Objectives To explore the relations of parent-child cardiometabolic risk factors and assess the influence of adiposity on these associations. Study design Associations of adiposity, blood pressure (BP), lipids, fasting insulin and glucose, and a risk factor cluster score (CS) were evaluated in a cross-sectional study of 179 parents and their children (6-18 years, N = 255). Insulin resistance was assessed by euglycemic clamp in parents and children aged 10 years or older. Metabolic syndrome in parents was defined by National Cholesterol Education Program's Adult Treatment Panel III criteria. CSs of the risk factors were created based on age-specific z-scores. Analyses included Pearson correlation and linear regression, adjusted for parent and child age, sex, race, and body mass index (BMI), accounting for within-family correlation. Results We found positive parent-child correlations for measures of adiposity (BMI, BMI percentile, waist, subcutaneous fat, and visceral fat; r = 0.22-0.34, all P ≤.003), systolic BP (r = 0.20, P =.002), total cholesterol (r = 0.39, P <.001), low-density lipoprotein cholesterol (r = 0.34, P <.001), high density lipoprotein cholesterol (r = 0.26, P <.001), triglycerides (r = 0.19, P =.01), and insulin sensitivity (r = 0.22, P =.02) as well as CSs (r = 0.15, P =.02). After adjustment for BMI all parent-child correlations, except systolic BP, remained significant. Conclusions Although adiposity is strongly correlated between parents and children, many cardiometabolic risk factors correlate independent of parent and child BMI. Adverse parental cardiometabolic profiles may identify at-risk children independent of the child's adiposity status.