Highlights
- •Increased screen time is associated with an increased risk of MetS among children and adolescents.
- •High-level screen time was associated with a statistically significant 58% increase in odds of MetS among children and adolescents.
- •There was a 29% increase in odds of MetS per 2 h of screen time per day.
- •More research is needed considering the type of screen time and study design.
Abstract
Aims
The metabolic syndrome (MetS) and its consequences are one of the main public health
challenges worldwide. We conducted a systematic review and dose-response meta-analysis
of studies that examined the association between screen time and the MetS among children
and adolescents.
Data synthesis
A systematic search was conducted using electronic databases, including PubMed, Scopus,
ProQuest, and Cochrane Library, for studies published from 1963 up to 2 May 2022.
In this systematic review and meta-analysis, observational studies with cross-sectional,
case-control, and cohort design evaluating the association between screen time and
MetS were included. Random effects models and linear and nonlinear dose-response meta-analyses
were used to pool study results.
Results
Seven studies were included in the meta-analysis. The summary OR of MetS among children
and adolescents for the highest vs. lowest time of screen time was 1.64 (95% CI: 1.32–2.03,
with little evidence of heterogeneity, I2 = 9.3%, P-heterogeneity = 0.35, n = 7 studies) and 1.64 (95% CI: 1.27–2.12, I2 = 27.7%, n = 6) for cross-sectional studies. Results persisted across several additional
subgroup analyses. There was a linear positive association between screen time and
the risk of MetS (P dose-response < 0.0001; P nonlinearity = 0.64) with an OR of 1.29 (95% CI: 1.12–1.46) per 2 h/day increment in screen time.
Conclusion
The current dose-response meta-analysis suggested that increased screen time is associated
with an increased risk of MetS among children and adolescents. Public health strategies
may target unhealthy screen-based related behaviors to halt the development of MetS
among children and adolescents.
Keywords
Abbreviations:
MetS (metabolic syndrome), BMI (body mass index), PA (physical activity), TV (television), AHRQ (Healthcare Research and Quality), OR (odds ratio), CI (confidence interval), MESH (Medical Subject Heading), ATP (III) (National Cholesterol Education Program Adult Treatment Panel), CVD (cardiovascular diseases)To read this article in full you will need to make a payment
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References
- Prevalence of metabolic syndrome and its determinants among Iranian adults: evidence of IraPEN survey on a bi-ethnic population.Sci Rep. 2019; 9: 7937
- The metabolic syndrome: prevalence in worldwide populations.Endocrinol Metab Clin N Am. 2004; 33 (table of contents): 351-375
- The metabolic syndrome.Lancet. 2005; 365 (16): 1415-1428
- Executive summary of the third report of the national cholesterol education Program (NCEP) expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment Panel III).JAMA. 2001; 285: 2486-2497
- Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents.JAMA. 2012; 307: 704-712
- Television viewing and time spent sedentary in relation to cancer risk: a meta-analysis.J Natl Cancer Inst. 2014; 106
- ‘Red Ruby’: an interactive web-based intervention for lifestyle modification on metabolic syndrome: a study protocol for a randomized controlled trial.BMC Publ Health. 2014; 14: 748
- Cardiovascular consequences of metabolic syndrome.Transl Res. 2017; 183 (1): 57-70
- Sedentary behavior as a mediator of type 2 diabetes.in: Diabetes and Physical Activity. Volume 60. 2014: 11-26
- Strong association between time watching television and blood glucose control in children and adolescents with type 1 diabetes [10].Diabetes Care. 2007; 30: 1567-1570
- Prevalence and correlates of problematic smartphone use in a large random sample of Chinese undergraduates.BMC Psychiatr. 2016; 16: 1-12
- The association between internet addiction and psychiatric co-morbidity: a meta-analysis.BMC Psychiatr. 2014; 14: 183
- Association of internet addiction in high school students with ADHD and tobacco/alcohol use.Dusunen Adam. 2015; 28: 204-212
- Parental factors associated with screen time in pre-school children in primary-care practice: a TARGet Kids! study.Publ Health Nutr. 2011; 14: 2134-2138
- Canadian sedentary behaviour guidelines for the early years (aged 0-4 years).Appl Physiol Nutr Metab Physiologie appliquee, nutrition et metabolisme. 2012; 37: 370-391
- Sedentary behaviors and subsequent health outcomes in adults: a systematic review of longitudinal studies, 19962011.Am J Prev Med. 2011; 41: 207-215
- Systematic review of sedentary behaviour and health indicators in school-aged children and youth.Int J Behav Nutr Phys Activ. 2011; 8: 98
- Acute sedentary behaviour and markers of cardiometabolic risk: a systematic review of intervention studies.J Nutr Metab. 2012; 2012
- The dose-response associations of sedentary time with chronic diseases and the risk for all-cause mortality affected by different health status: a systematic review and meta-analysis.J Nutr Health Aging. 2020; 24: 63-70
- Modern sedentary activities promote overconsumption of food in our current obesogenic environment.Obes Rev Off J Int Assoc Study Obesity. 2011; 12: e12-e20
- Low physical activity level and short sleep duration are associated with an increased cardio-metabolic risk profile: a longitudinal study in 8-11 year old Danish children.PLoS One. 2014; 9e104677
- Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group.JAMA. 2000; 283: 2008-2012
- Meta-analysis in clinical trials.Contr Clin Trials. 1986 Sep 1; 7: 177-188
- Newcastle-Ottawa quality assessment form for cohort studies. Evaluation and treatment of cryptorchidism.2012
- Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better?.Mil Med Res. 2020; 7: 7
- Meta-analysis of epidemiologic dose-response data.Epidemiology. 1993; : 218-228
- Generalized least squares for trend estimation of summarized dose–response data.STATA J. 2006; 6: 40-57
- Extending DerSimonian and Laird's methodology to perform multivariate random effects meta-analyses.Stat Med. 2010; 29: 1282-1297
- Measuring inconsistency in meta-analyses.BMJ (Clinical research ed). 2003; 327: 557-560
- Operating characteristics of a rank correlation test for publication bias.Biometrics. 1994; 50: 1088-1101
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- Relationship between screen time and metabolic syndrome in adolescents.J Pub Health (Oxford, England). 2008; 30: 153-160
- Correlates of metabolic syndrome among young Brazilian adolescents population.Nutr J. 2018; 17
- Unhealthy snack intake modifies the association between screen-based sedentary time and metabolic syndrome in Brazilian adolescents.Int J Behav Nutr Phys Activ. 2019; 16: 115
- Association between screen time and metabolic syndrome in children and adolescents in Korea: the 2005 Korean national health and nutrition examination survey.Diabetes Res Clin Pract. 2010;
- Prevalence of metabolic syndrome and associated risk factors among Korean adolescents: analysis from the Korean national survey.Asia Pac J Publ Health. 2012; 24: 464-471
- Screen time and metabolic syndrome among expatriate adolescents in the United Arab Emirates.Diabetes Metabol Syndr. 2019; 13: 2565-2569
- Television viewing over the life course and the metabolic syndrome in mid-adulthood: a longitudinal population-based study.J Epidemiol Community Health. 2014; 68: 928-933
- Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth.Can J Diabetes. 2014; 38: 53-61
- Screen time is associated with dietary intake in overweight Canadian children.Preventive Med Rep. 2015; 2: 265-269
- Screen time and childhood overweight/obesity: a systematic review and meta-analysis.Child Care Health Dev. 2019; 45: 744-753
- Screen time and body mass index among children and adolescents: a systematic review and meta-analysis.Front Pediatr. 2022 May 10; 10822108
- The association between screen time and cardiometabolic risk in young children.Int J Behav Nutr Phys Activ. 2020; 17 (41-41)
- Television watching and risk of childhood obesity: a meta-analysis.Eur J Publ Health. 2015; 26: 13-18
- Association of screen time and cardiometabolic risk in school-aged children.Preventive Med Rep. 2020; 20101183
- Prevalences of overweight and obesity and their association with physical activity pattern among Iranian adolescents aged 12–17 years.Publ Health Nutr. 2012; 15: 2246-2252
- The effect of screen advertising on children's dietary intake: a systematic review and meta-analysis.Obes Rev. 2019; 20: 554-568
- Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus.Pediatrics. 2005; 115: e290-e296
Article info
Publication history
Published online: August 14, 2022
Accepted:
August 3,
2022
Received in revised form:
July 27,
2022
Received:
January 24,
2022
Handling Editor: A. SianiIdentification
Copyright
© 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
