Bozhi Chen1, Jonathan Y Bernard2, Natarajan Padmapriya3, Yilin Ning4, Shirong Cai5, Carla Lança6, Kok Hian Tan7, Fabian Yap8, Yap-Seng Chong5, Lynette Shek9, Keith M Godfrey10, Seang Mei Saw1, Shiao-Yng Chan5, Johan G Eriksson11, Chuen Seng Tan1, Falk Müller-Riemenschneider12. 1. Saw Swee Hock School of Public Health, National University of Singapore, Singapore. 2. Centre for Research in Epidemiology and Statistics (CRESS), Université de Paris, National Institute of Health and Medical Research, Paris, France; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. 3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Departments of Obstetrics and Gynaecology, National University of Singapore, Singapore. 4. Department of Surgery, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, and National University of Singapore Graduate School of Integrative Science and Engineering, National University of Singapore, Singapore. 5. Departments of Obstetrics and Gynaecology, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. 6. Singapore Eye Research Institute, Singapore. 7. Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore. 8. Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. 9. Departments of Obstetrics and Gynaecology, National University of Singapore, Singapore; Department of Paediatrics, National University of Singapore, Singapore; Division of Paediatric Allergy, Immunology and Rheumatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore. 10. Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. 11. Departments of Obstetrics and Gynaecology, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Folkhalsan Research Center, Helsinki, Finland. 12. Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany. Electronic address: ephmf@nus.edu.sg.
Abstract
BACKGROUND: Screen viewing is a sedentary behaviour reported to interfere with sleep and physical activity. However, few longitudinal studies have assessed such associations in children of preschool age (0-6 years) and none have accounted for the compositional nature of these behaviours. We aimed to investigate the associations between total and device-specific screen viewing time at age 2-3 years and accelerometer-measured 24 h movement behaviours, including sleep, sedentary behaviour, light physical activity, and moderate-to-vigorous physical activity (MVPA) at age 5·5 years. METHODS: The Growing Up in Singapore Towards healthy Outcomes (GUSTO) study is an ongoing longitudinal birth cohort study in Singapore, which began in June 2009. We recruited pregnant women during their first ultrasound scan visit at two major public maternity units in Singapore. At clinic visits done at age 2-3 years, we collected parent-reported information about children's daily total and device-specific screen viewing time (television, handheld devices, and computers). At 5·5 years, children's movement behaviours for 7 consecutive days were measured using wrist-worn accelerometers. We assessed the associations between screen viewing time and movement behaviours (sedentary behaviour, light physical activity, MVPA, and sleep) using Dirichlet regression, which accounts for the compositional nature of such behaviours. This study is active but not recruiting and is registered with ClinicalTrials.gov, NCT01174875. FINDINGS: Between June 1, 2009, and Oct 12, 2010, 1247 pregnant women enrolled and 1171 singleton births were enrolled. 987 children had parent-reported screen data at either 2 or 3 years, of whom 840 attended the clinic visit at age 5·5 years, and 577 wore an accelerometer. 552 children had at least 3 days of accelerometer data and were included in the analysis. Total screen viewing time at age 2-3 years had a significant negative association with sleep (p=0·008), light physical activity (p<0·0001), and MVPA (p<0·0001) in relation to sedentary behaviour at age 5·5 years. Compared with children who spent 1 h or less per day screen viewing at age 2-3 years, children who screen viewed for 3 h or more per day at 2-3 years engaged in more sedentary behaviour (439·8 mins per day [≤1 h screen viewing time] vs 480·0 mins per day [≥3 h screen viewing time]), and less light physical activity (384·6 vs 356·2 mins per day), and MVPA (76·2 vs 63·4 mins per day) at age 5·5 years. No significant differences in time spent sleeping were observed between the groups (539·5 vs 540·4 mins per day). Similar trends were observed for television viewing and handheld device viewing. INTERPRETATION: Longer screen viewing time in children aged 2-3 years was associated with more time spent engaged in sedentary behaviour and shorter time engaged in light physical activity and MVPA in later childhood. Our findings indicate that screen viewing might displace physical activity during early childhood, and suggest that reducing screen viewing time in early childhood might promote healthier behaviours and associated outcomes later in life. FUNDING: Singapore National Research Foundation, and Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR).
BACKGROUND: Screen viewing is a sedentary behaviour reported to interfere with sleep and physical activity. However, few longitudinal studies have assessed such associations in children of preschool age (0-6 years) and none have accounted for the compositional nature of these behaviours. We aimed to investigate the associations between total and device-specific screen viewing time at age 2-3 years and accelerometer-measured 24 h movement behaviours, including sleep, sedentary behaviour, light physical activity, and moderate-to-vigorous physical activity (MVPA) at age 5·5 years. METHODS: The Growing Up in Singapore Towards healthy Outcomes (GUSTO) study is an ongoing longitudinal birth cohort study in Singapore, which began in June 2009. We recruited pregnant women during their first ultrasound scan visit at two major public maternity units in Singapore. At clinic visits done at age 2-3 years, we collected parent-reported information about children's daily total and device-specific screen viewing time (television, handheld devices, and computers). At 5·5 years, children's movement behaviours for 7 consecutive days were measured using wrist-worn accelerometers. We assessed the associations between screen viewing time and movement behaviours (sedentary behaviour, light physical activity, MVPA, and sleep) using Dirichlet regression, which accounts for the compositional nature of such behaviours. This study is active but not recruiting and is registered with ClinicalTrials.gov, NCT01174875. FINDINGS: Between June 1, 2009, and Oct 12, 2010, 1247 pregnant women enrolled and 1171 singleton births were enrolled. 987 children had parent-reported screen data at either 2 or 3 years, of whom 840 attended the clinic visit at age 5·5 years, and 577 wore an accelerometer. 552 children had at least 3 days of accelerometer data and were included in the analysis. Total screen viewing time at age 2-3 years had a significant negative association with sleep (p=0·008), light physical activity (p<0·0001), and MVPA (p<0·0001) in relation to sedentary behaviour at age 5·5 years. Compared with children who spent 1 h or less per day screen viewing at age 2-3 years, children who screen viewed for 3 h or more per day at 2-3 years engaged in more sedentary behaviour (439·8 mins per day [≤1 h screen viewing time] vs 480·0 mins per day [≥3 h screen viewing time]), and less light physical activity (384·6 vs 356·2 mins per day), and MVPA (76·2 vs 63·4 mins per day) at age 5·5 years. No significant differences in time spent sleeping were observed between the groups (539·5 vs 540·4 mins per day). Similar trends were observed for television viewing and handheld device viewing. INTERPRETATION: Longer screen viewing time in children aged 2-3 years was associated with more time spent engaged in sedentary behaviour and shorter time engaged in light physical activity and MVPA in later childhood. Our findings indicate that screen viewing might displace physical activity during early childhood, and suggest that reducing screen viewing time in early childhood might promote healthier behaviours and associated outcomes later in life. FUNDING: Singapore National Research Foundation, and Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR).
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