European Journal of Cardiovascular Medicine

All facets of life need communication. It makes no difference if one is interacting with others in public, at work, at school, or elsewhere. However, it might entail anything from sending emails or making phone calls to creating presentations or writing reports. A mobile phone is a portable, user-friendly gadget. It is easy to use without complicated technology or specialized knowledge. The increased usage of cell phones by students has resulted in several problems, such as poor attention, indiscipline, low academic performance, and low-class participation. As a result, the average difference for students who experienced impact was maintained at 22.5 percent.[i] 

A smartphone combines the features of an Internet browser with a mobile phone. Services offered by smartphones vary in quality. According to a study, teenagers who use smartphones may have uneven learning chances. Following a debate over whether or not smartphones are a performance mediator, it is ultimately shown that smartphone behaviour is the mediating variable influencing academic accomplishment.[ii] Reducing smartphone access might be detrimental to learning effectiveness and academic performance. These individuals deal with physiological, psychological, and social problems.[iii] Campaigns to raise public awareness about smartphone addiction and its detrimental effects on mental and physical health are necessary.[iv]

There are 600 million smartphone users in India. Problematic smartphone use was positively connected, both directly and indirectly, with negative body image, depression, social anxiety, emotional abuse, and neglect.[v] Numerous other issues arise from using smartphones. For instance, negative relationships between problematic smartphone use and emotional abuse and neglect have been found, both directly and indirectly, via the lens of body image dissatisfaction, depression, and social anxiety. Smartphone use may lead to failure to restrict usage despite negative impacts on one's, especially adolescent's, health, finances, physical well-being, and relationships with others, in addition to offering delight and reducing pain and stress.[vi]

Childhood and adolescence are critical periods of growth. Engaging in enough physical activity (PA) has been demonstrated to benefit children’s physical and mental health, such as reducing health risks, preventing obesity, and developing cognitive function.[vii] To achieve health benefits through PA, the World Health Organization (WHO) recommends that children and adolescents accumulate moderate-to-vigorous intensity PA (MVPA) exceeding 60 minutes per day.[viii] However, the rising prevalence of physical inactivity is a serious concern worldwide. Globally, about 70% of children and adolescents do not meet the recommendations on PA.[ix] To date, many researchers have explored the effect of smartphone interventions on improving the PA of children and adolescents through randomized controlled trials (RCT), but there are controversies about inconsistent research results. Given the fact that there have been many new RCTs in recent years,[x]^,[xi],[xii] and the previous study included comprehensive intervention strategies, it is unclear whether intervention effects were truly due to the smartphone itself, or rather the other intervention components.[xiii] Therefore, conducting a new study on this topic is necessary.

Aim: To study on Physical activity and lipid profiles to understand the impact of smartphone usage on adolescents in Malawa region, Indoor MP.

This cross-sectional study was conducted in the Department of Physiology, Index Medical College, Hospital and Research Centre Indore MP, India. After approval of the Institutional Ethical Committee. The study participants from primary, higher secondary, and intermediate schools located in rural and urban areas of Madhya Pradesh; of either sex adolescents (10 to 19 years) of age group were enrolled in this study. Subjects aged less than 10 years and more than 19 years, adolescents who do not use smartphones, Hereditary Overweight, and Obesity and neurological disorders were excluded from the study.

The outcome of the study:

• Anthropometric parameters (age, height, weight, and BMI)
• Physical inactivity
• Lipid profile screening (such as Total Cholesterol, Triglycerides, High-Density Lipoprotein, Low-Density Lipoprotein, and Very Low-Density Lipoprotein).

Statistical Analysis

Data was analyzed using Statistical Package for Social Sciences, version 20.0 (SPSS Inc., Chicago, IL). Results for continuous variables were presented as mean ± standard deviation, whereas results for categorical variables were presented as frequency/number (percentage). The correlation between the duration of smartphone use, BMI, and lipid profile was evaluated by the Pearson correlation coefficient test. The level P < 0.05 was considered as the cutoff value or significance.

The mean age of the study participants, was 15.9±2.5years, with a minimum of 10 to maximum 19 years. The mean weight (kg) of the study participants was 57.1±10.8. The mean height (cm) was 158.0±7.7. The mean BMI (kg/m2) was 22.9±4.9.

Table 1: Age and Anthropometric Variables Distribution

In our study population, all participants were eating chips, Kurkure, magi, burger, pizza, sweets, and using cold drinks. Our study also noted that 73.0% of children were using the smartphone while eating.

Table 2: Distribution of Dietary Habits

The table shows, that out of the 400 cases, 144 reported using a smartphone for less than 2 hours each day, which accounts for 36% of the cases. On the other, 256 participants reported using a smartphone for more than 2 hours each day, accounting for 64% of the cases.

Figure 1: Distribution of child uses the smartphone each day (hr./day)

When we compared indoor physical activity with lipid profile, then we noted that indoor physical activity everyday duration of was insignificant associated with lipid profile (p>0.05).

Table No 3: Comparison of indoor Physical activity with lipid profile

In this table, we noted that lower total cholesterol levels and higher HDL levels were significantly associated with outdoor physical activity greater than 60 minutes (<0.05), While the rest of the variables were insignificantly associated with outdoor physical activity duration (p>0.05).

Table No 4: Comparison of outdoor Physical activity with lipid profile

In this study, we noted that outdoor physical activity and total cholesterol levels were positively significantly associated (p<0.05). Lipid profile (total cholesterol, triglycerides, and LDL) was positive and HDL was negative significantly associated with the use of a smartphone every day (p<0.001).

Table No 4: Association of indoor and outdoor physical activity and child using a smartphone every day with lipid profile

In the present study, the mean age of the studied subjects was 15.9 years, with a standard deviation of 2.5 years. The majority of the subjects of 19 years (21.3%) followed by 18 years (17.8%). Among those 50.0% were male and 50.0% were females. The mean weight (kg) of study participants was 57.1±10.8. The mean height (cm) was 158.0±7.7. The mean BMI (kg/m2) was 22.9±4.9. Our findings were to the findings of Brodersen K et al[i] who reported that there were 55.7% identified as female, 38.5% as male, and 5.7% as transgender, other, or preferred not to disclose their gender. Youth were recruited from grades 9 (29.7%), 10 (20.4%), 11 (14.5%), and 12 (35.4%) and the average age was 16 years old. Ma Z et al[ii] shows that of the 7506 members with complete data, 3732(49.7%) were male, and 3774(50.3%) were female. The mean age of participants was 12.43 years old. According to Bhanderi DJ et al[iii] a total of 496 adolescent students in the age group of 16–19 years participated in our study, having a mean age of 17.8±1.1 years. Shuvo SD et al[iv] reported that of the 350 teenagers, 39.2% were females and 60.8% were guys. About 57% of the students studied in class nine, while 43.0% did so in class eight. In general, 62.4% of teenagers did not routinely engage in physical activity.

In our study population, all participants were eating chips, Kurkure, magi, burger, pizza, sweets, and using cold drinks. Our study also noted that 73.0% of children were using the smartphone while eating. Shuvo SD et al reported that 51.7% of them had bad eating habits while using electronic media. They also found that unhealthy eating practices when using electronic media were found to be strongly linked to obesity and overweight. Seaun R et al[v] chose seven distinct dietary risk variables that have been linked to diabetes, cancer, obesity, and cardiovascular disease in the past: eating less fruits and vegetables (excluding kimchi) and skipping breakfast more often; also, consuming Korean quick noodles (rameyon) more frequently[vi], Food items that are considered fast food include pizza, hamburgers, fried chicken, chips and crackers, and sugar-sweetened beverages (SSBs), such as fruit juice, sports drinks, carbonated drinks, and sweetened instant coffee. Our results are consistent with earlier research conducted in other nations.[vii]^,[viii] This could be because of prolonged sedentary behaviour and the high energy intake might promote visceral fat in adolescents.[ix] Unhealthy eating habits like diets higher in fat, and the drink more sodas, and the fast food during electronic device use might lead to overconsumption among school adolescents.[x] In agreement with the previous experimental studies.[xi]^,[xii]

The table shows, that out of the 400 cases, 144 reported using a smartphone for less than 2 hours each day, which accounts for 36% of the cases. On the other, 256 participants reported using a smartphone for more than 2 hours each day, accounting for 64% of the cases. Research shows that problematic smartphone use is significantly related to loneliness[xiii], low self-esteem, and depression.62 Poor mental health has also proven a risk factor for childhood obesity.[xiv] Additionally, a person's diet and daily routine are negatively impacted by smartphone reliance, which leads to overweight or obesity.[xv] Additionally, academic stress contributes to addictive behaviours, like smartphone addiction.[xvi]

In the present study, we found that total cholesterol, triglycerides, LDL, and VLDL were significantly higher in obese and overweight children (p<0.05). while HDL, outdoor and indoor physical activity was significantly lower in obese and overweight children (p<0.05). Our findings were comparable to the findings of Parkar MA et al[xvii] who examined the impact of cell phone use on the physiologic and hematologic parameters of male medical students in Bijapur, Karnataka), using the serum lipid profile as a reference. The results showed that Group II, who had been using cell phones for more than four years, had significantly higher levels of total cholesterol, VLDL, LDL, and triglycerides than Group I, who had never used a cell phone.

The rise of serum triglycerides in group II may be due to a lack of activity of lipoprotein lipase, which breaks up triglycerides inside chylomicrons, releasing fatty acids in the process. Fatty acids can either be used by muscles as energy or be absorbed by the fat cells, where they are reincorporated into triglycerides that can be stored for further energy needs.[xviii] It can therefore be postulated from this study that radiofrequency exposure was associated with a greater chance of becoming dyslipidemia.[xix]

There were sex-based differences in the association between problematic smartphone use and obese status. According to the study, there is a favourable correlation between female students' obese state and their problematic smartphone use for leisure. Instead, of playing online games, their problematic smartphone use for leisure may be more in the form of online books to read or movies to binge-watch, which may need more sedentary time. Because this type of usage necessitates sedentary behaviour, it may be the cause of the rise in obesity rates. To the best of our knowledge, this is the first population-based study that looks at how frequently common electronic devices are used by Indian teenagers enrolled in secondary schools and examines the relationship between using electronic media and being overweight or obese. This research implies that exposure to electronic media (EM) at a particular level may increase the likelihood that these early adolescents would become overweight or obese. More long-term research is also required to look into the specific usage patterns of EM and how they relate to BMI in the Madhya Pradesh area.

Limitations of the study

• Given the cross-sectional design of the study, it’s difficult to clarify temporal relation and thus it should not be interpreted as causal.
• Our data also lack information on the time of day (e.g., day compared with night) and environmental settings (e.g., home compared with outdoor) of smartphone use, and thus further studies are required to clarify relations accounting for various factors that may influence food options and appetite.

Strengths of the study

The key strength of the study is that we utilized youth citizens' smartphones, to ethically and efficiently collect data about health outcomes and screen time behaviours. Furthermore, by concentrating on both individual smartphone behaviours (such as gaming and messaging) and total smartphone use, this study modified established self-reported questionnaires to further analyze behaviours specific to smartphone devices.

The total cholesterol, triglycerides, LDL, and VLDL were significantly higher in obese and overweight children (p<0.05). while HDL, outdoor, and indoor physical activity were significantly lower in obese and overweight children (p<0.05). Eating fast food, less physical activity, and sedentary life were more prevalent among teenagers. This study does, however, strongly suggest that longitudinal research be done in the future to validate our results and determine the pattern of connection with lipid profile status. By implementing school-based intervention programs, teenagers and adolescents may use EM less frequently. In addition, parents have to take a proactive approach to minimize their kids' screen time and instead push them to participate in physical activities.

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