Family lifestyle patterns, obesity, and metabolic risk in children and adolescents

Abstract

Objective: Family-related lifestyle behaviors are associated with childhood obesity and obesity-related metabolic dysfunction. The Family Nutrition and Physical Activity (FNPA) instrument provides a multidimensional assessment of lifestyle behaviors related to diet, physical activity, screen exposure, and sleep routines. This study aimed to compare FNPA scores between children and adolescents with and without obesity and to examine the associations between FNPA scores and obesity-related metabolic risk indicators. Materials and Methods: In this single-center, cross-sectional study, 194 children and adolescents aged 6–18 years (97 with obesity and 97 normal-weight controls) were included. Anthropometric measurements were obtained using standardized protocols, and parental height and weight were measured directly to calculate body mass index (BMI). Parents completed the FNPA questionnaire and structured sociodemographic surveys. Screen time and sleep duration were categorized according to international guidelines. In the obesity group, fasting glucose, insulin, HbA1c, lipid profile, and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) were assessed. Multivariable linear and logistic regression analyses were performed to identify independent determinants of FNPA scores and factors associated with obesity. Results: Total FNPA scores were significantly lower in participants with obesity than in controls (p=0.013). Longer daily screen exposure was independently associated with lower FNPA scores, whereas adherence to age-specific sleep duration recommendations was positively associated with higher FNPA scores. In multivariable analyses, higher FNPA scores were independently associated with lower odds of obesity. Within the obesity group, FNPA scores were weakly but significantly inversely correlated with BMI Standard Deviation Score (SDS) (rs=−0.235, p=0.020) and remained inversely associated with fasting insulin (rp=−0.243, p=0.017) and HOMA-IR (rp=−0.223, p=0.029) after adjustment for pubertal status. Conclusion: Lower FNPA scores were associated not only with obesity but also with markers of insulin resistance within the obesity group. These findings suggest that the associations between lower FNPA scores and markers of insulin resistance are independent of pubertal status and that multidimensional assessment tools such as the FNPA may provide clinically useful information in the evaluation of pediatric obesity.