Descriptive statistics
A total of 486 children were validly surveyed in this study, including 168 children with prepuberty initiation (115 boys, 53 girls) and 318 children before puberty initiation (147 boys, 171 girls). Boys before puberty initiation had higher eating disorder scores than girls before puberty initiation (P < 0.05); however, there was no statistically significant difference between the eating disorder scores between boys after puberty initiation and girls after puberty initiation (P > 0.05), between boys before puberty initiation and boys after puberty initiation (P > 0.05), or between girls before puberty initiation and girls after puberty initiation (P > 0.05). See Fig. 1 for details.
Correlations between PPCBI, BMI, BID and ED.
In boys before puberty initiation, the PPCBI score, BMI and BID score were significantly positively correlated with the ED score (P < 0.05), and BMI, the PPCBI score, and the BID score were positively correlated with each other (P < 0.05). In girls before puberty initiation, the BID score was positively correlated with the ED score, BMI, and PPCBI score (P < 0.05). In boys after puberty initiation, the BID score was positively associated with the ED score, BMI, and PPCBI score (P < 0.05), and BM was positively associated with the PPCBI score (P < 0.05). In girls after puberty initiation, PPCBI and BID scores were positively correlated with the ED score (P < 0.05), and BMI, the PPCBI score and the BID score were positively correlated with each other (P < 0.05). See Table 1 for details.
Table 1
Correlation coefficients between PPCBI, BID, ED and BMI.
variable
|
PPCBI
|
BID
|
ED
|
BMI
|
Boys before puberty initiation
|
PPCBI
|
1
|
|
|
|
BID
|
0.401**
|
1
|
|
|
ED
|
0.420**
|
0.388**
|
1
|
|
BMI
|
0.399**
|
0.490**
|
0.372**
|
1
|
Girls before puberty initiation
|
PPCBI
|
1
|
|
|
|
BID
|
0.520**
|
1
|
|
|
ED
|
0.084
|
0.331*
|
1
|
|
BMI
|
0.167
|
0.323*
|
0.141
|
1
|
Boys after puberty initiation
|
PPCBI
|
1
|
|
|
|
BID
|
0.459**
|
1
|
|
|
ED
|
0.174
|
0.461**
|
1
|
|
BMI
|
0.196*
|
0.433**
|
0.185*
|
1
|
Girls after puberty initiation
|
PPCBI
|
1
|
|
|
|
BID
|
0.524**
|
1
|
|
|
ED
|
0.331**
|
0.454**
|
1
|
|
BMI
|
0.219**
|
0.416**
|
0.132
|
1
|
PPCBI parental pressure on children's body image. BMI body mass index. BID body image dissatisfaction. ED eating disorders. * P < 0.05, * * P < 0.01. |
Association between PPCBI, BMI, BID and ED.After adjusting for age, PPCBI score, BMI, BID score and ED score as dependent variables, and the variables associated with them as independent variables, multiple linear regression was conducted to analyze their associations (See Table
2 for details).
In boys before puberty initiation, the PPCBI and BID scores were positively associated with the ED score (P < 0.001; P < 0.05); the PPCBI score was positively associated with BMI and the BID score (P < 0.05; P < 0.05); and BMI was positively associated with the BID score (P < 0.05). In girls before puberty initiation, the BID score was positively associated with the ED score (P < 0.05); and the PPCBI score was positively associated with the BID score (P < 0.001). In boys and girls after puberty initiation, the BID score was positively associated with the ED score (P < 0.001); the PPCBI score was positively associated with BMI and the BID score (P < 0.05; P < 0.001); and BMI was positively associated with the BID score (P < 0.01). Therefore, there may be association pathways between PPCBI, BMI, BID and ED, as shown in Fig.
2.
Table 2
Multifactorial analysis of the association among PPCBI, BMI, BID and ED among children and adolescent with different development stages.
Dependent
variable
|
Independent
variable
|
B
|
SE
|
Beta
|
t
|
P
|
95%CI
|
Boys before puberty initiation
|
ED
|
BID
|
0.92
|
0.37
|
0.24
|
2.47
|
0.015
|
0.69
|
2.00
|
|
BMI
|
2.53
|
1.07
|
0.23
|
2.37
|
0.020
|
0.58
|
4.53
|
|
PPCBI
|
1.72
|
0.38
|
0.39
|
4.48
|
0.000
|
0.51
|
2.12
|
BID
|
BMI
|
1.10
|
0.25
|
0.38
|
4.44
|
0.000
|
0.61
|
1.59
|
|
PPCBI
|
0.31
|
0.10
|
0.27
|
3.04
|
0.003
|
0.11
|
0.51
|
BMI
|
PPCBI
|
0.16
|
0.04
|
0.39
|
4.46
|
0.011
|
0.09
|
0.23
|
Girls before puberty initiation
|
ED
|
BID
|
2.15
|
0.92
|
0.35
|
2.33
|
0.025
|
0.52
|
3.91
|
BID
|
PPCBI
|
0.40
|
0.10
|
0.48
|
3.95
|
0.000
|
0.20
|
0.60
|
Boys after puberty initiation
|
ED
|
BID
|
1.83
|
0.32
|
0.47
|
5.77
|
0.000
|
1.12
|
2.20
|
BID
|
PPCBI
|
0.44
|
0.08
|
0.39
|
5.63
|
0.000
|
0.29
|
0.60
|
|
BMI
|
1.02
|
0.21
|
0.34
|
4.87
|
0.000
|
0.60
|
1.43
|
BMI
|
PPCBI
|
0.07
|
0.03
|
0.20
|
2.43
|
0.016
|
0.01
|
0.14
|
Girls after puberty initiation
|
ED
|
BID
|
1.67
|
0.28
|
0.45
|
6.03
|
0.000
|
0.84
|
1.85
|
BID
|
PPCBI
|
0.53
|
0.07
|
0.46
|
7.23
|
0.000
|
0.39
|
0.68
|
|
BMI
|
1.06
|
0.21
|
0.32
|
5.02
|
0.000
|
0.64
|
1.48
|
BMI
|
PPCBI
|
0.08
|
0.03
|
0.22
|
2.90
|
0.004
|
0.02
|
0.13
|
PPCBI parental pressure on children's body image. BMI body mass index. BID body image dissatisfaction. ED eating disorders. |
Fitting of association pathways.
The preliminary association pathways between PPCBI, BMI, BID and ED were fitted, and the indices of the fitting models showed that all four association pathways had good fitting effects. See Table 3 for details.
Table 3
Structural equation simulation fit indices recommended indexes.
Model index
|
Paths in boys before puberty initiation
|
Paths in girls before puberty initiation
|
Paths in boys after puberty initiation
|
Paths in girls after puberty initiation
|
Standard value of recommended index
|
X2/DF
|
2.984
|
0.014
|
0.125
|
1.796
|
< 3.0
|
GFI
|
0.987
|
1.000
|
0.999
|
0.990
|
> 0.9
|
AGFI
|
0.870
|
0.999
|
0.996
|
0.948
|
> 0.8
|
SRMR
|
0.039
|
0.005
|
0.011
|
0.037
|
< 0.05
|
NFI
|
0.965
|
0.999
|
0.997
|
0.969
|
> 0.9
|
TLI
|
0.874
|
1.150
|
1.057
|
0.957
|
> 0.9
|
CFI
|
0.974
|
1.000
|
1.000
|
0.986
|
> 0.9
|
X2/DF chi-square/free ratio. GFI goodness-of-fit index. AGFI adjusted goodness-of-fit index. SRMR standardized root mean square residual. NFI standard fit index. TLI Tucker-Lewis index. CFI comparative fit index. |
In boys before puberty initiation, the PPCBI and BID scores positively predicted the ED score (β = 0.30, P < 0.001; β = 0.23, P < 0.05); the PPCBI score and BMI positively predicted the BID score (β = 0.25, P < 0.01; β = 0.38, P < 0.01); and the PPCBI score positively predicted BMI (β = 0.38, P < 0.001). Moreover, indirect pathways of PPCBI→BMI→BID→ED and PPCBI→BID→ED were statistically significant (β = 0.035, P < 0.01; β = 0.059, P < 0.01).
In girls before puberty initiation, the BID score positively predicted the ED score (β = 0.34, P < 0.01); and the PPCBI score positively predicted the BID score (β = 0.52, P < 0.001). The indirect pathway of PPCBI→BID→ED was statistically significant (β = 0.176, P < 0.01).
In boys after puberty initiation, the BID score positively predicted the ED score (β = 0.45, P < 0.01); the PPCBI score and BMI positively predicted the BID score (β = 0.39, P < 0.001; β = 0.36, P < 0.001); and the PPCBI score positively predicted BMI (β = 0.20, P < 0.05). The indirect pathways of PPCBI→BMI→BID→ED and PPCBI→BID→ED were statistically significant (β = 0.032, P < 0.01; β = 0.175, P < 0.001).
In girls after puberty initiation, the BID score positively predicted the ED score (β = 0.38, P < 0.001); the PPCBI score and BMI positively predicted the BID score (β = 0.46, P < 0.001; β = 0.32, P < 0.001); and the PPCBI score positively predicted BMI (β = 0.22, P < 0.01). The indirect pathways of PPCBI→BMI→BID→ED and PPCBI→BID→ED were statistically significant (β = 0.026, P < 0.01; β = 0.172, P < 0.001). The direct and indirect coefficients of association paths are shown in Fig. 3 and Table 4.
Table 4
Indirect coefficients of association paths among PPCBI, BMI, BID, ED in children and adolescents with different development stages.
Pathways
|
β
|
SE
|
P
|
95%CI
|
Boys before puberty initiation
|
PPCBI→BMI→BID→ED
|
0.035
|
0.013
|
0.002
|
0.014
|
0.067
|
PPCBI→BID→ED
|
0.059
|
0.028
|
0.009
|
0.014
|
0.126
|
Boys after puberty initiation
|
PPCBI→BMI→BID→ED
|
0.032
|
0.019
|
0.011
|
0.005
|
0. 078
|
PPCBI→BID→ED
|
0.175
|
0.049
|
0.000
|
0.092
|
0.284
|
Girls before puberty initiation
|
PPCBI→BID→ED
|
0.176
|
0.063
|
0.003
|
0.065
|
0.309
|
Girls after puberty initiation
|
PPCBI→BMI→BID→ED
|
0.026
|
0.011
|
0.003
|
0.009
|
0.056
|
PPCBI→BID→ED
|
0.172
|
0.061
|
0.000
|
0.069
|
0.303
|
PPCBI parental pressure on children's body image. BMI body mass index. BID body image dissatisfaction. ED eating disorders. |