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Epidemiology and Population Health

Association of sedentary patterns with body fat distribution among US children and adolescents: a population-based study



Children and adolescents spend a substantial amount of time being sedentary. The impact of prolonged sedentary patterns on fat distribution has not been elucidated especially in the context of physical activity level. Our objective is to examine the independent and joint associations of prolonged sedentary patterns and physical activity level with fat distribution among children and adolescents.


This included US children (8–11 years) and adolescents (12–19 years) from the National Health and Nutrition Examination Survey 2003–2006. Sedentary patterns comprise accelerometer-measured average sedentary bout duration and self-reported time of sitting watching TV/videos. Fat distribution (trunk and total fat percentage) was determined via dual X-ray absorptiometry.


Among 810 children and 2062 adolescents, average sedentary bout duration was associated with greater total and trunk fat percentages only among male children, after adjusting for moderate-to-vigorous physical activity (MVPA) level by accelerometer. Prolonged sitting watching TV/videos was associated with higher total and trunk fat percentages in male children and all adolescents, independent of levels of MVPA (all P for trend <0.05). Compared with ≤1 h/day, male children who spent ≥4 h/day sitting watching TV/videos had 4.43% higher trunk fat (95% CI, 1.69–7.17%), with similar associations for female (3.53%; 95% CI, 1.03–6.03%) and male adolescents (4.78%; 95% CI, 2.97–6.60%). About 13–17% children and adolescents spent <1 h on MVPA and ≥4 h sitting watching TV/videos per day. Compared with the most active group (MVPA ≥ 1 h/day and sitting watching TV/videos ≤1 h/day), trunk fat in this least active group was 6.21% higher in female children, 9.90% higher in male children, 6.84% higher in female adolescents, and 5.36% higher in male adolescents.


Prolonged time spent on sitting watching TV/videos was associated with fat accumulation among children and adolescents, independent of physical activity level.

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Fig. 1: Joint association of sitting watching TV/videos and MVPA level with trunk fat percentage among US children and adolescents, NHANES 2003–2006.


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This research was in part supported by U.S. National Institutes of Health (NIH) grant P30CA091842. JL was supported by the China Scholarship Council. JC was supported by T32 CA190194. ES is funded by a National Health and Medicine Research Council (NHMRC, Australia) through a Senior Research Fellowship (grant code: APP1110526), and a Leadership 2 fellowship (code: APP1180812). The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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JL, CC, and YC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: JL, CC, YC. Acquisition, analysis, or interpretation of data: all coauthors. Drafting of the manuscript: JL, CC, YC. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: JL, CC. Administrative, technical, or material support: YC. Study supervision: YC.

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Correspondence to Yin Cao.

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Liao, J., Cao, C., Hur, J. et al. Association of sedentary patterns with body fat distribution among US children and adolescents: a population-based study. Int J Obes 45, 2048–2057 (2021).

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