Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality: A Meta-analysis | Cardiology | JAMA | JAMA Network
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1.
Office for Official Publications of the European Communities.  Time use at different stages of life: results from 13 European countries, July 2003. http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-CC-03-001/EN/KS-CC-03-001-EN.PDF. Accessibility verified May 16, 2011
2.
Australian Bureau of Statistics.  How Australians Use Their Time. Canberra: Commonwealth of Australia; 2008
4.
Wiecha JL, Peterson KE, Ludwig DS, Kim J, Sobol A, Gortmaker SL. When children eat what they watch: impact of television viewing on dietary intake in youth.  Arch Pediatr Adolesc Med. 2006;160(4):436-44216585491PubMedGoogle ScholarCrossref
5.
Vereecken CA, Todd J, Roberts C, Mulvihill C, Maes L. Television viewing behaviour and associations with food habits in different countries.  Public Health Nutr. 2006;9(2):244-25016571179PubMedGoogle ScholarCrossref
6.
Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women.  JAMA. 2003;289(14):1785-179112684356PubMedGoogle ScholarCrossref
7.
Hu FB, Leitzmann MF, Stampfer MJ, Colditz GA, Willett WC, Rimm EB. Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men.  Arch Intern Med. 2001;161(12):1542-154811427103PubMedGoogle ScholarCrossref
8.
Gidwani PP, Sobol A, DeJong W, Perrin JM, Gortmaker SL. Television viewing and initiation of smoking among youth.  Pediatrics. 2002;110(3):505-50812205251PubMedGoogle ScholarCrossref
9.
Stroup DF, Berlin JA, Morton SC,  et al; Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group.  Meta-analysis of observational studies in epidemiology: a proposal for reporting.  JAMA. 2000;283(15):2008-201210789670PubMedGoogle ScholarCrossref
10.
Orsini N, Rino B, Sander G. Generalized least squares for trend estimation of summarized dose-response data.  Stata J. 2006;6(1):40-57Google Scholar
11.
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis.  Stat Med. 2002;21(11):1539-155812111919PubMedGoogle ScholarCrossref
12.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test.  BMJ. 1997;315(7109):629-6349310563PubMedGoogle ScholarCrossref
13.
Tobias A. Assessing the influence of a single study in the meta-analysis estimate.  Stata Tech Bull. 1999;47:15-17Google Scholar
14.
Wijndaele K, Brage S, Besson H,  et al.  Television viewing time and incident cardiovascular disease: prospective population-based study (EPIC Norfolk).  Obes Rev. 2010;11(suppl 1):305Google Scholar
15.
Leitzmann MF, Park Y, Blair A,  et al.  Physical activity recommendations and decreased risk of mortality.  Arch Intern Med. 2007;167(22):2453-246018071167PubMedGoogle ScholarCrossref
16.
Stamatakis E, Hamer M, Dunstan DW. Screen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up.  J Am Coll Cardiol. 2011;57(3):292-29921232666PubMedGoogle ScholarCrossref
17.
Krishnan S, Rosenberg L, Palmer JR. Physical activity and television watching in relation to risk of type 2 diabetes: the Black Women's Health Study.  Am J Epidemiol. 2009;169(4):428-43419056835PubMedGoogle ScholarCrossref
18.
Ford ES, Schulze MB, Kröger J, Pischon T, Bergmann MM, Boeing H. Television watching and incident diabetes: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam Study.  J Diabetes. 2010;2(1):23-2720923471PubMedGoogle ScholarCrossref
19.
Dunstan DW, Barr ELM, Healy GN,  et al.  Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab).  Circulation. 2010;121(3):384-39120065160PubMedGoogle ScholarCrossref
20.
Warren TY, Barry V, Hooker SP, Sui X, Church TS, Blair SN. Sedentary behaviors increase risk of cardiovascular disease mortality in men.  Med Sci Sports Exerc. 2010;42(5):879-88519996993PubMedGoogle ScholarCrossref
21.
Wijndaele K, Brage S, Besson H,  et al.  Television viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk study.  Int J Epidemiol. 2011;40(1):150-15920576628PubMedGoogle ScholarCrossref
22.
US Centers for Disease Control and Prevention.  Crude and age-adjusted incidence of diagnosed diabetes per 1,000 population aged 18-79 years, United States, 1980-2009. http://www.cdc.gov/diabetes/statistics/incidence/fig2.htm. Accessibility verified May 16, 2011
23.
Roger VL, Go AS, Lloyd-Jones DM,  et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee.  Heart disease and stroke statistics—2011 update: a report from the American Heart Association.  Circulation. 2011;123(4):e18-e20921160056PubMedGoogle ScholarCrossref
24.
Xu J, Kochanek K, Murphy S, Tejada-Vera B. Deaths: final data for 2007.  Natl Vital Stat Rep. 2010;58(19):1-136Google Scholar
25.
Mekary RA, Willett WC, Hu FB, Ding EL. Isotemporal substitution paradigm for physical activity epidemiology and weight change.  Am J Epidemiol. 2009;170(4):519-52719584129PubMedGoogle ScholarCrossref
26.
Parsons TJ, Manor O, Power C. Television viewing and obesity: a prospective study in the 1958 British birth cohort.  Eur J Clin Nutr. 2008;62(12):1355-136317717536PubMedGoogle ScholarCrossref
27.
Jakes RW, Day NE, Khaw KT,  et al.  Television viewing and low participation in vigorous recreation are independently associated with obesity and markers of cardiovascular disease risk: EPIC-Norfolk population-based study.  Eur J Clin Nutr. 2003;57(9):1089-109612947427PubMedGoogle ScholarCrossref
28.
Wijndaele K, Healy GN, Dunstan DW,  et al.  Increased cardiometabolic risk is associated with increased TV viewing time.  Med Sci Sports Exerc. 2010;42(8):1511-151820139784PubMedGoogle ScholarCrossref
29.
Ekelund U, Brage S, Griffin SJ, Wareham NJ.ProActive UK Research Group.  Objectively measured moderate- and vigorous-intensity physical activity but not sedentary time predicts insulin resistance in high-risk individuals.  Diabetes Care. 2009;32(6):1081-108619252168PubMedGoogle ScholarCrossref
30.
Beunza JJ, Martínez-González MA, Ebrahim S,  et al.  Sedentary behaviors and the risk of incident hypertension: the SUN cohort.  Am J Hypertens. 2007;20(11):1156-116217954361PubMedGoogle Scholar
31.
Fung TT, Hu FB, Yu J,  et al.  Leisure-time physical activity, television watching, and plasma biomarkers of obesity and cardiovascular disease risk.  Am J Epidemiol. 2000;152(12):1171-117811130623PubMedGoogle ScholarCrossref
32.
Manson JE, Greenland P, LaCroix AZ,  et al.  Walking compared with vigorous exercise for the prevention of cardiovascular events in women.  N Engl J Med. 2002;347(10):716-72512213942PubMedGoogle ScholarCrossref
33.
Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer.  Med Sci Sports Exerc. 2009;41(5):998-100519346988PubMedGoogle ScholarCrossref
34.
Weller I, Corey P. The impact of excluding non-leisure energy expenditure on the relation between physical activity and mortality in women.  Epidemiology. 1998;9(6):632-6359799173PubMedGoogle ScholarCrossref
35.
Olsen RH, Krogh-Madsen R, Thomsen C, Booth FW, Pedersen BK. Metabolic responses to reduced daily steps in healthy nonexercising men.  JAMA. 2008;299(11):1261-126318349087PubMedGoogle ScholarCrossref
36.
Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial.  JAMA. 1999;282(16):1561-156710546696PubMedGoogle ScholarCrossref
37.
Epstein LH, Roemmich JN, Robinson JL,  et al.  A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children.  Arch Pediatr Adolesc Med. 2008;162(3):239-24518316661PubMedGoogle ScholarCrossref
38.
Otten JJ, Jones KE, Littenberg B, Harvey-Berino J. Effects of television viewing reduction on energy intake and expenditure in overweight and obese adults: a randomized controlled trial.  Arch Intern Med. 2009;169(22):2109-211520008695PubMedGoogle ScholarCrossref
39.
Harris JL, Bargh JA, Brownell KD. Priming effects of television food advertising on eating behavior.  Health Psychol. 2009;28(4):404-41319594263PubMedGoogle ScholarCrossref
Clinical Review
June 15, 2011

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

Author Affiliations

Author Affiliations: Institute of Sport Science and Clinical Biomechanics, Department of Exercise Epidemiology, Center of Research in Childhood Health, University of Southern Denmark, Odense (Mr Grøntved); and Departments of Nutrition (Mr Grøntved and Dr Hu) and Epidemiology (Dr Hu), Harvard School of Public Health, Channing Laboratory, Harvard Medical School and Brigham and Women's Hospital (Dr Hu), Boston, Massachusetts.

JAMA. 2011;305(23):2448-2455. doi:10.1001/jama.2011.812
Abstract

Context 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.

Objective 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.

Data Sources and Study Selection 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 Extraction Data were extracted independently by each author and summary estimates of association were obtained using a random-effects model.

Data Synthesis 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.

Conclusion Prolonged TV viewing was associated with increased risk of type 2 diabetes, cardiovascular disease, and all-cause mortality.

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