title: Television viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk study.
abstract: BACKGROUND
  Television viewing (TV), a highly prevalent behaviour, is associated with higher cardiovascular risk independently of physical activity. The relationship with mortality, however, is relatively unknown.
  
  
  METHODS
  We examined the prospective relationship between TV time and all-cause, cardiovascular and cancer mortality in a population-based cohort [The European Prospective Investigation into Cancer and Nutrition (EPIC), Norfolk] of 13 197 men and women {age [SD (standard deviation)]: 61.5 ± 9.0 years}. Participants were free from stroke, myocardial infarction and cancer at baseline in 1998-2000 and were followed up for death ascertainment until 2009 (9.5 ± 1.6 years). TV time, total physical activity energy expenditure (PAEE), education level, smoking status, alcohol consumption, anti-hypertensive and lipid-lowering medication use, participant and family history of disease and total energy intake were self-reported; height and weight were measured by standardized procedures. Hazard ratios (HRs) [95% confidence interval (CI)] for mortality were estimated per 1-h/day increase in TV.
  
  
  RESULTS
  Each 1-h/day increase in TV time was associated with increased hazard of all-cause (HR = 1.04, 95% CI = 1.01-1.09; 1270 deaths) and cardiovascular (HR = 1.07, 95% CI = 1.01-1.15; 373 deaths), but not cancer mortality (HR = 1.04, 95% CI = 0.98-1.10; 570 deaths). This was independent of gender, age, education, smoking, alcohol, medication, diabetes history, family history of cardiovascular disease and cancer, body mass index (BMI) and PAEE. They were similar when stratified by gender, age, education, BMI and PAEE. The population-attributable fraction for all-cause mortality comparing the highest TV tertile (>3.6 h/day) with the lowest (<2.5 h/day) was 5.4%.
  
  
  CONCLUSIONS
  These findings suggest that public health recommendations should consider advising a reduction in TV time, a predominant leisure activity in modern society, in addition to advocating physical activity.
authors.affiliation: MRC Epidemiology Unit, Cambridge, UK.
authors.forename: Katrien
authors.initials: K
authors.lastname: Wijndaele
authors.forename: Søren
authors.initials: S
authors.lastname: Brage
authors.forename: Hervé
authors.initials: H
authors.lastname: Besson
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sharp
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D004522:Educational Status; D004734:Energy Metabolism; D005060:Europe / Q000453:epidemiology; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013690:Television
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents