Adulthood TV Viewing Relates Independently to Cardiometabolic Risk Profile in Early Middle Age.
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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

Emmanuel Stamatakis,1 Mark Hamer,1Gita Mishra1

1University College London

Department of Epidemiology & Public Health, London, UK


? Cardiometabolic Risk Profile in Early Middle Age.


? Cardiometabolic Risk Profile in Early Middle Age.


Sedentary behaviour as an independent risk marker
Sedentary behaviour as an “independent” risk marker: Cardiometabolic Risk Profile in Early Middle Age.


Sedentary behaviour as an independent risk marker1
Sedentary behaviour as an “independent” risk marker: Cardiometabolic Risk Profile in Early Middle Age.

Even if you do “enough” of this...


Sedentary behaviour as an independent risk marker2
Sedentary behaviour as an “independent” risk marker: Cardiometabolic Risk Profile in Early Middle Age.

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

Even if you do “enough” of this...


Study aims
Study aims Cardiometabolic Risk Profile in Early Middle Age.

  • 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?


Data source the 1958 british birth cohort
Data source: the 1958 British birth cohort Cardiometabolic Risk Profile in Early Middle Age.


Data source the 1958 british birth cohort1
Data source: the 1958 British birth cohort Cardiometabolic Risk Profile in Early Middle Age.


Study design
Study Design Cardiometabolic Risk Profile in Early Middle Age.:

1981

(age 23yrs)


Study design1
Study Design Cardiometabolic Risk Profile in Early Middle Age.:

1981

(age 23yrs)

Exposure

Weekly TV Frequency


Study design2

2002 Cardiometabolic Risk Profile in Early Middle Age.

(age 44yrs)

Study Design:

1981

(age 23yrs)

Exposure

Weekly TV Frequency


Study design3

2002 Cardiometabolic Risk Profile in Early Middle Age.

[N=9,377]

Study Design:

Outcomes

  • 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

Exposure

Weekly TV Frequency


Study design4

2002 Cardiometabolic Risk Profile in Early Middle Age.

[N=9,377]

Study Design:

Outcomes

  • 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

Exposure

Weekly TV Frequency

?


Study design5

2002 Cardiometabolic Risk Profile in Early Middle Age.

[N=9,377]

Study Design:

Outcomes

  • 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

Exposure

Weekly TV Frequency

Covariable

  • Weekly exercise frequency

  • Social class

Covariables

  • Daily TV time

  • Daily physical activity time (EPAQ2)

  • CVD medication

  • Smoking *

  • Alcohol intake

  • Social class*


Study design6

2002 Cardiometabolic Risk Profile in Early Middle Age.

[N=9,377]

Study Design:

Outcomes

  • 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

Exposure

Weekly TV Frequency

Covariables

  • Weekly exercise frequency

  • Social class

N=5,629

Covariables

  • Daily TV time

  • Daily physical activity time (EPAQ2)

  • CVD medication

  • Smoking *

  • Alcohol intake

  • Social class*


Study design7

2002 Cardiometabolic Risk Profile in Early Middle Age.

[N=9,377]

Study Design:

Outcomes

  • 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

1981

Exposure

Weekly TV Frequency

Covariables

  • Weekly exercise frequency

  • Social class

N=5,629

Covariables

  • Daily TV time

  • Daily physical activity time (EPAQ2)

  • CVD medication

  • Smoking *

  • Alcohol intake

  • Social class*


Factor analysis components
FACTOR ANALYSIS* COMPONENTS: Cardiometabolic Risk Profile in Early Middle Age.

  • 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


Factor analysis components1
FACTOR ANALYSIS* COMPONENTS: Cardiometabolic Risk Profile in Early Middle Age.

  • 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

Metabolic

*Principal Component Analysis; factor loading criterion: ≥ 0.35


Factor analysis components2
FACTOR ANALYSIS* COMPONENTS: Cardiometabolic Risk Profile in Early Middle Age.

  • 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

Metabolic

Haemostatic/inflammatory

*Principal Component Analysis; factor loading criterion: ≥ 0.35


Factor analysis components3
FACTOR ANALYSIS Cardiometabolic Risk Profile in Early Middle Age.* 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

Metabolic

Haemostatic/inflammatory

Cholesterol component

*Principal Component Analysis; factor loading criterion: ≥ 0.35


Factor analysis components4
FACTOR ANALYSIS COMPONENTS: Cardiometabolic Risk Profile in Early Middle Age.

  • 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

Metabolic

Haemostatic/inflammatory

Cholesterol component

Not fitting in any component

EXCLUDED:

-Glycated haemoglobin

-Insulin Growth Factor 1

-Resting Heart Rate


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

Adjusted for: sex


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

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


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

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


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

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


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

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


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

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


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

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


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

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


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

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


Results: TV at 23yrs Cardiometabolic Risk Profile in Early Middle Age. Risk factor components at 44yrs

N.S.

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


Sensitivity analysis active 1 participants n 1228
Sensitivity analysis Cardiometabolic Risk Profile in Early Middle Age.: active1participants (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
Sensitivity analysis Cardiometabolic Risk Profile in Early Middle Age.: Non-overweight at baseline (23yrs)(N=4783)


Sensitivity analysis overweight at baseline 23yrs n 772
Sensitivity analysis Cardiometabolic Risk Profile in Early Middle Age.: Overweight at baseline (23yrs)(N=772)


Study limitations
Study limitations Cardiometabolic Risk Profile in Early Middle Age.

  • 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. ClelandVJ, et al. Am J ClinNutr2008; 87,:1148-55]

  • TV is only a partial (i.e. incomplete) indicator of sedentary behaviour

  • Self-reported physical activity measures


Does tv frequency at 23yrs predict tv time at 44yrs
Does TV frequency at 23yrs predict TV time at 44yrs? Cardiometabolic Risk Profile in Early Middle Age.


Conclusions
Conclusions Cardiometabolic Risk Profile in Early Middle Age.

  • 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?


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]


Acknowledgments funding
Acknowledgments & Funding the association between TV & other screen-based entertainment time and CVD fatal/nonfatal events.

  • 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


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