Senin, 17 Agustus 2015

EVIDENCE-BASED MEDICAL PRACTICE

 Association between Duration of Watching Television and Obesity in Children

CHAPTER I
BACKGROUND
In this era, the concern about nutrition problem in children not only talk about the malnutrition but also in the over-nutrition.  This over-nutrition problem cause an obesity trend in children. There are several factors that can cause childhood obesity, such as daily diet, lack of physical activity, and genetic factor.[1] Most research only focused in the unbalanced food consumption as the risk factor of obesity. Thus, there is not much observation that discuss about the modern children lifestyle.
            One of the modern children lifestyle to be discussed is watching television (TV). The habit of watching TV for a long time can cause side effects for the child.[2]  These effects affect the both the physic and psychology of the children directly or indirectly. Watching TV in a long time limits the physical activity of the children. The time that is supposed to be used for outdoor activities is allocated into watching TV. It is accounted that a long time in TV viewing is closely related to the increase of Body Mass Index (BMI). Eating snacks while watching the TV also contributes to the increase of calorie intake. The increase of calorie intake that is not balanced with appropriate physical activity will cause fat accumulation in the child’s body.[3]
Obesity is one of the more widely discussed examples of television’s negative health consequences. There is extensive literature on associations between television viewing habitsand childhood obesity, including observational studies with cross-sectional and prospective designs.[2] Some studies have already done in some countries, such as Saudi Arabia and European, with the aim to examine the association between the television viewing habits and obesity in the children of school-age. The studies are given with the case-control design, with the data taken by questionnaires. The children selected for the data are mostly aged between 2-14 years, and the study considered some aspects such as children’s habitual television exposure time, television during meals, and having television in their bedrooms. All studies brought out the same result, that watching TV represents an important risk factor for obesity in children with school-age.



CHAPTER II
CONTENT
2.1 Method
Our objective was to assess association of television habit in relation to Obesity and overweight in children. To do this, We searched journals about the topic. We performed a literature search on PubMed and JFConline on May 2014. We use the following keywords: Children,Obesity,and television. We also use other relevant articles to help us understand more about this topic.
Journal have PICO design below
            P = Children
            I = Duration Viewing Television
            C = Watching television less than 1-2 h/day
            O = Obesity and overweight
The Journals Publish between 2010 until 2015, Abstracts of each journal were assessed for applicability and suitability with our topic. We do the critical appraisal for know the Validity , Importance and Applicability (VIA) of the journal.  There’s three journal we used for this topic
1.        Braithwaite, Irene et al. The Worldwide Association Between Televison Viewing And obesity in Children and Adolescents : Cross Sectional Study’ PloS ONE 8.9 (2013)
In this paper , the researcher focus on reported time spent viewing television relationship to their BMI. The researcher use Environmental Questionnaire /ER (available on webside isaac.auckland.ac.nz) . The EQ included question on height and weight reported by parents for the children. The model of the paper is cross sectional with any criteria (exclusion and inclusion) to minimize the bias. BMI was assessed separately for each age group using a general linear mixed model with centre as a random effect and age, sex,television watching and measurement type as fixed effects.

2.        Lauren Lissner et al. Eur J Epidemiol (2012) 27:705–715. Television habits in relation to overweight, diet and taste preferences in European children: the IDEFICS study

This report is based on data from the IDEFICS, is a multi-center cohort and intervention study with a focus on diet-related health outcomes. Participants were between 2 and 9 years old and recruited via their daycare centers or schools. The examination protocol included a detailed questionnaire in which parents and physical examination of all children. During the baseline survey, 16,864 children were examine, 16,220 met basic inclusion criteria of complete information and repeat after 2 years.
The researcher was collected data of weight and height to calculate BMI,  television viewing habits, dietary habits of high-fat and sweet foods and beverages. They also included parental education as a covariate and do taste preference tests. For analysis, logistic models were used to calculate prevalence odds ratios for overweight and logistic regression was used to describe odds of each television habit in relation to fat or sweet propensity after adjustment for age, sex, socioeconomic status and survey country studied. Prevalence odds ratios (OR) are reported with 95 % confidence intervals. Analyses and figures were done with the Statistical Analysis System, SAS, version 9.2.

3.        Sameer H. AlGhamdi. The association between watching television and obesity in children of schoolage in Saudi Arabia

In this journal the author use case control study and was performed to the students between nine and 14 years of age who attendded a school health clinic. The case were children that have obese, and the control were non-obese, but if there secondary cases to medical illnesses or chronic drug use were excluded. Then the data collection method, the estimation of sample size was based on the prevalence of exccessive watching of TV of children. The study was conducted by enrolling children who made unscheduled visits to the school health clinic. The data information which collected were demographic data, TV watching, physical activity, meals, and anthropometric measurements. For antropometric measurements of weight andd height a well trained nurses were collected and for all study participants was calculated with Body mass index (BMI), which is weight in kilograms divided by height in meters squared (kg/m2).



2.2 Result
According to journal “The Worldwide Association between Television Viewing and Obesity in Children and Adolescents: Cross Sectional Study”, there was a significant positive association between higher levels of television watching and BMI (p<0.0001)with an apparent dose response effect.
In this journal shows estimated BMI (SE) in kg/m2 for short television viewing and the increase in BMI (SE) for each television viewing category by age and sex. In the adolescent females, data were available for 104,712 adolescent females. The mean BMIs in the short viewing category were 18.9, 19.1, 19.6 and 20.0 kg/m2 for ages 12, 13, 14 and 15 respectively. In the female children, data were available for 38,272 female children. The mean BMIs in the short viewing category were 15.3, 15.3, 15.6 and 15.8 kg/m2 for ages 5, 6, 7 and 8 respectively. In male children, data were available for 38,731 male children. The mean BMIs in the short viewing category were 15.9, 15.6, 15.9 and 16.0 kg/m2 for ages 5, 6, 7 and 8 respectively. After controlling for centre, age, and measurement type, there was a positive association between higher levels of television watching and BMI (p<0.0001) with an apparent dose response effect. Relative risks and confidence intervals by sex in each age group for overweight or obesity in each television viewing category relative to the short television viewing category are shown in table 2.
There are similar result in other design study. One of them is an journal entitled “Television habits in relation to overweight, diet and taste preferences in European children: the IDEFICS study”, television were significantly related to increased odds for overweight. Eating while watching television was significantly associated with overweight, with prevalence odds ratios of 1.20 (95 % CI 1.04–1.40) for boys and 1.35 (95 %CI 1.17–1.55) for girls in fully adjusted models. Having a television in the bed- room showed similar associations: OR 1.39 (1.19–1.61) in boys and 1.23 (1.06–1.42) in girls. Finally, watching 60 min a day or more on weekdays and/or weekends was associated with overweight to a similar degree in both sexes: OR 1.20 (1.05–1.38) in boys and OR 1.21 (1.06–1.38) in girls. These estimates were all derived from statistical models that adjusted for age, survey country, parental education, dietary propensities, parental reports of physical activity, and the other two television variables. However, there is no independent associations between high-risk TV behaviors and taste preferences per se (data not shown).
            Beside European there is other design study that conduct in other region that had some similar result about relation watching television and obesity. According to journal “The association between watching television and obesity in children of school age in Saudi Arabia”, obesity was significantly associated with the number of TVs available at home. Of the students who had more than three TVs at home, 83.6% were obese compared to only 33.3% of students with only one TV at home (P=0.001). Children who watched TV late at night were more likely to be obese than those who watched television at other times (P=0.026). There was no significant association between a history of eating while watching TV and obesity (P=0.893).
In the logistic analysis, as the child’s age decreased by one year, there was a 32% reduction in obesity (OR=0.68, P=0.003). The presence of only one TV at home was associated with a 42% reduction in the risk of childhood obesity (OR=0.58, P<0.001). The child`s personal ownership of TV was associated with an increased risk of childhood obesity (OR=1.75, P=0.002). As the number of hours of watching TV at weekends decreased by one hour, there was a 19% reduction in the risk of obesity (OR=0.81,P=0.009)
2.3 Association watching television and obesity in children
All journals that are included in this review stated that watching television in long hours every day increase the risk of obesity. This result is obtained by comparing patient’s BMI to hours spent on television every day.
According to journal, “Television habits in relation to overweight, diet and taste preferences in European children: the IDEFICS study”, it did a research using young European children as sample to determine the relationship of weight status and propensity of types of foods consumed to the risk of getting obesity. Increasing of viewing television(TV) time, having TV in bedrooms and having meals while watching TV will increase the risk of overweight in young children.
This imply that taste preferences and TV habits may be independent determinants of weight status in children. For instance, despite standardization of the food frequency questions and some confirmation of their validity and reliability the representativeness of the food frequencies vis-a-vis children’s whole diets may vary due to differences in school meal practices in the different survey settings. It is possible that complex reporting errors are distorting the role of diet as a mediating factor in the TV-overweight association. In this context, an important source of error derives from the fact that all television viewing and dietary data are by necessity reported by parents or guardians of these young children; in addition to being imprecise, these estimates may be influenced by desire to report healthy habits
In journal, “The association between watching television and obesity in children of schoolage in Saudi Arabia,” watching television during childhood is associated with an increased BMI. In this study, watching TV for more than three hours per day, especially over the weekend, was significantly associated with childhood obesity. However, the evidence suggests that a reduction in the watching of TV could significantly reduce the prevalence of obesity..
There is other design study that show the similar result. Based on journal, “The Worldwide Association between Television Viewing and Obesity in Children and Adolescents: Cross Sectional Study” there was a positive association between longer periods of television viewing and BMI in both adolescents and children worldwide. There was a dose response effect in both age groups. There was a 10 to 27% increased risk of overweight or obesity in adolescents and children watching 1–3 hours of television per day, with adolescent females having a 45% increased risk when watching more than 5 hours of television per day. The strength of these associations are consistent with those found in previous studies. The associations are consistent with longitudinal studies that demonstrate a temporal sequence between television viewing and the development of overweight and also with intervention research that shows that reducing viewing time can slow the increase in BMI in adolescence.


CHAPTER III
CONCLUSION
Several genetic and lifestyle factors have been recognized to induce obesity, sedentary behaviors, including watching TV, have attracted a great deal of attention as potential risk factors for obesity since any child can be sedentary. Duration of watching television and obesity in children appear strong relation in many design of study whether cross sectional, case control or cohort and other present results support the widely held assumption that television plays a role in childhood obesity, while underscoring the complex and multifactorial nature  of  the  problem.



REFERENCES
1.      Braithwaite, I., Stewart, A. W., Hancox, R. J., Beasley, R., Murphy, R., & Mitchell, E. a. (2013). The Worldwide Association between Television Viewing and Obesity in Children and Adolescents: Cross Sectional Study. PLoS ONE, 8(9). http://doi.org/10.1371/journal.pone.0074263
2.      Lissner, L., Lanfer, A., Gwozdz, W., Olafsdottir, S., Eiben, G., Moreno, L. a., … Reisch, L. (2012). Television habits in relation to overweight, diet and taste preferences in European children: The IDEFICS study. European Journal of Epidemiology, 27(9), 705–715. http://doi.org/10.1007/s10654-012-9718-2
3.      Al-Ghamdi, S. H. (2013). The association between watching television and obesity in children of school-age in Saudi Arabia. Journal of Family & Community Medicine, 20(2), 83–9. http://doi.org/10.4103/2230-8229.114767




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