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Article(id=1241035819654378255, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035810628235909, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202407248, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1720886400000, receivedDateStr=2024-07-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815596735, onlineDateStr=2026-03-18, pubDate=1733760000000, pubDateStr=2024-12-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815596735, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815596735, creator=13701087609, updateTime=1773815596735, updator=13701087609, issue=Issue{id=1241035810628235909, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='23', pageStart='4225', pageEnd='4416', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815594584, creator=13701087609, updateTime=1773815743629, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241036435843764756, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035810628235909, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241036435843764757, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035810628235909, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=4244, endPage=4248, ext={EN=ArticleExt(id=1241035820124140330, articleId=1241035819654378255, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The chain mediating role of sedentary behavior and smoking in the relationship between screen exposure and visceral fat index in men, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the chain mediating effects of sedentary behavior and smoking on the relationship between screen exposure and visceral fat index in adult men.

Methods

Data were collected from the 2020 Chronic Disease Risk Factor Survey in Guizhou Province, focusing on male participants. A health behavior questionnaire was employed to gather information on electronic screen exposure time, sedentary behavior, and smoking quantity. Laboratory indicators were used to assess blood lipid levels, while physical measurements provided data on height, weight, and waist circumference. A correlation coefficient matrix was constructed to analyze the relationships among variables, and a multiple mediation model was developed to explore the mediating pathways of sedentary time and smoking in the relationship between screen exposure and visceral fat index. The PROCESS plugin in SPSS was used to test the chain mediation effects via the bootstrap method, and the mediation pathways were illustrated using Amos.

Results

A total of 1 174 subjects were included in the study. After controlling for age, urban/rural status, education level, marital status, and occupation, regression results indicated a significant direct effect of screen exposure on the visceral fat index in men (β=0.232, 95%CI: 0.915-0.270). Sedentary time (β=0.046, 95%CI: 0.038-0.055) and smoking quantity(β=0.031, 95%CI: 0.004-0.059) were also found to significantly influence the visceral fat index. The mediation analysis revealed that the simple mediating effects of sedentary time and smoking between screen exposure and the visceral fat index were 0.018(95%CI: 0.020-0.033) and 0.056 (95%CI: 0.042-0.072), respectively, while the chain mediation effect was 0.009 (95%CI:0.003-0.014).

Conclusion

Sedentary behavior and smoking exhibit mediating effects in the relationship between screen exposure and visceral fat index in men. As screen exposure is a prevalent lifestyle factor, it is crucial for men to reduce smoking and sedentary behaviors during screen time to mitigate the occurrence of visceral obesity.

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目的

探究屏幕暴露与成人男性的内脏肥胖指数之间的链式中介作用。

方法

本文采用2020年贵州省慢性病危险因素调查数据中男性调查对象，使用健康行为方式问卷获取电子屏幕接触时间、久坐情况、吸烟量；通过实验室指标检测获取血脂情况，体格测量获取身高、体重、腰围等体格情况。使用相关系数矩阵分析各变量之间的相关性大小，构建多重中介效应模型，研究久坐时间、吸烟量在男性屏幕暴露与内脏肥胖指数关系中的中介路径。使用SPSS的process插件并用bootstrap法检验链式中介效应，Amos绘制中介路径。

结果

共计纳入1 174例研究对象，在控制了年龄、城乡、教育程度、婚姻状况和职业以后，回归结果显示屏幕暴露对男性内脏肥胖指数的直接影响显著（β=0.232, 95%CI：0.915～0.270），久坐时间（β=0.046, 95%CI：0.038～0.055）和吸烟量（β=0.031, 95%CI：0.004～0.059）显著影响男性内脏肥胖指数。中介效应分析结果显示，久坐时间和吸烟量在屏幕暴露和男性内脏肥胖指数之间的简单中介效应分别为0.018（95%CI：0.020～0.033）和0.056（95%CI：0.042～0.072），链式中介效应为0.009（95%CI：0.003～0.014）。

结论

久坐和吸烟在屏幕暴露对男性内脏肥胖指数中存在中介效应，屏幕暴露是最常见的生活方式，尤其男性应减少屏幕暴露时间中的吸烟和久坐行为，减少内脏肥胖的发生。

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刘涛，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=A9q0qSbq1VEF1y8ugvEA3A==, magXml=XAHoI6jbNsWxhB1gWH5xLw==, pdfUrl=null, pdf=9zwwOafZh2zusiZwz9yBPw==, pdfFileSize=680563, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=MmoPVHciHmNooseEVu4HDw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=xTg/v+zNvmsCgNubgPuiEg==, mapNumber=null, authorCompany=null, fund=null, authors=

赵否曦（1984—），男，硕士，副主任医师，研究方向：慢性病预防与控制

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赵否曦（1984—），男，硕士，副主任医师，研究方向：慢性病预防与控制

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Journal of Physical Activity & Health, 2013, 10(1): 132-136., articleTitle=Sedentary behaviors and obesity in a low-income, ethnic-minority population, refAbstract=null)], funds=[Fund(id=1241069120989491769, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, awardId=gzwkj2021-550, language=CN, fundingSource=贵州省卫生健康委科学技术基金项目(gzwkj2021-550), fundOrder=null, country=null), Fund(id=1241069121106932292, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, awardId=黔科合基础-ZK（2022）一般-244, language=CN, fundingSource=贵州省科技厅基础研究项目(黔科合基础-ZK（2022）一般-244), fundOrder=null, country=null), Fund(id=1241069121203401297, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, awardId=null, language=CN, fundingSource=贵州省高层次创新型人才培养项目, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241069115142631592, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, xref=null, ext=[AuthorCompanyExt(id=1241069115151020200, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, companyId=1241069115142631592, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, China), AuthorCompanyExt(id=1241069115159408809, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, companyId=1241069115142631592, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=贵州省疾病预防控制中心，贵州 贵阳 550004)])], figs=[ArticleFig(id=1241069119102054812, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=EN, label=Figure 1, caption=Flow chart of variable screening, figureFileSmall=yFYdQ8l8r4+FIg7luYGVZA==, figureFileBig=BPSkS4pEvOBArKa+Jtrd6w==, tableContent=null), ArticleFig(id=1241069119294992812, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=CN, label=图1, caption=变量筛选步骤, figureFileSmall=yFYdQ8l8r4+FIg7luYGVZA==, figureFileBig=BPSkS4pEvOBArKa+Jtrd6w==, tableContent=null), ArticleFig(id=1241069119437599160, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=EN, label=Figure 2, caption=Mediation analysis model for the screen exposure and Chinese visceral adiposity index (CVAL), figureFileSmall=THfNZDJkXv0DQXER2cWSdA==, figureFileBig=I2fBhnAVpYXdI1oS7G5AZA==, tableContent=null), ArticleFig(id=1241069119559233988, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=CN, label=图2, caption=屏幕暴露与VAI中介分析结果模型

注： **代表P<0.01；*代表P<0.05。

, figureFileSmall=THfNZDJkXv0DQXER2cWSdA==, figureFileBig=I2fBhnAVpYXdI1oS7G5AZA==, tableContent=null), ArticleFig(id=1241069119697646039, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=EN, label=Table 1, caption=

Basic characteristics of survey subjects

, figureFileSmall=null, figureFileBig=null, tableContent=
变量数量屏幕暴露（h）吸烟量（只）久坐时间（h）VAI
城乡城市4973.38±2.1614.65±8.553.99±2.795.24±1.37
农村6773.20±2.1815.35±9.094.21±2.875.10±1.49
F/Welch（P）1.871（0.172）1.786（0.182）1.704（0.192）2.572（0.109）
年龄段（岁）18～<456663.43±2.0715.66±8.914.23±2.935.18±1.29
45～<603583.30±2.3515.02±8.874.16±2.855.25±1.58
≥601502.58±2.0712.47±8.223.52±2.294.84±1.68
F/Welch（P）9.459（<0.001）8.209（<0.001）3.985（0.021）4.449（0.011）
教育水平文盲、半文盲2722.83±2.1514.67±9.853.63±2.705.03±1.63
小学2693.30±2.1415.62±9.423.94±2.725.23±1.40
初中4493.23±2.1214.87±8.184.30±2.895.13±1.36
高中/中专1263.95±2.1615.61±7.904.56±2.965.38±1.37
大专及以上584.12±2.3814.48±8.564.85±2.985.16±1.42
F/Welch（P）8.275（<0.001）0.630（0.641）4.500（0.001）1.489（0.203）
婚姻状况单身1493.53±2.0114.16±7.754.62±3.045.10±1.22
已婚/同居9533.22±2.1615.28±9.114.03±2.785.16±1.47
离婚/丧偶/分居723.46±2.6313.89±7.774.29±3.145.30±1.54
F/Welch（P）1.561（0.210）1.698（0.183）2.934（0.054）0.467（0.627）
职业性质体力劳动9403.16±2.1215.32±9.144.02±2.785.12±1.47
脑力劳动2343.75±2.3113.99±7.64.52±3.035.29±1.32
F/Welch（P）14.072（<0.001）4.220（0.040）5.733（0.017）2.599（0.107）
总计1 1743.28±2.1715.06±8.874.12±2.845.16±1.44
), ArticleFig(id=1241069119831863774, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=CN, label=表1, caption=

调查对象的基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量数量屏幕暴露（h）吸烟量（只）久坐时间（h）VAI
城乡城市4973.38±2.1614.65±8.553.99±2.795.24±1.37
农村6773.20±2.1815.35±9.094.21±2.875.10±1.49
F/Welch（P）1.871（0.172）1.786（0.182）1.704（0.192）2.572（0.109）
年龄段（岁）18～<456663.43±2.0715.66±8.914.23±2.935.18±1.29
45～<603583.30±2.3515.02±8.874.16±2.855.25±1.58
≥601502.58±2.0712.47±8.223.52±2.294.84±1.68
F/Welch（P）9.459（<0.001）8.209（<0.001）3.985（0.021）4.449（0.011）
教育水平文盲、半文盲2722.83±2.1514.67±9.853.63±2.705.03±1.63
小学2693.30±2.1415.62±9.423.94±2.725.23±1.40
初中4493.23±2.1214.87±8.184.30±2.895.13±1.36
高中/中专1263.95±2.1615.61±7.904.56±2.965.38±1.37
大专及以上584.12±2.3814.48±8.564.85±2.985.16±1.42
F/Welch（P）8.275（<0.001）0.630（0.641）4.500（0.001）1.489（0.203）
婚姻状况单身1493.53±2.0114.16±7.754.62±3.045.10±1.22
已婚/同居9533.22±2.1615.28±9.114.03±2.785.16±1.47
离婚/丧偶/分居723.46±2.6313.89±7.774.29±3.145.30±1.54
F/Welch（P）1.561（0.210）1.698（0.183）2.934（0.054）0.467（0.627）
职业性质体力劳动9403.16±2.1215.32±9.144.02±2.785.12±1.47
脑力劳动2343.75±2.3113.99±7.64.52±3.035.29±1.32
F/Welch（P）14.072（<0.001）4.220（0.040）5.733（0.017）2.599（0.107）
总计1 1743.28±2.1715.06±8.874.12±2.845.16±1.44
), ArticleFig(id=1241069119940915689, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=EN, label=Table 2, caption=

Correlation coefficient matrix among variables

, figureFileSmall=null, figureFileBig=null, tableContent=
变量屏幕暴露（h）久坐（h）吸烟量（只）VAI
屏幕暴露1.000
久坐0.437**1.0006
吸烟量0.331**0.224**1.000
内脏脂肪肥胖0.471**0.277**0.410**1.000
), ArticleFig(id=1241069120062550519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=CN, label=表2, caption=

各变量之间相关系数矩阵

, figureFileSmall=null, figureFileBig=null, tableContent=
变量屏幕暴露（h）久坐（h）吸烟量（只）VAI
屏幕暴露1.000
久坐0.437**1.0006
吸烟量0.331**0.224**1.000
内脏脂肪肥胖0.471**0.277**0.410**1.000
), ArticleFig(id=1241069120188379649, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=EN, label=Table 3, caption=

Results of multiple mediation model regression analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量t值P值β (95%CI)R2值F值
模型1：久坐时间
常量0.5804.286<0.0012.488 (1.349～3.626)0.20549.942
屏幕暴露0.03516.312<0.0010.564 (0.496～0.631)
年龄0.005-3.1510.002-0.015 (-0.025～0.006)
城乡0.1532.2630.0240.345 (-0.046～0.645)
教育程度0.0761.6310.1030.124 (-0.025～0.273)
婚姻状况0.176-1.1660.244-0.205 (-0.551～0.140)
职业性质0.2100.0460.9630.010 (-0.402～0.422)
模型2：吸烟量
常量1.9145.200<0.0019.954 (6.198～13.710)0.13024.747
屏幕暴露0.1259.661<0.0011.211 (0.965～1.456)
久坐时间0.0963.4150.0010.328 (0.139～0.516)
年龄0.0161.4020.1610.022 (-0.009～0.054)
城乡0.5001.1000.2720.550 (-0.431～1.532)
教育程度0.249-0.2530.800-0.063 (-0.551～0.425)
婚姻状况0.5760.3560.7220.205 (-0.926～1.336)
职业性质0.687-2.8210.005-1.938 (-3.286～-0.590)
模型3：内脏肥胖评分
常量0.28212.824<0.0013.614 (3.061～4.167)0.30363.150
屏幕暴露0.01912.26<0.0010.232 (0.195～0.270)
久坐时间0.00410.866<0.0010.046 (0.038～0.055)
吸烟量0.0142.2330.0260.031 (0.004～0.059)
年龄0.002-1.0260.305-0.002 (-0.007～0.002)
城乡0.073-1.7010.089-0.124 (-0.267～0.019)
教育程度0.036-1.0470.295-0.038 (-0.109～0.033)
婚姻状况0.0841.3610.1740.114 (-0.051～0.279)
职业性质0.1001.0910.2750.109 (-0.087～0.306)
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多重中介模型回归结果

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变量t值P值β (95%CI)R2值F值
模型1：久坐时间
常量0.5804.286<0.0012.488 (1.349～3.626)0.20549.942
屏幕暴露0.03516.312<0.0010.564 (0.496～0.631)
年龄0.005-3.1510.002-0.015 (-0.025～0.006)
城乡0.1532.2630.0240.345 (-0.046～0.645)
教育程度0.0761.6310.1030.124 (-0.025～0.273)
婚姻状况0.176-1.1660.244-0.205 (-0.551～0.140)
职业性质0.2100.0460.9630.010 (-0.402～0.422)
模型2：吸烟量
常量1.9145.200<0.0019.954 (6.198～13.710)0.13024.747
屏幕暴露0.1259.661<0.0011.211 (0.965～1.456)
久坐时间0.0963.4150.0010.328 (0.139～0.516)
年龄0.0161.4020.1610.022 (-0.009～0.054)
城乡0.5001.1000.2720.550 (-0.431～1.532)
教育程度0.249-0.2530.800-0.063 (-0.551～0.425)
婚姻状况0.5760.3560.7220.205 (-0.926～1.336)
职业性质0.687-2.8210.005-1.938 (-3.286～-0.590)
模型3：内脏肥胖评分
常量0.28212.824<0.0013.614 (3.061～4.167)0.30363.150
屏幕暴露0.01912.26<0.0010.232 (0.195～0.270)
久坐时间0.00410.866<0.0010.046 (0.038～0.055)
吸烟量0.0142.2330.0260.031 (0.004～0.059)
年龄0.002-1.0260.305-0.002 (-0.007～0.002)
城乡0.073-1.7010.089-0.124 (-0.267～0.019)
教育程度0.036-1.0470.295-0.038 (-0.109～0.033)
婚姻状况0.0841.3610.1740.114 (-0.051～0.279)
职业性质0.1001.0910.2750.109 (-0.087～0.306)
), ArticleFig(id=1241069120465203734, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=EN, label=Table 4, caption=

Mediation effect test results

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效应路径效应量 (95%CI)效应占比 (%)
总效应0.0170.315 (0.281～0.349)100.00
直接效应路径10.0190.232 (0.195～0.270)73.65
中介效应0.0110.083 (0.061～0.104)26.35
路径20.0080.018 (0.002～0.033)5.71
路径30.0080.056 (0.042～0.072)17.78
路径40.0030.009 (0.003～0.014)2.85
), ArticleFig(id=1241069120632975909, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819654378255, language=CN, label=表4, caption=

中介效应显著性检验结果

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效应路径效应量 (95%CI)效应占比 (%)
总效应0.0170.315 (0.281～0.349)100.00
直接效应路径10.0190.232 (0.195～0.270)73.65
中介效应0.0110.083 (0.061～0.104)26.35
路径20.0080.018 (0.002～0.033)5.71
路径30.0080.056 (0.042～0.072)17.78
路径40.0030.009 (0.003～0.014)2.85
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久坐和吸烟在屏幕暴露对男性内脏肥胖指数关系的链式中介作用
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赵否曦 , 朱玲 , 汪姜涛 , 杜瑀 , 刘涛
现代预防医学 | 流行病与统计方法 2024,51(23): 4244-4248
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现代预防医学 | 流行病与统计方法 2024, 51(23): 4244-4248
久坐和吸烟在屏幕暴露对男性内脏肥胖指数关系的链式中介作用
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赵否曦, 朱玲, 汪姜涛, 杜瑀, 刘涛
作者信息
  • 贵州省疾病预防控制中心，贵州 贵阳 550004

    • 赵否曦（1984—），男，硕士，副主任医师，研究方向：慢性病预防与控制

通讯作者:

刘涛，E-mail:
The chain mediating role of sedentary behavior and smoking in the relationship between screen exposure and visceral fat index in men
Fou-xi ZHAO, Ling ZHU, Jiang-tao WANG, Yu DU, Tao LIU
Affiliations
  • Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, China
出版时间: 2024-12-10 doi: 10.20043/j.cnki.MPM.202407248
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摘要
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目的

探究屏幕暴露与成人男性的内脏肥胖指数之间的链式中介作用。

方法

本文采用2020年贵州省慢性病危险因素调查数据中男性调查对象，使用健康行为方式问卷获取电子屏幕接触时间、久坐情况、吸烟量；通过实验室指标检测获取血脂情况，体格测量获取身高、体重、腰围等体格情况。使用相关系数矩阵分析各变量之间的相关性大小，构建多重中介效应模型，研究久坐时间、吸烟量在男性屏幕暴露与内脏肥胖指数关系中的中介路径。使用SPSS的process插件并用bootstrap法检验链式中介效应，Amos绘制中介路径。

结果

共计纳入1 174例研究对象，在控制了年龄、城乡、教育程度、婚姻状况和职业以后，回归结果显示屏幕暴露对男性内脏肥胖指数的直接影响显著（β=0.232, 95%CI：0.915～0.270），久坐时间（β=0.046, 95%CI：0.038～0.055）和吸烟量（β=0.031, 95%CI：0.004～0.059）显著影响男性内脏肥胖指数。中介效应分析结果显示，久坐时间和吸烟量在屏幕暴露和男性内脏肥胖指数之间的简单中介效应分别为0.018（95%CI：0.020～0.033）和0.056（95%CI：0.042～0.072），链式中介效应为0.009（95%CI：0.003～0.014）。

结论

久坐和吸烟在屏幕暴露对男性内脏肥胖指数中存在中介效应，屏幕暴露是最常见的生活方式，尤其男性应减少屏幕暴露时间中的吸烟和久坐行为，减少内脏肥胖的发生。

屏幕暴露  /  内脏肥胖  /  中介分析
Objective

To investigate the chain mediating effects of sedentary behavior and smoking on the relationship between screen exposure and visceral fat index in adult men.

Methods

Data were collected from the 2020 Chronic Disease Risk Factor Survey in Guizhou Province, focusing on male participants. A health behavior questionnaire was employed to gather information on electronic screen exposure time, sedentary behavior, and smoking quantity. Laboratory indicators were used to assess blood lipid levels, while physical measurements provided data on height, weight, and waist circumference. A correlation coefficient matrix was constructed to analyze the relationships among variables, and a multiple mediation model was developed to explore the mediating pathways of sedentary time and smoking in the relationship between screen exposure and visceral fat index. The PROCESS plugin in SPSS was used to test the chain mediation effects via the bootstrap method, and the mediation pathways were illustrated using Amos.

Results

A total of 1 174 subjects were included in the study. After controlling for age, urban/rural status, education level, marital status, and occupation, regression results indicated a significant direct effect of screen exposure on the visceral fat index in men (β=0.232, 95%CI: 0.915-0.270). Sedentary time (β=0.046, 95%CI: 0.038-0.055) and smoking quantity(β=0.031, 95%CI: 0.004-0.059) were also found to significantly influence the visceral fat index. The mediation analysis revealed that the simple mediating effects of sedentary time and smoking between screen exposure and the visceral fat index were 0.018(95%CI: 0.020-0.033) and 0.056 (95%CI: 0.042-0.072), respectively, while the chain mediation effect was 0.009 (95%CI:0.003-0.014).

Conclusion

Sedentary behavior and smoking exhibit mediating effects in the relationship between screen exposure and visceral fat index in men. As screen exposure is a prevalent lifestyle factor, it is crucial for men to reduce smoking and sedentary behaviors during screen time to mitigate the occurrence of visceral obesity.

Screen exposure  /  Visceral fat  /  Mediation analysis
赵否曦, 朱玲, 汪姜涛, 杜瑀, 刘涛. 久坐和吸烟在屏幕暴露对男性内脏肥胖指数关系的链式中介作用. 现代预防医学, 2024 , 51 (23) : 4244 -4248 . DOI: 10.20043/j.cnki.MPM.202407248
Fou-xi ZHAO, Ling ZHU, Jiang-tao WANG, Yu DU, Tao LIU. The chain mediating role of sedentary behavior and smoking in the relationship between screen exposure and visceral fat index in men[J]. Modern Preventive Medicine, 2024 , 51 (23) : 4244 -4248 . DOI: 10.20043/j.cnki.MPM.202407248
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《中国居民营养与慢性病状况报告(2020年)》[1]显示，我国超过50%的成年人处于超重或肥胖状态，城乡各年龄组均呈现超重肥胖率持续上升趋势。内脏肥胖指数(visceral adiposity index，VAI)是超重肥胖的指标之一，VAI升高与多种慢性疾病的发生和发展密切相关，如心血管疾病、糖尿病、高血压等。
随着数字化信息时代的变迁，屏幕暴露已成为现代社会的一种普遍现象。人们在工作、学习和娱乐等各个领域都离不开电脑、手机、电视等屏幕设备。同时，屏幕暴露常常伴随着其他的不良生活方式，特别是男性还存在着久坐和吸烟相影响的情况，这些因素将导致肥胖尤其是内脏脂肪的堆积。而长时间屏幕暴露可能导致人体代谢紊乱、能量消耗减少，从而增加内脏肥胖的风险[2-3]。已有研究表明，吸烟和久坐都是男性VAI的重要危险因素，它们与屏幕暴露可能存在相互作用。吸烟会导致脂肪代谢紊乱，增加内脏脂肪的积累，而久坐则可能导致能量消耗减少，进一步加剧内脏肥胖的风险。因此，研究久坐时间和吸烟量在屏幕暴露与VAI之间的作用，有助于揭示屏幕暴露对男性VAI影响的复杂机制。本文旨在探讨屏幕暴露对男性VAI的关联性，并分析吸烟和久坐在其中的链式中介作用。可以为预防和控制男性内脏肥胖提供科学依据，并提供新的防控策略。
1 材料与方法
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1.1 数据来源
本文数据来源于贵州省2020年慢性病危险因素调查。对贵州省12个县（区、市）运用按人群规模比例抽样（PPS），在每个县（区、市）抽取4个乡镇（街道），每个乡镇（街道）抽取3个村（居委），每个村（居委）抽取1个50人以上的村（居民）组，采用KISH表对每个家庭内随机抽取18岁及以上居民开展调查，共计9 280人进行了调查，最终1 174人纳入分析。筛选过程如图1所示。本项目通过贵州省疾病预防控制中心伦理委员会批准（Q2023-12），所有调查对象均签署知情同意书。
1.2 变量选取
本研究选取了男性的VAI评分为因变量，屏幕暴露为自变量，吸烟量和久坐情况为中介变量。
（1）VAI：因变量为VAI，选取调查中基础数据、体格检查和生化指标检测的数据，分别为年龄(age)、身体质量指数（BMI）、腰围(WC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)等指标，按照如下公式进行计算：
男性：VAI=-267.63+0.68×age+0.3×BMI+4.0×WC+22.0×log10TG-16.32×HDL-C
（2）屏幕暴露时间：主要选取每日看电视时间、每日电脑（台式电脑、笔记本电脑、平板电脑）使用时间、每日手机使用时间。
（3）吸烟量：对具有吸烟行为的对象计算或折算每日吸烟量。
（4）每日坐、靠的总体静息时间：不包括睡眠时间。
（5）本文将年龄、婚姻状况、受教育水平、职业作为控制变量。
1.3 设定假设
根据链式中介效应分析的原理，对各项中介效应提出如下假设：
H1：屏幕暴露对男性VAI存在正相关。
H2a：久坐时间在屏幕暴露对男性VAI具有中介作用。
H2b：久坐时间对男性VAI存在正相关。
H3a：吸烟量在屏幕暴露对男性VAI具有中介作用。
H3b：吸烟量对男性VAI存在正相关。
H4：久坐时间与吸烟量在屏幕暴露对男性VAI存在链式中介效应作用。
1.4 统计学方法
采用SPSS 22.0统计软件进行数据分析，计数资料的统计描述采用频数相对数，计量资料采用描述。屏幕暴露时间、平均每日吸烟量、平均每日久坐时间、VAI彼此之间的相关性用相关系数矩阵进行分析，使用SPSS process 3.5，经bootstrap法进行链式中介效应检验。检验水准α=0.05。
2 结果
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2.1 调查对象的基本特征
本文研究对象为1 174例，屏幕暴露平均时间为（3.28±2.17） h，平均每日吸烟量为（15.06±8.87） 只，平均每日久坐时间为（3.99±2.79） h，VAI指数为（5.24±1.37） 分。见表1。
2.2 相关性分析
屏幕暴露与吸烟量（r=0.331,P<0.01）、久坐时间（r=0.437,P<0.01）、VAI（r=0.471,P<0.01）呈现正相关；吸烟量与久坐时间（r=0.224,P<0.01）、VAI（r=0.410,P<0.01）呈现正相关；久坐时间与内脏肥胖之间（r=0.277,P<0.05）呈现正相关。见表2。
2.3 久坐时间、吸烟量在屏幕暴露与VAI关系中的链式中介路径分析
以年龄、城乡、教育程度、婚姻状况和职业性质为控制变量，屏幕暴露为自变量，吸烟量和久坐时间为中介变量，VAI为因变量代入多重中介效应分析中，数据分析结果显示：屏幕暴露显著正向预测久坐时间（β=0.564,P<0.001），显著预测吸烟量（β=1.211,P<0.001），显著正向预测VAI（β=0.232,P<0.001）；久坐时间能够正向预测吸烟量（β=0.328，P=0.001），正向预测VAI（β=0.046,P<0.001）;久坐时间能够正向预测VA（Iβ=0.046,P<0.001）。见表3。
采用bootstrap法对上述中介效应进行检验，重复抽样5 000次，通过链式中介效应的分析结果来看，路径1至路径4的95%CI均不包括0，说明中介变量的中介效应显著，四条路径的效应值分别为：0.232、0.018、0.056、0.009，分别占效应总值的73.65%、5.71%、17.78%、2.85%，因此久坐时间和吸烟量在屏幕暴露和内脏肥胖中具有链式中介作用。见表4、图2。
3 讨论
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因工作、学习和生活的原因，现代人通常会花费大量时间注观看电视、或在社交软件上浏览等，屏幕暴露已经成为一个重要的公共卫生问题。本研究发现，对象的日屏幕暴露平均时长为3.28 h，与多数研究结果类似[4-5]。
3.1 屏幕暴露与VAI之间存在正相关关系
本研究结果显示，屏幕暴露与内脏肥胖之间存在正相关关系，相关研究表明，过度使用电子设备（ST）被认为是导致肥胖的危险行为，因为会导致睡眠时间减少、摄入更多的超加工食品有关。根据巴西一项研究结果显示，对数字设备的依赖会增加与不适当饮食习惯相关的疾病的风险，例如饮食失调、超重和肥胖[6],根据Chantal A. Vella[7]的研究发现发现屏幕时间与多项肥胖指标呈正相关，包括 BMI、脂肪量、腰围和脂质累积乘积。提示了与屏幕暴露时伴随着其他的不良生活方式行为有关，例如吸烟、久坐、睡眠质量下降产生有联系。
3.2 吸烟量在屏幕暴露和VAI之间存在中介作用
在本研究中，因吸烟量导致的效应占总效应的17.78%。有研究表明，屏幕使用与吸烟行为高度相关[8]，这一点在男性中较为常见。特别是过度的网络使用，这可能与自我控制能力较差，更容易患上网络成瘾，而网络成瘾会导致吸烟量进一步加重[9]。另外，也可能与男性在工作时，常常需要使用烟草来提神，促进工作效率有关。而吸烟行为又进一步促进了腹部脂肪的形成。
3.3 久坐在屏幕暴露和VAI之间存在中介作用
久坐行为的定义是能量消耗在1.0～1.5代谢当量(METs)范围内的活动[10]，基于久坐的屏幕暴露对健康有负面影响，会增加代谢综合征的风险[11]，根据本文研究显示，屏幕暴露通过久坐这一中介作用对内脏脂肪代谢发生作用，其效应占总体效应的5.71%。现代生活方式的改变，在工作以及休闲时间内，通常面对屏幕作业，利用手机进行休闲互动，无法避免面对久坐的屏幕使用行为。根据Ekelund U等人[12]的研究结果，中等强度的体育锻炼不能消除长时间屏幕暴露带来的死亡风险，这更提示了基于久坐带来的屏幕暴露对健康的损害，这可能是长时间坐着会削弱脂蛋白脂肪酶活性，从而影响骨骼肌中的脂质和葡萄糖代谢[13]。对脂质和葡萄糖代谢造成的有害变化无法通过增加身体活动来逆转或预防[14-15]。
3.4 久坐时间、吸烟量在屏幕暴露和VAI之间存在链式中介作用
屏幕暴露会导致内脏脂肪增积[16]，原因是多方面的，屏幕暴露会带来多种不良的生活方式，其一，屏幕暴露的情况下，通常是静态的姿势，例如久坐、躺卧等，会取代身体活动，其二，男性在屏幕暴露的条件下，常伴有吸烟行为，特别是处理工作、观看电视、玩游戏的状态下，尽管不同的年龄段和职业对屏幕暴露的方式是不同的，本文在控制了年龄、职业、文化程度、工作性质等变量后，调查的成人男性群体中，久坐时间和吸烟量在屏幕暴露和内脏脂肪存在链式中介效应，效应占总效应的2.85%，其占比不高，可能的理由如下：第一可能还有其他因素在屏幕暴露和内脏肥胖之间起到更重要的作用；第二久坐和吸烟可能通过不同机制影响内脏脂肪，而这些机制没有被当前研究充分捕获到；第三吸烟和久坐可能对内脏脂肪代谢有长期影响，这种机制可能需较长时间才能显现。基于以上原因，有待后续研究中进长时间追踪，并且考虑建立潜在中介变量和调节变量，以更为全面了解屏幕暴露对内脏肥胖的复杂机制。
综上所述，屏幕暴露是当前较为主要的生活工作方式，长时间暴露于屏幕之前不仅导致视觉疲劳，还可能引发吸烟和久坐等不良的生活习惯，从而增加了内脏肥胖的风险，应倡导健康的生活方式，合理安排屏幕使用时间，进行适量的运动，减少久坐带来的危害，同时提倡戒烟限酒，提高自我保健意识。
基金
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  • 贵州省卫生健康委科学技术基金项目(gzwkj2021-550)
  • 贵州省科技厅基础研究项目(黔科合基础-ZK（2022）一般-244)
  • 贵州省高层次创新型人才培养项目
文献
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参考文献 引证文献
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Information Office of the State Council. Report on nutrition and chronic diseases of Chinese residents (2020)[R]. Beijing: State Council Information Office of the People's Republic of China, 2020. (In Chinese)
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2024年第51卷第23期
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文章信息
doi: 10.20043/j.cnki.MPM.202407248
  • 接收时间：2024-07-14
  • 首发时间：2026-03-18
  • 出版时间：2024-12-10
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  • 收稿日期：2024-07-14
基金
贵州省卫生健康委科学技术基金项目(gzwkj2021-550)
贵州省科技厅基础研究项目(黔科合基础-ZK（2022）一般-244)
贵州省高层次创新型人才培养项目
作者信息
    贵州省疾病预防控制中心，贵州 贵阳 550004

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刘涛，E-mail:
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