Understanding How Much TV is Too Much: A Nonlinear Analysis of the Association Between Television Viewing Time and Adverse Health Outcomes

Abstract

Objective: To inform potential guideline development, we investigated nonlinear associations between television viewing time (TV time) and adverse health outcomes. Methods: From 2006 to 2010, 490,966 UK Biobank participants, aged 37 to 73 years, were recruited. They were followed from 2006 to 2018. Nonlinear associations between self-reported TV time (hours per day) and outcomes explored using penalized cubic splines in Cox proportional hazards adjusted for demographics and lifestyle. Population-attributable and potential impact fractions were calculated to contextualize population-level health outcomes associated with different TV time levels. Nonlinear isotemporal substitution analyses were used to investigate substituting TV time with alternative activities. Primary outcomes were mortality: all-cause, cardiovascular disease (CVD) and cancer; incidence: CVD and cancer; secondary outcomes were incident myocardial infarction, stroke, and heart failure and colon, lung, breast, and prostate cancer. Results: Those with noncommunicable disease (109,867 [22.4%]), CVD (32,243 [6.6%]), and cancer (37,81 [7.7%]) at baseline were excluded from all-cause mortality, CVD, and cancer analyses, respectively. After 7.0 years (mortality) and 6.2 years (disease incidence) mean follow-up, there were 10,306 (2.7%) deaths, 24,388 (5.3%) CVD events, and 39,121 (8.7%) cancer events. Associations between TV time and all-cause and CVD mortality were curvilinear (Pnon-linear <=.003), with lowest risk observed <2 hours per day. Theoretically, 8.64% (95% confidence interval [CI], 6.60-10.73) of CVD mortality is attributable to TV time. Limiting TV time to 2 hours per day might have prevented, or at least delayed, 7.97% (95% CI, 5.54-10.70) of CVD deaths. Substituting TV time with sleeping, walking, or moderate or vigorous physical activity was associated with reduced risk for all outcomes when baseline levels of substitute activities were low. Conclusion: TV time is associated with numerous adverse health outcomes. Future guidelines could suggest limiting TV time to less than 2 hours per day to reduce most of the associated adverse health events. (C) 2020 Mayo Foundation for Medical Education and Research

Objective: To inform potential guideline development, we investigated nonlinear associations between television viewing time (TV time) and adverse health outcomes. Methods: From 2006 to 2010, 490,966 UK Biobank participants, aged 37 to 73 years, were recruited. They were followed from 2006 to 2018. Nonlinear associations between self-reported TV time (hours per day) and outcomes explored using penalized cubic splines in Cox proportional hazards adjusted for demographics and lifestyle. Population-attributable and potential impact fractions were calculated to contextualize population-level health outcomes associated with different TV time levels. Nonlinear isotemporal substitution analyses were used to investigate substituting TV time with alternative activities. Primary outcomes were mortality: all-cause, cardiovascular disease (CVD) and cancer; incidence: CVD and cancer; secondary outcomes were incident myocardial infarction, stroke, and heart failure and colon, lung, breast, and prostate cancer. Results: Those with noncommunicable disease (109,867 [22.4%]), CVD (32,243 [6.6%]), and cancer (37,81 [7.7%]) at baseline were excluded from all-cause mortality, CVD, and cancer analyses, respectively. After 7.0 years (mortality) and 6.2 years (disease incidence) mean follow-up, there were 10,306 (2.7%) deaths, 24,388 (5.3%) CVD events, and 39,121 (8.7%) cancer events. Associations between TV time and all-cause and CVD mortality were curvilinear (Pnon-linear <=.003), with lowest risk observed <2 hours per day. Theoretically, 8.64% (95% confidence interval [CI], 6.60-10.73) of CVD mortality is attributable to TV time. Limiting TV time to 2 hours per day might have prevented, or at least delayed, 7.97% (95% CI, 5.54-10.70) of CVD deaths. Substituting TV time with sleeping, walking, or moderate or vigorous physical activity was associated with reduced risk for all outcomes when baseline levels of substitute activities were low. Conclusion: TV time is associated with numerous adverse health outcomes. Future guidelines could suggest limiting TV time to less than 2 hours per day to reduce most of the associated adverse health events. (C) 2020 Mayo Foundation for Medical Education and Research