title: The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries.
abstract: BACKGROUND
  Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake.
  
  
  METHODS
  We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153,996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels.
  
  
  RESULTS
  Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29-1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries.
  
  
  CONCLUSIONS
  The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.
authors: Scott A
authors: SA
authors: Lear
authors: Koon
authors: K
authors: Teo
authors: Danijela
authors: D
authors: Gasevic
authors: Xiaohe
authors: X
authors: Zhang
authors: Paul P
authors: PP
authors: Poirier
authors: Sumathy
authors: S
authors: Rangarajan
authors: Pamela
authors: P
authors: Seron
authors: Roya
authors: R
authors: Kelishadi
authors: Azmi Mohd
authors: AM
authors: Tamil
authors: Annamarie
authors: A
authors: Kruger
authors: Romaina
authors: R
authors: Iqbal
authors: Hani
authors: H
authors: Swidan
authors: Diego
authors: D
authors: Gómez-Arbeláez
authors: Rita
authors: R
authors: Yusuf
authors: Jephat
authors: J
authors: Chifamba
authors: V Raman
authors: VR
authors: Kutty
authors: Kubilay
authors: K
authors: Karsıdag
authors: Rajesh
authors: R
authors: Kumar
authors: Wei
authors: W
authors: Li
authors: Andrzej
authors: A
authors: Szuba
authors: Alvaro
authors: A
authors: Avezum
authors: Rafael
authors: R
authors: Diaz
authors: Sonia S
authors: SS
authors: Anand
authors: Annika
authors: A
authors: Rosengren
authors: Salim
authors: S
authors: Yusuf
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D001336:Automobiles; D003201:Computers; D003430:Cross-Sectional Studies; D003710:Demography; D019049:Developed Countries; D003906:Developing Countries; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology*; D010067:Ownership; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013690:Television