TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study.
TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study.
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DOI：
10.1371/journal.pmed.0030488
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发表时间：
2006-12
期刊：
影响因子：
15.8
通讯作者：
Andersen LB
中科院分区：
文献类型：
--
作者：
Ekelund U;Brage S;Froberg K;Harro M;Anderssen SA;Sardinha LB;Riddoch C;Andersen LB
青少年时期看电视与代谢风险因素有关。然而，尚不清楚这种关联是否独立于身体活动（PA）和肥胖。
我们在来自欧洲三个地区的9 - 10岁和15 - 16岁的男孩和女孩中进行了一项基于人群的横断面研究（n = 1921）。我们研究了看电视、通过加速度计测量的身体活动以及代谢风险因素（体脂、血压、空腹甘油三酯、高密度脂蛋白胆固醇倒置、血糖和胰岛素水平）之间的独立关联。代谢风险聚集情况以一个连续分布的分数来表示，该分数是六个子成分标准化值的平均值。看电视与肥胖之间存在正相关（p = 0.021）。然而，在对身体活动、性别、年龄组、研究地点、性成熟度、吸烟状况、出生体重和父母社会经济地位进行调整后，看电视与代谢风险聚集的关联不再显著（p = 0.053）。身体活动与收缩压和舒张压、空腹血糖、胰岛素（所有p < 0.01）以及甘油三酯（p = 0.02）呈独立的负相关。身体活动还与代谢风险聚集分数呈显著负相关（p < 0.0001），且独立于肥胖和其他混杂因素。
看电视和身体活动可能是不同的实体，与肥胖和代谢风险的关联也不同。看电视与代谢风险聚集之间的关联是由肥胖介导的，而身体活动与个体和代谢风险聚集指标的关联独立于肥胖。因此，针对儿童代谢风险的预防措施可能需要分别针对看电视和身体活动。
一项对1900多名欧洲儿童的研究表明，儿童看电视和身体活动分别与肥胖和代谢风险相关。
儿童肥胖是一个迅速增长的问题。25年前，超重儿童很少见。现在，全球有1.55亿儿童超重，其中3000 - 4500万儿童肥胖。这两种情况都是通过将儿童的体重指数（BMI；体重除以身高的平方）与同年龄和性别的平均BMI进行比较来诊断的。儿童时期超重令人担忧，因为它是所谓的代谢风险因素之一，会增加日后患糖尿病、心脏病或中风的几率。其他代谢风险因素包括腹部脂肪堆积、血脂异常、高血压以及身体对胰岛素和血糖的利用问题。直到最近，与肥胖一样，这些其他代谢风险因素只见于成年人，但现在在儿童中也越来越常见。在美国，每20名青少年中就有1人患有代谢综合征——即出现三种或更多这些风险因素。环境和行为变化可能导致了儿童代谢综合征的增加。总体而言，现在的儿童往往身体活动较少，而且更频繁地食用大量高能量食物。儿童时期看电视时间增加（以及使用其他媒体如电脑游戏）也与肥胖增加以及成年后健康状况较差有关。
一种流行的理论认为，看电视可能通过取代身体活动来影响肥胖和其他代谢风险因素。该理论认为，孩子们放学后不在院子里玩耍，而是在电视前闲逛。然而，支持这一观点的证据有限，卫生专业人员需要了解看电视和身体活动是否相关，以及它们如何影响代谢风险因素，以便改善儿童的健康。在这项研究中，研究人员研究了欧洲儿童看电视、身体活动和代谢风险因素之间的关联。
研究人员从欧洲三个地区招募了近2000名两个年龄组的儿童。他们测量了儿童的身高和体重，通过测量皮褶厚度来估计他们的体脂含量，测量了他们的血压，并检测了他们血液中葡萄糖、胰岛素和不同脂肪的水平。孩子们完成了一份关于他们看电视时长以及看电视时进食频率的电脑问卷，并且每个孩子佩戴一个加速度计四天来测量他们的身体活动。对这些数据进行统计分析时，研究人员发现看电视与代谢风险聚集（个体代谢风险因素的平均值）略有相关。这种关联是由于看电视与肥胖之间的关联——看电视最多的孩子往往是最胖的孩子。然而，看电视与身体活动无关。最活跃的孩子不一定是看电视最少的孩子。最重要的是，身体活动与除肥胖之外的所有个体风险因素以及代谢风险聚集相关。这些关联独立于肥胖。
这些结果表明，看电视并不像人们普遍认为的那样通过取代身体活动损害儿童健康。看电视与代谢风险聚集因素之间的关联是由肥胖介导的这一发现表明，针对诸如看电视时吃东西等行为可能是改善儿童健康的好方法。事实上，研究人员提供了一些证据表明看电视时吃东西与超重有关，但这项事后分析（事先未计划的分析）的结果需要得到证实。该研究的另一个局限性是孩子们可能不准确地报告了他们的看电视习惯。此外，由于代谢风险因素仅测量了一次，无法确定看电视或缺乏身体活动是否真的导致代谢风险因素增加。
尽管如此，这些结果强烈表明，促进身体活动对代谢风险因素有益，但对儿童肥胖的作用较小。在旨在扭转儿童肥胖和代谢综合征流行的项目中，看电视和身体活动应被视为不同的目标。
请通过本摘要的在线版本访问以下网站：http://dx.doi.org/doi:10.1371/journal.pmed.0030488
美国疾病控制与预防中心，有关超重和肥胖的信息
国际肥胖问题工作组，有关肥胖及其预防的信息，特别是在儿童时期
全球预防联盟，国际上遏制肥胖流行及其相关慢性病努力的详细信息
美国心脏协会，为患者和专业人员提供的有关代谢综合征和儿童健康的信息
TV viewing has been linked to metabolic-risk factors in youth. However, it is unclear whether this association is independent of physical activity (PA) and obesity. We did a population-based, cross-sectional study in 9- to 10-y-old and 15- to 16-y-old boys and girls from three regions in Europe (n = 1,921). We examined the independent associations between TV viewing, PA measured by accelerometry, and metabolic-risk factors (body fatness, blood pressure, fasting triglycerides, inverted high-density lipoprotein (HDL) cholesterol, glucose, and insulin levels). Clustered metabolic risk was expressed as a continuously distributed score calculated as the average of the standardized values of the six subcomponents. There was a positive association between TV viewing and adiposity (p = 0.021). However, after adjustment for PA, gender, age group, study location, sexual maturity, smoking status, birth weight, and parental socio-economic status, the association of TV viewing with clustered metabolic risk was no longer significant (p = 0.053). PA was independently and inversely associated with systolic and diastolic blood pressure, fasting glucose, insulin (all p < 0.01), and triglycerides (p = 0.02). PA was also significantly and inversely associated with the clustered risk score (p < 0.0001), independently of obesity and other confounding factors. TV viewing and PA may be separate entities and differently associated with adiposity and metabolic risk. The association between TV viewing and clustered metabolic risk is mediated by adiposity, whereas PA is associated with individual and clustered metabolic-risk indicators independently of obesity. Thus, preventive action against metabolic risk in children may need to target TV viewing and PA separately. A study of over 1,900 European children showed that TV viewing and physical activity in children are separately associated with obesity and metabolic risk. Childhood obesity is a rapidly growing problem. Twenty-five years ago, overweight children were rare. Now, 155 million of the world's children are overweight, and 30–45 million are obese. Both conditions are diagnosed by comparing a child's body mass index (BMI; weight divided by height squared) with the average BMI for their age and sex. Being overweight during childhood is worrying because it is one of the so-called metabolic-risk factors that increase the chances of developing diabetes, heart problems, or strokes later in life. Other metabolic-risk factors are fatness around the belly, blood-fat disorders, high blood pressure, and problems with how the body uses insulin and blood sugar. Until recently, like obesity, these other metabolic-risk factors were seen only in adults, but now they are becoming increasingly common in children. In the US, 1 in 20 adolescents has metabolic syndrome—three or more of these risk factors. Environmental and behavioural changes have probably contributed to the increase in metabolic syndrome in children. As a group, they tend to be less physically active nowadays and they eat bigger portions of energy-dense foods more often. Increased TV viewing during childhood (and the use of other media such as computer games) has also been linked to increased obesity and to poorer health as an adult. One popular theory is that TV viewing may affect obesity and other metabolic-risk factors by displacing PA. Instead of playing in the yard after school, the theory suggests, children laze about in front of the TV. However, there is limited evidence to support this idea, and health professionals need to know whether TV viewing and PA are related, and how they affect metabolic-risk factors, in order to improve children's health. In this study, the researchers examined the associations between TV viewing, PA, and metabolic-risk factors in European children. The researchers enrolled nearly 2,000 children in two age groups from three areas in Europe. They measured the children's height and weight, estimated how fat they were by measuring skin fold thickness, measured their blood pressure, and examined the levels of glucose, insulin, and different fats in their blood. The children completed a computer questionnaire about the lengths of time for which they watched TV and how often they ate while doing so, and their PA was measured using a device called an accelerometer that each child wore for four days. When these data were analyzed statistically, the researchers found that TV viewing was slightly associated with clustered metabolic risk (the average of the individual metabolic-risk factors). This association was due to an association between TV viewing and obesity—the children who watched most TV tended to be the fattest children. However, TV viewing was not related to PA. The most active children were not necessarily those who watched least TV. Most importantly, PA was related to all individual risk factors except for obesity and with clustered metabolic risk. These associations were independent of obesity. These results suggest that TV viewing does not damage children's health by displacing PA as popularly believed. The finding that the association between TV viewing and clustered metabolic-risk factors is mediated by obesity suggests that targeting behaviours like eating while watching TV might be a good way to improve children's health. Indeed, the researchers provide some evidence that eating while watching TV is associated with being overweight, but the results of this post hoc analysis—one that was not planned in advance—need to be confirmed. Another limitation of the study is the possibility that the children inaccurately reported their TV watching habits. Also, because measurements of metabolic-risk factors were made only once, it is impossible to say whether TV viewing or lack of PA actually causes an increase in metabolic-risk factors. Nevertheless, these results strongly suggest that promoting PA is beneficial in relation to metabolic-risk factors, but less so in relation to obesity in childhood. TV viewing and PA should be treated as separate targets in programs designed to reverse the obesity and metabolic-syndrome epidemic in children. Please access these Web sites via the online version of this summary at http://dx.doi.org/doi:10.1371/journal.pmed.0030488. US Centers for Disease Control and Prevention, information on overweight and obesity International Obesity Taskforce, information on obesity and its prevention, particularly in childhood Global Prevention Alliance, details of international efforts to halt the obesity epidemic and its associated chronic diseases American Heart Association, information for patients and professionals on metabolic syndrome and children's health
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影响因子：
5.1
作者：
MAFFEIS, C;SCHUTZ, Y;PINELLI, L
通讯作者：
PINELLI, L
影响因子：
5.8
作者：
Arslanian, S;Suprasongsin, C
通讯作者：
Suprasongsin, C
影响因子：
16.2
作者：
Ekelund, U;Brage, S;Wareham, NJ
通讯作者：
Wareham, NJ
影响因子：
7.1
作者：
DIETZ, WH;BANDINI, LG;CHING, PLYH
通讯作者：
CHING, PLYH
影响因子：
2.8
作者：
Cooper, Theodore V;Klesges, Lisa M;Shelton, Mary Lee
通讯作者：
Shelton, Mary Lee