Association of dietary habits with levels of physical activity and screen time among adolescents living in Saudi Arabia. Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults Relationships of physical activity with dietary behaviors among adults. Evaluation of the Web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes) Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials Time spent in sedentary behavior and changes in childhood BMI: a longitudinal study from ages 9 to 15 years Sedentary behavior and psychiatric symptoms in overweight and obese adults with schizophrenia and schizoaffective disorders (WAIST Study) Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Decreasing sedentary behaviors in treating pediatric obesity. The application of an occupational health guideline reduces sedentary behaviour and increases fruit intake at work: results from an RCT Physical activity as a substitute for sedentary behavior in youth Associations Between Screen-Based Sedentary Behavior and Cardiovascular Disease Risk Factors in Korean Youth Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region Sedentary Behaviours in Mid-Adulthood and Subsequent Body Mass Index Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies.
BACKGROUND Underst and ing the inter-relationships between lifestyle factors in youth is important with respect to the development of effective promotional programmes for healthy eating and active living . The present study aim ed to explore the associations of dietary habits ( DH ) with physical activity ( PA ) and screen time ( ST )  among Saudi adolescents aged between 15 and 19 years of age relative to gender . METHODS Data were obtained from the Arab Teens Lifestyle Study , a school-based multicentre lifestyle study conducted in 2009/2010 in three major cities in Saudi Arabia . A multistage stratified cluster r and om sampling technique was used . The number of participants with complete data for  DH  and  PA  was 2886 and the respective number for DH and ST was 2822 . Assessment included weight , height , body mass index , total daily ST ( television viewing , video/computer games and Internet use ) , PA and DH using self-reported question naires . RESULTS Females were significantly more sedentary and less active than males ( P < 0.001 ) . Two-way analysis of covariance , controlling for age , showed significant ( P < 0.05 ) gender by PA and gender by ST interactions for several DH . Logistic regression analyses revealed significant associations of higher PA with a higher consumption of fruit , vegetables , milk , French fries/potato chips and energy drinks , whereas higher ST was significantly associated with a higher consumption of sugar-sweetened drinks , fast foods , cake/doughnuts and energy drinks . CONCLUSIONS Healthful dietary habits were associated mostly with  PA  , whereas sedentary behaviours , independent of PA , negatively impacted upon eating behaviours . The low PA levels and high sedentary levels of Saudi females represent a great concern . The results reported in the present study have important implication s for both youth public health policies and intervention programmes Background There is no data on diet- and activity-related behaviors associated with overweight and obesity among Pakistani school-aged children . The study aim ed to explore  dietary behaviors , physical activity and sedentary lifestyle  associated with overweight and obesity , and their socio-demographic correlates , among Pakistani primary school children . Methods A population -based cross-sectional study was conducted with a representative multistage r and om cluster sample of 1860 children aged five to twelve years in Lahore , Pakistan . Overweight ( > + 1 SD ) and obesity ( > + 2 SD ) were defined using the World Health Organization reference 2007 . Chi-square test was used as the test of trend . Linear regression was used to examine the predictive power of independent variables in relation to body mass index ( BMI ) . Logistic regression was used to quantify the independent predictors and adjusted odds ratios ( aOR ) with 95 % confidence intervals ( CI ) were obtained . Statistical significance was considered at P < 0.05 . Results Children skipping breakfast ( 8 % ) , eating fast food and snacks ≥ once a week ( 43 % ) and being involved in sedentary lifestyle > one hour a day ( 49 % ) were significantly more likely to be overweight and obese while those participating in physical activity > twice a week ( 53 % ) were significantly less likely to be overweight and obese ( all P < 0.01 ) . Skipping breakfast ( P < 0.001 ) , eating fast food and snacks ( P = 0.001 ) and sedentary lifestyle ( P < 0.001 ) showed an independent positive association with BMI while physical activity showed an independent inverse association ( P = 0.001 ) . Skipping breakfast ( aOR 1.82 , 95 % CI 1.22 - 2.71 ) , eating fast food and snacks ≥ once a week ( OR 1.41 , 95 % CI 1.07 - 1.86 ) , physical activity > twice a week ( aOR 0.49 , 95 % CI 0.34 - 0.70 ) and sedentary lifestyle > one hour a day ( aOR 1.56 , 95 % CI 1.19 - 2.03 ) were independent predictors of being overweight . Skipping breakfast had independent inverse association with physical activity ( aOR 0.63 , 95 % CI 0.45 - 0.89 ) and eating fast food and snacks had independent positive association with sedentary lifestyle ( aOR 1.79 , 95 % CI 1.49 - 2.16 ) . Female gender was independently associated with skipping breakfast ( aOR 1.50 , 95 % CI 1.04 - 2.16 ) . Male gender ( aOR 1.64 , 95 % CI 1.33 - 2.02 ) , urban area with high SES ( aOR 5.09 , 95 % CI 3.02 - 8.60 ) and higher parental education ( aOR 1.74 , 95 % CI 1.12 - 2.68 ) were significant independent predictors of eating fast food and snacks ≥ once a week . Living in the rural area was independently associated ( aOR 2.51 , 95 % CI 1.71 - 3.68 ) with physical activity > twice a week . Male gender ( aOR 1.60 , 95 % CI 1.31 - 1.95 ) , urban area with low SES ( aOR 1.46 , 95 % CI 1.02 - 2.09 ) , high-income neighborhoods ( aOR 1.52 , 95 % CI 1.02 - 2.25 ) , higher parental education ( aOR 1.55 , 95 % CI 1.03 - 2.34 ) and fewer siblings ( aOR 1.38 , 95 % CI 1.10 - 1.73 ) were independent predictors of sedentary lifestyle > one hour a day . Conclusions Dietary behaviors , physical activity and sedentary lifestyle are independent predictors of overweight  and higher BMI among Pakistani primary school children , and are significantly affected by the child 's socio-demographic characteristics . These findings support the urgent need to develop a National strategy for diet and physical activity and to implement culturally relevant behavioral interventions in the re source -poor developing country setting Adults are sedentary for an alarming 9 to 10 hours per day ( 1 ) . Accordingly , the popular press has coined the phrase sitting is the new smoking to describe a current epidemic of developed nations ( 24 ) . Evidence indicates that sedentary time is associated with incident cardiovascular disease , incidence of cardiovascular diseaserelated risk factors , and mortality ( 5 , 6 ) . Of note , the risk conferred by prolonged sedentariness is eliminated only by high levels of moderate- to vigorous-intensity physical activity ( MVPA ) ( about 60 to 75 min/d ) , which exceed physical activity recommendations ( 7 , 8) . As such , sedentary behavior is now believed to represent a clinical ly important aspect of a person 's physical activity profile and is no longer considered simply the extreme low end of the physical activity continuum ( 5 ) . Studies linking sedentary behavior to health outcomes have relied almost exclusively on self-reported  sedentary time  , which is subject to reporting bias and measurement error ( 9 ) . A 2015 systematic review ( 5 ) identified only 1 study ( NHANES [ National Health and Nutrition Examination Survey ] ) that examined the association between objective ly measured sedentary time and health outcomes , a study limited by a small event rate ( 10 ) . New studies using NHANES data have since been published , with longer follow-up and higher event rates ( 1115 ) . However , some of these studies have reported an association between objective ly measured sedentary time and mortality ( 11 , 14 , 15 ) , but others have not ( 12 , 13 ) . Additional cohort studies are thus needed to rectify evidence gaps . Furthermore , studies using accelerometers to objective ly measure sedentary behavior conventionally operationalize sedentary time as the total number of sedentary minutes per day . This approach ignores patterns of accumulated sedentary behavior over time . For example , accumulation of sedentary time in a few long bouts or many short bouts represents 2 distinct patterns of sedentary time accrual . Experimental studies have shown that acute periods of prolonged , uninterrupted sedentary behavior cause greater detrimental cardiometabolic effects than sedentary behavior that is periodically interrupted ( 1618 ) , suggestive that it is not just total sedentary time that is relevant to health outcomes , but also the manner in which it is accumulated . Few longitudinal studies , however , have explored the association between prolonged , uninterrupted sedentary behavior and mortality to corroborate these findings . To inform guidelines on reducing sedentary behavior ( target reductions in overall sedentary time or target interruption of prolonged sedentary bouts ) , evidence from prospect i ve studies is needed to 1 ) confirm the association between total sedentary time and mortality using objective measures , 2 ) determine whether prolonged sedentary bouts confer risk for death , and 3 ) eluci date whether the total volume of sedentary time and its pattern of accumulation individually or jointly contribute to risk for death . The purpose of this study , therefore , was to examine the association between objective ly measured sedentary time ( both total volume and accrual in prolonged bouts ) and all-cause mortality in a national cohort of U.S. middle-aged and older adults enrolled in the REGARDS ( Reasons for Geographic and Racial Differences in Stroke ) study . Methods Study Population REGARDS is a population -based study design ed to examine racial and regional disparities in stroke . It comprises 30239 white and black adults aged 45 years or older enrolled between 2003 and 2007 from across the contiguous United States ( 19 , 20 ) . Detailed design and methods for REGARDS are described elsewhere ( 21 ) . Briefly , demographic and cardiovascular risk factor data were collected by telephone interview and an in-home physical assessment on enrollment . A detailed summary of baseline measures is provided in the Supplement . Participants ( or their proxies ) were then followed for 6-month intervals to ascertain vital status . Objective measurements of sedentary behavior were collected from active REGARDS participants from 2009 to 2013 ( mean time from study enrollment , 5.7 years [ SD , 1.5 ] ; range , 1.9 to 9.5 years ) ( 22 ) . A total of 7985 participants adhered to accelerometer wear requirements ( 4 days with accelerometer wear 10 hours ) , provided follow-up data , and were available for the current analyses ( Supplement Figure 1 ) . Supplement Table 1 shows the characteristics of included versus excluded REGARDS participants . The REGARDS study protocol was approved by the institutional review boards of participating institutions . All participants provided informed consent . Supplement . Supplementary Material Accelerometer Data Collection Methods for accelerometer data collection are described elsewhere ( 22 ) . Briefly , participants were fitted with an Actical ( Philips Respironics ) accelerometer secured to their right hip using a nylon belt and were instructed to wear the device during waking hours for 7 consecutive days . The Actical had been vali date d formeasurement of physical activity and sedentary behavior and was shown to have acceptable reliability ( 2325 ) . Activity counts were summed over 1-minute epochs . Nonwear periods were defined as at least 150 consecutive minutes of 0 activity counts . This nonwear algorithm was previously vali date d against daily log sheets in REGARDS participants ( 26 ) . Measurements of 0 to 49 , 50 to 1064 , and at least 1065 counts per minute were defined as sedentary behavior , light-intensity physical activity , and MVPA , respectively , as determined in a laboratory-based calibration study ( 27 ) . A sedentary bout was defined as consecutive minutes in which the accelerometer registered fewer than 50 counts per minute . A sedentary break was defined as at least 1 minute in which 50 or more counts per minute were registered after a sedentary bout . Both sedentary bouts and breaks were exclusively continuous periods , with no interruptions or nonwear intervals allowed in the definition . Outcome Ascertainment All-cause mortality was the primary outcome , defined as any death after completion of the accelerometer protocol regardless of cause . Date s of death were confirmed through review of death certificates , medical records , and administrative data bases . Deaths through 4 September 2015 were included in the current analysis . Statistical Analysis Sedentary and physical activity variables were averaged across compliant days ( 10 hours of wear ) . Because of a high correlation between total sedentary time and wear time ( Supplement Figure 2 ) , we corrected for the influence of wear time by st and ardizing total sedentary time to 16 hours of wear time per day using the residuals obtained when regressing total sedentary time on wear time ( see Methods section of the Supplement ) ( 2830 ) . Participants were stratified into quartiles according to total sedentary time and , separately , mean sedentary bout duration ( a measure of overall prolonged , uninterrupted sedentary behavior ) . Cox proportional hazards regression modeling was used to calculate the hazard ratio ( HR ) for all-cause mortality associated with quartiles of total sedentary time ( and separately , mean sedentary bout length ) . Crude HRs were initially calculated . Subsequent HRs were calculated after adjustment for age , race , sex , region of residence , education , and season the accelerometer was worn ( model 1 ) , with further adjustment for current smoking , alcohol use , body mass index ( BMI ) , diabetes , hypertension , dyslipidemia , estimated glomerular filtration rate less than 60 mL/min/1.73 m2 , atrial fibrillation , history of coronary heart disease , and history of stroke ( model 2 ) . Models were additionally adjusted for MVPA expressed continuously ( model 3 ) . Tests for linear trend across quartiles were conducted by including the quartile for each participant as an ordinal variable in regression models . Proportional hazards assumptions were confirmed with a Kolmogorov-type supremum test ( 31 ) . The above analyses were then repeated in a fully adjusted model , testing interactions for age ( < 65 and 65 years ) , sex ( male and female ) , race ( black and white ) , BMI category ( normal weight and overweight or obese ) , and MVPA category ( < 150 min/wk and 150 min/wk ) . As a secondary analysis , we examined the continuous doseresponse relationship between each sedentary characteristic and all-cause mortality in a fully adjusted model ( model 3 ) using restricted cubic splines ( 32 ) . Cubic polynomials were fitted with the mean of each sedentary characteristic set as the reference and knots placed at the 5th , 35th , 65th , and 95th percentiles ( 33 ) . Nonlinear associations were evaluated using the likelihood ratio test . For nonlinear associations , spline models were used to describe the associations and when the association was determined to be linear , a linear model was used . Because of multicollinearity between total sedentary time and mean sedentary bout duration ( r= 0.61 ) , both variables were not included in the same model . Alternatively , to examine the individual and joint associations of total sedentary time and prolonged , uninterrupted sedentary behavior with mortality , participants were classified into 4 categories : low total sedentary time ( < 750 min/d ) and low prolonged sedentary bout time ( < 10 min/bout ) , low total sedentary time  and high prolonged sedentary bout time  ( 10 min/bout ) , high total sedentary time  ( 750 min/d ) and low prolonged sedentary bout time , and high total sedentary time and high prolonged sedentary bout time . Hazard ratios for all-cause mortality were calculated for each joint category in comparison with the lowlow group in a fully adjusted model ( model 3 ) . Thresholds for total sedentary time ( 750 min/d ) and mean sedentary bout duration ( 10 min/bout ) were selected on the basis of the restricted cubic splines and were confirmed using a method described by Contal and O'Quigley ( see Methods section of the Supplement ) ( 34 ) . To allow for the possibility that sedentary bouts BACKGROUND Physical activity and diet are important influences on health , but few data are available about the relationship between these two factors . The purpose of this study was to examine relationships between physical activity and  dietary quality  and to identify determinants of the combination of sedentary behavior and suboptimal diet . METHODS The design of this study was cross-sectional . The setting was a large managed-care organization and the participants were 1,322 racially diverse men and women ages 25 - 91 years . We categorized subjects ' physical activity into vigorous , moderate , and sedentary based on answers to two vali date d interviewer-administered questions about intensity and duration of specified activities . Dietary assessment was by means of a vali date d short food frequency question naire . We defined suboptimal diet as consuming unhealthful quantities of at least two of the following five food groups : fruits , vegetables , whole grain foods , whole-fat dairy foods , and red and processed meats . RESULTS Seven hundred fifty-four ( 57 % ) subjects were sedentary and 617 ( 47 % ) consumed a suboptimal diet . Using multiple linear regression , we found that sedentary individuals consumed smaller amounts of foods and nutrients considered to be healthful , such as fruits and vegetables , fiber , calcium , folate , and vitamins A , C , and E , than more active participants . For nutrients considered to be harmful , such as saturated fat , trans fat , and dietary cholesterol , the association with physical activity was inverse . In multiple logistic regression analyses , the strongest sociodemographic correlates of the joint presence of inactivity and poor diet were less education [ odds ratio for 1-year decrease 1.14 ( 95 % confidence interval 1.06 , 1.22 ) ] , nonwhite race [ 1.48 ( 1.05 , 2.07 ) ] , and nonmarried status [ 1.49 ( 1.06 , 2.10 ) ] . CONCLUSIONS  Physical activity and diet quality  are correlated behaviors . Suboptimal diet and sedentary behavior tend to cluster in individuals who are less educated , not married , and of nonwhite race . Programs that target diet and activity together , informed by their joint determinants , may attain enhanced outcomes OBJECTIVE To evaluate the short- and long-term results of FATaintPHAT , a Web-based computer-tailored intervention aim ing to increase physical activity , decrease sedentary behavior , and promote healthy eating to contribute to the prevention of excessive weight gain  among adolescents . DESIGN Cluster r and omized trial with an intervention group and a no-intervention control group . SETTING Twenty schools in the Netherl and s. PARTICIPANTS A total of 883 students ( aged 12 - 13 years ) . INTERVENTION The FATaintPHAT ( VETisnietVET in Dutch ) Web-based computer-tailored intervention . OUTCOME MEASURES Self-reported behaviors ( diet , physical activity , sedentary behavior ) and pedometer counts were measured at baseline and at 4-month and 2-year follow-up ; body mass index ( BMI ) , waist circumference , and fitness were measured at baseline and at 2-year follow-up . Descriptive and multilevel regression analyses were conducted among the total study population and among students not meeting behavioral recommendations at baseline ( students at risk ) . RESULTS The complete case analyses showed that FATaintPHAT had no effect on BMI and waist circumference . However , the intervention was associated with lower odds ( 0.54 ) of drinking more than 400 mL of sugar-sweetened beverages per day and with lower snack intake ( β = -0.81 snacks/d ) and higher vegetable intake ( β = 19.3 g/d ) but also with a lower step count ( β = -10 856 steps/wk ) at 4-month follow-up . In addition , among students at risk , FATaintPHAT had a positive effect on fruit consumption ( β = 0.39 g/d ) at 4-month follow-up and on step count ( β = 14 228 steps/wk ) at 2-year follow-up but an inverse effect on the odds of sports participation ( odds ratio , 0.45 ) at 4-month follow-up . No effects were found for sedentary behavior . CONCLUSION The FATaintPHAT intervention was associated with positive short-term effects on diet but with no effects or unfavorable effects on physical activity and sedentary behavior Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting Objective : To determine if time spent in objective ly measured sedentary behavior is associated with a change in body mass index ( BMI ) between ages 9 and 15 years , adjusting for moderate-to-vigorous physical activity ( MVPA ) . Design : Prospect i ve observational study of children at ages 9 ( 2000 ) , 11 ( 2002 ) , 12 ( 2003 ) and 15 years ( 2006 ) .  Longitudinal quantile regression was used to model the influence of predictors on changes at the 10th , 25th , 50th , 75th and 90th BMI percentiles over time . Subjects : Participants were enrolled in the National Institute of Child Health and Human Development ( NICHD ) Study of Early Child Care and Youth Development and include both boys and girls ( n=789 ) . Measurements : Objective ly measured BMI ( kg m–2 ) was the outcome variable and objective ly measured sedentary behavior was the main predictor . Adjustment was also made for MVPA , gender , race , maternal education , hours of sleep and healthy eating index . Results : Increases in BMI were observed at all percentiles , with the greatest increase observed at the 90th BMI percentile . Spending more time in sedentary behavior  ( h per day ) was associated with additional increases in BMI at the 90th , 75th and 50th BMI percentiles , independent of MVPA and the other covariates ( 90th percentile=0.59 , 95 % confidence interval ( 95 % CI ) : 0.19–0.98 kg m–2 ; 75th percentile=0.48 , 95 % CI : 0.25–0.72 kg m–2 ; and 50th percentile=0.19 , 95 % CI : 0.05–0.33 kg m–2 ) . No associations were observed between sedentary behavior and changes at the 25th and 10th BMI percentiles . Conclusion : Sedentary behavior was associated with greater increases in BMI at the 90th , 75th and 50th BMI percentiles between ages 9 and 15 years , independent of MVPA . Preventing an increase in sedentary behavior from childhood to adolescence may contribute to reducing the number of children classified as obese OBJECTIVE Examine the association between sedentary behavior and psychiatric symptoms among overweight and obese adults with schizophrenia or schizoaffective disorders ( SZO/SA ) . DESIGN R and omized clinical trial ; Weight Assessment and Intervention in Schizophrenia Treatment ( WAIST ) Study : baseline data collected 2005 - 2008 . SETTING University of Pittsburgh Medical Center , Pittsburgh , PA , USA . PARTICIPANTS Community-dwelling adults diagnosed with SZO/SA , with mild symptom severity [ Positive and Negative Syndrome Scale (PANSS)<90 ] , who were interested in losing weight , age 18 - 70years , BMI > 27kg/m(2 ) . MEASUREMENTS Objective ly measured  sedentary behavior by accelerometry , and  psychopathology  assessed by PANSS . Participants wore the actigraphs for 7 consecutive days during their waking hours . Sedentary behavior was defined as ≤100 counts per minute during wear-time and excluded sleep and non-wear time . RESULTS On average , 81 % of the participant 's monitoring time or 756min/day was classified as sedentary behavior using accelerometry . No association was observed between sedentary behaviors and PANSS psychiatric symptoms [ total ( p≥0.75 ) , positive ( p≥0.81 ) , negative ( p≥0.59 ) and general psychopathology ( p≥0.65 ) subscales ] . No association was observed between sedentary behaviors and age , race , gender and BMI . CONCLUSION From a clinical and public health perspective , the amount of time ( approximately 13h ) and percentage of time ( 81 % excluding non-wear time associated with sleeping ) engaged in sedentary behavior among overweight and obese adults in this population is alarming , and points to an urgent need for interventions to decrease sedentary behaviors . The lack of associations between sedentary behavior and psychiatric symptoms may be due to a ceiling effect for sedentary behavior Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity Objective To evaluate the effectiveness of a draft occupational health practice guideline aim ed at preventing weight gain on employees ' physical activity , sedentary behaviour and dietary behaviour and on body weight-related outcomes . Methods A r and omised controlled trial was performed comparing guideline -based care to usual care among 16 occupational physicians and 523 employees in the Netherl and s between 2009 and 2011 . Occupational physicians in the intervention group followed the draft guideline by providing advice to employers on how to assess and intervene on the obesogenic work environment and conducted five face-to-face behavioural change counselling sessions with employees to improve their lifestyle . Data of employees were collected by question naire and physical measurements at baseline and 6-months follow-up . Linear and logistic regression analyses were performed to determine effects . Results The intervention showed significant effects on sedentary behaviour at work ( β −28 min/day , 95 % CI −2 to −54 ) and on fruit intake ( β 2.1 pieces/week ; 95 % CI 0.6 to 3.6 ) . No significant intervention effects were found for physical activity , sedentary behaviour in leisure time or during weekend days , snack intake and body weight-related outcomes . Conclusion Guideline -based care result ed in a more favourable sedentary behaviour at work and increased fruit intake but did not improve employees '  physical activity , snack intake or body weight-related outcomes . Trial registration number IS RCT N/73545254 and NTR/1190 Background : Youth may choose to be sedentary rather than physically active . Purpose : The purpose of this study was to use behavioral economics methods to investigate how experimental changes in the amount of sedentary behaviors influenced physical activity . Methods : Fifty-eight 8-to 16-year-old youth were studied in a within-subject crossover design with three 3-week phases : baseline , increasing , and decreasing targeted sedentary behaviors by 25 % to 50 % . Results : At baseline , boys were more active than girls ( 518.9 vs. 401.2 accelerometer counts/min , p = .02 ) , and obese youth more sedentary than nonobese youth ( 240.5 vs. 174.4 min/day , p = .003 ) . During the increase sedentary behavior phase , targeted sedentary behaviors increased by 52.1 % , with girls increasing sedentary behaviors more than boys ( 114.7 vs. 79.8 min/day , p = .04 ) . Physical activity decreased ( −48.3 counts/min , p < .01 ) when sedentary behaviors increased , with obese youth decreasing total and moderate to vigorous physical activity ( MVPA ) more than nonobese youth ( −110.4 vs. 8.9 counts/min , p < .001 ; −3.3 vs. −.03%MVPA , p = .013 ) . During the decrease sedentary behavior phase , targeted sedentary behaviors decreased by 55.6 % from baseline as nonobese youth increased physical activity , whereas obese youth decreased physical activity ( 55.8 vs. −48.0 counts/min , p = .042 ; 1.1 vs. −2.1 % MVPA , p = .021 ) . Youth who substituted physical activity when sedentary behaviors were increased had greater st and ardized body mass index ( z-body mass index = 1.4 vs. 0.4 , p = .018 ) , whereas youth who substituted physical activity when sedentary behaviors were decreased were less active at baseline ( 396.1 vs. 513.7 counts/min , p = .035 ) . Conclusions : Behavioral economics provides a methodology to underst and changes in physical activity when sedentary behaviors are modified and to identify factors associated with substitution of physically active for sedentary behaviors The purpose s of this study were to : 1 ) describe the patterns of screen-based sedentary behaviors  , and 2 ) examine the association between  screen-based sedentary behavior and cardiovascular disease ( CVD ) risk factors in representative Korean children and adolescents , aged 12 to 18 yr , in the Korean National Health and Nutrition Examination Survey .  Screen-based sedentary behavior  was measured using self-report question naires that included items for time spent watching TV and playing PC/video games . Physical activity  was measured using items for frequency and duration of moderate-to-vigorous physical activity ( MVPA )  . CVD risk factors such as body mass index ( BMI ) , waist circumference , LDL cholesterol , HDL cholesterol , total cholesterol , triglycerides , glucose , systolic blood pressure , and diastolic blood pressure were measured . Boys spent more time playing PC/video games , and girls spent more time watching TV . After adjusting for age , gender , annual household income , and MVPA , an additional hour of watching TV was significantly associated with the risk of overweight ( OR 1.17 [ 95 % CI 1.03 - 1.33 ] ) , high abdominal adiposity ( OR 1.27 [ 1.06 - 1.51 ] ) , and low HDL cholesterol ( OR 1.27 [ 1.10 - 1.47 ] ) . An additional hour spent playing PC/video games  also increased the risk of high abdominal adiposity ( OR 1.20 [ 1.03 - 1.40 ] ) . Prospect i ve observations and interventions are needed to determine causal relationships between  screen-based sedentary behavior  and CVD risk profiles in Korean youth Background Few lifestyle factors have been simultaneously studied and reported for Saudi adolescents . Therefore , the purpose of the present study was to report on the prevalence of physical activity , sedentary behaviors and dietary habits among Saudi adolescents and to examine the interrelationships among these factors using representative sample s drawn from three major cities in Saudi Arabia . Methods This school-based cross-sectional study was conducted during the years 2009 - 2010 in three cities : Al-Khobar , Jeddah and Riyadh . The participants were 2908 secondary -school males ( 1401 ) and females ( 1507 ) aged 14 - 19 years , r and omly selected using a multistage stratified sampling technique . Measurements included weight , height , sedentary behaviors (  TV viewing  , playing video games and computer use ) , physical activity using a vali date d question naire and dietary habits . Results A very high proportion ( 84 % for males and 91.2 % for females ) of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines . The majority of adolescents did not have a daily intake of breakfast , fruit , vegetables and milk . Females were significantly ( p < 0.05 ) more sedentary , much less physically active , especially with vigorous physical activity , and there were fewer days per week when they consumed breakfast , fruit , milk and diary products , sugar-sweetened drinks , fast foods and energy drinks than did males . However , the females ' intake of  French fries and potato chips , cakes and donuts , and c and y and chocolate was significantly ( p < 0.05 ) higher than the males ' . Screen time was significantly ( p < 0.05 ) correlated inversely with the intake of breakfast , vegetables and fruit .  Physical activity had a significant ( p < 0.05 ) positive relationship with fruit and vegetable intake but not with sedentary behaviors . Conclusions The high prevalence of sedentary behaviors , physical inactivity and unhealthy dietary habits among Saudi adolescents is a major public health concern . There is an urgent need for national policy promoting active living and healthy eating and reducing sedentary behaviors among children and adolescents in Saudi Arabia Objectives It is unclear whether sedentary behaviour , and the domain in which it occurs , is related to  body mass index ( BMI ) change . We aim to eluci date whether sedentary behaviour is prospect ively related to BMI change using markers from three domains ( leisure , work and commuting ) . Methods Among employed 1958 British birth cohort members ( n = 6,562 ) , we analysed whether TV-viewing , work sitting ( six categories : 0 h/d to > 4 h/d ) and motorised commuting ( at 45 y ) were related to BMI ( at 45 y and 50 y ) and BMI change 45–50 y , after adjusting for lifestyle and socioeconomic factors . Results Per category higher TV-viewing , 45 y and 50 y BMI were higher by 0.69 kg/m2 ( 95 % CI : 0.59,0.80 ) and 0.75 kg/m2 ( 0.64,0.86 ) respectively . A category higher TV-viewing was associated with 0.11 kg/m2 ( 0.06,0.17 ) increased BMI 45–50 y , attenuating to 0.06 kg/m2 ( 0.01,0.12 ) after adjustment . There was no trend for work sitting  with 45 y or 50 y BMI , nor , after adjustment , for BMI change . However , those sitting 2–3 h/d had greater BMI gain by 0.33 kg/m2 ( 0.10,0.56 ) compared to those sitting 0–1 h/d . Associations between TV-viewing and BMI change were independent of work sitting . Motorised commuting was associated with 45 y , but not 50 y BMI or change . Conclusions TV-viewing is associated with BMI gain in mid-adulthood ; evidence is weaker for other sedentary behaviours The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight
Sedentary behaviour continues to be associated with unhealthy diet in young people in mostly cross-sectional studies .
BACKGROUND Sedentary behaviour and its association with dietary intake in young people and adults are important topics and were systematic ally review ed in 2011 .
There is a need to up date this evidence given the changing nature of sedentary behaviour and continued interest in this field .
This review aims to assist research ers in better interpreting the diversity of findings concerning sedentary behaviour and weight status .
OBJECTIVE To provide an up date of the associations between sedentary behaviour and dietary intake across the lifespan .