Television viewing time independently predicts all-cause and cardiovascular mortality: The EPIC Norfolk study

MRC Epidemiology Unit, Cambridge, UK.
International Journal of Epidemiology (Impact Factor: 9.18). 02/2011; 40(1):150-9. DOI: 10.1093/ije/dyq105
Source: PubMed


Television viewing (TV), a highly prevalent behaviour, is associated with higher cardiovascular risk independently of physical activity. The relationship with mortality, however, is relatively unknown.
We examined the prospective relationship between TV time and all-cause, cardiovascular and cancer mortality in a population-based cohort [The European Prospective Investigation into Cancer and Nutrition (EPIC), Norfolk] of 13 197 men and women {age [SD (standard deviation)]: 61.5 ± 9.0 years}. Participants were free from stroke, myocardial infarction and cancer at baseline in 1998-2000 and were followed up for death ascertainment until 2009 (9.5 ± 1.6 years). TV time, total physical activity energy expenditure (PAEE), education level, smoking status, alcohol consumption, anti-hypertensive and lipid-lowering medication use, participant and family history of disease and total energy intake were self-reported; height and weight were measured by standardized procedures. Hazard ratios (HRs) [95% confidence interval (CI)] for mortality were estimated per 1-h/day increase in TV.
Each 1-h/day increase in TV time was associated with increased hazard of all-cause (HR = 1.04, 95% CI = 1.01-1.09; 1270 deaths) and cardiovascular (HR = 1.07, 95% CI = 1.01-1.15; 373 deaths), but not cancer mortality (HR = 1.04, 95% CI = 0.98-1.10; 570 deaths). This was independent of gender, age, education, smoking, alcohol, medication, diabetes history, family history of cardiovascular disease and cancer, body mass index (BMI) and PAEE. They were similar when stratified by gender, age, education, BMI and PAEE. The population-attributable fraction for all-cause mortality comparing the highest TV tertile (>3.6 h/day) with the lowest (<2.5 h/day) was 5.4%.
These findings suggest that public health recommendations should consider advising a reduction in TV time, a predominant leisure activity in modern society, in addition to advocating physical activity.

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    • "Sedentary behaviours—defined by low energy expenditure (ranging from 1.0 to 1.5 metabolic equivalents) in a sitting or reclining position (Owen, 2012; Sedentary Behaviour Research N, 2012)—have emerged as an additional element with concerns about physical activity and health. Television (TV) viewing time, a common leisure-time sedentary behaviour, has been associated with major chronic diseases and adverse cardio-metabolic health outcomes (Thorp et al., 2010; Wijndaele et al., 2010), decreased life expectancy (Veerman et al., 2011) and all-cause and cardiovascular mortality (Dunstan et al., 2010; Grontved and Hu, 2011; Wijndaele et al., 2011). Despite increasing evidence on the detrimental health consequences of high volumes of TV viewing time, little is known about the relationships of TV viewing time with health-related quality of life. "
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    ABSTRACT: Objective: Television (TV) viewing, a common leisure-time sedentary behaviour, is associated adversely with cardio-metabolic health, fatigue, depression and mental health. However, associations of TV viewing time with health-related quality of life attributes are less well understood. We examined associations of TV viewing time with physical well-being, mental well-being and vitality in a large population-based sample of Australian adults. Method: The study sample comprised 4,483 men and 5,424 women (mean age 51±14years) from the Australian Diabetes, Obesity and Lifestyle study (1999-2000). Multiple linear regressions examined associations of TV viewing time (h/day) with the SF-36v1 physical and mental health component summary scores and the vitality sub-score, adjusting for leisure-time physical activity and waist circumference. Results: Each 1-h/day increment in TV viewing time was associated with lower physical (-0.56 [95% CI: -0.77, -0.34]) and mental (-0.41 [-0.70, -0.12]) component summary scores and vitality (-0.51 [-0.81, -0.21]). Associations remained significant after adjustment for leisure-time physical activity and waist circumference. There was a gender interaction for the association of TV viewing time with vitality (significant in men only). Conclusions: TV viewing time is associated adversely with physical well-being, mental well-being and vitality. Further studies are required to better understand potential causal relationships and variations by gender and leisure-time physical activity.
    Preventive Medicine 09/2014; DOI:10.1016/j.ypmed.2014.09.007 · 3.09 Impact Factor
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    • "A growing body of evidence suggests that sedentary behavior (time spent sitting or reclining) is independently associated with all-cause and cardiovascular mortality [1–4], cardiovascular disease [5, 6], type 2 diabetes [7, 8], and some cancers [9]. Sedentary behavior appears to have physiological consequences, distinct from the effects associated with an absence of moderate- to vigorous-intensity physical activity, that may further contribute to chronic disease risk [10, 11]. "
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    ABSTRACT: Background Most sedentary behavior measures focus on occupational or leisure-time sitting. Our aim was to develop a comprehensive measure of adult sedentary behavior and establish its measurement properties. Method The SIT-Q was developed through expert review (n???=???7), cognitive interviewing (n???=???11) and pilot testing (n???=???34). A convenience sample of 82 adults from Calgary, Alberta, Canada, participated in the measurement property study. Test-retest reliability was assessed by intraclass correlation coefficients (ICCs) comparing two administrations of the SIT-Q conducted one month apart. Convergent validity was established using Spearman???s rho, by comparing the SIT-Q estimates of sedentary behaviour with values derived from a 7-Day Activity Diary. Results The SIT-Q exhibited good face validity and acceptability during pilot testing. Within the measurement property study, the ICCs for test-retest reliability ranged from 0.31 for leisure-time computer use to 0.86 for occupational sitting. Total daily sitting demonstrated substantial correlation (ICC???=???0.65, 95% CI: 0.49, 0.78). In terms of convergent validity, correlations varied from 0.19 for sitting during meals to 0.76 for occupational sitting. For total daily sitting, estimates derived from the SIT-Q and 7 Day Activity Diaries were moderately correlated (?????=???0.53, p???<???0.01). Conclusion The SIT-Q has acceptable measurement properties for use in epidemiologic studies.
    BMC Public Health 09/2014; 14(1):899. DOI:10.1186/1471-2458-14-899 · 2.26 Impact Factor
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    • "Several plausible mechanisms may explain the observed association between sedentary behavior and risk of some cancers. First, when a substantial amount of time is spent sitting, especially in front of the TV, this automatically means less physical activity, and it may lead to a higher energy intake [34], both which affect energy balance in such a way that possibly overweight/obesity results. However, the observed associations remained when adjusting for BMI or WC, energy intake, and physical activity. "
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    ABSTRACT: Background Sedentary behavior is ubiquitous in modern adults' daily lives and it has been suggested to be associated with incident cancer. However, the results have been inconsistent. In this study, we performed a systematic review and meta-analysis of prospective cohort studies to clarify the association between sedentary behavior and incident cancer. Method PubMed and Embase databases were searched up to March 2014. All prospective cohort studies on the association between sedentary behavior and incident cancer were included. The summary relative risks (RRs) with 95% confidence intervals (CIs) were estimated using random effect model. Results A total of 17 prospective studies from 14 articles, including a total of 857,581 participants and 18,553 cases, were included in the analysis for sedentary behavior and risk of incident cancer. The overall meta-analysis suggested that sedentary behavior increased risk of cancer (RR = 1.20, 95%CI = 1.12–1.28), with no evidence of heterogeneity between studies (I2 = 7.3%, P = 0.368). Subgroup analyses demonstrated that there were statistical associations between sedentary behavior and some cancer types (endometrial cancer: RR = 1.28, 95% CI = 1.08–1.53; colorectal cancer: RR = 1.30, 95%CI = 1.12–1.49; breast cancer: RR = 1.17, 95%CI = 1.03–1.33; lung cancer: RR = 1.27, 95%CI = 1.06–1.52). However, there was no association of sedentary behavior with ovarian cancer (RR = 1.26, 95%CI = 0.87–1.82), renal cell carcinoma (RR = 1.11, 95%CI = 0.87–1.41) or non-Hodgkin lymphoid neoplasms (RR = 1.09, 95%CI = 0.82–1.43). Conclusion The present meta-analysis suggested that prolonged sedentary behavior was independently associated with an increased risk of incident endometrial, colorectal, breast, and lung cancers, but not with ovarian cancer, renal cell carcinoma or non-Hodgkin lymphoid neoplasms.
    PLoS ONE 08/2014; 9(8):e105709. DOI:10.1371/journal.pone.0105709 · 3.23 Impact Factor
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