The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries

Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical...

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Vydané v:	Canadian Medical Association journal (CMAJ) Ročník 186; číslo 4; s. 258 - 266
Hlavní autori:	Lear, Scott A., Teo, Koon, Gasevic, Danijela, Zhang, Xiaohe, Poirier, Paul P., Rangarajan, Sumathy, Seron, Pamela, Kelishadi, Roya, Tamil, Azmi Mohd, Kruger, Annamarie, Iqbal, Romaina, Swidan, Hani, Gómez-Arbeláez, Diego, Yusuf, Rita, Chifamba, Jephat, Kutty, V. Raman, Karsidag, Kubilay, Kumar, Rajesh, Li, Wei, Szuba, Andrzej, Avezum, Alvaro, Diaz, Rafael, Anand, Sonia S., Rosengren, Annika, Yusuf, Salim
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Canada Joule Inc 04.03.2014 CMA Impact, Inc Canadian Medical Association
Predmet:	Adult ADULTS Aged Anthropometry Automobiles Computers Consumer electronics Cross-Sectional Studies Demography Developed Countries Developing Countries Diabetes Diabetes Mellitus, Type 2 - epidemiology Endocrinology and Diabetes Endokrinologi och diabetes Energy Intake Female Folkhälsovetenskap, global hälsa och socialmedicin FOOD FREQUENCY QUESTIONNAIRES Health aspects Households Humans Income - statistics & numerical data INTERHEART Low income groups Male Middle Aged Motor Activity MYOCARDIAL-INFARCTION Obesity Obesity - epidemiology Ownership Physical fitness PHYSICAL-ACTIVITY POPULATION Prospective Studies Public Health, Global Health and Social Medicine RISK Risk factors Surveys and Questionnaires TELEVISION Type 2 diabetes VIEWING TIME WEIGHT STATUS Canada
ISSN:	0820-3946, 1488-2329, 1488-2329
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Abstract	Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153,996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29-1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries. The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.
AbstractList	Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake.BACKGROUNDHousehold devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake.We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153,996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels.METHODSWe performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153,996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels.Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29-1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries.RESULTSOwnership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29-1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries.The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.INTERPRETATIONThe ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health. Interpretation: The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health. Background: Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. Methods: We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. Results: Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.291.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries. Interpretation: The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health. Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153,996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29-1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries. The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health. Results: Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29- 1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries. There was increased odds of obesity and diabetes with the ownership of any 1 household device, after taking community- and country-level clustering into account and adjustment for covariates (Table 5). This increase was greatest going from no device ownership to ownership of 1 device (obesity: OR 1.43, 95% CI 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50) and increased with owning a second device (obesity: OR 1.58, 95% CI 1.45-1.73; diabetes: OR 1.43, 95% CI 1.30-1.56). Ownership of a third device was asso- ciated with a decrease in likelihood. Subsequent adjustment for lifestyle factors had little effect on the association between household devices ownership and obesity; however, it modestly attenuated the association between device ownership and diabetes (OR 1.30, 95% CI 1.19-1.42). There was a modest association between obesity and owning 3 devices in upper-middle (OR 1.35, 95% CI 1.14-1.60) and lower-middle income countries (OR 1.37, 95% CI 1.12-1.67) (Appendix 3, available at www.cmaj .ca /lookup /suppl /doi :10 .1503 /cmaj .131090/-/DC1). There was no association in upper-middle income countries after adjustment for lifestyle factors. In low income countries, there was a marked and stepped increase in the odds of obesity with increasing device ownership (3 devices: OR 3.15, 95% CI 2.33-4.25). There were no associations between household devices ownership and odds of diabetes in high (OR 1.69, 95% CI 0.11- 25.6), upper-middle (OR 1.22, 95% CI 0.96- 1.55) and lower-middle (OR 0.99, 95% CI 0.79- 1.25) income countries. In low income countries, owning 3 devices was associated with an increased odds of diabetes (OR 1.97, 95% CI 1.53-2.53); however, adjustment for lifestyle factors attenuated this association (OR 1.67, 95% CI 1.25-2.23). Background: Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. Methods: We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. Results: Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29-1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries. Interpretation: The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.
Audience	Professional
Author	Seron, Pamela Avezum, Alvaro Karsidag, Kubilay Li, Wei Kruger, Annamarie Iqbal, Romaina Poirier, Paul P. Gasevic, Danijela Teo, Koon Anand, Sonia S. Kumar, Rajesh Yusuf, Salim Diaz, Rafael Kutty, V. Raman Rosengren, Annika Lear, Scott A. Swidan, Hani Zhang, Xiaohe Szuba, Andrzej Tamil, Azmi Mohd Yusuf, Rita Rangarajan, Sumathy Gómez-Arbeláez, Diego Chifamba, Jephat Kelishadi, Roya
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/24516093$$D View this record in MEDLINE/PubMed https://gup.ub.gu.se/publication/198430$$DView record from Swedish Publication Index (Göteborgs universitet)
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ContentType	Journal Article
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Copyright	COPYRIGHT 2014 Joule Inc. Copyright Canadian Medical Association Mar 4, 2014 1995-2014, Canadian Medical Association 2014
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Snippet	Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus.... Background: Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2... Interpretation: The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical... Results: Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical...
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SubjectTerms	Adult ADULTS Aged Anthropometry Automobiles Computers Consumer electronics Cross-Sectional Studies Demography Developed Countries Developing Countries Diabetes Diabetes Mellitus, Type 2 - epidemiology Endocrinology and Diabetes Endokrinologi och diabetes Energy Intake Female Folkhälsovetenskap, global hälsa och socialmedicin FOOD FREQUENCY QUESTIONNAIRES Health aspects Households Humans Income - statistics & numerical data INTERHEART Low income groups Male Middle Aged Motor Activity MYOCARDIAL-INFARCTION Obesity Obesity - epidemiology Ownership Physical fitness PHYSICAL-ACTIVITY POPULATION Prospective Studies Public Health, Global Health and Social Medicine RISK Risk factors Surveys and Questionnaires TELEVISION Type 2 diabetes VIEWING TIME WEIGHT STATUS
Title	The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries
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