Ding Huimin, Jiang Liqun, Lin Xuanqiao, Ye Chaoying, Chun Buongo
Graduate School of Physical Education, Myongji University, 116th, Mingzhi Road, Churen District, Yongin City, Gyeonggi Province, 17058, Republic of Korea.
Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China.
BMC Public Health. 2025 Apr 1;25(1):1231. doi: 10.1186/s12889-025-22434-8.
This study aimed to systematically evaluate the dose-response relationships between physical activity (PA), sedentary behavior(SB) (including near work [NW] and screen time [ST]), sleep duration (SD), and myopia risk among children and adolescents.
Systematic review and dose-response meta-analysis.
We systematically searched PubMed, EMBASE, Cochrane Library, and Web of Science up to November 19, 2024. Methodological quality was assessed using Joanna Briggs Institute (JBI) and ROBINS-I tools. Random-effects meta-analyses were used to estimate categorical and continuous dose-response relationships. Subgroup analyses and sensitivity analyses were performed to explore heterogeneity sources and test robustness.
A total of 45 observational studies (766,848 participants aged 5-19 years) were included. Categorical analyses showed that, compared with the lowest exposure categories, higher PA levels (highest: OR = 0.77, 95% CI: 0.63-0.96; intermediate: OR = 0.76, 95% CI: 0.63-0.93) and longer SD (highest: OR = 0.67, 95% CI: 0.48-0.92; intermediate: OR = 0.82, 95% CI: 0.73-0.92) significantly reduced myopia risk. Conversely, higher levels of NW (highest: OR = 1.71, 95% CI: 1.28-2.27; intermediate: OR = 1.34, 95% CI: 1.19-1.50) and ST (highest: OR = 1.59, 95% CI: 1.14-2.22; intermediate: OR = 1.29, 95% CI: 1.12-1.49) were associated with significantly increased risk. In the continuous dose-response meta-analysis, a linear association was observed between PA, ST, and myopia. Each additional hour of PA per day reduced the risk of myopia by 12%, while each additional hour of ST increased the risk by 31%. Nonlinear associations were found between NW, SD, and myopia. Among children and adolescents, 1.5 and 2.5 h/day of NW increased the risk of myopia by 25% and 29%, respectively. Although longer SD was associated with a reduced risk of myopia, this effect did not reach statistical significance at any exposure level.Subgroup analyses revealed that protective effects of PA were more evident in low- and middle-income countries, smaller sample sizes, and cross-sectional studies, while increased risks related to ST and NW were stronger in low-income settings. No subgroup significantly modified the association between SD and myopia risk.
Increasing PA, while limiting ST and NW, effectively reduces the risk of myopia among children and adolescents. The association between sleep duration and myopia remains inconclusive, warranting further investigation.
本研究旨在系统评估儿童和青少年的身体活动（PA）、久坐行为（SB）（包括近距离工作[NW]和屏幕时间[ST]）、睡眠时间（SD）与近视风险之间的剂量反应关系。
系统评价和剂量反应荟萃分析。
我们系统检索了截至2024年11月19日的PubMed、EMBASE、Cochrane图书馆和Web of Science。使用乔安娜·布里格斯研究所（JBI）和ROBINS-I工具评估方法学质量。采用随机效应荟萃分析来估计分类和连续的剂量反应关系。进行亚组分析和敏感性分析以探索异质性来源并检验稳健性。
共纳入45项观察性研究（766848名5 - 19岁参与者）。分类分析表明，与最低暴露类别相比，较高的PA水平（最高：OR = 0.77，95%CI：0.63 - 0.96；中等：OR = 0.76，95%CI：0.63 - 0.93）和较长的SD（最高：OR = 0.67, 95%CI：0.48 - 0.92；中等：OR = 0.82，95%CI：0.73 - 0.92）显著降低近视风险。相反，较高水平的NW（最高：OR = 1.71，95%CI：1.28 - 2.27；中等：OR = 1.34，95%CI：1.19 - 1.50）和ST（最高：OR = 1.59，95%CI：1.14 - 2.22；中等：OR = 1.29，95%CI：1.12 - 1.49）与风险显著增加相关。在连续剂量反应荟萃分析中，观察到PA、ST与近视之间存在线性关联。每天PA每增加1小时，近视风险降低12%，而ST每增加1小时，风险增加31%。发现NW、SD与近视之间存在非线性关联。在儿童和青少年中，每天1.5小时和2.5小时的NW分别使近视风险增加25%和29%。虽然较长的SD与近视风险降低相关，但在任何暴露水平下这种效应均未达到统计学显著性。亚组分析显示PA的保护作用在低收入和中等收入国家、较小样本量以及横断面研究中更为明显，而与ST和NW相关的风险增加在低收入环境中更强。没有亚组显著改变SD与近视风险之间的关联。
增加PA，同时限制ST和NW，可有效降低儿童和青少年的近视风险。睡眠时间与近视之间的关联仍无定论，有待进一步研究。
