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Background  Relatively few studies have investigated the effects of diet on behavior problems among preschoolers, particularly, physical aggression. In addition, children raised by poorly educated mothers usually have a higher probability of developing negative outcomes. Additionally, highly educated mothers have a higher probability of providing more healthy foods for their children. Thus, mothers providing healthy foods might mitigate children’s behavior problems. The study aims to examine whether preschoolers’ dietary pattern, as a manipulable factor, mediates the association between maternal education level and physical aggression.    Methods  Data came from the Taiwan Birth Cohort Study (TBCS), a nationally representative population-based cohort study, which included 18,513 five-year-old Taiwanese children. Mothers and primary caregivers reported the information on preschoolers’ physical aggression and food consumption at age 5 and maternal education level at age 6 months. Two dietary patterns, namely a healthy diet and a high-fat-sugar-salt (HFSS) diet, were retrieved by exploratory factor analysis. Mediation hypotheses were tested by a series of multiple regression models conducted using the PROCESS macro of SAS 9.4. All models were adjusted for children’s sex, parental marital status, household income, mental distress at age 5 and children’s physical aggression at age 3.    Results  Maternal education positively linked to healthy dietary patterns (B = 0.014,  p  = 0.002) which was negatively associated with preschoolers’ physical aggression (B = -0.096,  p  = 0.013), and it is negatively related to the HFSS dietary pattern (B = -0.042,  p  = 0.002) which was directly positively associated with preschoolers’ physical aggression (B = 0.123,  p  = 0.008). The association between maternal education and preschoolers’ physical aggression was partially mediated by preschoolers’ healthy (B = -0.001,  p  < .001) and HFSS (B = -0.005, p = <.001) dietary patterns, respectively. The R-square of the mediation model is 0.178.    Conclusions  Preschoolers’ dietary patterns directly associate with their physical aggression. In addition, mothers with poor education may provide less healthy foods and more unhealthy foods to their children, which may increase the level of physical aggression. The results imply partial mediating effects of dietary patterns between maternal education and physical aggression. It is suggested that a parent-based nutritional education program focusing on healthy meal preparation for poor educated mothers might be beneficial for preschoolers’ healthy development.

bmc pediatrics

The mediating effect of dietary patterns on the association between mother’s education level and the physical aggression of five-year-old children: a population-based cohort study