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Summary   Objective  Evidence suggests that TV viewing is associated with body mass index (BMI) and metabolic syndrome (MetS) in adolescents. However, it is unclear whether dietary intake mediates these relationships.    Methods  A cross‐sectional analysis was conducted in adolescents (12–19 years) participating in the 2003–2006 United States National Health and Nutrition Examination Survey. BMI  z  scores (zBMI) ( n  = 3,161) and MetS ( n  = 1,379) were calculated using age‐ and sex‐specific criteria for adolescents. TV viewing (h/day) was measured via a self‐reported questionnaire, and dietary intake was assessed using two 24‐h recalls. Using the MacKinnon method, a series of mediation analyses were conducted examining five dietary mediators (total energy intake, fruit and vegetable intake, discretionary snacks, sugar‐sweetened beverages and diet quality) of the relationships between TV viewing and zBMI and MetS.    Results  Small positive relationships were observed between TV viewing and zBMI (β = 0.99,  p  < 0.001) and TV viewing and MetS (OR = 1.18,  p  = 0.046). No dietary element appeared to mediate the relationship between TV viewing and zBMI. However, sugar‐sweetened beverage consumption and fruit and vegetable intake partially mediated the relationship between TV viewing and MetS, explaining 8.7% and 4.1% of the relationship, respectively.    Conclusions  These findings highlight the complexity of the relationships between TV viewing, dietary intake and cardiometabolic health outcomes, and that TV viewing should remain a target for interventions.

Mediating effects of dietary intake on associations of TV viewing, body mass index and metabolic syndrome in adolescents