Screen Time and Body Mass Index Among Children and Adolescents: A Systematic Review and Meta-Analysis

Associations between body mass index and sleep duration in Brazilian children and adolescents: the moderating role of screen time

OBJECTIVES

To verify the moderating role of screen time in the relationship between body mass index (BMI) and sleep duration in children and adolescents.

METHODS

This cross-sectional study involved 1,338 children and adolescents (aged 6-17 years old; 761 girls) recruited from a municipality in south Brazil. Body weight and height were assessed to calculate BMI. Information regarding screen time, sleep duration, age, sex, sexual maturation, housing area, and socioeconomic status was obtained through a self-reported questionnaire. Moderation was tested using multiple linear regression modelling through an SPSS program extension. All models were adjusted for sex, age, sexual maturation, housing area, and socioeconomic status.

RESULTS

No association was found between BMI and sleep duration (β=0.830; 95 % CI=-0.943; 2.603). However, when the role of screen time was considered, it was observed that this variable significantly moderated the relationship between BMI and sleep duration (β=-0.006; 95 % CI=-0.011; -0.001). Specifically, children and adolescents who spent more than 360 min per day in front of the screens presented higher BMI and shorter sleep durations.

CONCLUSIONS

The more time children and adolescents spend in front of screens, the higher the likelihood it will negatively affect their BMI and sleep duration. These findings emphasize the need for interventions that promote healthy screen habits and encourage behaviors that support optimal sleep duration to mitigate the potential negative effects on body weight and overall health.

How Screen Time Affects Greek Schoolchildren's Eating Habits and Functional Food Consumption?-A Cross-Sectional Study

BACKGROUND

Television (TV), video games, PC and devices such as tablets and smart phones have become part of everyday life at an ever-younger age. Increased screen time correlates with unhealthy eating habits among children.

METHODS

374 children aged 9-12 years and their parents (n = 159), from 3 schools in Lemnos and 5 schools in Thessaloniki, Greece, took part in this cross-sectional study. The children completed the KIDMED score and a questionnaire about their physical activity, time spent watching TV, PC and playing electronic games, the frequency of cooking or shopping with their parents, the frequency of eating fast food, soft drinks and Functional Foods (FFs). Statistical analysis was performed with SPSS-29.0, using One Way ANOVA and Pearson chi-square.

RESULTS

As the hours of TV viewing increased, so did the percentage of children who consumed soft drinks (p = 0.03). A statistically significant association detected between television (p = 0.024), video games (p = 0.028), all screen categories (p = 0.011) and fast-food consumption. Increased screen time is associated with a higher weekly consumption of fast food (p = 0.011). The more hours children spent in front of screens, the less adherence they had to the Mediterranean Diet (p = 0.001) and less natural FFs consumption (p = 0.001).

CONCLUSIONS

The results suggest that screen time seems to affect children's eating behaviors. The study concluded that the longer the screen time, the unhealthier the dietary habits of schoolchildren become. Future research should focus on reducing screen time, as a means of improving dietary patterns and potentially reducing childhood obesity.

Lifestyle Behaviors of Childhood and Adolescence: Contributing Factors, Health Consequences, and Potential Interventions

In this narrative review, we summarized evidence from peer-reviewed articles, published before February 2024, that investigated lifestyle behaviors among children (≤12 years) and adolescents (13-18 years) representing different geographic descents. These behaviors included dietary patterns, screen time, physical activity, smoking, alcohol consumption, oral hygiene, unsafe sex, and sleep duration and quality. We documented the significant impacts of parental, school, and sociodemographic factors on the adoption of numerous lifestyle behaviors in this age category. Several health consequences could be attributed to unhealthy lifestyle behaviors during childhood and adolescence. For example, poor dietary habits can lead to a higher risk of obesity and cardiovascular disease. Physical inactivity contributes to the development of musculoskeletal and psychological disorders. Excessive screen time is associated with visual acuity problems, poor sleep, and psychological and behavioral problems. Tobacco use poses a significant risk for severe respiratory and cardiovascular diseases. Risky sexual behaviors are related to sexually transmitted infections and exposure to violence. Short sleep duration is associated with a lack of physical fitness and poor cognitive function. However, potential interventions, such as school-based health programs, community outreach initiatives, and national health policies and regulations, can improve lifestyle behaviors among children and adolescents.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

Association between Types of Screen Time and Weight Status during the COVID-19 Pandemic: A Longitudinal Study in Children and Adolescents

BACKGROUND

This study aimed to investigate the changes in distinct types of screen time and explore their longitudinal association with children and adolescents' weight status.

METHODS

A two-wave longitudinal study was conducted among 2228 children and adolescents (6-19 years) in Shanghai, China, before and during the pandemic. Recreational screen time (watching TV/videos, online gaming, using social media, and browsing webpages), educational screen time (online homework and online class), and BMI were measured using a self-reported questionnaire. Mixed-effects models were constructed to assess the associations between screen time and weight status.

RESULTS

The prevalence of overweight and obesity was 20.5% and 10.2% at baseline, respectively. Both recreational and educational screen time increased significantly over two months. While recreational screen time was found to be a risk factor for obesity, it was not the case for educational screen use. Specifically, adolescents who spent more time watching TV/videos had a higher obesity risk (OR = 1.576). No significant associations were found in children.

CONCLUSIONS

Overweight and obesity were prevalent among children and adolescents in China. Reducing screen-based activities is a promising strategy to prevent unhealthy weight gain in Chinese children and adolescents, while it is necessary to consider the content and distinguish between educational and recreational screen use.

Proportion of Chinese Children and Adolescents Meeting 24-Hour Movement Guidelines and Associations with Overweight and Obesity

Background: Since there is little knowledge about the 24-hour movement behaviors of Chinese children and adolescents, the purposes of this study were to investigate the proportion of Chinese children and adolescents meeting the 24-Hour Movement Guidelines and to further evaluate its relationship with overweight and obesity. Methods: A total of 440 children and adolescents aged 7−18 years from 7 cities in China were selected to measure physical activity using accelerometers, and sleep (SLP) and screen time (ST) using questionnaires. The data were analyzed with the independent T-test, Mann−Whitney U test, Cox−Stuart test, chi-square test, and logistic regression. Results: The proportion of Chinese children and adolescents meeting the overall 24-Hour Movement Guidelines was 7.3%. Boys (11.8%) were higher than girls (3.4%) (p < 0.001) and showed a downward trend with age (Ptrend = 0.03). The rates of overweight and obesity among children and adolescents who met the ST, MVPA + ST, ST + SLP, and MVPA + SLP + ST guidelines were 39%, 15%, and 36%, and 25% did not meet any guidelines. The rates of overweight and obesity among those who met 1, 2, and 3 guidelines were lower than the rate among those who did not meet any guidelines (odds ratio (OR) = 0.51, 95% confidence interval (CI): 0.22−1.17; OR = 0.32, 95% CI: 0.13−0.77; OR = 0.23, 95% CI: 0.07−0.81) and showed a decreasing trend (Ptrend = 0.006). Conclusions: The proportion of Chinese children and adolescents meeting the overall 24-Hour Movement Guidelines was low. The rate of overweight and obesity among children and adolescents who met the overall 24-Hour Movement Guidelines was the lowest compared with the rates among those who met any one or two. There was a dose−response relationship between the number of guidelines met and the overweight and obesity rate.

Dose-response relationship between daily screen time and the risk of low back pain among children and adolescents: a meta-analysis of 57831 participants

BACKGROUND

The risk of low back pain (LBP) increases steeply during adolescence, and adolescents with LBP are more likely to have low back pain in their adult years. This study aimed to investigate the dose-response relationship between daily screen time and the risk of low back pain among children and adolescents.

METHODS

PubMed, the Cochrane Library, Embase, and Web of Science were searched to collect relevant studies on daily screen time and the risk of low back pain from the establishment of the database up to December 2022. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 was used to perform a dose-response meta-analysis and the methodological quality evaluation of the included studies.

RESULTS

The results of the meta-analysis showed that there is a positive correlation between daily computer time (OR = 1.32, 1.05-1.60), daily mobile phone time (OR = 1.32, 1.00-1.64), daily TV watching (OR = 1.07, 1.04-1.09) and the risk of low back pain, separately. The dose-response meta-analysis showed that there is a linear relationship between daily computer use and low back pain. The risk of low back pain increased by 8.2% for each 1-hour of daily computer use.

CONCLUSIONS

Screen time is related to the risk of low back pain, and there is a linear relationship between daily computer use and the risk of low back pain. A number of strategic measures should be taken to prevent adolescents from developing severe low back pain.