Parental health literacy and advanced bone age among school-aged children with overweight or obesity: a cross-sectional study

BackgroundExisting studies have shown that parental health literacy is closely associated with the development of childhood overweight and obesity. Childhood overweight and obesity, in turn, can lead to a range of health outcomes, including adult obesity, type 2 diabetes, and advanced bone age. However, no studies have yet examined the relationship between parental health literacy and advanced bone age in overweight and obese children.MethodsOverweight and obese children were classified into two groups based on whether their bone age was advanced. Baseline characteristics between the two groups were compared. Multivariate logistic regression was used to analyze the association between health literacy and advanced bone age. Multivariate linear regression was performed for sensitivity analyses, with sequential adjustment for age, sex, BMI SDS, and other factors. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative ability of parental health literacy for advanced bone age. Finally, stratified analyses were conducted to assess differences in the strength of the association across subgroups.ResultsHigher levels of parental health literacy were associated with a lower risk of advanced bone age in children. Paternal health literacy was influenced by confounding factors, whereas maternal health literacy showed a more consistent association across the fitted models. However, the formal comparison showed no statistically significant difference between the regression coefficients for maternal and paternal health literacy (χ2 = 0.444, p = 0.505). Exploratory ROC curve analysis showed that adding maternal health literacy to a model based on basic characteristics improved discriminative ability (AUC = 0.734), compared with adding paternal health literacy (AUC = 0.717) or combining both parents’ health literacy (AUC = 0.733). The negative association between maternal health literacy and advanced bone age was more pronounced among mothers with higher educational levels.ConclusionThese findings suggest that, in pediatric nursing practice, parental health literacy, particularly maternal health literacy, can be improved through health education and other approaches to better support healthy skeletal growth and development in overweight and obese children.