Residential greenness and atherosclerotic cardiovascular disease risk in a rural Chinese adult population

Association of at-home and out-of-home eating frequency with the estimated 10-year arteriosclerotic cardiovascular disease risk in rural population: the Henan Rural Cohort Study

PURPOSE

Insufficient evidence currently exists regarding the relationship between eating frequency and arteriosclerotic cardiovascular disease (ASCVD). Thus, the objective of this study was to explore the association of at-home eating (AHE) and out-of-home eating (OHE) frequency with 10-year ASCVD risk.

METHODS

A total of 23,014 participants were included from the Henan Rural Cohort Study. A face-to-face questionnaire was used to acquire data on the frequency of OHE and AHE. The relationship of OHE and AHE frequency with 10-year ASCVD risk was evaluated by logistic regression. Mediation analysis was conducted to evaluate whether BMI mediated the association of OHE and AHE frequency with 10-year ASCVD risk.

RESULTS

The adjusted OR and 95% CI of 10-year ASCVD risk for participants who ate out 7 or more times a week was 2.012 (1.666, 2.429) compared with participants who had OHE 0 times. Compared to those who had AHE ≤ 11 times, the adjusted OR and 95% CI for the participants eating every meal at home (21 times) was 0.611 (0.486, 0.769). The relationship of OHE and AHE frequency with 10-year ASCVD risk was mediated by BMI, and the proportion of BMI explained was 25.3% and 36.6%.

CONCLUSIONS

The OHE frequency was associated with increased 10-year ASCVD risk, while AHE was related to decreased 10-year ASCVD risk, and BMI may play a partial mediating role in the relationship. Implementing health promotion strategies that promote AHE and discourage frequent OHE may prove to be an effective approach to preventing and controlling ASCVD.

TRIAL REGISTRATION NUMBER

ChiCTR-OOC-15006699 (2015-07-06).

Residential greenness and cardiac conduction abnormalities: epidemiological evidence and an explainable machine learning modeling study

BACKGROUND

Previous studies indicated the beneficial influence of residential greenness on cardiovascular disease (CVD), however, the association of residential greenness with cardiac conduction performance remains unclear. This study aims to examine the epidemiological associations between residential greenness and cardiac conduction abnormalities in rural residents, simultaneously exploring the role of residential greenness for cardiac health in an explainable machine learning modeling study.

METHODS

A total of 27,294 participants were derived from the Henan Rural Cohort. Two satellite-based indices, the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI), were used to estimate residential greenness. Independent and combined associations of residential greenness indices and physical activities with electrocardiogram (ECG) parameter abnormalities were evaluated using the logistic regression model and generalized linear model. The Gradient Boosting Machine (GBM) and the SHapely Additive exPlanations (SHAP) were employed in the modeling study.

RESULTS

The odds ratios (OR) and 95% confidence interval (CI) for QRS interval, heart rate (HR), QTc interval, and PR interval abnormalities with per interquartile range in NDVI were 0.896 (0.873-0.920), 0.955 (0.926-0.986), 1.015 (0.984-1.047), and 0.986 (0.929-1.045), respectively. Furthermore, the participants with higher physical activities plus residential greenness (assessed by EVI) were related to a 1.049-fold (1.017-1.081) and 1.298-fold (1.245-1.354) decreased risk for abnormal QRS interval and HR. Similar results were also observed in the sensitivity analysis. The NDVI ranked fifth (SHAP mean value 0.116) in the analysis for QRS interval abnormality risk in the modeling study.

CONCLUSION

A higher level of residential greenness was significantly associated with cardiac conduction abnormalities. This effect might be strengthened in residents with more physical activities. This study indicated the cruciality of environmental greenness to cardiac functions and also contributed to refining preventive medicine and greenness design strategies.

Associations between residential greenness and the predicted 10-year risk for atherosclerosis cardiovascular disease among Chinese adults

BACKGROUND

Exposure to build environments, especially residential greenness, offers benefits to reduce the development of atherosclerotic cardiovascular diseases (ASCVD). The 10-year ASCVD risk is a useful indicator for long-term ASCVD risk, but the evidence on the association and potential pathway of residential greenness in mitigating its development remains unclear.

OBJECTIVES

This study aimed to investigate the associations between residential greenness and the 10-year predicted ASCVD risks, and potentially mediation effect on this association by air pollution, body mass index (BMI) and physical activity (PA).

METHODS

The baseline of the China Multi-Ethnic Cohort (CMEC) study, enrolling 99,556 adults during 2018-2019, was used in this cross-sectional study. The participants' 10-year ASCVD risks were predicted as low-, moderate-, and high-risk groups, based on the six risk factors: age, smoking, hypertension, low-density lipoprotein cholesterol (LDL-C), high high-density lipoprotein cholesterol (HDL-C), and high total cholesterol (TC). The 3-year mean value within the circular buffer of 500 m and 1000 m of Enhanced Vegetation Index (EVI_500m and EVI_1000m) were used to assess greenness exposure. Multiple logistic regression was used to evaluate the association between residential greenness and the 10-year ASCVD risks. Stratified analyses by sex, age and smoking status were performed to identify susceptible populations. Causal mediation analysis was used to explore the mediation effects of air pollution, BMI and PA.

RESULTS

A total of 75,975 participants were included, of which 17.9 % (n = 13,614) and 5.6 % (n = 4253) had the moderate and high 10-year ASCVD risks, respectively. Compared to the low-risk group, each interquartile increase in EVI_500m and EVI_1000m reduced the ASCVD risk of the moderate-risk group by 4 % (OR = 0.96 [0.94, 0.98]) and 4 % (OR = 0.96 [0.94, 0.98]), respectively; and reduced the risk of the high-risk group by 8 % (OR = 0.92 [0.90, 0.96]) and 7 % (OR = 0.93 [0.90, 0.97]), respectively. However, the increased greenness did not affect the ASCVD risk of the high-risk group when compared to the moderate-risk group. Effects of residential greenness on the ASCVD risk were stronger in women than in men (p < 0.05), and were not observed in those aged ≥55. PA and BMI partially mediated the association between greenness and the 10-year ASCVD risk.

CONCLUSIONS

ASCVD prevention strategies should be tailored to maximize the effectiveness within the groups with different ASCVD risks, better at early stages when the ASCVD risk is low.

Rural-urban disparities in the associations of residential greenness with diabetes and prediabetes among adults in southeastern China

AIMS

Greenness offers health benefits to prevent diabetes in urban areas. However, urban-rural disparities in this association have not been explored, with the underlying pathways understudied as well. We aimed to investigate and compare the associations and potential pathways between residential greenness and the risks for diabetes and prediabetes in urban and rural areas.

METHODS

Diabetes and prediabetes were diagnosed by fasting blood glucose (FBG). The participants' residential greenness exposure was estimated by the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). The association of residential greenness with the risks for diabetes and prediabetes was estimated by logistic regression and the generalized additive model. The potential mediation effects of air pollution, body mass index (BMI), and physical activity (PA) were examined by causal mediation analysis.

RESULTS

Of the 50,593 included participants, and the prevalence of prediabetes and diabetes were 21.22 % and 5.63 %, respectively. Each 0.1-unit increase in EVI_500m and NDVI_500m for healthy people reduced the risk for prediabetes by 12 % and 8 %, respectively, and substantially reduced the risk for diabetes by 23 % and 19 %, respectively. For those with prediabetes, each 0.1-unit increase in EVI_500m and NDVI_500m reduced the diabetes risk by 14 % and 12 %, respectively. Compared to the risks for diabetes at the 25th percentile of EVI_500m/NDVI_500m, such risks significantly reduced when EVI_500m (NDVI_500m) increased over 0.43 (0.48) and 0.28 (0.39) in urban and rural areas, respectively. The residential greenness-prediabetes/diabetes associations were mediated by air pollution and PA in urban areas and by air pollution and BMI in rural areas.

CONCLUSIONS

Exposure to residential greenness was associated with a lower risk for prediabetes and diabetes in urban areas and, more strongly, in rural areas, which were partly mediated by air pollution, PA, and BMI.

Associations and pathways between residential greenness and metabolic syndromes in Fujian Province

Background

Greenness exposure is beneficial to human health, but its potential mechanisms through which the risk for metabolic syndrome (MetS) could be reduced have been poorly studied. We aimed to estimate the greenness-MetS association in southeast China and investigate the independent and joint mediation effects of physical activity (PA), body mass index (BMI), and air pollutants on the association.

Methods

A cross-sectional study was conducted among the 38,288 adults based on the Fujian Behavior and Disease Surveillance (FBDS), established in 2018. MetS was defined as the presence of three or more of the five components: abdominal obesity, elevated triglyceride, reduced high-density lipoprotein cholesterol (HDL-C), high blood pressure, and elevated fasting glucose. The residential greenness exposure was measured as the 3-year mean values of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) within the 250, 500, and 1,000 meters (m) buffer zones around the residential address of each participant. Logistic regression models were used to estimate the greenness-MetS association. The causal mediation analysis was used to estimate the independent and joint mediation effects of PA, BMI, particulate matter with an aerodynamic diameter of 2.5 μm (PM_2.5), particulate matter with an aerodynamic diameter ≤ 10 μm (PM₁₀), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂).

Results

Each interquartile range (IQR) increase in greenness was associated with a decrease of 13% (OR = 0.87 [95%CI: 0.83, 0.92] for NDVI_500m and OR = 0.87 [95%CI: 0.82, 0.91] for EVI_500m) in MetS risk after adjusting for covariates. This association was stronger in those aged < 60 years (e.g., OR = 0.86 [95%CI: 0.81, 0.92] for NDVI_500m), males (e.g., OR = 0.73 [95%CI: 0.67, 0.80] for NDVI_500m), having an educational level of primary school or above (OR = 0.81 [95%CI: 0.74, 0.89] for NDVI_500m), married/cohabitation (OR = 0.86 [95%CI: 0.81, 0.91] for NDVI_500m), businessman (OR = 0.82 [95%CI: 0.68, 0.99] for NDVI_500m), other laborers (OR = 0.77 [95%CI: 0.68, 0.88] for NDVI_500m), and non-smokers (OR = 0.77 [95%CI: 0.70, 0.85] for NDVI_500m). The joint effect of all six mediators mediated about 48.1% and 44.6% of the total effect of NDVI_500m and EVI_500m on the MetS risk, respectively. Among them, BMI showed the strongest independent mediation effect (25.0% for NDVI_500m), followed by NO₂ and PM₁₀.

Conclusion

Exposure to residential greenness was associated with a decreased risk for MetS. PA, BMI, and the four air pollutants jointly interpreted nearly half of the mediation effects on the greenness-MetS association.

Exploring the impacts of street-level greenspace on stroke and cardiovascular diseases in Chinese adults

In recent years, cardiovascular diseases (CVDs) have become the primary cause of death in the world. Existing studies have found that greenspace is important for the prevention of CVDs and stroke. However, since they only focus on large green infrastructure (e.g., urban parks) or the general greenspace (usually being evaluated through normalized difference vegetation index), little information exists regarding the association between street-level greenspace and CVDs (stroke). In this study, the CVDs and stroke data of participants were retrieved from the 33 Chinese Community Health Study. We measured participants' exposure to street-level greenspace exposure using street view images and machine learning technique. Multilevel logistic regressions were applied. While controlling for confounders, we found that higher level of street-level greenspace exposure was associated with lower CVDs prevalence. However, street-level greenspace exposure was associated with stroke prevalence only for females. The associations were stronger among females, younger adults, participants with educational attainment above high school, physically active participants and participants who were not overweight. None of the mediators (air pollution, physical exercise, and BMI) can explain the associations between street-level greenspace exposure and CVDs (stroke) prevalence. Our findings suggest that street-level vegetation should be increased to cope with the rapid growth of the CVDs burdens. Also, the differences between the effect of street-level trees and grasses should be noted before formulating specific urban planning policies.

Using Multiple Statistical Methods to Derive Dietary Patterns Associated with Cardiovascular Disease in Patients with Type 2 Diabetes: Results from a Multiethnic Population-Based Study

Background

There are few reports on the relationship between dietary patterns and cardiovascular disease (CVD) risk in patients with type 2 diabetes (T2D). This study aimed to explore relationships between dietary patterns and CVD risk in the T2D population using multiple statistical analysis methods.

Methods

A total of 2,984 patients with T2D from the Xinjiang Multi-Ethnic Cohort, 555 of whom were suffering from CVD, were enrolled in this study. Participants' dietary intake was measured by the semiquantitative food frequency questionnaire (FFQ). Three statistical methods were used to construct dietary patterns, including principal component analysis (PCA) method, reduced-rank regressions (RRR) method, and partial least-squares regression (PLS) method. Then, the association between dietary patterns and CVD risk in T2D patients was analyzed by logistic regression. After excluding participants with CVD, the associations between dietary patterns and 10-year CVD risk scores were subsequently evaluated to reduce reverse causality.

Results

In this study, four dietary patterns were identified by three methods. Adjustment for confounding factors, subjects with the highest scores on the "high-protein and high-carbohydrate" patterns derived from PCA, RRR, and PLS had higher odds of CVD than those with the lowest scores (OR: 2.89, 95% CI: 2.11-3.96, P _trend < 0.001; OR: 2.96, 95% CI: 2.17-4.03, P _trend < 0.001; OR: 2.01, 95% CI: 1.50-2.70, P _trend < 0.001, respectively). However, the dietary pattern of PCA-prudent was not significantly related to the odds of having CVD in T2D patients (adjusted OR_Q4vsQ1: 0.93, 95% CI: 0.70-1.24, P _trend =0.474). Interestingly, we also found significant associations between "high-protein and high-carbohydrate" patterns and the elevated predicted 10-year CVD risk in T2D patients (all P _trend < 0.05).

Conclusion

The positive correlation between "high-protein and high-carbohydrate" patterns and CVD risk in T2D patients was robust across all three data-driven approaches. These findings may have public health significance, encouraging an emphasis on food choices in the usual diet and promoting nutritional interventions for patients with T2D to prevent CVD.

Short-term PM1 and PM2.5 exposure and asthma mortality in Jiangsu Province, China: What's the role of neighborhood characteristics?

BACKGROUND

Evidence suggests that particulate matter (PM) with smaller particle sizes (such as PM₁, PM with an aerodynamic diameter≤1 µm) may have more toxic health effects. However, the short-term association between PM₁ and asthma mortality remains largely unknown.

OBJECTIVE

This study aimed to examine the short-term effects of PM₁ and PM_2.5 on asthma mortality, as well as to investigate how neighborhood characteristics modified this association.

METHODS

Daily data on asthma mortality were collected from 13 cities in Jiangsu Province, China, between 2016 and 2017. A time-stratified case-crossover design was attempted to examine the short-term effects of PM₁ and PM_2.5 on asthma mortality. Individual exposure levels of PM₁ and PM_2.5 on case and control days were determined based on individual's residential addresses. Stratified analyses by neighborhood characteristics (including green space, tree canopy, blue space, population density, nighttime light and street connectivity) were conducted to identify vulnerable living environments.

RESULTS

Mean daily concentrations of PM₁ and PM_2.5 on case days were 33.8 μg/m³ and 54.3 μg/m³. Each 10 μg/m³ increase in three-day-averaged (lag02) PM₁ and PM_2.5 concentrations were associated with an increase of 6.66% (95%CI:1.18%,12.44%) and 2.39% (95%CI: 0.05%-4.78%) asthma mortality, respectively. Concentration-response curves showed a consistent increase in daily asthma mortality with increasing PM₁ and PM_2.5 concentrations. Subgroup analyses indicated that the effect of PM₁ appeared to be evident in neighborhood characteristics with high green space, low urbanization level and poor street connectivity.

CONCLUSION

This study suggested an association between short-term PM₁ and PM_2.5 exposures and asthma mortality. Several neighborhood characteristics (such as green space and physical supportive environment) that could modify the effect of PM₁ on asthma mortality should be further explored.

Living near greenness is associated with higher bone strength: A large cross-sectional epidemiological study in China

BACKGROUND

Living near green spaces may benefit various health outcomes. However, no studies have investigated the greenness-bone linkage in the general population. Moreover, to which extent ambient air pollution (AAP), physical activity (PA), and body mass index (BMI) mediate this relationship remains unclear. We aimed to explore the association between greenness and bone strength and the potential mediating roles of AAP, PA, and BMI in Chinese adults.

METHODS

This cross-sectional analysis enrolled 66,053 adults from the China Multi-Ethnic Cohort in 2018-2019. The normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) were employed to define residential greenness. The calcaneus quantitative ultrasound index (QUI) was used to indicate bone strength. Multiple linear regression models and mediation analyses were used to estimate the residential greenness-bone strength association and potential pathways operating through AAP (represented by PM_2.5 [particulate matter <2.5 μm in diameter]), PA, and BMI. Stratification analyses were performed to identify susceptible populations.

RESULTS

Higher residential exposure to greenness was significantly associated with an increase in QUI, with changes (95% confidence interval) of 3.28 (3.05, 3.50), 3.57 (3.34, 3.80), 2.68 (2.46, 2.90), and 2.93 (2.71, 3.15) for every interquartile range increase in NDVI_500m, NDVI_1000m, EVI_500m, and EVI_1000m, respectively. Sex, urbanicity, annual family income, smoking, and drinking significantly modified the association of greenness-bone strength, with more remarkable associations in males, urban residents, subjects from wealthier families, smokers, and drinkers. For the NDVI_500m/EVI_500m-QUI relationship, the positive mediating roles of PM_2.5 and PA were 6.70%/8.50 and 2.43%/2.69%, respectively, whereas those negative for BMI and PA-BMI were 0.88%/1.06% and 0.05%/0.05%, respectively.

CONCLUSION

Living in a greener area may predict higher bone strength, particularly among males, urban residents, wealthier people, smokers, and drinkers. AAP, PA, BMI, and other factors may partially mediate the positive association. Our findings underscore the importance of optimizing greenness planning and management policies.

Association between residential greenness and gut microbiota in Chinese adults

BACKGROUND

A growing body of studies have reported the health benefits of greenness. However, less is known about the potential beneficial effects of residential greenness on gut microbiota, which is essential to human health. In this study, we aim to examine the association between residential greenness and gut microbiota in a population-based cohort study.

METHODS

We included 1758 participants based on the China Multi-Ethnic Cohort (CMEC) study and collected their stool samples for 16S sequencing to derive gut microbiota data. Residential greenness was estimated using the satellite-based data on enhanced vegetation index (EVI) and the normalized differential vegetation index (NDVI) in circular buffers of 250 m, 500 m, and 1000 m. The relationships between residential greenness levels and the composition of gut microbiota, measured by standardized α-diversity and taxonomic composition, were assessed using linear regression and Spearman correlation weighted by generalized propensity scores.

RESULTS

Higher greenness levels were significantly positively associated with standardized α-diversity. Per interquartile range (IQR) increase of EVI and NDVI in the circular buffer of 250 m were associated with the increments of 0.995(95% confidence interval (CI): 0.212-1.778) and 0.653(95% CI: 0.160-1.146) in the standardized Shannon index. For the taxonomic composition of gut microbiota, higher greenness levels were significantly correlated with 29 types of microbial taxonomic composition. NDVI in the circular buffer of 250 m was associated with increased Firmicutes (r = 0.102, adjusted p value = 0.004), which was the dominant composition in the gut microbiota.

CONCLUSIONS

Increased amounts of residential greenness may support healthy gut microbiota by benignly altering their composition. These findings suggested that green spaces should be designed to support diverse gut microbiota and ultimately optimize health benefits.

A negative association between prevalence of diabetes and urban residential area greenness detected in nationwide assessment of urban Bangladesh

Residential area greenness may influence diabetes, but limited studies have explored this relationship in developing countries. This study assessed the association between residential area greenness and diabetes among urban adults in Bangladesh. The mediation effect of the body mass index (BMI) was also assessed. A total of 2367 adults aged ≥ 35 years were extracted from a nationally representative survey. Diabetes was characterised as fasting plasma glucose level be ≥ 7.0 mmol/L or taking prescribed medications to reduce blood sugar level. Residential area greenness was estimated by enhanced vegetation index. Binary logistic regression models were employed to estimate the association between residential area greenness and diabetes adjusting for sociodemographic factors. Mediation analysis was performed to assess whether BMI mediated the association between greenness and diabetes. Greater area greenness was associated with lower odds of diabetes (adjusted odds ratio 0.805, 95% confidence interval 0.693–0.935, p = 0.0052). BMI significantly mediated 36.4% of the estimated association between greenness and diabetes. Presence of areas of greenness adjacent to living area tends to be associated with lower diabetes prevalence. Findings emphasised the importance of preserving the local environment to tackle the growing diabetes prevalence in Bangladesh.