Research article
Television, Adiposity, and Cardiometabolic Risk in Children and Adolescents

https://doi.org/10.1016/j.amepre.2012.09.049Get rights and content

Background

It is largely unknown how TV use relates to depot-specific adiposity or cardiometabolic risk in children.

Purpose

To examine relationships between having a TV in the bedroom and TV viewing time with total fat mass, abdominal subcutaneous and visceral adiposity, and cardiometabolic risk in children and adolescents.

Methods

A cross-sectional study of 369 children and adolescents aged 5–18 years was conducted (2010–2011; analysis 2011–2012). Waist circumference; resting blood pressure; fasting triglycerides, high-density lipoprotein cholesterol [HDL-C] and glucose; fat mass by dual-energy x-ray absorptiometry; and abdominal subcutaneous and visceral adiposity by MRI were assessed. Cardiometabolic risk was defined as three or more risk factors including adverse levels of waist circumference, blood pressure, triglycerides, HDL-C, and glucose. Logistic regression analysis was used to compute ORs of high fat mass; subcutaneous and visceral adipose tissue mass (top age-adjusted quartile); and cardiometabolic risk, based on self-reported TV present in the bedroom and TV viewing time, controlling for age, gender, ethnicity, moderate-to-vigorous physical activity level, and unhealthy diet.

Results

In multivariable models, presence of a TV in the bedroom and TV viewing time were associated with (p<0.05) higher odds of high waist circumference (OR=1.9–2.1); fat mass (OR=2.0–2.5); and subcutaneous adiposity (OR=2.1–2.9), whereas viewing TV ≥5 hours/day was associated with high visceral adiposity (OR=2.0). Having a TV in the bedroom was associated with elevated cardiometabolic risk (OR=2.9) and high triglycerides (OR=2.0).

Conclusions

Having a bedroom TV and TV viewing time were related to high waist circumference, fat mass, and abdominal subcutaneous adiposity. TV viewing time was related to visceral adiposity, and bedroom TV was related to cardiometabolic risk in children, controlling for moderate-to-vigorous physical activity and an unhealthy diet.

Registration

This study is registered at Clinicaltrials.gov NCT01595100.

Introduction

It is recommended that children's TV viewing time be limited to ≤2 hours/day.1 Yet TV viewing consumes approximately 4.5 hours every day for the average child aged 8–18 years in the U.S., and seven of ten youth have a TV in their bedroom.2 Concurrently, 33.2% of those aged 6–19 years are considered overweight or obese.3 One reason to limit TV viewing is its association with unfavorable body composition and health outcomes in children, as demonstrated in a meta-analysis of 232 studies.4 Viewing TV for >2 hours/day and having a TV in the bedroom have each been associated with higher odds of overweight among children and adolescents in the National Survey of Children's Health.5, 6 Compared to peers who viewed TV <2 hours/day, obese children aged 4–17 years who viewed TV 2–4 hours/day or ≥4 hours/day had a 2.5 and 3.3 greater odds of hypertension, respectively.7 TV viewing time during childhood and adolescence tracks into adulthood,8 resulting in overweight and elevated total cholesterol in adulthood.9

The established association between TV and obesity is predominantly based on BMI.4 The association between TV and fat mass, adiposity stores in specific depots (including abdominal subcutaneous and visceral adipose tissue), and cardiometabolic risk is less well understood. One cross-sectional study of 434 African-American and white youth aged 14–18 years demonstrated that TV viewing time was related to body fat percentage but not to visceral adiposity.10 The present study is a cross-sectional examination of youth aged 5–18 years to determine the association of TV viewing time and having a bedroom TV with subcutaneous adiposity, visceral adiposity, fat mass, and cardiometabolic risk factors. It is hypothesized that higher levels of TV viewing and the presence of a TV in the bedroom are associated with higher amounts of depot-specific adiposity and cardiometabolic risk.

Section snippets

Participants

Overall, 423 children and adolescents aged 5–18 years participated in a cross-sectional study of factors related to abdominal adiposity. Participants were recruited from Baton Rouge LA, and a telephone screening attempted to balance the sample across gender, ethnicity, age, and BMI status. Data collection occurred between 2010 and 2011, with the study analysis occurring in 2011–2012.

Participants were excluded from the present analysis if they were missing data on primary analysis variables or

Results

Participants with a TV in the bedroom accounted for 65.6% of the sample. TV viewing time of 0–2 hours/day was reported by 35.2% of the sample; 31.4% reported 3–4 hours/day; and 33.3% reported ≥5 hours/day spent watching TV. Having a bedroom TV and TV viewing time were related (p<0.0001): Those who had a TV in the bedroom were more likely to watch more hours/day of TV. Based on CDC BMI percentile classification,11 99 boys and 93 girls were normal weight, 23 boys and 30 girls were overweight, and

Discussion

This present study presents novel findings in regard to the relationship between TV and fat mass and depot-specific adiposity, utilizing DXA and MRI: the gold standards for these measurements. Having a TV in the bedroom and viewing TV >2 hours/day were each associated with 2 to 2.5 times the odds of being in the top quartile of fat mass, even when adjustments were made for age, gender, ethnicity, MVPA level, and diet. Similarly, both having a TV in the bedroom and viewing TV >2 hours/day were

Conclusion

This study demonstrated that high levels of TV viewing and having a TV in the bedroom are independently associated with fat mass, subcutaneous adiposity, and waist circumference, even when MVPA and diet are controlled. Viewing TV for 5 or more hours/day was associated with increased visceral adiposity, and having a TV in the bedroom was associated with elevated triglycerides and overall cardiometabolic risk. The influence of TV on the health of children and adolescents is of substantial

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