Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality A Meta-analysis

Institute of Sport Science and Clinical Biomechanics, Department of Exercise Epidemiology, Center of Research in Childhood Health, University of Southern Denmark, Odense.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2011; 305(23):2448-55. DOI: 10.1001/jama.2011.812
Source: PubMed


Prolonged television (TV) viewing is the most prevalent and pervasive sedentary behavior in industrialized countries and has been associated with morbidity and mortality. However, a systematic and quantitative assessment of published studies is not available.
To perform a meta-analysis of all prospective cohort studies to determine the association between TV viewing and risk of type 2 diabetes, fatal or nonfatal cardiovascular disease, and all-cause mortality.
Relevant studies were identified by searches of the MEDLINE database from 1970 to March 2011 and the EMBASE database from 1974 to March 2011 without restrictions and by reviewing reference lists from retrieved articles. Cohort studies that reported relative risk estimates with 95% confidence intervals (CIs) for the associations of interest were included.
Data were extracted independently by each author and summary estimates of association were obtained using a random-effects model.
Of the 8 studies included, 4 reported results on type 2 diabetes (175,938 individuals; 6428 incident cases during 1.1 million person-years of follow-up), 4 reported on fatal or nonfatal cardiovascular disease (34,253 individuals; 1052 incident cases), and 3 reported on all-cause mortality (26,509 individuals; 1879 deaths during 202,353 person-years of follow-up). The pooled relative risks per 2 hours of TV viewing per day were 1.20 (95% CI, 1.14-1.27) for type 2 diabetes, 1.15 (95% CI, 1.06-1.23) for fatal or nonfatal cardiovascular disease, and 1.13 (95% CI, 1.07-1.18) for all-cause mortality. While the associations between time spent viewing TV and risk of type 2 diabetes and cardiovascular disease were linear, the risk of all-cause mortality appeared to increase with TV viewing duration of greater than 3 hours per day. The estimated absolute risk differences per every 2 hours of TV viewing per day were 176 cases of type 2 diabetes per 100,000 individuals per year, 38 cases of fatal cardiovascular disease per 100,000 individuals per year, and 104 deaths for all-cause mortality per 100,000 individuals per year.
Prolonged TV viewing was associated with increased risk of type 2 diabetes, cardiovascular disease, and all-cause mortality.

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    • "Exploring the health effects of sedentary behavior, independent of physical activity, has been a relatively new scientific pursuit, with a proliferation of studies published in the past decade. Evidence to date suggests that prolonged sedentary time is associated with increased risk for a variety of adverse health outcomes23456789101112, including cancers of the breast, colon/rectum, ovaries, endometrium, and prostate11121314. In addition, greater sedentary time among adults is associated with weight gain, higher body mass index (BMI), and obesity151617181920, which is a known risk factor for cancer [21]. "

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    • "Measuring the full 24h cycle with a single monitor would be a potentially convenient and cost-effective way to collect information about health and well- being[12]. Indeed, both sleep and physical activity/sedentary behaviors impact health[13], with both sedentary behaviors[14,15]and poor sleep quality[16,17]being associated with negative health outcomes. In addition, the dynamic interaction between these behaviors in the 24h day mediates health outcomes. "
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    ABSTRACT: There is a growing need for free-living monitoring of the full 24 h spectrum of behaviors with a single or integrated set of sensors. The validity of field standard wearable monitors in sleep and physical activity have yet to be assessed for the complementary behavior in the context of 24 h continuous monitoring. We conducted a free-living comparison study of the Actigraph GT3X + (GT3X +) to assess sleep parameters as compared with the Actiwatch-64 (AW-64) and concurrently, the AW-64 to assess sedentary and physical activity behaviors as compared with the GT3X +. Thirty young adults (15 female, 19.2 ± 0.86 years) wore both monitors for 3 consecutive days and 2 consecutive nights. Agreement of sleep, sedentary, and physical activity metrics were evaluated using analyses of variance, intraclass correlation coefficients, Bland-Altman plots with associated confidence limits, mean absolute percentage of errors and equivalence tests. For sleep, the GT3X + showed high agreement for total sleep time and sleep efficiency, but underestimated wakefulness after sleep onset and sleep onset latency relative to the AW-64. For sedentary behavior and physical activity, the AW-64 showed a moderate agreement for activity energy expenditure, but not for sedentary, light or moderate-vigorous physical activities relative to the GT3X +. Overall our results showed good agreement of the GT3X + with AW-64 for assessing sleep but a lack of agreement between AW-64 and GT3X + for physical activity and sedentary behaviors. These results are likely due to the monitor placement (wrist vs hip), as well as the algorithm employed to score the data. Future validation work of existing and emerging technologies that may hold promise for 24 h continuous monitoring is needed.
    No preview · Article · Jan 2016 · Physiology & Behavior
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    • "From a public health perspective, there is certainly a need to help families reduce screen time globally , and there is a growing literature suggesting that television and other passive viewing may be the key behavior to target in interventions. Reducing television time could potentially have benefits not only on children's physical strength, but also on other health outcomes such as weight status, sleep duration and quality, cardiovascular disease, and risk of diabetes404142. The current recommendations for adults to break up every hour of inactivity time with 10 minutes of standing or movement could also be applied and encouraged in children , beyond the recommended 60 minutes per day of moderate to vigorous physical activity. Studies are beginning to show that breaks in sedentary time in children are associated with better child BMI and cardiometabolic risk [43], but it remains to be seen how this might also influence children's strength, or whether this can be successfully manipulated by intervention [44]. "
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    ABSTRACT: Background Physical strength is associated with improved health outcomes in children. Heavier children tend to have lower functional strength and mobility. Physical activity can increase children’s strength, but it is unknown how different types of electronic media use impact physical strength. Methods Data from the NHANES National Youth Fitness Survey (NNYFS) from children ages 6–15 were analyzed in this study. Regression models were conducted to determine if screen-based sedentary behaviors (television viewing time, computer/video game time) were associated with strength measures (grip, leg extensions, modified pull-ups, plank) while controlling for potential confounders including child age, sex, BMI z-score, and days per week with 60+ minutes of physical activity. Grip strength and leg extensions divided by body weight were analyzed to provide measures of relative strength together with pull-ups and plank, which require lifting the body. Results The results from the regression models showed the hypothesized inverse association between TV time and all strength measures. Computer time was only significantly inversely associated with the ability to do one or more pull-ups. Conclusions This study shows that television viewing, but not computer/videogames, is inversely associated with measures of child strength while controlling for child characteristics and physical activity. These findings suggest that “screen time” may not be a unified construct with respect to strength outcomes and that further exploration of the potential benefits of reducing television time on children’s strength and related mobility is needed.
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