屏幕时间与儿童、青少年及年轻成人肥胖的系统综述：性别特异性途径及对公共卫生干预的启示。
完整摘要 · 中文译文
引言：屏幕时间与多种不良健康结局相关，包括肥胖。然而，针对儿童和青少年的证据有限且不一致，且潜在的性别特异性差异尚未明确。本系统评价旨在综合关于屏幕时间与儿童、青少年及年轻人肥胖相关结局之间关联的证据，重点关注性别特异性途径及其对公共卫生干预措施的启示。 方法：本系统评价遵循《2020年系统评价和荟萃分析优先报告条目》指南，并基于预先制定的方案。两名评价者独立筛选研究、提取数据，并使用纽卡斯尔-渥太华量表评估偏倚风险。根据关联方向和性别差异模式对数据进行综合。 结果：在纳入的22项研究中，18项报告屏幕时间与肥胖相关结局之间存在显著正相关。还观察到性别特异性模式，一些研究报告仅在女性（n = 6）或男性（n = 4）中存在关联。在女性中，观察到的关联更常涉及肥胖程度、代谢不健康型肥胖以及心理因素（如身体形象担忧和体重不满）；而在男性中，关联则更常与行为因素相关，如热量摄入增加、深夜屏幕使用和睡眠减少。 结论：我们的研究结果表明，屏幕时间与儿童、青少年及年轻人的肥胖相关。 这些发现提示，在行为、生理和心理机制方面可能存在性别差异。这些发现强调，干预措施需要超越简单的屏幕时间减少，并考虑可能导致肥胖风险性别差异的机制。潜在策略可能包括：在女孩中促进体育活动，在男孩中解决问题性屏幕使用、屏幕相关进食和睡眠中断问题，并将屏幕相关的心理社会因素纳入肥胖预防和管理。鉴于正式评估性别与屏幕时间交互作用的研究数量有限，需要进一步研究以更好地描述这些观察到的模式。
完整摘要 · 英文原文
INTRODUCTION: Screen time is associated with multiple adverse health outcomes, including obesity. However, evidence for children and adolescents is limited and inconsistent, and potential sex-specific differences have not been characterized. This systematic review aimed to synthesize evidence on the association between screen time and obesity-related outcomes among children, adolescents, and young adults, with a focus on sex-specific pathways and implications for public health interventions. METHODS: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was based on an a priori protocol. Two reviewers independently selected studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Data were synthesized based on the direction of associations and patterns of sex differences. RESULTS: Of the 22 studies included, 18 reported a significant positive association between screen time and obesity-related outcomes. Sex-specific patterns were also observed, with some studies reporting associations only among females (n = 6) or males (n = 4). Among females, observed associations more frequently involved adiposity, metabolically unhealthy obesity, and psychologic factors such as body image concerns and weight dissatisfaction, whereas among males, associations were more often linked to behavioral factors such as increased caloric intake, late-night screen use, and reduced sleep. CONCLUSION: Our findings indicate that screen time is associated with obesity among children, adolescents, and young adults, with evidence suggesting potential sex differences in the behavioral, physiologic, and psychologic mechanisms. These findings highlight the need for interventions that move beyond simple screen time reduction and consider the mechanisms that may underlie sex-related differences in obesity risk. Potential strategies may include promoting physical activity among girls and addressing problematic screen use, screen-related eating, and sleep disruption among boys, as well as integrating screen-related psychosocial factors into obesity prevention and management. Given the limited number of studies formally assessing sex-screen time interactions, further research is needed to better characterize these observed patterns.