls aged 10 to 12 from Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain were included in the analyses. Data were obtained via questionnaires assessing obesity related dietary, physical activity and sedentary behaviors and basic anthropometric objectively measured indicators (weight, height, waist circumference). The possible mediating effect of sugared drinks intake, breakfast consumption, active transportation to school, sports participation, TV viewing, computer use and sleep duration in the association between parental education and children’s body composition was explored via MacKinnon’s product-of-coefficients test in single and multiple mediation models. Two different body composition indicators were included in the models, namely Body Mass Index and waist circumference.


The association between parental education and children’s body composition was partially mediated by breakfast consumption, sports participation, TV viewing and computer use. Additionally, a suppression effect was found for sugared drinks intake. No mediation effect was found for active transportation and sleep duration. The significant mediators explained a higher proportion of the association between parental education and waist circumference compared to the association between parental education and BMI.


Tailored overweight and obesity prevention strategies in low SES preadolescent populations should incorporate specific messages focusing on the importance of encouraging daily breakfast consumption, increasing sports participation and decreasing TV viewing and computer use. However, longitudinal research to support these findings is needed.

Mediation analysis; Body composition; Parental education; Childhood obesity; Energy balance-related behaviors