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. 2022 Mar 19;19(1):30.
doi: 10.1186/s12966-022-01273-5.

Television viewing time and all-cause mortality: interactions with BMI, physical activity, smoking, and dietary factors

Christopher T V Swain  1   2 , Julie K Bassett  3 , Allison M Hodge  3   4 , David W Dunstan  5   6 , Neville Owen  7   8 , Yi Yang  3   4 , Harindra Jayasekara  3   4   9 , James R Hébert  10   11 , Nitin Shivappa  10   11 , Robert J MacInnis  3   4 , Roger L Milne  3   4   12 , Dallas R English  3   4 , Brigid M Lynch  3   4   5
Affiliations

Television viewing time and all-cause mortality: interactions with BMI, physical activity, smoking, and dietary factors

Christopher T V Swain et al. Int J Behav Nutr Phys Act. .

Abstract

Background: Higher levels of time spent sitting (sedentary behavior) contribute to adverse health outcomes, including earlier death. This effect may be modified by other lifestyle factors. We examined the association of television viewing (TV), a common leisure-time sedentary behavior, with all-cause mortality, and whether this is modified by body mass index (BMI), physical activity, smoking, alcohol intake, soft drink consumption, or diet-associated inflammation.

Methods: Using data from participants in the Melbourne Collaborative Cohort Study, flexible parametric survival models assessed the time-dependent association of self-reported TV time (three categories: < 2 h/day, 2-3 h/day, > 3 h/day) with all-cause mortality. Interaction terms were fitted to test whether there was effect modification of TV time by the other risk factors.

Results: From 19,570 participants, 4,417 deaths were reported over a median follow up of 14.5 years. More TV time was associated with earlier mortality; however, this relationship diminished with increasing age. The hazard ratio (HR) and 95% confidence interval (95% CI) for > 3 h/day compared with < 2 h/day of TV time was 1.34 (1.16, 1.55) at 70 years, 1.14 (1.04, 1.23) at 80 years, and 0.95 (0.84, 1.06) at 90 years. The TV time/mortality relationship was more evident in participants who were physically inactive (compared with active; p for interaction < 0.01) or had a higher dietary inflammatory index score (compared with a lower score; p for interaction = 0.03). No interactions were detected between TV time and BMI, smoking, alcohol intake, nor soft-drink consumption (all p for interaction > 0.16).

Conclusions: The relationship between TV time and all-cause mortality may change with age. It may also be more pronounced in those who are otherwise inactive or who have a pro-inflammatory diet.

Keywords: Prospective study; Sedentary behavior; Survival analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant selection
Fig. 2
Fig. 2
Time varying HR for A. 2-3 h/day; and B. > 3 h/day of TV time and all-cause mortality. < 2 h/day was the reference category. The thick red line represents the HR, the shaded area represents the 95% CI. Age was the underlying time metric. Models included alcohol consumption, BMI, country of birth, CVD comorbidities, the dietary inflammatory index, education, marital status, physical activity, SEIFA, sex, smoking, and soft drink consumption
Fig. 3
Fig. 3
Time varying HR for > 3 h/ day TV time and all-cause mortality when participants were A Physically inactive; B Insufficiently active; and C Sufficiently active. < 2 h/day TV time was the reference category. The thick red line represents the HR, the shaded area represents the 95% CI. Age was the underlying time metric. Adjusted for alcohol consumption, BMI, country of birth, CVD comorbidities, education, the dietary inflammatory index, marital status, SEIFA, sex, smoking, and soft drink consumption
Fig. 4
Fig. 4
Time varying HR for > 3 h/ day TV time and all-cause mortality when participants had a A Low energy adjusted dietary inflammatory index, B Medium dietary inflammatory index, and C High dietary inflammatory index. < 2 h/day TV time was the reference category. The thick red line represents the HR, the shaded area represents the 95% CI. Age was the underlying time metric. Adjusted for alcohol consumption, BMI, country of birth, CVD comorbidities, education, marital status, physical activity, SEIFA, sex, smoking, and soft drink consumption
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