Poitras Veronica J, Gray Casey E, Janssen Xanne, Aubert Salome, Carson Valerie, Faulkner Guy, Goldfield Gary S, Reilly John J, Sampson Margaret, Tremblay Mark S
Healthy Active Living and Obesity Research Group, RI #1, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
University of Strathclyde, School of Psychological Science and Health, G1 1QE, Glasgow, Scotland, UK.
BMC Public Health. 2017 Nov 20;17(Suppl 5):868. doi: 10.1186/s12889-017-4849-8.
The purpose of this systematic review was to examine the relationships between sedentary behaviour (SB) and health indicators in children aged 0 to 4 years, and to determine what doses of SB (i.e., duration, patterns [frequency, interruptions], and type) were associated with health indicators.
Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, 1 month to 4.99 years), intervention/exposure and comparator (durations, patterns, and types of SB), and outcome/health indicator (critical: adiposity, motor development, psychosocial health, cognitive development; important: bone and skeletal health, cardiometabolic health, fitness, risks/harm). The quality of the evidence was assessed by study design and outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
Due to heterogeneity, meta-analyses were not possible; instead, narrative syntheses were conducted, structured around the health indicator and type of SB. A total of 96 studies were included (195,430 participants from 33 countries). Study designs were: randomized controlled trial (n = 1), case-control (n = 3), longitudinal (n = 25), longitudinal with additional cross-sectional analyses (n = 5), and cross-sectional (n = 62). Evidence quality ranged from "very low" to "moderate". Associations between objectively measured total sedentary time and indicators of adiposity and motor development were predominantly null. Associations between screen time and indicators of adiposity, motor or cognitive development, and psychosocial health were primarily unfavourable or null. Associations between reading/storytelling and indicators of cognitive development were favourable or null. Associations between time spent seated (e.g., in car seats or strollers) or in the supine position, and indicators of adiposity and motor development, were primarily unfavourable or null. Data were scarce for other outcomes.
These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years, but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling. Additional high-quality research using valid and reliable measures is needed to more definitively establish the relationships between durations, patterns, and types of SB and health indicators, and to provide insight into the appropriate dose of SB for optimal health in the early years.
本系统评价旨在研究0至4岁儿童的久坐行为（SB）与健康指标之间的关系，并确定何种剂量的SB（即持续时间、模式[频率、中断情况]和类型）与健康指标相关。
在在线数据库中检索符合预先设定纳入标准的同行评审研究：人群（表面健康，1个月至4.99岁）、干预/暴露和对照（SB的持续时间、模式和类型）以及结局/健康指标（关键指标：肥胖、运动发育、心理社会健康、认知发育；重要指标：骨骼健康、心脏代谢健康、体能、风险/危害）。采用推荐分级评估、制定和评价（GRADE）框架，根据研究设计和结局评估证据质量。
由于存在异质性，无法进行荟萃分析；取而代之的是，围绕健康指标和SB类型进行叙述性综合分析。共纳入96项研究（来自33个国家的195,430名参与者）。研究设计包括：随机对照试验（n = 1）、病例对照研究（n = 3）、纵向研究（n = 25）、带有额外横断面分析的纵向研究（n = 5）以及横断面研究（n = 62）。证据质量从“极低”到“中等”不等。客观测量的总久坐时间与肥胖及运动发育指标之间的关联大多为无关联。屏幕时间与肥胖、运动或认知发育以及心理社会健康指标之间的关联主要为不利关联或无关联。阅读/讲故事与认知发育指标之间的关联为有利关联或无关联。坐在（如汽车座椅或婴儿车中）或仰卧位的时间与肥胖及运动发育指标之间的关联主要为不利关联或无关联。其他结局的数据较少。
这些发现继续支持在早期减少屏幕时间对疾病预防和健康促进的重要性，但也凸显了诸如阅读和讲故事等基于非屏幕的互动久坐行为对认知的潜在益处。需要更多使用有效且可靠测量方法的高质量研究，以更明确地确定SB的持续时间、模式和类型与健康指标之间的关系，并深入了解早期最佳健康状态下SB的合适剂量。
