Emmanuel Stamatakis, 1 Mark Hamer, 1 Gita Mishra 1 1 University College London

Emmanuel Stamatakis,1 Mark Hamer,1 Gita Mishra1

1University College LondonDepartment of Epidemiology & Public Health,

London, UK

Adulthood TV Viewing Relates Independently

to Cardiometabolic Risk Profile in Early

Middle Age.The 1958 British birth cohort (1981 & 2003 waves)

03/03/2010. AHA

50th Joint Cardiovascular

Disease Epidemiology

and Prevention - & - Nutrition,

Physical Activity and Metabolism Conference,

San Francisco, CA

Sleeping (0.9 MET)

Sedentary(1 - 1.5 MET)

Light-intensity physical activity

(1.5-3 MET )

Moderate -intensity physical

activity (3-6 MET)

Vigorous-intensity physical activity

(>6 MET)

Sleeping (0.9 MET)

Sedentary(1 - 1.5 MET)


(1.5-3 MET )


activity (3-6 MET)


(>6 MET)

?

Sleeping (0.9 MET)

Sedentary behaviour(1 - 1.5 MET)


(1.5-3 MET )


activity (3-6 MET)


(>6 MET)

?

Sedentary behaviour as an “independent” risk marker:

Sleeping (0.9 MET)



(1.5-3 MET )


activity (3-6 MET)


(>6 MET)


Sleeping (0.9 MET)



(1.5-3 MET )


activity (3-6 MET)


(>6 MET)

Even if you do “enough” of this...


Sleeping (0.9 MET)



(1.5-3 MET )


activity (3-6 MET)


(>6 MET)

Even if you do “enough” of this......you may still be at risk if you do “too much” of this

Sleeping (0.9 MET)



(1.5-3 MET )


activity (3-6 MET)


(>6 MET)

To investigate the relationship between TV viewing in early adulthood and cardiometabolic risk profile in early middle age

Is this relationship independent of physical activity participation?

Study aims

Data source: the 1958 British birth cohort

Study Design:1981

(age 23yrs)

Study Design:

Weekly TV Frequency

1981 (age 23yrs)

Exposure

Study Design:

Weekly TV Frequency

1981 (age 23yrs)

2002 (age 44yrs)

Exposure

Study Design:

Weekly TV Frequency

Cardiometabolic risk markers:

•Triglycerides •Total cholesterol •HDL cholesterol •LDL cholesterol •D-dimer •Fibrinogen •vonWillebrand antigen factor •C-reactive protein •BMI •Waist circumference •Systolic blood pressure•Diastolic blood pressure•Glycated haemoglobin (HbA1c) •Insulin Growth Factor 1•Resting Heart Rate

1981

2002 [N=9,377]

Outcomes

Exposure

Study Design:

Weekly TV Frequency



1981 Outcomes

Exposure?

2002 [N=9,377]

Study Design:

Weekly TV Frequency



1981

Covariables

Outcomes

Exposure

Covariable

2002 [N=9,377]

•Weekly exercise frequency

•Social class

•Daily TV time•Daily physical activity time (EPAQ2)•CVD medication•Smoking *•Alcohol intake•Social class*

Study Design:

Weekly TV Frequency



1981

Covariables

Outcomes

Exposure

Covariables


•Social class

2002 [N=9,377]

N=5,629•Daily TV time•Daily physical activity time (EPAQ2)•CVD medication•Smoking *•Alcohol intake•Social class*

FACTOR ANALYSIS:

COMPONENT 1 •Triglycerides •HDL cholesterol •BMI •Waist circumference •Systolic BP•Diastolic BP

COMPONENT 2 •vonWillebrand antigen factor •Fibrinogen•D-dimer •C-reactive protein

COMPONENT 3 •Total cholesterol •LDL cholesterol --------------EXCLUDED---------------------Glycated haemoglobin (HbA1c) -Insulin Growth Factor 1 -Resting Heart Rate

Study Design:

Weekly TV Frequency


•Social class

1981

Covariables

Outcomes

Exposure

Covariables

2002 [N=9,377]

N=5,629•Daily TV time•Daily physical activity time (EPAQ2)•CVD medication•Smoking *•Alcohol intake•Social class*

FACTOR ANALYSIS* COMPONENTS:C1 (27% V.E.)• Triglycerides

• HDL cholesterol • BMI

• Waist circumference • Systolic BP• Diastolic BP

C2 (16% V.E.)• vonWillebrand antigen

factor • Fibrinogen• D-dimer

• C-reactive protein

C3 (13% V.E.)• Total cholesterol • LDL cholesterol

*Principal Component Analysis; factor loading criterion: ≥ 0.35








Metabolic









Metabolic

Haemostatic/inflammatory









Metabolic


Cholesterol component


FACTOR ANALYSIS COMPONENTS:C1 (27% V.E.)• Triglycerides







EXCLUDED: -Glycated haemoglobin

-Insulin Growth Factor 1 -Resting Heart Rate

Metabolic

Cholesterol component

Not fitting in any component


Generalized linear model coefficients (95% CI)

Model 1 Model 2 Model 3 Model 4Component 1 (metabolic)≤ 2 Referent3-4 0.07

( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)

Trend P <0.001 <0.001 <0.001 0.02Component 2 (haemostatic/inflammatory)≤ 2 Referent3-4 0.06 (-0.03,

0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03

Component 3 (Cholesterol)≤ 2 Referent3-4 0.04 ( -

0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 3.0 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57

Results: TV at 23yrs Risk factor components at 44yrs



( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)


0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03


0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 0.3 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57




( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)


0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03


0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 3.0 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57




( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)


0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03


0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 3.0 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57


Adjusted for: sex



( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)


0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03


0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 3.0 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57


Adjusted for: sex, smoking, social class, alcohol, CVD medication



( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)


0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03


0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 3.0 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57


Adjusted for: sex, smoking, social class, alcohol, CVD medication, physical activity (age 23 & 44)



( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)


0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03


0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 3.0 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57


Adjusted for: sex, smoking, social class, alcohol, CVD medication, physical activity (age 23 & 44), daily TV time (age 44 )


Model 1 Model 2 Model 3 Model 4*Component 1 (metabolic)≤ 2 Referent3-4 0.07

( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)


0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03


0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 3.0 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57


*Adjusted for: sex, smoking, social class, alcohol, CVD medication, physical activity (age 23 & 44), daily TV time (age 44 )


Model 1 Model 2 Model 3 Model 4*Component 1 (metabolic)≤ 2 Referent3-4 0.07

( -.009,1.54)0.07 (-0.008,15.2)

0.06 (-0.01, 0.15) 0.04 (-0.03,0.12)

≥ 5 0.19 (0.13 ,0.26)

0.17 (0.10, 0.23)

0.16 (0.09, 0.22) 0.10 (0.03,0.16)


0.15)0.05 ( -.04,0.13)

0.04 (-.05,0.13) 0.02(-0.07, 0.10)

≥ 5 0.23 (0.15, 0.30)

0.14 ( 0.07,0.21)

0.13 ( 0.06,0.20) 0.07 (-0.003,0.14)

Trend P <0.001 <0.001 0.03 0.03


0.05,0.10)0.0 (-0.5, 0.13) 0.04 (-0.05, 0.13) 0.04 (-0.05,0.13)

≥ 5 0.03 (-0.04 ,0.10)

0.03 (-0.04,0.10)

0.04 (-0.04,0.11) 0.03 ( -0.05,0.10)

Trend P 0.57 0.54 0.44 0.57


N.S.

*Adjusted for: sex, smoking, social class, alcohol, CVD medication, physical activity (age 23 & 44), daily TV time (age 44 )

Sensitivity analysis: active1 participants (N=1228)

1≥1/wk sport at age 23 AND meeting the moderate to vigorous physical activity guidelines at age 44 yrs

Sensitivity analysis: Non-overweight at baseline (23yrs)(N=4783)

Low

TV

23

Hig

hTV

23/L

ow T

V44

Hig

hTV

23/H

igh

TV44

Low

TV

23

Hig

hTV

23/L

ow T

V44

Hig

hTV

23/H

igh

TV44

Low

TV

23

Hig

hTV

23/L

ow T

V44

Hig

hTV

23/H

igh

TV44

Component 1 Component 2 Component 3

-.300

-.200

-.100

.000

.100

.200

Sco

re

p<0.001

p=0.156

p<0.001

p<0.001

p=0.156

p<0.001

Sensitivity analysis: Overweight at baseline (23yrs)(N=772)

Low

TV

23

Hig

hTV

23/L

ow T

V44

Hig

hTV

23/H

igh

TV44

Low

TV

23

Hig

hTV

23/L

ow T

V44

Hig

hTV

23/H

igh

TV44

Low

TV

23

Hig

hTV

23/L

ow T

V44

Hig

hTV

23/H

igh

TV44

Component 1 Component 2 Component 3

-0.50

-0.30

-0.10

0.10

0.30

0.50

0.70

0.90

1.10

Sco

re

p=0.09

p=0.009

p=0.34

Crude TV measurement at baseline: what does it capture exactly? ◦ Frequency only?◦ Increased tendency to be sedentary in general?◦ Larger volumes of TV viewing?◦ Dietary confounding? (see e.g. Cleland VJ, et al. Am J Clin Nutr

2008; 87,:1148-55] TV is only a partial (i.e. incomplete)

indicator of sedentary behaviour Self-reported physical activity measures

Study limitations

Multivariable-adjusted∫ odds ratios for >2hrs/day of TV watching at age 44, by TV watching frequency at age 23. O.R. 95% C.I.TV frequency at age 23yrs≤ 2 (reference) 13-4 1.37 1.12 - 1.67≥ 5 2.67 2.27 - 3.15

(p<0.001) ∫Adjusted for sex, social class, recreational physical activity and recreational PC use time at age 44.

Does TV frequency at 23yrs predict TV time at 44yrs?

TV habits in early adulthood may predict an adverse cardiometabolic risk profile in early middle age independently of physical activity

Sedentary behaviour affects CV health through metabolic & haemostatic pathways?

Conclusions

The extent to which certain biological risk factors explain the association between TV & other screen-based entertainment time and CVD fatal/nonfatal events. Prospective study (4.5yrs follow up), N=1928 Scottish adults >35yrs

[Stamatakis E, Hamer M, Dunstan DW. Under revision]

This analysis was funded by a National Institute for Health Research (UK) personal Fellowship.

The 1958 British Birth Cohort was funded by:

◦ Wellcome Trust ◦ Department of Health and Social Security◦ Department of Education and Science◦ Department of Employment◦ Manpower Services Commission◦ Department of the Environment◦ Medical Research Council

Acknowledgments & Funding

Emmanuel Stamatakis, 1 Mark Hamer, 1 Gita Mishra 1 1 University College London

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