Longitudinal associations of away-from-home eating, snacking, screen time, and physical activity behaviors with cardiometabolic risk factors among Chinese children and their parents

Background: Little is known about intergenerational differences in associations of urbanization-related lifestyle behaviors with cardiometabolic risk factors in children and their parents in rapidly urbanizing China. Objective: We tested the intergenerational differences in longitudinal associations of away-from-home eating, snacking, screen time, and leisure-time sports with high waist-to-height ratio (WHtR), elevated blood pressure (BP), elevated glycated hemoglobin (HbA1c), and elevated C-reactive protein (CRP) among Chinese children and their parents. Design: We studied children enrolled in the longitudinal China Health and Nutrition Survey (1991-2009, 7 surveys) aged 7-17 y in >= 2 surveys (average follow-up: 2.3 surveys out of a possible 4 surveys with the age restriction; n = 3875, including 1175 siblings) and their parents (2947 mothers, 2632 fathers) living in the same household. We used 3 consecutive interviewer-administered 24-h dietary recalls to derive a 3-d average for away-from-home eating (nonconsumer, >0 and, <1 meal/d, or >= 1 meals/d) and consumption of fruit or vegetable snacks (any or none) and other snacks (any or none) and a self-reported 7-d physical activity recall for screen time (<= 1, >1 and <= 2, or >2 h/d) and leisure-time sports (any or none). Random-effects logistic regression was used to examine the associations of lagged (average: 3 y) behaviors with cardiometabolic risk factors (WHtR, BP, HbA1c, and CRP). Results: We detected intergenerational differences in associations between lagged behaviors and risk factors (P-interaction, 0.1). Generation-specific models showed that lagged away-from-home eating of >= 1 meal/d (compared with none) was negatively associated with parents' high WHtR (OR: 0.68; 95% CI: 0.53, 0.88) but positively associated with children's high WHtR (OR: 1.46; 95% CI: 1.01, 2.12). Lagged fruit and vegetable snack consumption was negatively related to parents' (OR: 0.76; 95% CI: 0.59, 0.97) and children's (OR: 0.58; 95% CI: 0.33, 1.00) high WHtR. Lagged screen time (>2 compared with <= 1 h/d) was positively associated with parents' (OR: 2.58; 95% CI: 1.56, 4.28) and children's high WHtR (OR: 2.26; 95% CI: 1.06, 4.83). Conclusion: Parent-offspring differences in associations between lifestyle behaviors and cardiometabolic risk factors provide insight into intergenerational differences in cardiometabolic risk with urbanization.