ࡱ > c f \ ] ^ _ ` a b { h bjbjBrBr q 6 H H D f l " ` , L3 b3 b3 b3 5 9 | ; _ _ _ _ _ _ _ $ [b
e H _ i ; 5 5 " ; ; _ b3 b3 H ;` XF XF XF ; b3 b3 TV X XF ; _ XF XF Q | lS b3 RZ A ( pR @V Q` 0 ` R Ue A Z Ue $ lS lS \ Ue S x ; ; XF ; ; ; ; ; _ _ XF ; ; ; ` ; ; ; ; Ue ; ; ; ; ; ; ; ; ; H h : SEDENTARY BEHAVIOUR AND DIET ACROSS THE LIFESPAN: AN UPDATED SYSTEMATIC REVIEW
*Matthew Hobbs, Carnegie, Leeds Metropolitan University, Leeds, LS6 3QT, UK.
*Natalie Pearson, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
Perry, J. Foster, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
Stuart J.H. Biddle, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
Corresponding Author:
Matthew Hobbs
227 Fairfax Hall,
Headingley Campus
Leeds Metropolitan University,
Leeds,
LS6 3QT
UK
m.hobbs@leedsmet.ac.uk
+44 (0)113 8124017
Keywords
Sedentary Behaviour, Diet, Systematic Review, Lifespan.
*First authorship between Matthew Hobbs and Natalie Pearson is considered is joint
Word count = 3592ABSTRACT
Background: Sedentary behaviour and its association with dietary intake in young people and adults is an important topic and was systematically reviewed in 2011. There is a need to update this evidence given the changing nature of sedentary behaviour and continued interest in this field. This review aims to assist researchers in better interpreting the diversity of findings concerning sedentary behaviour and weight status.
Objective: To provide an update of the associations between sedentary behaviour and dietary intake across the lifespan.
Methods: Electronic databases searched were Medline, PsychInfo, Cochrane Library, Web of Science and Science Direct for publications between January 2010 and October 2013 thus updating a previous review. Included studies were observational studies assessing an association between at least one sedentary behaviour and at least one aspect of dietary intake in pre-school children (< 5 years), school-aged children (6-11 years), adolescents (12-18 years), and adults (> 18 years).
Results: 27 papers met inclusion criteria (pre-school k=3, school-aged children k=9; adolescents k=15; adults k=3). For all three groups of young people, trends were evident for higher levels of sedentary behaviour, especially TV viewing, to be associated with a less healthful diet, such as less fruit and vegetable and greater consumption of energy-dense snacks and sugar sweetened beverages. Data for the three studies with adults were less conclusive.
Conclusions: Sedentary behaviour continues to be associated with unhealthy diet in young people in mostly cross-sectional studies. More studies utilising a prospective design are needed to corroborate findings and more studies are needed with adults.
What are the new findings?
Sedentary time has been implicated in obesity yet this could be due to energy intake rather just low energy expenditure.
We provide review-level evidence linking sedentary time and various diet outcomes across the lifespan, including pre-school children for the first time
We build on a previous review by providing updated evidence linking sedentary behaviour and elements of an unhealthy diet at a time when sedentary behaviours are continually evolving
1.0 Introduction
Sedentary behaviour refers to sitting or lying tasks done in waking hours with low levels of energy expenditure. HYPERLINK \l "_ENREF_1" \o "Sedentary Behaviour Research Network, 2012 #10151" ADDIN EN.CITE Sedentary Behaviour Research Network201210151101511015117Sedentary Behaviour Research Network,Letter to the Editor: Standardized use of the terms sedentary and sedentary behavioursApplied Physiology, Nutrition & MetabolismApplied Physiology, Nutrition & Metabolism5405423720121 Studies show associations between sedentary behaviour (usually assessed as screen-based behaviours such as TV and computer use) and a range of health outcomes, including all-cause mortality, cardiovascular disease, ADDIN EN.CITE Katzmarzyk200989418941894117Katzmarzyk, P.T.Church, T.S.Craig, C.L.Bouchard, C.Sitting time and mortality from all causes, cardiovascular disease, and cancerMedicine and Science in Sports & ExerciseMedicine and Science in Sports & Exercise998-10054152009pdf/sed beh/health/sitting time ACMDunstan201093129312931217Dunstan, D.W.E.L.M. BarrG.N. HealyJ. SalmonJ.E. ShawB. BalkauD.J. MaglianoA.J. CameronP.Z. ZimmetN. OwenTelevision viewing time and mortality: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)CirculationCirculation384-3911212010pdf/sed beh/health outcomes/ausdiab ACM (2010) HYPERLINK \l "_ENREF_2" \o "Katzmarzyk, 2009 #8941" 2 HYPERLINK \l "_ENREF_3" \o "Dunstan, 2010 #9312" 3 poor cardio-metabolic health, HYPERLINK \l "_ENREF_4" \o "Dunstan, 2007 #8625" ADDIN EN.CITE Dunstan200786258625862517Dunstan, D.W.Salmon, J.Healy, G.N.Shaw, J. E.Jolley, D.Zimmet, P. Z.Owen, N.on behalf of the AusDiab Steering Committee,Association of television viewing with fasting and 2-hr post-challenge plasma glucose levels in adults without diagnosed diabetesDiabetes CareDiabetes Care516-5223020074 and obesity. HYPERLINK \l "_ENREF_5" \o "Hancox, 2004 #6908" ADDIN EN.CITE Hancox200469086908690817Hancox, R.J.Milne, B.J.Poulton, R.Association between child and adolescent television viewing and adult health: A longitudinal birth cohort studyThe LancetThe Lancet257-262364200455S/pdfs/sed behaviour/health outcomes/TV in childhood and adult health (Lancet 2004)5
In 2011, Pearson and Biddle HYPERLINK \l "_ENREF_6" \o "Pearson, 2011 #2956" ADDIN EN.CITE Pearson201129562956295617Pearson, NBiddle, SSedentary Behavior and Dietary Intake in Children, Adolescents and AdultsAmerican Journal of Preventative MedicineAmerican Journal of Preventative Medicine178-18841220116 published the first systematic review to investigate associations between sedentary behaviours and dietary intake. This was predicated on the fact that not all associations between sedentary behaviour and health outcomes were consistent and some associations might be due to the influence of third variables, or co-existing health behaviours, such as diet.
In adults, prospective observational cohort studies show evidence of an association between sedentary behaviour and weight status. For example, parent- and self-reported time spent watching television between 5 and 15 years in New Zealand was shown to predict BMI at 26 years of age HYPERLINK \l "_ENREF_5" \o "Hancox, 2004 #6908" ADDIN EN.CITE Hancox200469086908690817Hancox, R.J.Milne, B.J.Poulton, R.Association between child and adolescent television viewing and adult health: A longitudinal birth cohort studyThe LancetThe Lancet257-262364200455S/pdfs/sed behaviour/health outcomes/TV in childhood and adult health (Lancet 2004)5. The Nurses Health Study of over 50,000 women HYPERLINK \l "_ENREF_7" \o "Hu, 2003 #8630" ADDIN EN.CITE Hu200386308630863017Hu, Frank B.Li, Tricia Y.Colditz, Graham A.Willett, Walter C.Manson, JoAnn E.Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in womenJournal of the American Medical AssociationJournal of the American Medical Association1785-1791289142003April 9, 200355s & project stil/pdfs/TV diabetes women (Hu JAMA 2003)http://jama.ama-assn.org/cgi/content/abstract/289/14/1785 10.1001/jama.289.14.17857 showed that those who were normal weight or overweight at baseline had a 23% increased risk of developing obesity during 6 years of follow-up for each 2-hour per day increment in time spent watching TV. In another study of over 18,000 women, Blanck et al HYPERLINK \l "_ENREF_8" \o "Blanck, 2007 #9477" ADDIN EN.CITE Blanck200794779477947717Blanck, H.M. McCullough, M.L. Patel, A.V. Gillespie, C. Calle, E.E.Cokkinides, V.E.Galuska, D.A.Khan, L.K.Serdula, M.K. Sedentary behavior, recreational physical activity, and 7-year weight gain among postmenopausal U.S. womenObesityObesity1578-1588152007pdf/sed beh/health/7-year weight gain (Blanck 2007)8 showed an elevated risk of weight gain in those who were normal weight at baseline and reporting more than 6 hours of leisure time sitting compared to those who reported less than 3 hours/day. For adults, therefore, associations between sedentary behaviour and weight status are suggestive of a positive association. HYPERLINK \l "_ENREF_9" \o "Williams, 2008 #8663" ADDIN EN.CITE Williams200886638663866317Williams, D.M.Raynor, H. A.Ciccolo, J. T.A review of TV viewing and its association with health outcomes in adultsAmerican Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine250-2592200855S9 However, studies either do not control for confounding factors, such as diet or physical activity, or this is done inconsistently across studies. One variable that has been hypothesized to co-vary with some sedentary behaviour, and in particular TV viewing, is diet.
For young people, there has been a longstanding assumption that TV viewing is associated with overweight and obesity. HYPERLINK \l "_ENREF_10" \o "Dietz, 1985 #5105" ADDIN EN.CITE Dietz198551055105510517Dietz, W.H.Gortmaker, S.L.Do we fatten our children at the television set? Obesity and television viewing in children and adolescentsPediatricsPediatrics807-81275198555S10 However, a meta-analysis of mainly cross-sectional studies found that this association was very small. HYPERLINK \l "_ENREF_11" \o "Marshall, 2004 #6852" ADDIN EN.CITE Marshall200468526852685217Marshall, S.J.Biddle, S.J.H.Gorely, T.Cameron, N.Murdey, I.Relationships between media use, body fatness and physical activity in children and youth: A meta-analysisInternational Journal of ObesityInternational Journal of Obesity1238-1246282004RR10.1038/sj.ijo.080270611 Also, a review of sedentary behaviour intervention studies showed inconsistent weight loss for young people. HYPERLINK \l "_ENREF_12" \o "DeMattia, 2007 #8139" ADDIN EN.CITE DeMattia200781398139813917DeMattia, L.Lemont, L.Meurer, L.Do interventions to limit sedentary behaviours change behaviour and reduce childhood obesity? A critical review of the literatureObesity ReviewsObesity Reviews69-8182007pdf/sed beh/interventions/review of sb interventions (demattia)12 Overall, therefore, sedentary behaviour in the form of screen time is implicated in youth overweight and obesity, but findings are less clear cut than some claim.
For adults and young people, during the time spent watching television, little energy is expended, HYPERLINK \l "_ENREF_13" \o "Klesges, 1993 #43" ADDIN EN.CITE Klesges199343434317Klesges, R. C.Shelton, M. L.Klesges, L. M.Effects of television on metablic rate: potential implications for childhood obesityPediatricsPediatrics281-28691199313 and viewers are exposed to numerous advertisements that can influence the type of food desired and consumed. ADDIN EN.CITE Dennison200854545417Dennison, B. A.Edmunds, L. S.The role of television in childhood obesityProgress in Pediatric CardiologyProgress in Pediatric Cardiology191-197252008Scully200910310310317Scully, MareeDixon, HelenWakefield, MelanieAssociation between commercial television exposure and fast-food consumption among adultsPublic Health NutritionPublic Health Nutrition105-110120120091368-9800http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=3046264&fulltextType=RA&fileId=S1368980008002012 doi:10.1017/S13689800080020122009 HYPERLINK \l "_ENREF_14" \o "Dennison, 2008 #54" 14 HYPERLINK \l "_ENREF_15" \o "Scully, 2009 #103" 15 Furthermore, eating in front of the TV may differ than when undertaken in other settings. For example, TV or snack commercials may be a distraction resulting in a lack of awareness of food consumption or overlooking food cues. This could disrupt habituation and lead to overconsumption. HYPERLINK \l "_ENREF_16" \o "Temple, 2007 #44" ADDIN EN.CITE Temple200744444417Temple, Jennifer LGiacomelli, April MKent, Kristine MRoemmich, James NEpstein, Leonard HTelevision watching increases motivated responding for food and energy intake in childrenAm J Clin NutrAm J Clin Nutr355-3618522007February 1, 2007http://www.ajcn.org/cgi/content/abstract/85/2/35516
Dietary intake and its association with sedentary behaviour in young people and adults is an important topic that may assist researchers in better interpreting the diversity of findings concerning sedentary behaviour and weight status. However, it is recognised that sedentary pursuits using technology can change very quickly. Computer technology has become more mobile and will this change the way people use and interact with such devices. Moreover, TV channels have increased and the TV viewing experience has changed with greater access to high definition screens and even 3D TV. To this end, it is important to update the review of studies on the association between sedentary behaviour and dietary behaviour. In addition, we feel it is important to differentiate studies with young people into pre-school, children, and adolescents. This systematic review, therefore, provides an update of the associations between sedentary behaviour and diet across the lifespan.2.0 Methods
2.1 Search Strategy
A literature search was conducted using electronic databases, sedentary behaviour review papers, manual searches of existing reference lists and personal files. The electronic database searches used Medline, PsychInfo, Cochrane Library, Web of Science and Science Direct for publications between January 2010 and October 2013 thus updating the previous review. HYPERLINK \l "_ENREF_6" \o "Pearson, 2011 #2956" ADDIN EN.CITE Pearson201129562956295617Pearson, NBiddle, SSedentary Behavior and Dietary Intake in Children, Adolescents and AdultsAmerican Journal of Preventative MedicineAmerican Journal of Preventative Medicine178-18841220116 To ensure a broad search, a comprehensive list of keywords was used to guide the search process that included the most common forms of sedentary behaviour and dietary intake.
2.2 Inclusion and Exclusion Criteria
To be included studies had to: (1) be observational in design; (2) report data on pre-school children (<5 years), school-aged children (6-11 years), adolescents (12-18 years) and adults (>18 years) (or a mean within these ranges) at baseline; (3) measure at least one domain of sedentary behaviour and one aspect of dietary intake; (4) assess an association between at least one sedentary behaviour and one aspect of dietary intake; (5) be published in English between January 2010 to October 2013. Studies that reported physical inactivity (low physical activity) as a measure of sedentary behaviour were excluded. Studies that manipulated a sedentary behaviour and/or aspects of dietary intake were excluded as were studies that did not involve healthy free living individuals were excluded (i.e. chronic illnesses preventing physical activity), although articles that reported risk factors were included.
2.3 Identification of relevant studies
Titles then abstracts of potentially relevant articles were screened independently by two authors. The full text of any relevant abstracts were then obtained and screened to determine whether they met the full inclusion criteria. Any uncertainty was resolved by consulting a third author in order to determine whether to include the paper in the final sample upon reading the full text. Studies that did not meet the inclusion criteria at this stage were excluded.
2.4 Data Extraction
Two authors extracted the data from relevant articles in accordance with a standardised form developed for a previous review. HYPERLINK \l "_ENREF_6" \o "Pearson, 2011 #2956" ADDIN EN.CITE Pearson201129562956295617Pearson, NBiddle, SSedentary Behavior and Dietary Intake in Children, Adolescents and AdultsAmerican Journal of Preventative MedicineAmerican Journal of Preventative Medicine178-18841220116 The following data were extracted from each paper: (1) author and year; (2) study design and duration of follow-up if prospective; (3) geographical location; (4) age group; (5) sample size and sub-groups; (6) sedentary behaviour outcome and primary measure; (7) dietary intake outcome and primary measure; (8) timing, reliability and validity of assessment methods; (8) the analysis and results of an association between sedentary behaviour and dietary intake. Authors were contacted when missing information prevented data extraction. All data extraction was completed by the researchers independently. Any differences or discrepancies (interpretation errors or factual errors, such as transposed information) were discussed and resolved. Finally, inter-rater reliability was calculated and reported for study quality and data extraction.
2.5 Coding Associations between Sedentary Behaviour and Dietary Intake
An independent sample was used as the unit of analysis and was defined as the smallest independent subsample for which relevant data was reported (i.e. boys and girls). The column No. of samples in Table 1 and 2 (supplementary material) shows the number of samples that have been studies for each dietary behaviour. The Summary column includes the number of samples, references, and the direction of association (i.e. positive (+), inverse (-), or no association (0)).
TABLE 1 & 2 (SUPPLEMENTARY DATA)
2.6 Study Quality
The quality of the studies included in this review was assessed using a previously used scale. HYPERLINK \l "_ENREF_6" \o "Pearson, 2011 #2956" ADDIN EN.CITE Pearson201129562956295617Pearson, NBiddle, SSedentary Behavior and Dietary Intake in Children, Adolescents and AdultsAmerican Journal of Preventative MedicineAmerican Journal of Preventative Medicine178-18841220116 Studies were given a score based on sampling procedure, sample size, response rates, the validity and reliability of the measures used to assess sedentary behaviour and dietary intake and whether confounders had been considered in the analysis. Each included paper was given a score out of 16 with a higher score meaning higher study quality. Studies were categorised as high (scoring 12+), moderate (scoring 6-11), and poor (scoring 0-5) quality. There was good initial agreement for study quality (91% r = 0.98) between authors.
3.0 Results
3.1 Flow of studies included
The literature search identified 13,883 articles from which 209 were identified as potentially relevant upon reviewing the title. Following the screening of the full text of the article 27 were identified that sufficiently examined the association between sedentary behaviour and dietary intake. Figure 1 presents the flow of papers from citations retrieved. The results are reported separately for pre-school children, school-aged children, adolescents and adults.
INSERT FIGURE 1 AROUND HERE
3.2 Study Quality
Study quality for studies including children of pre-school age ranged from 2/16 to 6/16, median = 6 [individual scores 6: n=2 ADDIN EN.CITE Brown201029572957295717Brown, JBroom, DNicholson, JBittman, MDo working mothers raise couch potato kids? Maternal employment and children's lifestyle behaviours and weight in early childhoodSocial Science & MedicineSoc Sci MedSocial science & medicine1816-1824102010Sisson201229592959295917Sisson, SShay, CBroyles, SLeyva, MTelevision-viewing time and dietary quality among U.S. children and adults.American Journal of Preventative MedicineAmerican Journal of Preventative Medicine196-2004322012 HYPERLINK \l "_ENREF_17" \o "Brown, 2010 #2957" 17 HYPERLINK \l "_ENREF_18" \o "Sisson, 2012 #2959" 18; 2: n=1 HYPERLINK \l "_ENREF_19" \o "Cox, 2012 #2960" ADDIN EN.CITE Cox201229602960296017Cox, RSkouteris, HRutherford, LFuller-Tyszkiewicz, MDell' Aquila, DHardy, LTelevision viewing, television content, food intake, physical activity and body mass index: a cross-sectional study of preschool children aged 2-6 years.Health Promotion Journal of AustraliaHealth Promotion Journal of Australia58-62231201219]. Study quality in studies including children ranged from 4/16 to 8/16, median = 6 [individual scores 6: n=4 ADDIN EN.CITE ADDIN EN.CITE.DATA HYPERLINK \l "_ENREF_17" \o "Brown, 2010 #2957" 17 HYPERLINK \l "_ENREF_18" \o "Sisson, 2012 #2959" 18 HYPERLINK \l "_ENREF_20" \o "Danielsen, 2011 #2961" 20 HYPERLINK \l "_ENREF_21" \o "Brown, 2011 #2962" 21; 7: n=2 ADDIN EN.CITE Ouwens201229652965296517Ouwens, MCebolla, AVan Strien, TEating style, television viewing and snacking in pre-adolescent childrenNutricion HospitalariaNutricion Hospitalaria1072-10782742012Seghers201029662966296617Seghers, JRutter, CClustering of multiple lifestyle behaviours and its relationship with weight status and cardiorespiratory fitness in a sample of Flemish 11- to 12-year-oldsPublic Health NutritionPublic Health NutrPublic health nutrition1838-184613112010 HYPERLINK \l "_ENREF_22" \o "Ouwens, 2012 #2965" 22 HYPERLINK \l "_ENREF_23" \o "Seghers, 2010 #2966" 23; 8: n=1 HYPERLINK \l "_ENREF_24" \o "Gebremariam, 2013 #2958" ADDIN EN.CITE Gebremariam201329582958295817Gebremariam, MBergh, IAndersen, LOmmundsen, YTotland, TBjelland, MGrydeland, MLien, NAre screen-based sedentary behaviors longitudinally associated with dietary behaviors and leisure-time physical activity in the transition into adolescence?International Journal of Behavioral Nutrition and Physical ActivityInternational Journal of Behavioral Nutrition and Physical ActivityInt. J. Behav. Nutr. Phys. Act.1-810201324; 4: n=1 HYPERLINK \l "_ENREF_25" \o "Fuller-Tyszkiewicz, 2012 #2964" ADDIN EN.CITE Fuller-Tyszkiewicz201229642964296417Fuller-Tyszkiewicz, MSkouteris, HHardy, LHalse, CThe associations between TV viewing, food intake, and BMI. A prospective analysis of data from the Longitudinal Study of Australian ChildrenAppetiteAppetite945-94859201225; 5: n=1 HYPERLINK \l "_ENREF_26" \o "McCormack, 2011 #2963" ADDIN EN.CITE McCormack201129632963296317McCormack, GHawe, PPerry, RBlackstaffe, AAssociations between familial affluence and obesity risk behaviours among childrenPediatric Child HealthPediatric Child Health19-25161201126].
Adolescent study quality ranged from 4/16 to 15/16, median=8 [scores 19: n= 1 HYPERLINK \l "_ENREF_27" \o "Ranjit, 2010 #2977" ADDIN EN.CITE Ranjit201029772977297717Ranjit, NEvans, MByrd-Williams, CEvans, AHoelscher, DDietary and activity correlates of sugar-sweetened beverage consumption among adolescentsPediatricsPediatrics754-7611264201027; 10: n=4 HYPERLINK \l "_ENREF_28" \o "Arora, 2012 #2971" ADDIN EN.CITE ADDIN EN.CITE.DATA 28-31; 8: n=2 ADDIN EN.CITE Al-Hazzaa201329822982298217Al-Hazzaa, HAl-Sobayel, HAbahussain, NQahwaji, DAlahmadi, MMusaiger, AAssociation of dietary habits withe levels of physical activity and screen time among adolescent living in Saudi ArabiaJournal of Human Nutrition and DieteticsJournal of Human Nutrition and DieteticsJ. Hum. Nutr. Diet.1-10272013Fernandes201129692969296917Fernandes, RChristofaro, DCasonatto, JKuwaguti, SRonque, ECardoso, JFreitas, JOliveira, ACross-sectional association between healthy and unhealthy food habts and leisure physical activity in adolescentsJournal de PediatriaJournal de Pediatria252-2568732011 HYPERLINK \l "_ENREF_32" \o "Al-Hazzaa, 2013 #2982" 32 HYPERLINK \l "_ENREF_33" \o "Fernandes, 2011 #2969" 33; 7: n=1 HYPERLINK \l "_ENREF_34" \o "Ciccone, 2013 #2979" ADDIN EN.CITE Ciccone201329792979297917Ciccone, JWoodruff, SFryer, KCampbell, TCole, MAssociations among evening snacking, screen time, weight status, and overall diet quality in young adolescentsApplied Physiology Nutrition and MetabolismApplied Physiology Nutrition and Metabolism789-79438201334; 6: n=5 ADDIN EN.CITE ADDIN EN.CITE.DATA HYPERLINK \l "_ENREF_18" \o "Sisson, 2012 #2959" 18 HYPERLINK \l "_ENREF_35" \o "Cuenca-Garcia, 2013 #2981" 35-38; 5: n=1 HYPERLINK \l "_ENREF_39" \o "Lee, 2013 #2980" ADDIN EN.CITE Lee201329802980298017Lee, JJun, NBaik, IAssociations between dietary patterns and screen time among Korean adolescentsNutrition Research and PracticeNutrition Research And Practice330-33574201339; 4: n=1 HYPERLINK \l "_ENREF_40" \o "Al-Hazzaa, 2011 #2976" ADDIN EN.CITE Al-Hazzaa201129762976297617Al-Hazzaa, HAbahussain, NAl-Sobayel, HQahwaji, DMulsager, APhysical activity, sedentary behaviours and dietary habits among Saudi adolescents relative to age, gender and religionInternational Journal of Behavioral Nutrition and Physical ActivityInternational Journal of Behavioral Nutrition and Physical ActivityInt. J. Behav. Nutr. Phys. Act.140-1548201140. Study quality scores in adults for studies ranged from 5/16 to 7/16, median=6 [scores 7: n=1 HYPERLINK \l "_ENREF_41" \o "Huffman, 2012 #2974" ADDIN EN.CITE Huffman201229742974297417Huffman, FVaccaro, JExebio, JZarini, GKatz, TDixon, ZTelevision watching, diet quality, and physical activity and diabetes among three ethnicities in the United StatesJournal of Environmental and Public HealthJournal of Environmental and Public Health1-1020201241; 6: n=1 HYPERLINK \l "_ENREF_18" \o "Sisson, 2012 #2959" ADDIN EN.CITE Sisson201229592959295917Sisson, SShay, CBroyles, SLeyva, MTelevision-viewing time and dietary quality among U.S. children and adults.American Journal of Preventative MedicineAmerican Journal of Preventative Medicine196-200432201218; 5: n=1. HYPERLINK \l "_ENREF_42" \o "Tucker, 2011 #2978" ADDIN EN.CITE Tucker201129782978297817Tucker, LTucker, JTelevision viewing and obesity in 300 women: Evaluation of the pathways of energy intake and physical activityObesityObesityObesity950-9561910201142
3.3 Associations between Sedentary Behaviour and Diet in Pre-school Children
Three studies (three samples) including pre-school children were eligible for review (Table 3). Two studies were conducted in Australia and one in the USA. Two studies examined associations between sedentary behaviour and dietary outcomes for boys and girls combined, one study examined associations separately for boys and girls. The majority used a cross-sectional research design (n=2), two of the studies assessed sedentary behaviour through parental report and one through self-report. Dietary behaviour was also assessed through parent report (n=2) and self-report (n=1). TV viewing was the most commonly assessed sedentary behaviour in association with dietary intake, studied in all three studies. In studies including children of pre-school age, five dietary behaviours were identified.
INSERT TABLE 3 HERE
Average weekday and weekend TV viewing, weekday and weekend non-commercial and weekday commercial TV viewing were inversely associated with fruit and vegetable consumption in one sample. However, weekday commercial TV viewing was positively associated with fruit and vegetable consumption in one sample. Finally, TV viewing was inversely associated with the healthy eating index in both boys and girls in one sample and with vegetable intake in one other sample.
TV viewing was positively associated with energy-dense food in two of two samples and positively associated with fast food in one sample. There was one longitudinal study HYPERLINK \l "_ENREF_17" \o "Brown, 2010 #2957" ADDIN EN.CITE Brown201029572957295717Brown, JBroom, DNicholson, JBittman, MDo working mothers raise couch potato kids? Maternal employment and children's lifestyle behaviours and weight in early childhoodSocial Science & MedicineSoc Sci MedSocial science & medicine1816-182410201017 which scored well on study quality and had a large sample size (n=4983). This study corroborates the results from the limited cross sectional studies showing that TV viewing is positively associated with energy-dense food. Overall, sedentary behaviour in pre-school children seems to be trending towards an association with elements of an unhealthy diet, yet caution is required when interpreting results due to the paucity of studies. That said, these results are confirmed in a large high quality longitudinal study.
3.3 Associations between Sedentary Behaviour and Diet in Children
Nine studies (nine samples) of school-age children were eligible for review (Table 4). Three studies were conducted in Australia and two in Norway. The remaining four were carried out in Canada, Netherlands, USA and Belgium. Eight studies examined associations between sedentary behaviour and dietary outcomes for boys and girls combined whilst one study examined associations separately for boys and girls. The majority of studies used a cross-sectional design (n=6), six assessed sedentary behaviour through self-report and three by parental report. One used an objective measure of accelerometry yet specific methodological information on cut-points was withheld. Dietary behaviour was assessed through 24 hour recall (n=3), food diary (n=4) and questionnaire (n=3). TV viewing was the most commonly assessed sedentary behaviour in association with dietary intake (n=6). Nine dietary behaviours were identified and tabulated, the most common being energy-dense food.
INSERT TABLE 4 AROUND HERE
Sedentary behaviour was inversely associated with vegetable intake in two samples (one assessed TV viewing and the other both computer use and screen time), yet computer use was positively associated with vegetable intake in one sample. Sedentary behaviour was inversely associated with fruit intake in two samples (one assessed TV viewing and the other both computer use and screen time), yet computer use had no association with fruit intake in one sample. Finally, homework was positively associated with the healthy eating index (one sample) and TV viewing in boys and girls and computer use was inversely associated with the healthy eating index (two samples).
Sedentary behaviour was positively associated with energy-dense food in five samples (four assessed TV viewing and the other both screen time and computer use). However, computer use was inversely associated with energy-dense food in one sample. Sedentary behaviour was positively associated with fat, sugar and total calorie intake in three samples (three used self-report and one study objectively assessed sedentary behaviour) and was positively associated with sugar sweetened beverage intake in two samples (one assessed screen time and computer use and the other assessed computer use and TV viewing). Finally, TV viewing was positively associated with diet quality based on fat and sugar intake (one sample).
Two longitudinal studies assessed the association between sedentary behaviour and diet in children. ADDIN EN.CITE Brown201029572957295717Brown, JBroom, DNicholson, JBittman, MDo working mothers raise couch potato kids? Maternal employment and children's lifestyle behaviours and weight in early childhoodSocial Science & MedicineSoc Sci MedSocial science & medicine1816-1824102010Gebremariam201329582958295817Gebremariam, MBergh, IAndersen, LOmmundsen, YTotland, TBjelland, MGrydeland, MLien, NAre screen-based sedentary behaviors longitudinally associated with dietary behaviors and leisure-time physical activity in the transition into adolescence?International Journal of Behavioral Nutrition and Physical ActivityInternational Journal of Behavioral Nutrition and Physical ActivityInt. J. Behav. Nutr. Phys. Act.1-8102013 HYPERLINK \l "_ENREF_17" \o "Brown, 2010 #2957" 17 HYPERLINK \l "_ENREF_24" \o "Gebremariam, 2013 #2958" 24 Both scored at and above the median score on study quality and had moderate to large sample sizes (n=908 and n=4464). These studies corroborated findings from the cross-sectional evidence that various sedentary behaviours (TV viewing, screen time and computer use) are positively associated with consumption of energy-dense food and sugar sweetened beverages. Overall, sedentary behaviour in children again seems to be trending towards an association with elements of a less healthy diet. However, the number of comparisons is small, the studies are often diverse in the measurement methods adopted, and are often cross-sectional in design in both pre-school and children. This makes it difficult to draw meaningful conclusions. That said, two medium to large longitudinal studies of moderate to good quality did show associations between sedentary behaviour and unhealthy diet.
3.4 Associations between Sedentary Behaviour and Diet in Adolescents
All fifteen studies were cross-sectional in design. Data were reported separately for gender in eight studies. The remaining seven studies combined male and female data. Participants were aged between 11 and 19 years. Three studies reported data from the US and two presented combined data from Europe.
The majority of studies (60%) measured TV-viewing as the sedentary behaviour. Two of these also separately measured computer use and one also measured study time. A further two studies measured internet and video game use alongside TV-viewing, two additional studies measured computer use, internet for study, video games and study time alongside TV-viewing. One study measured screen time as one outcome (TV + video games + computer use + internet use), another also measured small screen recreation time (TV+/or video+/or DVDs + video games + computer games + computer not for homework) and sedentary education time (reading + homework). Sedentary behaviour was assessed by self-report in the majority of studies, one study used an interview administered technique. Sedentary behaviour was measured using questionnaires in all fifteen adolescent studies (Table 5).
INSERT TABLE 5 HERE
A total of eighteen dietary behaviours were assessed. Eleven studies assessed diet by self-report and the remaining study used a telephone interview technique. Diet was measured using unnamed questionnaires in eight studies, a web-based food behaviour questionnaire in another study, food frequency questionnaire in two studies, and using 24-hour recall methods in three studies. Finally, one study used a combination of a food frequency questionnaire and 24-hour recall.
Separate measures of TV-viewing and various categories of screen time were positively associated with sugar sweetened beverages in five of five samples and inversely associated in one sample. Separate measures of TV-viewing and various categories of screen time were also inversely associated with separate measures of fruit and vegetable consumption in three of three studies, and positively associated in another. Further, the inclusion of sedentary behaviours such as internet use for study and studying evident in one study resulted in a positive association with a separate measure of fruit and vegetable consumption. TV-viewing and computer use were also inversely associated with a composite measure of fruit and vegetable consumption in one of one sample.
Overall, sedentary behaviour in adolescents appears to be associated with elements of an unhealthy diet. However, caution should be expressed when interpreting this association due to the low number of studies reporting the same sedentary and dietary behaviours.
3.5Associations between Sedentary Behaviour and Diet in Adults
Characteristics of studies concerning adults are shown in Table 6. All three studies were cross-sectional in design. Male and female data were reported separately in two studies and one reported only female data. Studies were conducted in the US in two papers.
All three studies assessed self-reported TV-viewing as the sedentary behaviour using questionnaires. Dietary intake was measured using food-frequency questionnaires, 7-day weighed food records and a 24 hour recall. Two studies measured Healthy Eating Index Score, the other measured total energy intake. TV-viewing was marginally positively associated with total energy intake in adults and marginally inversely and positively associated with healthy food index scores. Again, caution should be headed when interpreting analyses with fewer than five studies, as estimates of an association may be imprecise.
Based on the lack of evidence, it is difficult to provide a clear conclusion on the association between TV-viewing and dietary behaviour in adults. Although limited, the available evidence tends to suggest that high TV-viewing is positively associated with total energy intake and unhealthy diet quality. Similar to findings with adolescents, caution should be taken when interpreting associations regarding adults due the lack of research.
INSERT TABLE 6 HERE
4.0 Discussion
This systematic review builds on the published review by Pearson and Biddle. HYPERLINK \l "_ENREF_6" \o "Pearson, 2011 #2956" ADDIN EN.CITE Pearson201129562956295617Pearson, NBiddle, SSedentary Behavior and Dietary Intake in Children, Adolescents and AdultsAmerican Journal of Preventative MedicineAmerican Journal of Preventative Medicine178-18841220116 An update was attempted because technology-based sedentary behaviours are likely to be changing quickly, and it is timely to examine new papers that were emerging but by differentiating pre-school children from children and adolescents. Adults were again included to allow for a lifespan approach.
For pre-school children, three new studies were found since early 2010. These showed a clear trend for greater time in sedentary behaviour (mainly TV viewing) to be associated with unhealthy eating. This showed in less fruit and vegetable consumption and lower scores on a healthy eating index, as well as higher levels of energy dense food and fast food. In the 2011 review, we combined this age group with older children. The present review, therefore, shows that the coupling of screen time and possibly commercial TV viewing time with an unhealthy diet starts at an early age and leads to the obvious conclusion that parental, family and other interventions are required with children in the first few years of life. However, caution is required at this stage due to the small number of studies. Clearly this is an important area of research development.
For children aged 5-11 years, results across nine studies showed a clear trend for sedentary behaviour to be associated with a less healthy diet. With 19 studies reported by Pearson and Biddle for pre-adolescent children, including pre-school children, this shows a continued interest in diet and sedentary behaviour in this age group. In the current review, sedentary screen time, and mainly TV viewing, is associated with greater consumption of energy-dense food, fat, sugar, sugar sweetened beverages and total caloric intake. It is also associated with consumption of less fruit and vegetables.
Confidence in these trends in enhanced by two reasonably large longitudinal studies that show that screen time is associated energy-dense food and sugar sweetened beverage consumption. Sugar sweetened beverages have been implicated in weight gain HYPERLINK \l "_ENREF_43" \o "Malik, 2006 #10550" ADDIN EN.CITE Malik200610550105501055017Malik, V.S.Schulze, Matthias B.Hu, Frank B.Intake of sugar-sweetened beverages and weight gain: a systematic reviewAmerican Journal of Clinical NutritionAmerican Journal of Clinical Nutrition274-2888422006August 1, 2006http://ajcn.nutrition.org/content/84/2/274.abstract43 HYPERLINK \l "_ENREF_44" \o "Hu, 2013 #10551" ADDIN EN.CITE Hu201310551105511055117Hu, Frank BResolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseasesObesity ReviewsObesity Reviews606-619148201310.1111/obr.1204044 and might be one mechanism linking screen time with obesity and account for the variable findings in this area. In other words, weight status may be as much to do with energy consumption as it is with low energy expenditure from sedentary time, thus accounting for inconsistency of findings when just investigating TV and weight status.10 Studies are required that investigate further this association, including availability of food and drinks during different sedentary behaviours, and prompts or cues that encourage or discourage such consumption.
With 15 studies reported in the current review concerning associations between sedentary behaviour and diet in adolescents, this shows that researchers continue to view this topic and age group as important. In less than four years, this represents more than a 50% increase in the number of studies. However, while there is a trend for higher levels of sedentary behaviour to be associated with poorer diet, there are rather few studies assessing the same sedentary behaviour and same diet outcome variable. Future studies need to build on these associations by ensuring that similar measures are taken. It appears that TV and, to a certain extent computer screen time, are implicated in being associated with poorer diet. The dietary outcomes, therefore, need standardising by studies ensuring that they measure at least fruit and vegetable intake, energy-dense snacks, and sugar sweetened beverages. That way a more comprehensive picture will emerge for adolescents at an important time of change in this age group.
Data on adults have not expanded much since the last review. Only three studies were reviewed in the present paper, with 11 in 2011. With so few studies, firm conclusions are not possible, although similar trends noted elsewhere in this review are still evident. Future studies need more data on the context of sedentary behaviours and what might be cuing certain dietary behaviours in the presence of screen or other sitting behaviours.
Conclusion
In conclusion, sedentary behaviour, mainly in form of screen viewing and especially TV, is associated with indicators of unhealthy dietary intake in pre-school children, school-aged children and adolescents in predominantly cross-sectional studies. The results for adults are sparse and less clear. Findings largely confirm and extend the review published in 2011. We have added to knowledge by investigating pre-school children separately, and documenting the continued study of sedentary behaviour and diet in young people. Research on adults needs to develop. Future studies need to standard measures of diet, and include a wider variety of sedentary behaviours, as well as document the context that sedentary behaviour may be associated with dietary intake.
References
ADDIN EN.REFLIST 1. Sedentary Behaviour Research Network. Letter to the Editor: Standardized use of the terms sedentary and sedentary behaviours. Applied Physiology, Nutrition & Metabolism 2012;37:54042.
2. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine and Science in Sports & Exercise 2009;41(5):998-1005.
3. Dunstan DW, Barr ELM, Healy GN, Salmon J, Shaw JE, Balkau B, et al. Television viewing time and mortality: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation 2010;121:384-91.
4. Dunstan DW, Salmon J, Healy GN, Shaw JE, Jolley D, Zimmet PZ, et al. Association of television viewing with fasting and 2-hr post-challenge plasma glucose levels in adults without diagnosed diabetes. Diabetes Care 2007;30:516-22.
5. Hancox RJ, Milne BJ, Poulton R. Association between child and adolescent television viewing and adult health: A longitudinal birth cohort study. The Lancet 2004;364:257-62.
6. Pearson N, Biddle S. Sedentary Behavior and Dietary Intake in Children, Adolescents and Adults. American Journal of Preventative Medicine 2011;41(2):178-88.
7. 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. Journal of the American Medical Association 2003;289(14):1785-91.
8. Blanck HM, McCullough ML, Patel AV, Gillespie C, Calle EE, Cokkinides VE, et al. Sedentary behavior, recreational physical activity, and 7-year weight gain among postmenopausal U.S. women. Obesity 2007;15:1578-88.
9. Williams DM, Raynor HA, Ciccolo JT. A review of TV viewing and its association with health outcomes in adults. American Journal of Lifestyle Medicine 2008;2:250-59.
10. Dietz WH, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 1985;75:807-12.
11. Marshall SJ, Biddle SJH, Gorely T, Cameron N, Murdey I. Relationships between media use, body fatness and physical activity in children and youth: A meta-analysis. International Journal of Obesity 2004;28:1238-46.
12. DeMattia L, Lemont L, Meurer L. Do interventions to limit sedentary behaviours change behaviour and reduce childhood obesity? A critical review of the literature. Obesity Reviews 2007;8:69-81.
13. Klesges RC, Shelton ML, Klesges LM. Effects of television on metablic rate: potential implications for childhood obesity. Pediatrics 1993;91:281-86.
14. Dennison BA, Edmunds LS. The role of television in childhood obesity. Progress in Pediatric Cardiology 2008;25:191-97.
15. Scully M, Dixon H, Wakefield M. Association between commercial television exposure and fast-food consumption among adults. Public Health Nutrition 2009;12(01):105-10.
16. Temple JL, Giacomelli AM, Kent KM, Roemmich JN, Epstein LH. Television watching increases motivated responding for food and energy intake in children. Am J Clin Nutr 2007;85(2):355-61.
17. Brown J, Broom D, Nicholson J, Bittman M. Do working mothers raise couch potato kids? Maternal employment and children's lifestyle behaviours and weight in early childhood. Social science & medicine 2010;10:1816-24.
18. Sisson S, Shay C, Broyles S, Leyva M. Television-viewing time and dietary quality among U.S. children and adults. American Journal of Preventative Medicine 2012;43(2):196-200.
19. Cox R, Skouteris H, Rutherford L, Fuller-Tyszkiewicz M, Dell' Aquila D, Hardy L. Television viewing, television content, food intake, physical activity and body mass index: a cross-sectional study of preschool children aged 2-6 years. Health Promotion Journal of Australia 2012;23(1):58-62.
20. Danielsen Y, Jlusson P, Nordhus I, Kleiven M, Meltzer H, Olsson S, et al. The relationship between life-style and cardio-metabolic risk indicators in children: the importance of screen time. Acta paediatrica 2011;100(2):253-59.
21. Brown J, Nicholson J, Broom D, Bittman M. Television Viewing by School-Age Children: Associations with Physical Activity, Snack Food Consumption and Unhealthy Weight. Social Indicators Research 2011;101:221-25.
22. Ouwens M, Cebolla A, Van Strien T. Eating style, television viewing and snacking in pre-adolescent children. Nutricion Hospitalaria 2012;27(4):1072-78.
23. Seghers J, Rutter C. Clustering of multiple lifestyle behaviours and its relationship with weight status and cardiorespiratory fitness in a sample of Flemish 11- to 12-year-olds. Public health nutrition 2010;13(11):1838-46.
24. Gebremariam M, Bergh I, Andersen L, Ommundsen Y, Totland T, Bjelland M, et al. Are screen-based sedentary behaviors longitudinally associated with dietary behaviors and leisure-time physical activity in the transition into adolescence? Int. J. Behav. Nutr. Phys. Act. 2013;10:1-8.
25. Fuller-Tyszkiewicz M, Skouteris H, Hardy L, Halse C. The associations between TV viewing, food intake, and BMI. A prospective analysis of data from the Longitudinal Study of Australian Children. Appetite 2012;59:945-48.
26. McCormack G, Hawe P, Perry R, Blackstaffe A. Associations between familial affluence and obesity risk behaviours among children. Pediatric Child Health 2011;16(1):19-25.
27. Ranjit N, Evans M, Byrd-Williams C, Evans A, Hoelscher D. Dietary and activity correlates of sugar-sweetened beverage consumption among adolescents. Pediatrics 2010;126(4):754-61.
28. Arora M, Nazar G, Gupta V, Perry C, Srinath R, Stigler M. Association of breakfast intake with obesity, dietary and physical activity behaviour among urban school-aged adolescents in Dehli, India: Results of a cross-sectional study. BMC Public Health 2012;12:881-93.
29. Santaliestra-Pasias A, Mouratidou T, Verbestel V, Huybrechts I, Gottrand F, Le Donne C, et al. Food consumption and screen-based sedentary behaviours in European adolescents. Archives of Paediatrics and Adolescent Medicine 2012;166(11):1010-20.
30. Verzeletti C, Maes L, Santinell M, Baldassari D, Vereecken C. Food-related family lifestyle associated with fruit and vegetable consumption among young adolescents in Belgium Flanders and the Veneto Region of Italy. Appetite 2010;54:394-97.
31. Williams S, Mummery K. Associations between adolescent nutrition behaviours and adolescent and parent characteristics. . Nutrition and Pediatrics 2012;69:95-101.
32. Al-Hazzaa H, Al-Sobayel H, Abahussain N, Qahwaji D, Alahmadi M, Musaiger A. Association of dietary habits withe levels of physical activity and screen time among adolescent living in Saudi Arabia. J. Hum. Nutr. Diet. 2013;27:1-10.
33. Fernandes R, Christofaro D, Casonatto J, Kuwaguti S, Ronque E, Cardoso J, et al. Cross-sectional association between healthy and unhealthy food habts and leisure physical activity in adolescents. Journal de Pediatria 2011;87(3):252-56.
34. Ciccone J, Woodruff S, Fryer K, Campbell T, Cole M. Associations among evening snacking, screen time, weight status, and overall diet quality in young adolescents. Applied Physiology Nutrition and Metabolism 2013;38:789-94.
35. Cuenca-Garcia M, Ruiz J, Ortega F, Labayen I, Gonzalez-Gross M, Moreno L, et al. Association breakfast consumption with objectively measured and self-reported physical activity, sedentary time and physical fitness in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Public health nutrition 2013;11:1-11.
36. Del Mar Bibiloni M, Martinez E, Llull R, Pons A, Tur J. Western and Mediterranean dietary patterns among Balearic Islands adolescents: Socio-economic and lifestyle determinants. Public health nutrition 2011;15(4):683-92.
37. Honkala S, Behbehani J, Honkala E. Daily consumption of sugary drinks and foods as a behavioural risk for health of adolescents in Kuwait. Oral Health and Preventitive Densitry 2012;10:113-22.
38. Shi L, Mao Y. Excessive recreational computer use and food consumption behaviour among adolescents. Ital. J. Pediatr. 2010;36:52-55.
39. Lee J, Jun N, Baik I. Associations between dietary patterns and screen time among Korean adolescents. Nutrition Research and Practice 2013;7(4):330-35.
40. Al-Hazzaa H, Abahussain N, Al-Sobayel H, Qahwaji D, Mulsager A. Physical activity, sedentary behaviours and dietary habits among Saudi adolescents relative to age, gender and religion. Int. J. Behav. Nutr. Phys. Act. 2011;8:140-54.
41. Huffman F, Vaccaro J, Exebio J, Zarini G, Katz T, Dixon Z. Television watching, diet quality, and physical activity and diabetes among three ethnicities in the United States. Journal of Environmental and Public Health 2012;20:1-10.
42. Tucker L, Tucker J. Television viewing and obesity in 300 women: Evaluation of the pathways of energy intake and physical activity. Obesity 2011;19(10):950-56.
43. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. American Journal of Clinical Nutrition 2006;84(2):274-88.
44. Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity Reviews 2013;14(8):606-19.
Table 1. Characteristics of early years and child studies included in the review: sample size, gender, study design, nature of sedentary behaviour assessed, assessment and measurement of sedentary behaviour, type of dietary behaviours assessed, assessment and measurement of dietary behaviour and country of study.
Early years
(>2 x <5 years)Children
( e"5 x <