Prospective Association of Maternal Educational Level with Child’s Physical Activity, Screen Time, and Diet Quality

Abstract

Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children’s lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child’s physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child’s socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child’s screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children.

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Citation: Cárdenas-Fuentes, G.;
Homs, C.; Ramírez-Contreras, C.;
Juton, C.; Casas-Esteve, R.; Grau, M.;
Aguilar-Palacio, I.; Fitó, M.; Gomez,
S.F.; Schröder, H. Prospective
Association of Maternal Educational
Level with Child’s Physical Activity,
Screen Time, and Diet Quality.
Nutrients 2022,14, 160. https://
doi.org/10.3390/nu14010160
Academic Editor: Melissa Melough
Received: 29 October 2021
Accepted: 21 December 2021
Published: 30 December 2021
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4.0/).
nutrients
Article
Prospective Association of Maternal Educational Level with
Child’s Physical Activity, Screen Time, and Diet Quality
Gabriela Cárdenas-Fuentes 1, 2, †, Clara Homs 3 ,4 ,†, Catalina Ramírez-Contreras 5,6 , Charlotte Juton 7,8 ,
Rafael Casas-Esteve 9, Maria Grau 10, 11 , Isabel Aguilar-Palacio 12 , Montserrat Fitó13,14,
Santiago F. Gomez 3,15,*,† and Helmut Schröder 11 ,13 ,*, †
1Non-Communicable Disease and Environment Research Group, Barcelona Institute for Global
Health (ISGlobal), 08003 Barcelona, Spain; gabriela.cardenas@isglobal.org
2Health Science Faculty, Blanquerna—Universitat Ramon Llull, 08022 Barcelona, Spain
3Gasol Foundation, 08830 Sant Boi de Llobregat, Spain; choms@gasolfoundation.org
4PSITIC Research Group, Psychology, Education and Sport Sciences Department, Blanquerna—Universitat
Ramon Llull, 08022 Barcelona, Spain
5Department of Nutrition, Food Science and Gastronomy, Food Science Torribera Campus,
08921 Barcelona, Spain; catalinaramirez.nut@gmail.com
6INSA-UB, Nutrition and Food Safety Research Institute, 08007 Barcelona, Spain
7Endocrinology Department, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain;
charlottejuton@gmail.com
8PhD Program, Food and Nutrition University of Barcelona, 08028 Barcelona, Spain
9CSM Nou Barris, Programa de Jóvenes, 08042 Barcelona, Spain; rafael.casas@csm9b.com
10 Serra-Hunter Fellow, Department of Medicine, University of Barcelona, 08028 Barcelona, Spain;
mgrau@imim.es
11 CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III Madrid,
28029 Madrid, Spain
12 Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), IIS Aragón, Preventive Medicine and
Public Health Department, University of Zaragoza, 50001 Zaragoza, Spain; iaguilar@unizar.es
13 Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research
Institute (IMIM), 08003 Barcelona, Spain; mfito@imim.es
14 CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III Madrid,
28029 Madrid, Spain
15 GREpS, Health Education Research Group, Nursing and Physiotherapy Department, University of Lleida,
25008 Lleida, Spain
*Correspondence: sgomez@gasolfoundation.org (S.F.G.); hschroeder@imim.es (H.S.)
† These authors contributed equally to this work.
Abstract:
Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in
children, so it is essential to identify factors that could influence children’s lifestyles. The objective of
the present study was to analyze the association of baseline maternal educational level with child’s
physical activity, screen time, and dietary habits at follow-up. This community-based cohort study
was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal
educational level was used as an indicator of child’s socioeconomic status. Physical activity, screen
time, and dietary habits were assessed by validated questionnaires. The odds of having commercially
baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food
restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR
3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower
educational level compared to their peers whose mothers had a higher level. These associations held
for taking sweets and candy several times a day after additional adjustment for the corresponding
dietary behavior at baseline. Maternal educational level was inversely associated (p< 0.001) with
child’s screen time at follow up and being in the lowest maternal educational category was associated
with an increased odds of surpassing the maximum recommended time of screen time of 120 min
per day (OR (95% CI) 1.43 (1.07 to 1.90), p= 0.016). Maternal education is a predictor for unhealthy
dietary habits and high screen time in children.
Nutrients 2022,14, 160. https://doi.org/10.3390/nu14010160 https://www.mdpi.com/journal/nutrients

Nutrients 2022,14, 160 2 of 10
Keywords:
maternal educational level; lifestyle behaviors in children; diet quality; sedentary
behaviors; physical activity; prospective cohort study
1. Introduction
In recent decades, the exponential increase in the prevalence of childhood obesity has
become a major public health problem [
1
,
2
]. From 1975 to 2016, it changed globally from
less than 1% to more than 6% and 8% in girls and boys, respectively [
3
], while in Spain, the
prevalence of obesity has reached almost 15% of the child-youth population (as recently
reported in [
4
]). Despite relevant improvements in the prevention of this disease, there is
still uncertainty as to the key factors to be addressed.
Evidence indicates that unhealthy lifestyle behaviors, such as low levels of physical
activity (PA) [
5
,
6
], a low-quality diet [
7
,
8
], and increased screen time [
9
,
10
], promote
the development of obesity [
11
,
12
]. Unfortunately, the prevalence of these unhealthy
behaviors is especially high in children and adolescents with 80% reporting insufficient
level of PA [
13
]. Moreover, it has been described a drastic increase in the time spent in
sedentary behaviors (such as watching television) and a substantial decrease in the time
spent in physically demanding activities (such as running) after the age of six [
6
]. Equally
disturbing is the proportion of children that consumes a low-quality diet. According to
the WHO European Childhood Obesity Surveillance Initiative (COSI), 67% and 77% of
children do not consume fruits and fresh vegetables, respectively, on a daily basis [
14
]. This
discouraging evidence, along with the fact that a low-quality diet tends to endure during
later adolescence, demands for a prompt call to action [
14
,
15
]. In this line, one of the initial
steps is to identify the determinants of detrimental lifestyle behaviors to improve, on a later
stage, the design of public health strategies.
Evidence suggests that maternal educational level, measured as a proxy of the child’s
socioeconomic status, is related to the child’s diet quality, physical activity, and screen
time [
16
–
29
]. Cross-sectional data indicates that children whose mothers have a low
educational level are at higher risk of reporting an unhealthy diet, a low level of physical
activity, and high level of screen time [
16
–
22
]. Cross-sectional data aid in hypothesis
generation and establish an association, but prospective studies are needed to determine
whether these associations may change over time. However, prospective data is somewhat
limited [
23
–
29
]. Therefore, the aim of the present study was to analyze the association of
baseline maternal educational level with child’s physical activity, screen time and dietary
habits at follow-up, in a Spanish cohort. The hypothesis of this study was that baseline
maternal education is predictive for child’s physical activity, and dietary and sedentary
behaviors, measured two years after baseline.
2. Materials and Methods
2.1. Study Population
The current study was a prospective cohort in the framework of the POIBC study
(Spanish acronym for Prevention of Childhood Obesity: a community-based model). The
complete protocol of the POIBC can be found elsewhere [
30
]. In brief, the POIBC study was
a two-year, parallel trial that assessed the efficacy of the THAO—Child Health Program in
the prevention of childhood obesity. This program was developed with the aim to improve
child’s lifestyle and to reduce the incidence of overweight and obesity in children. The
theoretical framework of the program is based on the attitude–social influence–self-efficacy
(ASE) model [
31
], social marketing strategies used in the public health field [
32
], and
CBI guidelines for obesity prevention [
33
,
34
]. The program was implemented by the city
council, which appointed a local coordinator. In the intervention cities, the coordinator was
selected from the community health department. Up to nine different community activities,
such as familiar workshops about eating habits and cooking techniques, were implemented
in the intervention cities. The POIBC study included a convenience sample of 2249 children

Nutrients 2022,14, 160 3 of 10
aged 8 to 10 years old from elementary schools (4th and 5th grade) from 4 municipalities
(Gavà, Terrassa, Sant Boi de Llobregat, and Molins de Rei) of the autonomous community
of Catalonia. The study lasted two academic years (2012–2014) and had an average follow-
up of 15 months. After excluding participants with missing data on any of the included
variables, a final sample of 1405 children (699 girls and 706 boys) with a mean age of
10.1 ±0.6 years old
were included. Parents written consent was obtained on behalf of all
children and the study protocol was approved by the local Ethics Committee (CEIC—Parc
de Salut Mar, Barcelona, Spain). The POIBC inclusion criteria were an age range from 8 to
10 years and a signed parent consent.
2.2. Meassurement of Exposure
Maternal education level was self-reported and categorized into 3 levels: (i) no school-
ing or primary school, (ii) secondary school, (iii) technical or higher (graduate-level) uni-
versity degree.
2.3. Measssurement of Outcomes
2.3.1. Dietary Behaviors
Mothers and children responded themselves to the corresponding questionnaires. The
diet quality in children was estimated by the KIDMED index [
35
]. This questionnaire was
developed to assess diet quality by considering the principles that support and those that
undermine the adherence to the Mediterranean diet. This questionnaire was previously
validated [
35
] in Spanish children in the framework of the EnKid study. It is a 16 items-
questionnaire with 4 items indicating non-adherence and punctuated with
−
1 and 12 items
indicating adherence and punctuated with +1. The final score ranges from
−
4 to 12 points,
with higher scores indicating a higher adherence. The items included in the current study
were those related with the principles that undermine the MedDiet and included the
followings: (i) skips breakfast, (ii) has commercially baked goods or pastries for breakfast,
(iii) goes more than once a week to a fast-food restaurant, and (iv) takes sweets and candies
several times every day.
2.3.2. Physical Activity
The physical activity questionnaire for children (PAQ-C) was used to assess the levels
of PA in the children [
36
]. It includes nine items, each of the ones scored from one to five
points. The final PAQ-C score was the mean of the nine items. Higher scores indicated
higher levels of PA.
2.3.3. Screen-Time
Screen-time was assessed by the screen-time sedentary behaviour questionnaire [
37
],
which asks about the time spent in four activities, separately for weekdays and weekends.
The activities included (1) watching television, (2) playing computer games, (3) playing con-
sole (video) games, and (4) using a mobile phone. Children with equal or more than 120 min
of screen time per day were classified as non-compliers of screen time recommendation [
38
].
2.4. Statistical Analysis
Baseline characteristics of the study population were described across the levels of
maternal education and general linear models were fitted to obtain pvalues for linear trends.
Two statistical models were used to respond to the research question: “is baseline maternal
education predictive for child’s behavior at follow-up?” (i) For continuous outcomes,
general linear models were applied with baseline maternal education as the fixed factor
and screen time and PA at follow-up as the dependent variables. Polynomial contrast
was used to estimate pfor linear trend with a post-hoc Bonferroni correction for multiple
comparisons. Models were adjusted for sex, age, zBMI, municipality, school, and allocation
to intervention or control group. (ii) For dichotomous outcomes, multiple logistic regression
models were used to determine the associations between baseline maternal education and

Nutrients 2022,14, 160 4 of 10
child
´
s dichotomous outcomes at follow-up including risk of meeting child’s screen time
recommendation and presenting an unhealthy dietary habit (skipping breakfast, having
commercially baked goods or pastries for breakfast, going more than once a week to a
fast-food restaurant, and taking sweets and candies several times every day). Models were
adjusted for sex, age, zBMI, municipality, school, and allocation to intervention or control
group in the first model and additionally with the corresponding dietary behavior in the
second model.
Interactions of sex, age, and allocation to intervention or control group with maternal
education were tested. The associations were considered significant if p< 0.05. All statistical
analysis was performed using SPSS for Windows version 22 (SPSS, Inc., Chicago, IL, USA).
3. Results
Table 1shows descriptive data on the study population according to maternal ed-
ucation. From the 1405 children included in the analysis 26.4%, 39.4%, and 34.2% had
mothers with primary education, secondary education, and equal or higher than techni-
cal or university education, respectively. Descriptive analysis revealed that children of
mothers with higher educational level were somewhat younger, ate healthier, and spent
less time in front of a screen compared to their peers whose mothers had a lower level
(Table 1). The associations between baseline maternal educational level and children’s level
of PA and screen time at follow up are shown in Table 2. Children of mothers with higher
educational level showed a significant (p< 0.001) lower increase in time in front of a screen
compared with children of mothers with lower level. This association was strongly affected
by child baseline sedentary time which was significantly higher in the low educated group
compared to the high educated group (Table 1).
Table 1.
Baseline characteristics of the study population across levels of maternal education
(n= 1405) a.
Maternal Education
Primary
n= 371
Secondary
n= 553
University
n= 481
P for Linear
Trend
Sex (%)
Girls 183 (49.3) 273 (49.4) 243 (50.5) 0.72
Boys 188 (50.7) 280 (50.6) 238 (49.5)
Age (years) 10.2 (10.1 to 10.2) 10.1 (10.0 to 10.1) 10.1 (10.0 to 10.1) 0.004
zBMI b0.71 (0.59 to 0.83) 0.73 (0.64 to 0.83) 0.65 (0.54 to 0.76) 0.483
PAQ-C score (unit) c3.0 (2.9 to 3.0) 2.9 (2.9 to 3.0) 3.0 (3.0 to 3.1) 0.114
Screen time (minutes per day) d102.9 (49.3 to 200.0) 87.9 (49.3 to 167.9) 81.4 (45.0 to 128.6) <0.001
Screen time recommendation (%)
e43.3 (38.5 to 48.3) 38.5 (34.5 to 42.5) 28.7(24.3 to 33.0) <0.001
Skips breakfast (%) 4.0 (1.9 to 6.2) 5.4 (3.7 to 7.2) 4.0 (2.0 to 5.8) 0.949
Has commercially baked goods or
pastries for breakfast (%) 28.8 (24.7 to 33.0) 20.3 (16.8 to 23.7) 18.1 (14.4 to 21.8) <0.001
Goes more than once a week to a
fast-food restaurant (%) 25.6 (21.9 to 29.3) 20.1 (16.9 to 23.3) 10.4 (7.0 to 13.8) <0.001
Takes sweets and candies several
times every day (%) 25.6 (21.9 to 29.4) 17.4 (14.7 to 20.4) 8.3 (5.1 to 11.6) <0.001
a
Values are presented as number (proportion), mean (confidence interval), and median (interquartile range) for
categorical, continuous normal, and continuous non-normal distributed variables, respectively.
b
z-value for BMI.
c
The physical activity questionnaire for children (PAQ-C) includes nine items, each one scoring one to five points.
The mean of the scores was used as the final PAQ-C score. Higher scores indicate higher levels of PA.
d
Screen
time included time spent using the computer, watching television, and playing with a gaming console.
e
Not
meeting recommendations for screen time views (not more than 2 h per day).

Nutrients 2022,14, 160 5 of 10
Table 2.
Association of baseline maternal education with child’s physical activity and screen time at
follow-up a.
Maternal Education
Primary Secondary University P Linear Trend
n= 371 n= 553 n= 481
PAQ-C score (unit) b3.0 (2.9 to 3.1) 3.1 (3.0 to 3.2) 3.1 (3.0 to 3.2) 0.324
Screen time (min/d) c294.9 (180.2 to 209.6) 173.4 (161.7 to 185.2) 147.0 (134.1 to 160.0) <0.001
a
Adjusted for sex, age, baseline zBMI, municipality, school, and allocation to intervention or control group. Values
are expressed as means (confidence intervals).
b
The physical activity questionnaire for children (PAQ-C) includes
nine items, each one scoring one to five points.
c
Screen time includes time spent using the computer, watching
television, and playing with a gaming console.
Figure 1presents the odds ratio of unhealthy dietary habits of the children in relation
with maternal educational level. Children from low educated mothers showed a 1.47 (1.03
to 2.10, (p= 0.046), 1.64 (1.20 to 2.26) (p= 0.003), and 3.23 (2.14 to 4.87) (p< 0.001) higher
odds of eating commercially baked goods or pastries for breakfast, going more than
once a week to a fast-food restaurant, and taking sweets several times daily, respectively,
compared to children from highly educated mothers. These associations held only for
taking sweets several times daily after additional adjustment for the corresponding baseline
dietary behavior.
Children of mothers with the lowest educational level showed 43% major odds of
surpassing the maximum recommended level of screen time of 120 min per day [OR
(95% CI) 1.43 (1.07 to 1.90)], p= 0.016) at follow-up compared to their peers whose mothers
had the highest level.
There was no significant interaction between maternal education, sex, age, and alloca-
tion to intervention or control group.
Nutrients 2022, 13, x FOR PEER REVIEW 6 of 11
Figure 1. Association of maternal education with children’s having unhealthy dietary habits. Model
1. Multiple logistic regression models adjusted for sex, age, zBMI, municipality, school, and alloca-
tion to intervention or control group. Model 2. Multiple logistic regression models adjusted for sex,
age, zBMI, municipality, school, allocation to intervention or control group, and the corresponding
dietary behavior at baseline. Skips breakfast (no = 0, yes = 1), has commercially baked goods or
pastries for breakfast (no = 0, yes = 1), takes sweets and candies several times every day (no = 0, yes
= 1), goes more than once a week to a fast-food restaurant (no = 0, yes = 1).
Figure 1. Cont.

Nutrients 2022,14, 160 6 of 10
Nutrients 2022, 13, x FOR PEER REVIEW 6 of 11
Figure 1. Association of maternal education with children’s having unhealthy dietary habits. Model
1. Multiple logistic regression models adjusted for sex, age, zBMI, municipality, school, and alloca-
tion to intervention or control group. Model 2. Multiple logistic regression models adjusted for sex,
age, zBMI, municipality, school, allocation to intervention or control group, and the corresponding
dietary behavior at baseline. Skips breakfast (no = 0, yes = 1), has commercially baked goods or
pastries for breakfast (no = 0, yes = 1), takes sweets and candies several times every day (no = 0, yes
= 1), goes more than once a week to a fast-food restaurant (no = 0, yes = 1).
Figure 1.
Association of maternal education with children’s having unhealthy dietary habits. Model 1.
Multiple logistic regression models adjusted for sex, age, zBMI, municipality, school, and allocation
to intervention or control group. Model 2. Multiple logistic regression models adjusted for sex, age,
zBMI, municipality, school, allocation to intervention or control group, and the corresponding dietary
behavior at baseline. Skips breakfast (no = 0, yes = 1), has commercially baked goods or pastries for
breakfast (no = 0, yes = 1), takes sweets and candies several times every day (no = 0, yes = 1), goes
more than once a week to a fast-food restaurant (no = 0, yes = 1).
4. Discussion
The present study found that a lower level of maternal education was associated
with an increased risk of having unhealthy dietary habits in children, including having
commercially baked goods for breakfast, going to a fast-food restaurant more than once a
week, or taking sweets and candys several times a day. Adjustment for the corresponding
dietary behavior at baseline resulted in a loss of significance with the exception of taking
sweets and candys several times a day. Furthermore, lower maternal educational level was
positively associated with child screen-time and not meeting screen-time recommendations.
Several studies, with both cross-sectional [
16
–
19
] and longitudinal [
23
–
25
] designs,
have shown an inverse association between parental educational level and the time spent
in front of a screen in children. These findings are aligned with the results of the present
study which additionally showed that a lower maternal educational level was predictive
for not meeting screen-time recommendation for children. This is of concern due to the
positive relationship of time in front of a screen and obesity in children [10].
The evidence showing the association of maternal education with children’s physical
activity level have shown inconsistent results. Cross-sectional data from the HELENA
study showed non-significant difference of objectively measured PA between children
whose mothers had a lower or higher educational level [
39
]. In addition, pooled data
from 10 studies conducted in Europe, Australia, Brazil, and the USA [
40
] concluded that
adolescents of mothers with lower education may not be at a disadvantage in terms of
overall objectively measured PA. This cross-sectional evidence is in concordance with
prospective findings from the present study. Conversely, a twin study performed in the
Netherlands and Finland [
26
] evidenced that higher PA levels are more likely to be observed
within children whose parents have a higher educational level. Mutz and colleagues found
that the socioeconomic status, measured by parent’s mean educational level and income,
positively predicts moderate to vigorous PA in children between 8 and 11 years of age [
20
].

Nutrients 2022,14, 160 7 of 10
High diet quality during childhood is commonly associated with higher maternal
educational level [
21
,
28
,
41
,
42
], higher socioeconomic status [
22
,
28
,
43
], and less social vul-
nerabilities [
41
,
42
]. Moreover, unhealthy eating patterns, characterized by high intakes
of sweet food and drinks, snacks, pastries, or fast food [
21
,
22
,
28
,
44
] are most commonly
observed within children of parents with a lower educational status. Our results are aligned
with the existing evidence since children whose mothers had a higher educational level
are less likely to carry out unhealthy behaviors such as having commercially baked goods
or pastries for breakfast, going more than once a week to a fast-food restaurant, or tak-
ing sweets and candies several times every day. Parental practices are crucial to prevent
unhealthy food consumption within children [
45
]. Specifically, a “restrictive guidance”
parental practice, characterized by the capacity of parents to set limits, rules, or restrictions
regarding food consumption, could be effective in preventing unhealthy eating for children
seven years old and older. Mothers with lower educational levels have less opportunities
of deploying adequate parenting skills since they could spend less time with their kids [
46
]
and have less parenting support and higher stress levels [
47
]. In this sense, general family
functioning and parental psychological distress is associated with poorer eating habits [
48
].
Moreover, mothers with a low educational level tend to use more frequently unhealthy
foods as an economical accessible reward to their kids in the European context [
49
]. Using
food as a reward from early childhood is prospectively associated with picky eating [
49
]
and with poorer health outcomes [
50
]. Furthermore, evidence indicates that healthy dietary
choices were associated with higher economic costs in children and adolescents [51]. This
fact might also partially explain poorer eating habits among children with mothers of low
socioeconomic levels.
It has been shown that children whose mothers have a lower educational level are more
likely to present a higher screen time, a lower physical activity level, and an unbalanced
dietary pattern [
52
–
55
]. It is relevant to highlight that increasing physical activity levels
and reducing screen time is longitudinally related to better health-related quality-of-life
and socio-emotional outcomes [
55
] and a reduced risk of non-communicable diseases such
as depression [56] or obesity [9,10].
Data on adherence to the Mediterranean diet, PA, and screen time were recorded by
questionnaires and therefore prone to the inherent limitations of self-reported data, such
as memory bias, misunderstanding, and social desirability. At about eight years of age,
children have the cognitive skills to self-report health data [
57
], and several questionnaires,
including those used in the present study, have been designed and validated to collect
these data from children aged eight years and older [
58
]. The mean age of participants in
our study is 10 years old and the time invested to answer the questionnaire was usually
more than 25 min; the attention span could be shorter at this age than for older children
more used to investing time in reading.
Additionally, cognitive skills of children aged 8 to 10 are not fully developed, which
could have a stronger effect on response accuracy of self-reported data, compared to adults
or older children.
Low maternal education was predictive for child’s poor eating habits, high screen-time,
and not meeting screen-time recommendations in Spanish children.
Author Contributions:
G.C.-F. and C.H. conducted the analysis and prepared the manuscript, with
significant input and feedback from all co-authors. H.S., S.F.G., C.R.-C., C.J., R.C.-E., M.G., I.A.-P. and
M.F. participated in the design and execution of the study and contributed to the critical revision of
the manuscript for important intellectual content. All authors have read and agreed to the published
version of the manuscript.
Funding:
This work was supported by a grant from Instituto de Salud Carlos III FEDER, (PI11/01900).
Centro de Investigación Biomédica en Red Epidemiologia y Salud Publica (CIBERESP) is an initiative
of the Instituto de Salud Carlos III (ISCIII) of Spain, which is financed by the European Regional
Development Fund (ERDF), “A way to make Europe”/“Investing in your future” (CB06/03). It
is supported by the official funding agency for biomedical research of the Spanish government,
ISCIII, Spain.

Nutrients 2022,14, 160 8 of 10
Institutional Review Board Statement:
The study protocol was approved by the local Ethics Com-
mittee (CEIC—Parc de Salut Mar, Barcelona, Spain).
Informed Consent Statement: Parents written consent was obtained on behalf of the children.
Data Availability Statement: Available on request.
Acknowledgments:
We are thankful to the staff, pupils, parents, schools, and municipalities of Gavà,
Molins de Rei, Sant Boi de Llobregat, and Terrassa for their participation, enthusiasm, and support.
Conflicts of Interest: The authors declare no conflict of interest.
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