Intra-familial concordance in lifestyle behaviors and cardiometabolic risk in rapidly modernizing China

China has been experiencing rapid changes in lifestyle behaviors and dramatic increases in cardiometabolic disease (CMD) risk factors in both adults and children in the past two decades. Lifestyle behaviors are important contributors to cardiometabolic health. Children share lifestyle behaviors, genes, and home environments with parents, which could underlie clustering in CMD risk in households. However, the extent to which children share behaviors and CMD risk factors with each of their parents has not been studied in a geographically-diverse Chinese population undergoing rapid urbanization. We capitalized on 18-year (1991-2009) longitudinal data from the China Health and Nutrition Survey (>3,000 households with children aged 7-17y), with measured CMD risk factors, diet, physical activity, and sociodemographics. Using random-effects regression, we investigated parent-offspring associations in CMD risk factors (waist-to-height ratio, hemoglobin A1c, blood pressure, and C-reactive protein) and lifestyle behaviors (animal-source foods, away-from-home eating, snacking, screen time, and leisure-time sports). We additionally examined the associations between these behaviors and risk factors in children and their parents, and determined whether household structure (presence of grandparents and presence of siblings in the household) was associated with children’s behaviors or risk factors. We found positive associations in lifestyle behaviors and CMD risk factors between children and their parents. However, the magnitude of parent-offspring associations for behaviors declined over time. We also found faster increases in away-from-home eating and snacking in children than their parents. Compared to children who lived with siblings in the household, only children consumed more animal-source foods, away-from-home foods, snacks, and had higher HbA1c, after adjusting for age, sex, household income, and urbanicity. CMD risk factors in children and their parents were negatively associated with the consumption of fruit and vegetable snacks and positively associated with screen time, with difference in associations between children and their parents for some risk factors. Promoting healthy diet and decreasing screen time are commonly-used intervention strategies to reduce CMD risk. However, given the observed intergenerational differences in behavior changes and behavior-risk associations, generation-specific intervention strategies may be needed. Further, only-children households should specifically be considered for interventions targeting children’s behaviors and CMD risk in this population.Doctor of Philosoph