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Yet, longitudinal studies are scarce. This study aims to evaluate the longitudinal association of childhood digital media (DM) use trajectories with MetS and its components.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Children from Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden participating in the IDEFICS\/I.Family cohort were examined at baseline (W1: 2007\/2008) and then followed-up at two examination waves (W2: 2009\/2010 and W3: 2013\/2014). DM use (hours\/day) was calculated as sum of television viewing, computer\/game console and internet use. MetS z-score was calculated as sum of age- and sex-specific z-scores of four components: waist circumference, blood pressure, dyslipidemia (mean of triglycerides and HDL-cholesterol<jats:sup>\u22121<\/jats:sup>) and homeostasis model assessment for insulin resistance (HOMA-IR). Unfavorable monitoring levels of MetS and its components were identified (cut-off:\u2009\u2265\u200990<jats:sup>th<\/jats:sup> percentile of each score). Children aged 2\u201316\u00a0years with\u2009\u2265\u20092 observations (W1\/W2; W1\/W3; W2\/W3; W1\/W2\/W3) were eligible for the analysis. A two-step procedure was conducted: first, individual age-dependent DM trajectories were calculated using linear mixed regressions based on random intercept (hours\/day) and linear slopes (hours\/day\/year) and used as exposure measures in association with MetS at a second step. Trajectories were further dichotomized if children increased their DM duration over time above or below the mean.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>10,359 children and adolescents (20,075 total observations, 50.3% females, mean age\u2009=\u20097.9, SD\u2009=\u20092.7) were included. DM exposure increased as children grew older (from 2.2\u00a0h\/day at 2\u00a0years to 4.2\u00a0h\/day at 16\u00a0years). Estonian children showed the steepest DM increase; Spanish children the lowest. The prevalence of MetS at last follow-up was 5.5%. Increasing media use trajectories were positively associated with z-scores of MetS (slope: \u03b2\u2009=\u20090.54, 95%CI\u2009=\u20090.20\u20130.88; intercept: \u03b2\u2009=\u20090.07, 95%CI\u2009=\u20090.02\u20130.13), and its components after adjustment for puberty, diet and other confounders. Children with increasing DM trajectories above mean had a 30% higher risk of developing MetS (slope: OR\u2009=\u20091.30, 95%CI\u2009=\u20091.04\u20131.62). Boys developed steeper DM use trajectories and higher risk for MetS compared to girls.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Digital media use appears to be a risk factor for the development of MetS in children and adolescents. These results are of utmost importance for pediatricians and the development of health policies to prevent cardio-metabolic disorders later in life.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ISRCTN, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.isrctn.com\/ISRCTN62310987\">ISRCTN62310987<\/jats:ext-link>. Registered 23 February 2018- retrospectively registered.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12966-021-01186-9","type":"journal-article","created":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T17:32:12Z","timestamp":1634578332000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Media use trajectories and risk of metabolic syndrome in European children and adolescents: the IDEFICS\/I.Family cohort"],"prefix":"10.1186","volume":"18","author":[{"given":"Elida","family":"Sina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Buck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toomas","family":"Veidebaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Siani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Reisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Pohlabeln","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Pala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis A.","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9nes","family":"Molnar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Lissner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiannis","family":"Kourides","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefaan","family":"De Henauw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Eiben","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Ahrens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Hebestreit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the IDEFICS, I.Family consortia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"1186_CR1","volume-title":"Global status report on noncommunicable diseases 2014","author":"World Health Organization","year":"2014","unstructured":"World Health Organization. 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