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

Abstract

Background:

There is evidence for a relation of TV viewing with adiposity and increased cardiometabolic risk factors in children and adolescents. It is unclear to what extent this relation is mediated by snacking and lack of physical activity. We determined whether associations of screen time with adiposity and cardiometabolic markers were mediated by these behaviours.

Methods:

Children from a population-representative Dutch birth cohort (n=1447) reported screen time and other lifestyle factors by a questionnaire around the age of 11 years (range 10–14) and had anthropometry and cardiometabolic markers measured around the age of 12 years (range 12–14). Adjusted associations of screen time with snacking, physical activity, adiposity and cardiometabolic markers (total-to-high-density lipoprotein cholesterol (TC/HDLC) ratio, blood pressure, glycated haemoglobin) were assessed by using formal mediation analysis. We tested the hypothesized paths by structural equation modeling, which allows quantification of the indirect effects associated with potential mediators.

Results:

Children with 20 h screen time per week consumed more snacks (1.9 vs 1.3 portions per day) and were less physically active (4.3 vs 4.8 days per week) than children with maximum 6 h screen time. Screen time was directly associated with higher adiposity (standardized β=0.10–0.12 depending on the outcome, P<0.001), and indirectly through less physical activity. The association of screen time with TC/HDLC ratio was almost completely mediated by adiposity (β=0.39, P<0.0001), and to a minor extent by physical activity (β=−0.06, P=0.02). There was no direct association of screen time with TC/HDLC ratio.

Conclusions:

The adverse association of screen time with adiposity was partly mediated by physical activity, but not by snacking. The association of screen time with TC/HDLC ratio was almost completely mediated by adiposity. Our results may suggest that future efforts in society and public health should be directed to replace screen time with physical activity for reducing children’s adiposity and cardiometabolic risk.

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Acknowledgements

The authors gratefully acknowledge the contribution of all participating children and parents or caregivers of the PIAMA study. We thank Ada Wolse, Marjan Tewis and Marieke Oldenwening for their contribution to the data collection and data management. The Prevention and Incidence of Asthma and Mite Allergy Study was funded by grants from The Netherlands Organisation for Health Research and Development; the Netherlands Asthma Foundation; the Netherlands Ministry of Planning, Housing and the Environment; the Netherlands Ministry of Health, Welfare and Sport; and the Institute for Public Health and the Environment. The study sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Correspondence to N E Berentzen.

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Berentzen, N., Smit, H., van Rossem, L. et al. Screen time, adiposity and cardiometabolic markers: mediation by physical activity, not snacking, among 11-year-old children. Int J Obes 38, 1317–1323 (2014). https://doi.org/10.1038/ijo.2014.110

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