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INTRODUCTION: Over the past decades, children have been increasingly using screen devices, while at the same time their sleep duration has decreased. Both behaviors have been associated with excess weight, and it is possible they act as mutually reinforcing behaviors for weight gain. The aim of the study was to explore independent, prospective associations of screen time and sleep duration with incident overweight in a sample of European children. METHODS: Data from 4,285 children of the IDEFICS/I.Family cohort who were followed up from 2009/2010 to 2013/2014 were analyzed. Hours per day of screen time and of sleep duration were reported by parents at baseline. Logistic regression analyses were carried out in separate and mutually adjusted models controlled for sex, age, European country region, parental level of education, and baseline BMI z-scores. RESULTS: Among normal weight children at baseline (N = 3,734), separate models suggest that every hour increase in screen time and every hour decrease in sleep duration were associated with higher odds of the child becoming overweight or obese at follow-up (OR = 1.16, 95% CI: 1.02-1.32 and OR = 1.23, 95% CI: 1.05-1.43, respectively). In the mutually adjusted model, both associations were attenuated slightly ( screen time OR = 1.13, 95% CI: 0.99-1.28; sleep duration OR = 1.20, 95% CI: 1.03-1.40), being consistently somewhat stronger for sleep duration. DISCUSSION/CONCLUSION: Both screen time and sleep duration increased the incidence of overweight or obesity by 13-20%. Interventions that include an emphasis on adequate sleep and minimal screen time are needed to establish their causal role in the prevention of overweight and obesity among European children. CC BY-NC 4.0https://www.karger.com/open-access/types-licences-copyright-costsPublished online: November 1, 2021Correspondence to: Monica Hunsberger, monica.hunsberger@gu.seFunding SourcesV.G.’s contribution to this study was supported by the Swedish Institute. The Swedish section of this study was co-financed by the Swedish Research Council for Environment, Agricultural Sciences, and Spatial Planning (2012-00038), the Swedish Research Council (2015-02508), the ALF-agreement for western Sweden (ALFGBG-722441), and the Swedish Research Council for Health, Working Life and Welfare (FORTE Grant 2014-01994).

Paediatric overweight continues to be a public health problem, and the etiology of obesity is multifactorial and complex. Dietary patterns, physical activity (PA) and sedentary behaviors are acknowledged as major behavioural determinants of obesity. New technologies and electronic based activities have produced a decrease in PA levels, and an increase in sedentary activities in children and adolescents. Potential mechanisms that explain the association between TV viewing and childhood obesity are: displacement of PA, unhealthy food preferences produced by food advertisements, a higher energy intake by automatic eating and overconsumption caused by distraction. Interventions aimed to reduce time in sedentary behaviours are in children generally positive. However, their benefits on adiposity markers are small. Thus, if global and macro-level obesogenic factors are not changed substantially, the interventions oriented to prevent obesity will produce small benefits. El sobrepeso en población en edad pediátrica continúa siendo uno de los problemas de salud pública. La alimentación, actividad física y las conductas sedentarias son los mayores determinantes de la obesidad. Las nuevas tecnologías y las actividades basadas en la electrónica han producido un descenso en los niveles de actividad física y un aumento de las actividades sedentarias en niños y adolescentes. Diversos mecanismos se han sugerido para explicar la asociación entre ver la televisión y la obesidad: desplazamiento de actividad física, los efectos de la publicidad de alimentos, el aumento de la ingesta energética en ausencia de hambre (automáticamente), y el aumento de la ingesta producida por la distracción. Intervenciones orientadas a reducir el comportamiento sedentario en niños y adolescentes han mostrado ser exitosas. Sin embargo, su impacto sobre marcadores de adiposidad es pequeño. Por lo tanto, si los factores obesogénicos que dependen de escalas a nivel global y macro no son cambiados substancialmente, los beneficios de las intervenciones para prevenir la obesidad serán muy modestos.