Screen time, adiposity and cardiometabolic markers: mediation by physical activity, not snacking, among 11-year-old children

Relationship between youth cardiometabolic health and physical activity in medical records

BACKGROUND

Thers is limited research examining modifiable cardiometabolic risk factors with a single-item health behavior question obtained during a clinic visit. Such information could support clinicians in identifying patients at risk for adverse cardiometabolic health. We investigated if children meeting physical activity or screen time recommendations, collected during clinic visits, have better cardiometabolic health than children not meeting recommendations. We hypothesized that children meeting either recommendation would have fewer cardiometabolic risk factors.

METHODS AND FINDINGS

This cross-sectional study used data from electronic medical records (EMRs) between January 1, 2013 through December 30, 2017 from children (2-18 years) with a well child visits and data for ≥1 cardiometabolic risk factor (i.e., systolic and diastolic blood pressure, glycated hemoglobin, alanine transaminase, high-density and low-density lipoprotein, total cholesterol, and/or triglycerides). Physical activity and screen time were patient/caregiver-reported. Analyses included EMRs from 63,676 well child visits by 30,698 unique patients (49.3% female; 41.7% Black, 31.5% Hispanic). Models that included data from all visits indicated children meeting physical activity recommendations had reduced risk for abnormal blood pressure (odds ratio [OR] = 0.91, 95%CI 0.86, 0.97; p = 0.002), glycated hemoglobin (OR = 0.83, 95%CI 0.75, 0.91; p = 0.00006), alanine transaminase (OR = 0.85, 95%CI 0.79, 0.92; p = 0.00001), high-density lipoprotein (OR = 0.88, 95%CI 0.82, 0.95; p = 0.0009), and triglyceride values (OR = 0.89, 95%CI 0.83, 0.96; p = 0.002). Meeting screen time recommendations was not associated with abnormal cardiometabolic risk factors.

CONCLUSION

Collecting information on reported adherence to meeting physical activity recommendations can provide clinicians with additional information to identify patients with a higher risk of adverse cardiometabolic health.

Psychosocial and environmental risk factors of obesity and hypertension in children and adolescents-a literature overview

Childhood obesity has become a worldwide epidemic in the 21st century. Its treatment is challenging and often ineffective, among others due to complex, often not obvious causes. Awareness of the existence and meaning of psychosocial and environmental risk factors seems to be an essential element in the prevention and treatment of obesity and its complications, especially arterial hypertension. In this review, we will discuss the role of that risk factors linking obesity and increased cardiovascular disorders including the role of nutritional factors (including the role of unhealthy diet, inadequate hydration), unhealthy behaviors (e.g. smoking, alcohol and drugs, sedentary behavior, low physical activity, disrupted circadian rhythms, sleep disorders, screen exposure), unfavorable social factors (such as dysfunctional family, bullying, chronic stress, mood disorders, depression, urbanization, noise, and environmental pollution), and finally differences in cardiovascular risk in girls and boys.

Prolonged screen watching behavior is associated with high blood pressure among children and adolescents: a systematic review and dose-response meta-analysis

BACKGROUND

Numerous cardio-metabolic risk factors influence screen-related behaviors in children and adolescents. Numerous studies with inconsistent results revealed a relationship between blood pressure and screen time in the children and adolescents. This systematic review and meta-analysis summarized the data regarding the relationship between screen time and hypertension (HTN) in children and adolescents.

METHODS

We examined three electronic databases, including Scopus, PubMed, and Embase to find the recent research on the relationship between screen time and HTN up to 19 July 2022. Twenty papers were included in the final two-class and dose-response meta-analysis. We conducted subgrouping to identify the source of heterogeneity.

RESULTS

The highest category of screen time increased the odds of HTN by 8% [odds ratio (OR): 1.15; 95% confidence interval (CI): 1.08, 1.23; P < 0.001; I2 = 83.20%] and 1.9 mmHg increase in systolic blood pressure [weighted mean difference (WMD): 1.89; 95% CI: 0.18-3.62; P = 0.030; I2 = 83.4]. However, there was no significant difference in diastolic blood pressure. Moreover, screen time in hypertensive children and adolescents was 0.79 h (47.4 min) higher than normotensive subjects (WMD: 0.79; 95% CI: 0.02, 1.56; P = 0.046; I2 = 92.8). A departure from linearity was observed between increased screen time [digital video discs, personal computers, and video games and HTN (Pnonlinearity = 0.049).

CONCLUSION

This systematic meta-analysis review is the first to demonstrate a positive correlation between screen time and HTN in children and adolescents.

The association between screen use and central obesity among children and adolescents: a systematic review and meta-analysis

Currently, there is no summative study evaluating the association between central obesity and screen time. This systematic review and meta-analysis aimed to summarize the results of studies evaluating the association between screen time and central obesity among children and adolescents. To this end, we performed a systematic search in three electronic databases, including Scopus, PubMed, and Embase to retrieve the related studies up to March 2021. Nine studies were eligible to be included in the meta-analysis. There was no association between odds of central obesity and screen time [odds ratio (OR) 1.136; 95% CI 0.965-1.337; P = 0.125]; however, waist circumference (WC) was 1.23 cm higher in those with highest screen time versus those in the lowest screen time category [weighted mean difference (WMD) = 1.23; 95% 95% CI 0.342-2.112; P = 0.007; Fig. 3]. Moreover, the possible sources of heterogeneity in the included studies were continent and sample size. No evidence of publication bias was reported. For the first time, the current systematic review and meta-analysis revealed that those with the highest screen time had higher WC compared with those with the lowest screen time. Although, there was no association between odds of central obesity and screen time. Due to the observational design of the included studies, it is impossible to infer the cause-effect relationship. Therefore, further interventional and longitudinal studies are warranted to better elucidate the causality of these associations.

Risks of Digital Screen Time and Recommendations for Mitigating Adverse Outcomes in Children and Adolescents

BACKGROUND

The COVID-19 pandemic caused an unprecedented move to emergency remote learning around the world, leading to increased digital screen time for children and adolescents. This review highlights the potential risk of increased screen time to the eye and general health and makes recommendations to mitigate the risks posed.

METHODS

A narrative review of evidence of increased digital time during the COVID-19 pandemic, the risks linked to increased screen time and offer possible steps to mitigate these in students.

RESULTS

Digital screen time was found to have increased for children and adolescents in all the studies examined during the pandemic and data suggests that this has an impact on eye and general health. We discuss the associated risk factors and adverse outcomes associated with increased digital screen time.

CONCLUSIONS

This review offers evidence of increased digital time, highlights some of the well-known and not so well-known risks linked to increased screen time, and offers possible steps to mitigate these in children and adolescents during the pandemic, as well as offering schools and parents strategies to support the eye health of children and adolescents post-pandemic. We discuss a number of interventions to reduce the risk of eye strain, myopia, obesity, and related diseases that have been shown to be linked to increased digital screen time.

Quantile regression to examine the association of air pollution with subclinical atherosclerosis in an adolescent population

BACKGROUND

Air pollution has been associated with carotid intima-media thickness test (CIMT), a marker of subclinical atherosclerosis. To our knowledge, this is the first study to report an association between ambient air pollution and CIMT in a younger adolescent population.

OBJECTIVE

To investigate the associations beyond standard mean regression by using quantile regression to explore if associations occur at different percentiles of the CIMT distribution.

METHODS

We measured CIMT cross-sectionally at the age of 16 years in 363 adolescents participating in the Dutch PIAMA birth cohort. We fit separate quantile regressions to examine whether the associations of annual averages of nitrogen dioxide (NO₂), fine particulate matter (PM_2.5), PM_2.5 absorbance (a marker for black carbon), PM_coarse and ultrafine particles up to age 14 assigned at residential addresses with CIMT varied across deciles of CIMT. False discovery rate corrections (FDR, p < 0.05 for statistical significance) were applied for multiple comparisons. We report quantile regression coefficients that correspond to an average change in CIMT (µm) associated with an interquartile range increase in the exposure.

RESULTS

PM_2.5 absorbance exposure at birth was statistically significantly (FDR < 0.05) associated with a 6.23 µm (95% CI: 0.15, 12.3) higher CIMT per IQR increment in PM_2.5 absorbance in the 10th quantile of CIMT but was not significantly related to other deciles within the CIMT distribution. For NO₂ exposure we found similar effect sizes to PM_2.5 absorbance, but with much wider confidence intervals. PM_2.5 exposure was weakly positively associated with CIMT while PM_coarse and ultrafine did not display any consistent patterns.

CONCLUSIONS

Early childhood exposure to ambient air pollution was suggestively associated with the CIMT distribution during adolescence. Since CIMT increases with age, mitigation strategies to reduce traffic-related air pollution early in life could possibly delay atherosclerosis and subsequently CVD development later in life.

Effect of Covid-19 lockdown on indian children with autism

BACKGROUND

To prevent the spread of Coronavirus-19 a complete lockdown was enforced in India by March, 2020. The lockdown led to drastic negative effects on the social and communicative life of people. Among these, children and adolescents have been majorly affected. The study aims to investigate the effect of lockdown on Indian children with Autism.

METHODS AND PROCEDURES

Thirty parents of children with Autism were given questionnaires to rate the performance of their children, pre- and post-lockdown. The questionnaires were analysed for development across activities of daily living (ADL), language and behavioral characteristics along with school and therapy performance.

OUTCOME AND RESULTS

The results revealed a significant regression in performance of children post-lockdown which was evident across all the domains assessed. Various additional issues like changes in sleep patterns, inadequate sitting behavior, attention span, concentration, limited eye contact, mood swings, laziness, clumsiness, hyperactivity and impulsivity were also noted post-lockdown, which were not very prominent before lockdown.

CONCLUSIONS AND IMPLICATIONS

The study anticipates to help be better prepared for such situations in future. This includes involvement of better intervention which includes home-based training strategies for these children. Moreover, the study highlights impact of online therapy and schooling for children with Autism.

Promoting Sleep and Balanced Screen Time among School-Aged Children with Neurodevelopmental and Mental Health Disorders: A Parent Perspective

Background: Children with neurodevelopmental and mental health disorders (N/MHD), such as autism spectrum, mood disorders, and anxiety, are more likely to engage in excessive screen time, receive insufficient sleep, and to have obesity than neurotypical peers. However, little is known about how parents of these children approach promoting sleep and balanced screen time. Methods: We conducted semistructured interviews with 24 parents of children aged 8-15 years with a diagnosis of N/MHD to assess barriers and facilitators to promoting sleep and balanced screen time. Interviews were transcribed, double-coded using constant comparative methods, and summarized into themes using NVivo 11. Results: Many parents described children's chronic sleep challenges, often compounded by screen use and no clear solutions. When feeling overwhelmed, some parents reluctantly reported co-sleeping or allowing gaming devices in bed. Nearly all participants reported chronic, occasionally severe, conflict when managing children's screen time, with some parents experiencing opposition and physical aggression. Parents struggled to weigh the benefits of screen use (i.e., behavior management, learning, and social connection) with the costs (i.e., reduced self-care and limited physical activity). To combat barriers, parents described firm routines (i.e., "screens off" time and consistent bedtime on weekdays and weekends), moderating access (i.e., shutting down internet and no device in bedroom), verbal priming, and coping strategies (i.e., music and books). Conclusions: Parents of children with N/MHD face unique challenges in promoting sleep and balanced screen time. Given these behaviors may impact weight status and mental health, future interventions should examine ways to support parents in reducing conflict while promoting healthy habits.

The Prevalence of Overweight and Obesity Among Women in Jordan: A Risk Factor for Developing Chronic Diseases

Objective

The study aimed to investigate the prevalence of obesity among Jordanian women and its association with a wide range of chronic diseases.

Methods

Subjects were enrolled in the present cross-sectional study based on a random drop-off technique at the Obstetrics and Gynecology clinics at Jordan University Hospital. Initially, any female 18 years of age and older was asked to enroll in the study. Relevant data were gathered using a questionnaire composed of 30 questions, and body mass index (BMI) was determined from each participant’s weight and height. The following variables were collected: socio-demographic, chronic diseases, and health status. Each variable’s frequencies were reported, and the 95% confidence interval (95% CI) for each variable was calculated. For association analysis, Chi-square analysis was performed with an odds ratio (OR) and 95% CI. Multinomial logistic regression analysis was applied to a combination of independent variables and a dependent condition with covariate factors.

Results

The age-standardized prevalence of overweight/obese Jordanian women was 70.6% (95% CI 66.0–74.8%). On the other hand, the age-standardized prevalence of only obese women was 36.4 (95% Cl 31.9–41.2%). Furthermore, the association between age and overweight/obesity was significant (p<0.0001). The percentage of overweight and obesity started to be significant in the 30–39 year age group. Moreover, the OR for obesity ranged from 2.7 to 7.0 (p<0.05–0.01) for those women with only elementary education. Besides, high parity was significantly associated with obesity and elementary education. For chronic conditions, the percentages of hypertension, diabetes, hypertriglyceridemia, osteoporosis, and rheumatoid arthritis were significantly correlated with increased BMI in Jordanian women. With age adjustment, however, only hypertension was associated with obese level 3 with OR of 7.2 and 95% CI of 2.1–25.1 (p<0.01).

Conclusion

There is a high prevalence of overweight/obesity among women in Jordan, which was related to high parity and low education level. This high prevalence of obesity increased the incidence of chronic diseases, such as hypertension. Therefore, community-based multiple strategies are required to combat obesity in Jordanian women.

Weekday-Weekend Sedentary Behavior and Recreational Screen Time Patterns in Families with Preschoolers, Schoolchildren, and Adolescents: Cross-Sectional Three Cohort Study

Background: Excessive recreational screen time (RST) has been associated with negative health consequences already being apparent in preschoolers. Therefore, the aim of this study was to reveal parent-child sedentary behavior, and RST patterns and associations with respect to the gender, age category of children, and days of the week. Methods: Our cross-sectional survey included 1175 parent-child dyads with proxy-reported RST data collected during a regular school week during the spring and fall between 2013 and 2019. The parent-child RST (age and RST) relationship was quantified using Pearson’s (r_P) correlation coefficient. Results: Weekends were characterized by longer RST for all family members (daughters/sons: +34/+33 min/day, mothers/fathers: +43/+14 min/day) and closer parent-child RST associations than on weekdays. The increasing age of children was positively associated with an increase in RST on weekdays (+6.4/+7.2 min per year of age of the daughter/son) and weekends (+5.8/+7.5 min per year of age of the daughter/son). Conclusions: Weekends provide a suitable target for implementation of programs aimed at reducing excessive RST involving not only children, but preferably parent-child dyads.

Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review

As a consequence of the COVID-19 pandemic, different measures have been implemented by governments from each affected country. Such measures usually involve restrictions on the movement of citizens, and have had a profound effect on usual activities and timetables. As a result of school closures and strict restrictions regarding going outside home, children have been one of the most disadvantaged population groups during the lockdown period. We therefore aimed to investigate potential health risk behaviors amongst isolated pre-school and school-aged children. We retrieved relevant articles from MEDLINE, Web of Science, PsycInfo, and Scopus databases to describe identified health-related behaviors (i.e. screen exposure, environmental influence, physical activity and fitness, sedentariness, sleep patterns, eating habits, psychological response, body composition, and injuries) in relation to social isolation and social deprivation of children without previous illness or conditions. This review depicts the potential health-related behaviors according to related literature, and put the focus on future short and long-term sequels of social isolation. Socio-affective complications and insufficient physical activity are underscored as two of the main concerns, particularly among socio-economic deprived children. Both issues could be effectively addressed with either adequate parental or community guidance.

A systematic review of screen-time literature to inform educational policy and practice during COVID-19

There is an urgent need for consensus around the matter of screen time (ST) during the COVID-19 pandemic. Some governments announced restrictions for online schooling time per day to protect students from perceived risks of prolonged screen-use, but critics and an emerging body of research question such regulations. Our review of 52 empirical studies found (a) an overwhelming majority of literature shows effect sizes too small to be of practical or clinical significance, and (b) findings more specifically on educational ST are inconclusive and critically underrepresented. These facts, along with the undeniable benefits of online learning in the absence of brick-and-mortar schooling and the ominous forecasts of learning loss caused by prolonged school closure, inform our recommendations for a more moderate policy and practical stance on restrictions - one that is focused on responsibly leveraging the educational and social benefits of ST in a world still recovering from the COVID-19 pandemic.

Relationship between sleep duration and TV time with cardiometabolic risk in adolescents

Objective

To verify the association between sleep duration and television time with cardiometabolic risk and the moderating role of age, gender, and skin color/ethnicity in this relationship among adolescents.

Methods

Cross-sectional study with 1411 adolescents (800 girls) aged 10 to 17 years. Television time, sleep duration, age, gender, and skin color/ethnicity were obtained by self-reported questionnaire. Cardiometabolic risk was evaluated using the continuous metabolic risk score, by the sum of the standard z-score values for each risk factor: high-density lipoprotein cholesterol, triglycerides, glycemia, cardiorespiratory fitness, systolic blood pressure, and waist circumference. Generalized linear regression models were used.

Results

There was an association between television time and cardiometabolic risk (β, 0.002; 95% CI, 0.001; 0.003). Short sleep duration (β, 0.422; 95% CI, 0.012; 0.833) was positively associated with cardiometabolic risk. Additionally, age moderated the relationship between television time and cardiometabolic risk (β, − 0.009; 95% CI, − 0.002; − 0.001), suggesting that this relationship was stronger at ages 11 and 13 years (β, 0.004; 95% CI, 0.001; 0.006) compared to 13 to 15 years (β, 0.002; 95% CI, 0.001; 0.004). No association was found in older adolescents (β, 0.001; 95% CI, − 0.002; 0.002).

Conclusions

Television time and sleep duration are associated with cardiometabolic risk; adolescents with short sleep have higher cardiometabolic risk. In addition, age plays a moderating role in the relationship between TV time and cardiometabolic risk, indicating that in younger adolescents the relationship is stronger compared to older ones.

Heavy Screen Use on Weekends in Childhood Predicts Increased Body Mass Index in Adolescence: A Three-Year Follow-Up Study

PURPOSE

We aimed to examine whether sedentary screen time changes when transitioning from childhood to adolescence and whether children's screen time, separately for school days and weekends, affects body mass index (BMI) in adolescents.

METHODS

This prospective 3-year follow-up study included 5,084 children with a mean (standard deviation) age of 11 (1) years at baseline and 14 (1) years at follow-up. Children reported screen time, more specifically, time spent viewing TV programs and using a computer outside school while sitting. We categorized children into light, medium, and heavy TV viewers and computer users separately for school days and weekends. We also calculated the age- and gender-specific BMI z-score (BMIz).

RESULTS

Time spent viewing TV changed from baseline to follow-up on school days and on weekends (p < .001 for both); the proportion of heavy TV viewers on school days (≥3 h/d) increased from 16% to 23% and on weekends (≥4 h/d) from 19% to 30%. Heavy TV viewers and computer users on both school days and on weekends had a higher BMIz 3 years later (p < .001 for all). After adjusting for age, gender, language, baseline BMIz, sleep duration, eating habits, exercise, and the other screen-time variables, heavy TV viewing on weekends remained significantly associated with an increased BMIz at follow-up (B = .078; p = .013).

CONCLUSIONS

The proportion of heavy screen users increases when transitioning from childhood to adolescence. Moreover, heavy screen use, especially on weekends in 11-year-old children, is associated with an increased BMI 3 years later.

The association between screen time and cardiometabolic risk in young children

OBJECTIVES

While studies exist on the association between screen time and cardiometabolic risk among adolescents, research examining the effect of screen time on cardiometabolic risk in young children is lacking. The primary objective of this study was to examine the association between daily screen time and cardiometabolic risk (CMR) [sum of age- and sex-standardized z-scores of systolic blood pressure (SBP), glucose, log-triglycerides, waist circumference (WC), and negative high-density lipoprotein (HDL) cholesterol divided by the square root of five] in young children. Secondary objectives included examining individual CMR risk factors, including waist-to-height ratio and non high-density lipoprotein (non-HDL) cholesterol, as well as the individual cut-offs of these risk factors. Additional analyses include examining the association between screen time and CMR by handheld/non-handheld devices.

METHODS

A study was conducted among young children 3 to 6 years from the TARGet Kids! practice-based research network in Toronto and Montreal, Canada. Children with one or more measures of screen time and CMR were included in this study. Generalized estimating equation (GEE) multivariable linear regressions and multivariable logistic regressions, using published cut-offs, were conducted to evaluate these associations.

RESULTS

Data from 1317 children [mean age 52 months (SD = 13.36), 44.34% female] were included for analyses. There was no evidence of associations between screen time and total CMR score or individual risk factors (p > 0.05) after adjusting for confounders. A statistically significant, but small association between daily screen time and non-HDL cholesterol was found (B = 0.046; CI = [0.017 to 0.075]; p = 0.002.

CONCLUSIONS

Though no relationship was reported between daily screen time and the majority of CMR factors in early childhood, there was an association between daily screen time and non-HDL cholesterol. As the relationship between daily screen time and CMR factors may not be apparent in early childhood, studies to evaluate longer-term cardiometabolic effects of screen time are needed. Although there is an evidence-based rationale to reduce screen time in early childhood, prevention of cardiometabolic risk may not be the primary driver.

Childhood obesity in urban Ghana: evidence from a cross-sectional survey of in-school children aged 5-16 years

BACKGROUND

Childhood obesity is a growing public health concern in many low-income urban settings; but its determinants are not clear. The purpose of this study is to assess the prevalence of childhood obesity and associated factors among in-school children aged 5-16 years in a Metropolitan district of Ghana.

METHODS

A cross-sectional quantitative survey was conducted among a sample of 285 in-school children aged 5-16 years. Pre-tested questionnaires and anthropometric data collection methods were used to collect data. Descriptive, bivariate, binary and multivariate logistic regression statistical techniques were used to analyse data.

RESULTS

Some 46.9% (42.2% for males and 51.7% for females) of the children were overweight. Of this, 21.2% were obese (BMI falls above 95th percentile). Childhood obesity was higher in private school (26.8%) than public school (21.4%), and among girls (27.2%) than boys (19%). Factors that increased obesity risks included being aged 11-16 as against 5-10 years (aOR = 6.07; 95%CI = 1.17-31.45; p = 0.025), having a father whose highest education is 'secondary' (aOR =2.97; 95% CI = 1.09-8.08; p = 0.032), or 'tertiary' (aOR = 3.46; 95% CI = 1.27-9.42; p = 0.015), and consumption of fizzy drinks most days of the week (aOR = 2.84; 95% CI = 1.24-6.52; p = 0.014). Factors that lowered obesity risks included engaging in sport at least 3times per week (aOR = 0.56; 95% CI = 0.33-0.96; p = 0.034), and sleeping for more than 8 h per day (aOR = 0.38; 95% CI = 0.19-0.79; p = 0.009).

CONCLUSION

Higher parental (father) educational attainment and frequent consumption of fizzy drinks per week may increase obesity risks among in-school children aged 5-16 years in the Metropolitan district of Ghana. However, regular exercise (playing sport at least 3 times per week) and having 8 or more hours of sleep per day could lower obesity risks in the same population. Age and sex-appropriate community and school-based interventions are needed to promote healthy diet selection and consumption, physical activity and healthy life styles among in-school children.

SEDENTARY BEHAVIOR AND CARDIOVASCULAR RISK IN CHILDREN: A SYSTEMATIC REVIEW

ABSTRACT In recognition of the increasing time spent in sedentary activities in modern life, an emerging area of study linking sedentary time to health has highlighted its role in the development of chronic diseases. Therefore, the objective of this systematic review was to investigate the indicators and characteristics of sedentary behavior associated with cardiovascular risk factors in children and adolescents. The databases SciVerse Scopus, MEDLINE®/PubMed and LILACS were selected as a source of reference, using the associated terms “sedentary lifestyle” or “sedentary behavior” or “sedentary” AND “cardiovascular diseases” AND “child or adolescent” to identify studies published from January 2006 to March 2019. The methodological quality of the studies was evaluated and a score was assigned. Fifty articles were included in this review at the end. Extensive sedentary time, especially greater screen and TV exposure time, were associated with cardiovascular risk factors. In addition, the accumulation of prolonged sedentary bouts with few breaks in sedentary time tended to compromise the cardiometabolic profile. These findings highlight the importance of differentiating and considering these various indicators and characteristics of sedentary behavior. Further studies are needed to elucidate the multiple and overlapping facets of sedentary behavior and their relationship with health, and to encourage the development of evidence-based recommendations for this population. Level of Evidence I; Systematic Review of Level I Studies.

The associations of air pollution, traffic noise and green space with overweight throughout childhood: The PIAMA birth cohort study

BACKGROUND

Air pollution, traffic noise and absence of green space may contribute to the development of overweight in children.

OBJECTIVES

To investigate the combined associations of air pollution, traffic noise and green space with overweight throughout childhood.

METHODS

We used data for 3680 participants of the Dutch PIAMA birth cohort. We estimated exposure to air pollution, traffic noise and green space (i.e. the average Normalized Difference Vegetation Index (NDVI) and percentages of green space in circular buffers of 300 m and 3000 m) at the children's home addresses at the time of parental reported weight and height measurements. Associations of these exposures with overweight from age 3 to 17 years were analyzed by generalized linear mixed models, adjusting for potential confounders. Odds ratios (OR's) are presented for an interquartile range increase in exposure.

RESULTS

odds of being overweight increased with increasing exposure to NO₂ (adjusted OR 1.40 [95% confidence interval (CI) 1.12-1.74] per 8.90 µg/m³) and tended to decrease with increasing exposure to green space in a 3000 m buffer (adjusted OR 0.86 [95% CI 0.71-1.04] per 0.13 increase in the NDVI; adjusted OR 0.86 [95% CI 0.71-1.03] per 29.5% increase in the total percentage of green space). After adjustment for NO₂, the associations with green space in a 3000 m buffer weakened. No associations of traffic noise with overweight throughout childhood were found. In children living in an urban area, living further away from a park was associated with a lower odds of being overweight (adjusted OR 0.67 [95% CI 0.52-0.85] per 359.6 m).

CONCLUSIONS

Exposure to traffic-related air pollution, but not traffic noise or green space, may contribute to childhood overweight. Future studies examining the associations of green space with childhood overweight should account for air pollution exposure.

Longitudinal associations of physical activity and sedentary time with cardiometabolic risk factors in children

BACKGROUND

There are few prospective studies on the associations of changes in objectively measured vigorous physical activity (VPA_∆ ), moderate-to-vigorous physical activity (MVPA_∆ ), light physical activity (LPA_∆ ), and sedentary time (ST_∆ ) with changes in cardiometabolic risk factors (_∆ ) in children. We therefore investigated these relationships among children.

METHODS

The participants were a population sample of 258 children aged 6-8 years followed for 2 years. We assessed PA and ST by a combined heart rate and movement sensor; computed continuous age- and sex-adjusted z-scores for waist circumference, blood pressure, and fasting insulin, glucose, triglycerides, and high-density lipoprotein (HDL) cholesterol; and constructed a cardiometabolic risk score (CRS) of these risk factors. Data were analyzed using linear regression models adjusted for age, sex, the explanatory and outcome variables at baseline, and puberty.

RESULTS

VPA_∆ associated inversely with CRS_∆ (β = -0.209, P = 0.001), body fat percentage (BF%)_∆ (β = -0.244, P = 0.001), insulin_∆ (β = -0.220, P = 0.001), and triglycerides_∆ (β = -0.164, P = 0.012) and directly with HDL cholesterol_∆ (β = 0.159, P = 0.023). MVPA_∆ associated inversely with CRS_∆ (β = -0.178, P = 0.012), BF%_∆ (β = -0.298, P = <0.001), and insulin_∆ (β = -0.213, P = 0.006) and directly with HDL cholesterol_∆ (β = 0.184, P = 0.022). LPA_∆ only associated negatively with CRS_∆ (β = -0.163, P = 0.032). ST_∆ associated directly with CRS_∆ (β = 0.218, P = 0.003), BF%_∆ (β = 0.212, P = 0.016), and insulin_∆ (β = 0.159, P = 0.049).

CONCLUSIONS

Increased VPA and MVPA and decreased ST were associated with reduced overall cardiometabolic risk and major individual risk factors. Change in LPA had weaker associations with changes in these cardiometabolic risk factors. Our findings suggest that increasing at least moderate-intensity PA and decreasing ST decrease cardiometabolic risk in children.

Cardiovascular disease risk factor clustering in children and adolescents: a prospective cohort study

OBJECTIVE

The early identification of predictors related to cardiovascular disease risk factor clustering (CVD-RFC) can help prevent chronic disease. We aimed to identify the risk factors for CVD-RFC in adolescents.

METHODS

A prospective longitudinal cohort study design was used to obtain data included in these analyses from school-aged children who participated in the Korean Child-Adolescent Study 2008-2014. A total of 1309 children aged 6-15 years were enrolled. We compared the participants based on the presence or absence of CVD-RFC and examined the cumulative incidence of CVD-RFC.

RESULTS

Of the total 1309 children, 410 (31.32%) had CVD-RFC in adolescence. A higher average household income ≥3 million Korean Republic won (KRW)/month (3-5 million KRW/month: HR 0.75 (95% CI 0.58 to 0.97); ≥5 million KRW/month: HR 0.58 (95% CI 0.44 to 0.77)) was associated with a lower CVD-RFC incidence, while the presence of parental CVD history (HR 1.28 (95% CI 1.04 to 1.57)), overweight or obesity (HR 3.83 (95% CI 3.05 to 4.80)) and shorter sleep duration of 8-9 hour/day (HR 1.80 (95% CI 1.05 to 3.07)) and <8 hour/day (HR 1.93 (95% CI 1.11 to 3.34)) had higher CVD-RFC incidences.

CONCLUSIONS

Obesity in childhood, short sleep duration and parental factors such as low socioeconomic status and parental history of CVD are significant risk factors for the development of CVD-RFC in adolescents. Efforts to create awareness regarding sufficient sleep duration in children via intervention programmes targeting cardiometabolic health in children and special attention to lifestyle modifications and socioeconomic components of the family should be considered.

Eating breakfast and snacks while television viewing are associated with some cardio metabolic risk factors among Iranian children

AIM

We aimed to investigate the association of eating meals while television viewing (TVV) and screen-based behaviors with cardio metabolic risk factors (CRFs) among school-aged children in Shiraz.

MATERIALS AND METHODS

This cross-sectional study was done on 409 primary school children (217 boys), aged 6-9 years. Physical activity, time spent on screen-based behaviors and frequency of eating meals while TVV were measured using a questionnaire. Anthropometric indices, fasting blood sugar (FBS), blood lipids, blood pressure (BP), dietary intakes and physical activity were assessed. Association of eating while TVV with CRFs were assessed using linear regression, adjusted for potential confounders. All statistical analysis were conducted using the Stata 13 software.

RESULTS

Fully adjusted model showed that TVV time had significant positive association with waist circumferences (WC), and BP (p <0.05). Also, we found an inverse relationship between using Computer and Video games with TG level (β=-0.3; CI: -0.64, -0.09). Children who ate two or more breakfast meal while TVV had higher WC (β=2.02; CI: 0.51, 3.53) and FBS (β=3.58; CI: 0.39, 6.78) compared to who never ate breakfast while TVV. After adjustment for Screen time and BMI, eating snacks while TVV was positively associated with FBS and systolic BP. However, Eating dinner and lunch while TVV were not significantly associated with any of CRFs after adjustment for confounders.

CONCLUSIONS

We found that both eating breakfast and snacks while TVV were associated with WC, FBS and BP in children. Also, excessive TVV was associated with WC and BP.

Gender-related differences in cardiometabolic risk factors and lifestyle behaviors in treatment-seeking adolescents with severe obesity

BACKGROUND

Obesity during adolescence is associated with cardiovascular mortality in adulthood. The adverse obesity-related cardiometabolic risk profile is already observed in adolescence. We aimed to examine possible gender differences in cardiometabolic risk factors and lifestyle behaviors among adolescents with severe obesity, hypothesizing that boys would have both a higher prevalence of the metabolic syndrome as well as less healthy lifestyle behaviors than girls.

METHODS

Cross-sectional study of treatment-seeking adolescents with severe obesity who attended the Morbid Obesity Centre at Vestfold Hospital Trust and who were consecutively enrolled in the Vestfold Register of Obese Children between September 2009 and September 2015. A total of 313 adolescents aged 12 to 18 years were recruited, whereof 268 subjects (49% boys) completed a food and activity frequency questionnaire and were included in the analysis.

RESULTS

Mean (SD) age, BMI and BMI SDS were 15 (1.6) years, 38.6 (5.9) kg/m² and 3.5 (0.6). Levels of LDL cholesterol, fasting insulin and glucose and diastolic blood pressure (DBP) did not differ between genders. Compared to girls, boys had significantly higher triglycerides (p = 0.037) and systolic blood pressure (SBP) (p = 0.003), as well as lower HDL cholesterol (p = 0.002). The metabolic syndrome was present in 27% of the boys and 19% of the girls (p = 0.140), and the prevalence of high DBP, dyslipidemia and dysglycemia also did not differ significantly between genders. The prevalence of high SBP was higher in boys than in girls (19% vs. 9%, p = 0.021). Gender was associated with a number of lifestyle habits, as a larger proportions of boys had higher screen time (p = 0.032), more regular breakfast eating (p = 0.023), higher intake of sugar sweetened soda (p = 0.036), and lower intake of vegetables than girls (p = 0.011). By contrast, physical activity level and intake of fruit and berries did not differ between genders.

CONCLUSIONS

Male treatment-seeking adolescents with severe obesity had a more unfavorable set of metabolic and behavioral risk factors for cardiovascular disease than girls. Our results indicate that lifestyle behavioral markers should be thoroughly assessed in both genders, and possible gender-related differences in risk profile should be taken into account in future treatment programs.

Evidence for increasing physical activity in children with physical disabilities: a systematic review

AIM

To summarize the best evidence of interventions for increasing physical activity in children with physical disabilities.

METHOD

A systematic review was conducted using an electronic search executed in Academic Search Elite, Academic Search Premier, CINAHL, Embase, MEDLINE, PEDro, PsychINFO, and SPORTDiscus up to February 2016. The selection of articles was performed independently by two researchers according to predetermined eligibility criteria. Data extraction, methodological quality, and levels of evidence were independently assessed by two researchers using a data-collection form from the Cochrane Collaboration and according to the guidelines of the American Academy for Cerebral Palsy and Developmental Medicine.

RESULTS

Seven studies were included. Five randomized controlled trials ranged from strong level I to weak level II studies, and two pre-post design studies were classified as level IV. There is level I evidence for no effect of physical training on objectively measured physical activity, conflicting level II evidence for interventions with a behavioural component on the increase of objectively measured physical activity directly after the intervention, and level II evidence for no effect during follow-up. Results are limited to children with cerebral palsy as no other diagnoses were included.

INTERPRETATION

Increasing physical activity in children with physical disabilities is very complex and demands further development and research.

Isotemporal Substitution Analysis for Sedentary Behavior and Body Mass Index

PURPOSE

This study examined the prospective associations of reallocating time spent in different types of sedentary behavior, physical activity, and sleep with body mass index (BMI) in children using isotemporal substitution analysis.

METHODS

Chinese children in grades 1-3 were recruited to a cohort study in 2009 and were followed up over a 2-yr period. Reports were gathered from the parents on children's sedentary behavior, sleep duration, and sociodemographic variables. The reported sedentary behavior types were then grouped into three categories: screen time (e.g., watching TV), academic-related activities (e.g., doing homework), and other sedentary behaviors (e.g., sitting and talking). Moderate-to-vigorous physical activity (MVPA) and light-intensity physical activity were assessed by ActiGraph accelerometry (ActiGraph, Pensacola, FL). Isotemporal substitution models were performed to examine the effects of time allocation on BMI.

RESULTS

A total of 672 children (359 boys, mean age at recruitment = 7.6 yr) who had provided valid accelerometer data for at least one assessment time point were included in the analysis. Controlling for covariates and total behavior time, isotemporal substitution models indicated that the displacement of 30 min·d of other sedentary behaviors with equal amounts of screen time (B = 0.12; 95% confidence interval, 0.04-0.20) or academic-related activities (B = 0.13; 95% confidence interval, 0.04-0.21) was associated with higher BMI. Reallocating 30 min·d of MVPA with each of the sedentary behavior variables resulted in increased BMI.

CONCLUSIONS

The substitution of screen time or academic-related activities with other sedentary behaviors or MVPA was associated with lower BMI in Chinese children.

Clinical and psychological effects of excessive screen time on children

Over recent years, screen time has become a more complicated concept, with an ever-expanding variety of electronic media devices available throughout the world. Television remains the predominant type of screen-based activity among children. However, computer use, video games and ownership of devices, such as tablets and smart phones, are occurring from an increasingly young age. Screen time, in particular, television viewing, has been negatively associated with the development of physical and cognitive abilities, and positively associated with obesity, sleep problems, depression and anxiety. The physiological mechanisms that underlie the adverse health outcomes related to screen time and the relative contributions of different types of screen and media content to specific health outcomes are unclear. This review discusses the positive and negative effects of screen time on the physiological and psychological development of children. Furthermore, recommendations are offered to parents and clinicians.

No influence of sugar, snacks and fast food intake on the degree of obesity or treatment effect in childhood obesity

BACKGROUND

Increased consumption of sweetened beverages has previously been linked to the degree of childhood obesity.

OBJECTIVE

The aim of the present study was to assess whether the intake of sweetened beverages, candy, snacks or fast food at baseline in a multidisciplinary childhood obesity treatment program was associated with the baseline degree of obesity or the treatment effect.

METHODS

This prospective study included 1349 overweight and obese children (body mass index standard deviation scores (BMI SDS) ≥ 1.64) enrolled in treatment at The Children's Obesity Clinic, Copenhagen University Hospital Holbaek. The children were evaluated at baseline and after up to 5.9 years of treatment (median 1.3 years).

RESULTS

Both boys and girls decreased their BMI SDS during treatment with a mean decrease in boys of 0.35 (p < 0.0001) and in girls of 0.22 (p < 0.0001) after 1 year of treatment. There were no associations between the baseline intake of sweetened beverages, candy, snacks, and/or fast food and BMI SDS at baseline or the change in BMI SDS during treatment.

CONCLUSIONS

The intake of sweetened beverages, candy, snacks or fast food when entering a childhood obesity treatment program was not associated with the degree of obesity at baseline or the degree of weight loss during treatment.

Clustering patterns of obesity-related multiple lifestyle behaviours and their associations with overweight and family environments: a cross-sectional study in Japanese preschool children

OBJECTIVES

The purpose of this study is (1) to identify obesity-related lifestyle behaviour patterns of diet, physical activity, sedentary and sleep behaviours in preschool children, (2) to examine the association between identified behaviour clusters and overweight/obesity and (3) to investigate differences in children's family environments according to clusters.

DESIGN SETTING AND PARTICIPANTS

A cross-sectional study on 2114 preschool children aged 3-6 years who attended childcare facilities (24 nursery schools and 10 kindergartens) in Tsuruoka city, Japan in April 2003 was conducted.

MAIN OUTCOME MEASURES

Children's principal caregivers completed a questionnaire on children's lifestyle behaviours (dinner timing, outside playtime, screen time and night-time sleep duration), family environment (family members, maternal employment, mealtime regularity and parents' habitual exercise and screen time) and measurements of weight and height. Cluster analysis was performed using children's 4 lifestyle behaviours based on those non-missing values (n=1545). The χ² tests and analysis of variance (ANOVA) estimated cluster differences in overweight/obesity and family environments.

RESULTS

6 clusters were identified. Children's overweight/obesity varied across clusters (p=0.007). The cluster with the most screen time, shorter night-time sleep duration, average dinner timing and outside playtime had the highest overweight/obesity prevalence (15.1%), while the cluster with the least screen time, the longest sleep duration, the earliest dinner timing and average outside playtime had the lowest prevalence (4.0%). Family environments regarding mealtime regularity and both parents' screen time also significantly varied across clusters. The cluster having the highest overweight/obesity prevalence had the highest proportion of irregular mealtimes and the most screen time for both parents.

CONCLUSIONS

This study suggests that public health approaches to prevent children's overweight/obesity should focus on decreasing screen time and increasing night-time sleep duration. To shape those behaviours, regular mealtimes and decreasing parents' screen time within family environments need to be targeted among family members.

Association of Parental Overweight and Cardiometabolic Diseases and Pediatric Adiposity and Lifestyle Factors with Cardiovascular Risk Factor Clustering in Adolescents

Cardiometabolic risk factors or their precursors are observed in childhood and may continue into adulthood. We investigated the effects of parental overweight and cardiometabolic diseases and pediatric lifestyle factors on the clustering of cardiovascular risk factors among adolescents, and examined the mediating and modifying effects of pediatric adiposity on these associations. Representative adolescents (n = 2727; age, 12–16 years) were randomly recruited through multistage stratified sampling from 36 schools in Southern Taiwan. Adolescent and parent surveys were conducted in schools and participant homes, respectively. Their demographic factors, diet patterns, and physical, anthropometric, and clinical parameters were collected and analyzed. Adolescents with 1–2 and ≥3 risk components for pediatric metabolic syndrome (MetS) were defined as potential MetS (pot-MetS) and MetS, respectively. Adolescents whose parents were overweight/obese, or with diabetes and hypertension had a higher prevalence ratio of pot-MetS and MetS (1.5–1.6 and 1.9–4.2-fold, respectively). Low physical activity (<952.4 MET·min/week), long screen time (≥3 h/day) and high sugar-sweetened beverage intake (>500 mL/day) were associated with a 3.3- (95% confidence intervals (CI) = 1.5–7.3), 2.2- (95% CI = 1.1–4.4), and 26.9-fold (95% CI = 3.2–229.0) odds ratio (OR) of MetS, respectively. Pediatric body mass index (BMI) accounted for 18.8%–95.6% and 16.9%–60.3% increased prevalence ratios of these parental and pediatric risk factors for MetS. The OR of pot-MetS + MetS for sugar-sweetened beverage consumption was multiplicatively enhanced among adolescents with overweight/obesity (combined OR, 8.6-fold (95% CI = 4.3–17.3); p for multiplicative interaction, 0.009). The results suggest that parental overweight and cardiometabolic diseases and pediatric sedentary and high sugar-intake lifestyles correlate with the development of adolescent MetS, and an elevated child BMI explains a part of these associations. Pediatric adiposity might be multiplicatively associated with sugar-sweetened beverage consumption for enhancing the MetS prevalence ratio among adolescents.

An evidence-update on the prospective relationship between childhood sedentary behaviour and biomedical health indicators: a systematic review and meta-analysis

Evidence for adverse health effects of excessive sedentary behaviour in children is predominantly based on cross-sectional studies, measuring TV viewing as proxy for sedentary behaviour. This systematic review and meta-analysis summarizes the evidence on the prospective relationship between childhood sedentary behaviour and biomedical health indicators, overall and stratified by type of sedentary behaviour (TV viewing, computer use/games, screen time and objective sedentary time). PubMed, EMBASE, PsycINFO and Cochrane were systematically searched till January 2015. Methodological quality of all included studies was scored, and a best evidence synthesis was applied. We included 109 studies of which 19 were of high quality. We found moderate-to-strong evidence for a relationship of overall sedentary time with some anthropometrics (overweight/obesity, weight-for-height), one cardiometabolic biomarker (HDL-cholesterol) and some fitness indicators (fitness, being unfit). For other health indicators, we found no convincing evidence because of inconsistent or non-significant findings. The evidence varied by type of sedentary behaviour. The meta-analysis indicated that each additional baseline hour of TV viewing (β = 0.01, 95%CI = [-0.002; 0.02]) or computer use (β = 0.00, 95%CI = [-0.004; 0.01]) per day was not significantly related with BMI at follow-up. We conclude that the evidence for a prospective relationship between childhood sedentary behaviour and biomedical health is in general unconvincing.

Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update

This systematic review is an update examining the relationships between objectively and subjectively measured sedentary behaviour and health indicators in children and youth aged 5–17 years. EMBASE, PsycINFO, and Medline were searched in December 2014, and date limits were imposed (≥February 2010). Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth, mean age: 5–17 years), intervention (durations, patterns, and types of sedentary behaviours), comparator (various durations, patterns, and types of sedentary behaviours), and outcome (critical: body composition, metabolic syndrome/cardiovascular disease risk factors, behavioural conduct/pro-social behaviour, academic achievement; important: fitness, self-esteem) study criteria. Quality of evidence by outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Due to heterogeneity, a narrative analysis was conducted. A total of 235 studies (194 unique samples) were included representing 1 657 064 unique participants from 71 different countries. Higher durations/frequencies of screen time and television (TV) viewing were associated with unfavourable body composition. Higher duration/frequency of TV viewing was also associated with higher clustered cardiometabolic risk scores. Higher durations of TV viewing and video game use were associated with unfavourable behavioural conduct/pro-social behaviour. Higher durations of reading and doing homework were associated with higher academic achievement. Higher duration of screen time was associated with lower fitness. Higher durations of screen time and computer use were associated with lower self-esteem. Evidence ranged from “very low” to “moderate” quality. Higher quality studies using reliable and valid sedentary behaviour measures should confirm this largely observational evidence.

Sedentary behavior in Brazilian children and adolescents: a systematic review

OBJECTIVE

To describe the methodological characteristics of the studies selected and assess variables associated with sedentary behavior in Brazilian children and adolescents.

METHODS

For this systematic review, we searched four electronic databases: PubMed, Web of Knowledge, LILACS, SciELO. Also, electronic searches were applied in Google Scholar. A supplementary search was conducted in the references lists of the included articles and in non-indexed journals. We included observational studies with children and adolescents aged from three to 19 years developed in Brazil, presenting analyses of associations based on regression methods and published until September 30, 2014.

RESULTS

Of the 255 potential references retrieved by the searches, 49 met the inclusion criteria and composed the descriptive synthesis. In this set, we identified a great number of cross-sectional studies (n = 43; 88.0%) and high methodological variability on the types of sedentary behavior assessed, measurement tools and cut-off points used. The variables most often associated with sedentary behavior were "high levels of body weight" (in 15 out of 27 studies; 55.0%) and "lower level of physical activity" (in eight out of 16 studies; 50.0%).

CONCLUSIONS

The findings of this review raise the following demands to the Brazilian agenda of sedentary behavior research geared to children and adolescents: development of longitudinal studies, validation of measuring tools, establishment of risk cut-offs, measurement of sedentary behavior beyond screen time and use of objective measures in addition to questionnaires. In the articles available, the associations between sedentary behavior with "high levels of body weight" and "low levels of physical activity" were observed in different regions of Brazil.

Impact of e-Discipline on Children's Screen Time

With rapid technological advancement, the prevalence and undesirable effects of excess screen time on children have become a mounting issue worldwide. There are many studies investigating the phenomenon's impact on society (e.g., behavioral, academic, health), but studies that uncover the causes and factors that increase the odds of children's excess screen time are limited. To this end, this study introduces the term "e-discipline" to refer to systematic practices that use screen devices as discipline tools. As such, the aim of this study is to investigate the association between e-discipline and children's screen time by gender. Analysis was performed on 3,141 children aged 7-11 years old. Bivariate logistic regression models were used to calculate the odds of exceeding the American Academy of Pediatrics guidelines of 2 hours of screen time per day by boys and girls whose parents practice e-discipline. The results showed that children whose parents used screen devices as discipline tools had significantly more screen time compared to children whose parents did not. Furthermore, no statistically significant gender differences were found in the odds of exceeding the recommended screen time under e-discipline. Recommendations stemming from all the results are discussed.

Higher screen time is associated with overweight, poor dietary habits and physical inactivity in Brazilian adolescents, mainly among girls

OBJECTIVES

To analyse the associations between high screen time and overweight, poor dietary habits and physical activity in adolescents according to sex.

METHODS

The study comprised 515 boys and 716 girls aged 14-17 years from Londrina, Brazil. Nutritional status (normal weight or overweight/obese) was assessed by calculating the body mass index. Eating habits and time spent in physical activity were reported using a questionnaire. The measurement of screen time considered the time spent watching television, using a computer and playing video games during a normal week. Associations between high screen time and dependent variables (nutritional status, eating habits and physical activity levels) were assessed by binary logistic regression, adjusted for sociodemographic and lifestyle variables.

RESULTS

Most adolescents (93.8% of boys and 87.2% of girls) spent more than 2 hours per day in screen-time activities. After adjustments, an increasing trend in the prevalence of overweight and physical inactivity with increasing time spent on screen activities was observed for both sexes. Screen times of >4 hours/day compared with <2 hours/day were associated with physical inactivity, low consumption of vegetables and high consumption of sweets only in girls and the consumption of soft drinks in both sexes.

CONCLUSIONS

The frequency of overweight and physical inactivity increased with increasing screen time in a trending manner and independently of the main confounders. The relationship between high screen time and poor eating habits was particularly relevant for adolescent girls.