Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 2 - Apr/Jun - 2018

Original Article Imprimir 

Páginas 65 a 71


Relationship between nutritional status and screen time in adolescents

Relación entre estado nutricional y tiempo ante una pantalla en adolescentes

Relação entre estado nutricional e tempo de tela em adolescentes

Autores: Luciane Peter Grillo1; Luiza Ramos Schiffer2; Luana Klann3; Tatiana Mezadri4; Leo Lynce Valle de Lacerda5

1. Pos-Doctorate in Epidemiology by the Epidemiological Research Center of the Federal University of Pelotas (UFPEL). Pelotas, RS, Brazil. Professor of the Nutrition Course and the Professional Master´s Degree Program in Health and Labor Management at the University of Vale do Itajaí. Itajaí, SC, Brazil
2. Academic Professor at the Course of Nutrition- Health Sciences Center - University of Vale do Itajaí. Itajaí, SC, Brazil
3. Academic Professor at the Course of Nutrition - Health Sciences Center - University of Vale do Itajaí. Itajaí, SC, Brazil
4. Doctor in Food Sciences by the Sevilla University – Spain. Academic Professor at the Course of Nutrition and the Master´s Program in Occupational Health and Management, Vale do Itajaí University. Itajaí, SC, Brazil
5. Doctor in Education by the University of Vale do Itajaí (UNIVALI). Lecturer in Speech Therapy Course, Nutrition and Professional Master's Degree in Health and Work Management at University of Vale do Itajaí. Itajaí, SC, Brazil

Luciane Peter Grillo
Rua Adolfo Sacani, nº36, apto: 502
Jaraguá do Sul, SC, Brasil. CEP: 89253-075
(grillo@univali.br)

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How to cite this article

Keywords: Adolescent, sedentary lifestyle, nutritional status.
Palabra Clave: Adolescente, estilo de vida sedentario, estado nutricional.
Descritores: Adolescente, estilo de vida sedentário, estado nutricional.

Abstract:
OBJECTIVE: Evaluate the nutritional status related to screen time in adolescents of a public school in the city of Balneário Piçarras, Santa Catarina, Brazil.
METHODS: The screen time was operationalized from the measurement of the average daily time (hours/minutes) spent watching television, playing video games and using the computer on weekdays and weekends during a typical or usual week. The nutritional evaluation was made through body mass index/age and waist circumference.
RESULTS: Were evaluated 121 adolescents, being 49% male and 51% female. The predominant nutritional status was eutrophy (77%) followed by overweight (23%). High trunk fat mass was found in 12% of participants. The average screen time on weekdays, weekends and daily was 4.8h (4.04-5.46), 5.9h (5.06-6.75) e 5.1h (4.40-5.76), respectively. There were no significant differences in nutritional status between genders, however boys presented higher waist circumference (p=0.0128) and screen time during weekdays (p=0.0044), weekend (p=0.0038) and daily (p=0.0016) when compared to girls.
CONCLUSION: Screen time was not significantly associated with nutritional status. However, 74.4% of the adolescents presented screen time above the recommended level, being necessary to develop interventions in this population group.

Resumen:
OBJETIVO: Evaluar el estado nutricional relacionado al tiempo ante una pantalla en adolescentes de una escuela pública en el municipio de Balneario Pizarras, Santa Catarina, Brasil.
MÉTODOS: El tiempo ante una pantalla se ha controlado a partir de la medición del tiempo promedio diario (horas / minutos) gastado viendo televisión, jugando a videojuegos y utilizando el ordenador los días laborables y el fin de semana, durante una semana típica o habitual. La evaluación nutricional fue hecha por medio del índice de masa corporal / edad y circunferencia de la cintura.
RESULTADOS: Se evaluaron 121 adolescentes, siendo el 49% del sexo masculino y el 51% del sexo femenino. El estado nutricional predominante fue la eutrofia (77%) seguido por el exceso de peso (23%). La acumulación de grasa en la región del tronco fue encontrada en el 12% de los participantes. La medida de tiempo ante una pantalla en los días laborables, los fines de semana y la diaria fue de 4,8h (4,04-5,46), 5,9h (5,06-6,75) y 5,1h (4, 40-5,76), respectivamente. No se observaron diferencias significativas en el estado nutricional entre los sexos, pero los niños presentaron mayor circunferencia de la cintura (p = 0,0128) y tiempo ante una pantalla durante los días hábiles (p = 0,0044), finales de semana (p = 0,0038) y diariamente (p = 0,0016) en comparación con las niñas.
CONCLUSIÓN: El tiempo ante una pantalla no se asoció significativamente con el estado nutricional. Sin embargo, el 74,4% de los adolescentes presentaron un tiempo ante una pantalla por encima de lo recomendado, siendo necesario el desarrollo de intervenciones en este grupo poblacional.


Resumo:
OBJETIVO: Avaliar o estado nutricional relacionado ao tempo de tela em adolescentes de uma escola pública no município de Balneário Piçarras, Santa Catarina, Brasil.
MÉTODOS: O tempo de tela foi operacionalizado a partir da medida do tempo médio diário (horas/minutos) despendido assistindo televisão, jogando videogames e usando o computador nos dias úteis e no final de semana, durante uma semana típica ou habitual. A avaliação nutricional foi feita por meio do índice de massa corporal/idade e circunferência da cintura.
RESULTADOS: Foram avaliados 121 adolescentes, sendo 49% do sexo masculino e 51% do sexo feminino. O estado nutricional predominante foi a eutrofia (77%) seguido por excesso de peso (23%). Acúmulo de gordura na região do tronco foi encontrado em 12% dos participantes. A média de tempo de tela nos dias úteis, nos finais de semana e diária foi de 4,8h (4,04-5,46), 5,9h (5,06-6,75) e 5,1h (4,40-5,76), respectivamente. Não se observou diferenças significativas no estado nutricional entre os sexos, porém os meninos apresentaram maior circunferência da cintura (p=0,0128) e tempo de tela durante os dias úteis (p=0,0044), finais de semana (p=0,0038) e diariamente (p=0,0016) quando comparado as meninas.
CONCLUSÃO: O tempo de tela não se associou significativamente com o estado nutricional. No entanto, 74,4% dos adolescentes apresentaram tempo de tela acima do recomendado, sendo necessário o desenvolvimento de intervenções neste grupo populacional.

INTRODUCTION

Adolescence is a phase of life that has its own characteristics, marked by the passage from childhood to adulthood, with physical and emotional changes. According to the World Health Organization, the age limits that define this phase are 10 and 19 years1. Adolescents, while experiencing biological, cognitive, emotional, and social changes, experience an important moment for adopting new practices, behaviors and gaining autonomy, as well as exposure to various situations involving present and future risks to health, such as inadequate food and sedentary lifestyle. These factors are associated with the development of most chronic non communicable diseases, such as cardiovascular, diabetes and cancer, leading to the causes of death in adult life, in the country and in the world2.

In Brazil, access to school is 84.3% for the 15- and 17-year-old age groups, regardless of the monthly income class3. Therefore, the school is an important place to monitor the health of the school.

Although it is practically a consensus that the growth of overweight people is due to the higher consumption of foods with high energetic density and especially rich in lipids and simple carbohydrates, this fact alone isn´t able to explain the exponential increase of obesity in the world. In this sense, the greater time dedicated to low-intensity activities, such as watching television, using computers and playing video games, has contributed to the weight gain of adolescents2,4.

In a study that gathered data from 220,000 young people in 42 countries in Europe and North America on adolescent health, including information on screen time, the authors noted that the habit of watching two hours or more of television per day between 13 and 15-year-olds were 62% and 63%, respectively5. The WHO recommends that children should not spend more than two hours in front of TV and video games on a daily basis6.

Among the reasons why children and adolescents have been less active are the increase in TV, internet and videogame time, reductions in physical education classes in schools and active leisure options due to violence and urban mobility, as well as by the increase in the automobile fleet and the concern of those responsible for safety7,8.

Therefore, research related to nutritional status and increasing weight gain in adolescents and its relation with associated factors, such as screen time, are important to estimate a possible association between the prevalence of overweight in adolescents and their sedentary behaviors.

Regarding nutritional status, the latest national survey shows that in Brazil, 3.4% of adolescents had weight deficits, 20.5% were overweight and 4.9% were obese. In the South, these values were 2.5%, 26.9% and 7.6%, respectively9.

In the National School Health Survey, the habit of watching more than two hours of television on a weekday was reported by approximately 60.0% of schoolchildren. When asked about the time they sat on an ordinary weekday not only watching television, but performing other activities such as using a computer, playing video games, or doing other sitting activities, 56.1% reported staying more than three hours sitting2.

As the popularity of internet access increases and as adolescents most often engage in multiple activities simultaneously, it is assumed that the longer the screen time, the less physical activity will be. As a consequence, weight gain and the prevalence of obesity will be higher in this age group10.

The increase in the prevalence of adolescents who are exposed to excessive screen time is cause for concern, as there are already studies that show their association with several health problems, such as excess body weight and obesity, changes in blood glucose and cholesterol, low school performance, decreased social interaction and lower levels of physical activity2.

Thus, screen time is important for the understanding of sedentary lifestyle and adolescents' health. As population data on the subject and its health consequences in segments of the Brazilian population are scarce, this study is justified in order to evaluate the interrelationship between the nutritional status and the screen time of adolescents.


OBJECTIVE

To evaluate the interrelationship between the nutritional status and the screen time of high school adolescents of a small municipality on the coast of Santa Catarina.


METHODS

This is a cross-sectional study, carried out in the city of Balneário Piçarras, Santa Catarina, Brazil. This municipality is located 110 km from the state capital, Florianópolis, and currently has about 21,253 inhabitants, of whom approximately 1,524 are adolescents between the ages of 15 and 1911.

The study population consisted of 651 individuals aged 14-19 years and regularly enrolled in high school in a public school in Balneário Piçarras. The exclusion criteria were being pregnant or nursing, and the presence of physical disability that made anthropometric evaluation impossible.

Data collection took place in the second half of 2016. The information was collected by a previously tested questionnaire, completed by adolescents in the classroom and at regular school hours, according to the instructions provided by the collection team.

The sociodemographic variables analyzed were sex and age in complete years determined from the difference between the date of birth and the date of data collection.

Nutritional status was assessed in a private setting. The weight measurements, in kilograms, using the Serene Digi-Health scale and height in centimeters, were verified with the aid of the Standard Sanny stadiometer. From these data the body mass index (BMI = kg / height2) was calculated according to the classification of the World Health Organization12 and the cut-off points of the Ministry of Health13. Waist circumference was measured using an inelastic tape measure at the midpoint between the last rib and the iliac crest, according to the cut-off points of Taylor et al.14

Excessive screen time was calculated by measuring the average daily time (hours/minutes) spent watching television, playing video games and using the computer on weekdays and weekends during a typical or usual week. For the final result, the weighted mean was calculated from the following procedure: sum of the time spent in sedentary behaviors on weekdays (Monday to Friday) divided by five, added to the time of weekend days (Saturday or Sunday) divided by two. The sum of the averages of weekdays and weekends was made. This result was divided by seven to obtain the average number of hours per day that adolescents spent on screen activities15. Excessive screen time was defined as spending more than two hours per day on these behaviors6.

The present study was approved by the Research Ethics Committee of the University of the Vale do Itajaí under the opinion 1,664,931.

Data were analyzed using descriptive statistics (frequency distribution, mean, standard deviation and 95% confidence interval) and inferential (chi-square and t-test) using Stata Software, version 13.0 with significance level of 5%. The results of the present study were compared with regional and national data2.


RESULTS

A total of 121 adolescents were evaluated, 49% male and 51% female, totaling 18.6% of the students enrolled in the secondary school of the School of Basic Education.

Table 1 shows the anthropometric characteristics of adolescents. There were significant differences between the sexes in the variables weight (p=0.0012), height (p=0.0000) and waist circumference (p=0.0128).




The screen time on weekdays, weekends and daily is presented in Table 2. Screen time was not significantly associated with nutritional status (p=0.3943), but 74.4% of adolescents had time to screen above recommended (more than 2h/day).




The predominant nutritional status was eutrophy (77%) followed by overweight (23%), low weight values were not found. When comparing the adolescents from Balneário Piçarras with those from the Southern Region and from Brazil, it was observed that the schoolchildren in the studied municipality had lower values of underweight and overweight, with the exception of males in relation to the values of the South Region (Figure 1 ). The accumulation of fat in the trunk region was present in 12% of adolescents.


Figure 1. Nutritional status of adolescents analyzed in Balneário Piçarras, organized by sex, comparing with regional and national data. Balneário Piçarras, 2017.



Overweight adolescents presented 5.6 ± 3.7 hours / day of screen time while the eutrophic ones, 4.9 ± 3.8 hours/day.


DISCUSSION

It was verified that the proportion of adolescents at screen time was high and predominantly male. Contrary to what has been speculated in the literature, excessive screen time was not associated with excess body weight in this population. High prevalences of excessive screen time, often observed in adolescents, may be due to the changes that have occurred in society in the last two to three decades, such as the economic growth that allowed families, especially middle-income access to television, computer, greater use of the Internet in leisure time, reduction of public spaces for physical activities, associated with insecurity observed in urban centers15.

When the nutritional status of the adolescents was evaluated, 23% were overweight, with no differences between the sexes. Higher results were found in southern Brazil, 29.5% in schoolboys16 and 29.1% in Paraná175. In the Southeast region, in Niterói-RJ, 25.7% of the 328 adolescents evaluated were overweight8. The lowest values were found in Belém do Pará, in the North region, 20.4% of the 557 students studied18 and in the northeast region, in João Pessoa (PB), 13.2% of 2874 adolescents8.

The National School Health Survey2 showed that the prevalence of underweight among adolescents aged 13 to 17 years was 3.1%, being higher in males (3.8%) when compared to females (2.5%), indicating a small frequency of malnutrition in this population. Regarding the overweight indicator, the prevalence was higher, 23.7%, which corresponds to an estimated 3 million adolescents, showing little variation between the two sexes (23.7% for males and 23 , 8% for females). In the total population evaluated, 8.3% of the boys and 7.3% of the girls were considered obese. The distribution of adolescents, according to the Major Regions, shows that the prevalence of underweight was higher in the North and Northeast Regions (3.7%), and the South Region had the lowest rate (2.4% ). In all the Major Regions the overweight indicator exceeded 20.0%, with the South Region being the highest with 28.2% and the Northeast Region with the lowest prevalence rate (20.5%). The distribution of obesity prevalence in the Major Regions was similar to the distribution of overweight. Higher prevalences were observed in the South Region, with 10.2%, against 6.1% in the Northern Region. The present study presented lower values of low weight and excess weight when compared with the values found for the South region and with general data for Brazil.

Regarding waist circumference, 12% presented fat accumulation in the trunk region, being significantly larger in males. In a study conducted in Santa Cruz do Sul, RS, evaluating 658 schoolchildren, 18.2% presented high waist circumference16.

The average daily screen time spent by the adolescents of this research was 5.0 hours, which was 4.7 hours on weekdays and 5.9 hours on weekends. Higher values were found in males when compared to females. The daily value of these adolescents was lower than another study also performed in a small municipality in the state of Santa Catarina, Paulo Lopes (6.01 hours / day)19. In Rio de Janeiro, the average weekly screen time of adolescents was 24.2 hours or approximately 3.5 hours per day and varied little between the days of the week or weekend, and corroborating with the present study, was more prevalent in boys8.

Regarding total screen time, 74.4% of adolescents stayed two hours or more in front of the television, and / or video games, and / or computer. Results were higher than those found in Rio Grande do Sul (55.5%),16 in São Luís do Maranhão (64%) 20, similar to those in Paraíba (79.5%)15 and inferior to those in Santa Catarina (90.5%)19 and Paraná (87.9%)17.

The screen time in the present study was not significantly associated with overweight, corroborating with the northeastern study15 and contrary to the Carioca results8.

As a limitation of the present study, it was highlighted the refusal of many adolescents to participate in the study, although the activities were carried out individually and in a restricted place. One possible explanation may be in the adolescence phase, characterized by extreme appreciation of physical appearance and ideal social patterns of beauty, mainly mediated, which can generate strong feelings of dissatisfaction and low self-esteem to the body itself.


CONCLUSION

It was concluded that there is a high prevalence of sedentary behavior based on screen time in high school adolescents of a small city in southern Brazil. Guidelines on this topic are important because this sedentary behavior is modifiable and may contribute to the prevention of overweight and associated diseases in adolescents. Because watching television, playing video games, or using a computer is a reality in adolescents' current lives, it is suggested that they reconcile these activities with the time recommended for physical activity at this stage. More research is needed to increase understanding of how patterns of physical activity and sedentary behaviors are interrelated and the relationship between different sedentary and screen behaviors and their negative health effects on adolescents.


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