Is air quality index associated with cardiometabolic risk factors in adolescents? The CASPIAN-III Study

Longitudinal associations of air pollution and green space with cardiometabolic risk factor clustering among children in the Netherlands

BACKGROUND

This study examines longitudinal associations of air pollution and green space with cardiometabolic risk among children in the Netherlands.

METHODS

Three Dutch prospective cohorts with a total of 13,822 participants aged 5 to 17 years were included: (1) the Amsterdam Born Children and their Development (ABCD) study from Amsterdam (n = 2,547), (2) the Generation R study from Rotterdam (n = 5,431), and (3) the Lifelines study from northern Netherlands (n = 5,844). Air pollution (PM2.5, PM10, NO2, and elemental carbon (EC)) and green space exposures (density in multiple Euclidean buffer sizes) from 2006 to 2017 at home address level were used. Cardiometabolic risk factor clustering was assessed by a MetScore, which was derived from a confirmatory factor analysis of six cardiometabolic risk factors to assess the overall risk. Linear regression models with change in Metscore as the dependent variable, adjusted for multiple confounders, were conducted for each cohort separately. Meta-analyses were used to pool cohort-specific estimates.

RESULTS

Exposure to higher levels of NO2 and EC was significantly associated with increases in MetScore in Lifelines (per SD higher exposure: βNO2 = 0.006, 95 % CI = 0.001 to 0.010; βEC = 0.008, 95 % CI = 0.002 to 0.014). In the other two cohort studies, these associations were in the same direction but these were not significant. Higher green space density in 500-meter buffer zones around participants' residential addresses was not significantly associated with decreases of MetScore in all three cohorts. Higher green space density in 2000-meter buffer zones was significantly associated with decreases of MetScore in ABCD and Lifelines (per SD higher green space density: βABCD = -0.008, 95 % CI = -0.013 to -0.003; βLifelines = -0.002, 95 % CI = -0.003 to -0.00003). The pooled estimates were βNO2 = 0.003 (95 % CI = -0.001 to 0.006) for NO2, βEC = 0.003 (95 % CI = -0.001, 0.007) for EC, and β500m buffer = -0.0014 (95 % CI = -0.0026 to -0.0001) for green space.

CONCLUSIONS

More green space exposure at residence was associated with decreased cardiometabolic risk in children. Exposure to more NO2 and EC was also associated with increased cardiometabolic risk.

Longitudinal associations of an exposome score with serum metabolites from childhood to adolescence

Environmental and lifestyle factors, including air pollution, impaired diet, and low physical activity, have been associated with cardiometabolic risk factors in childhood and adolescence. However, environmental and lifestyle exposures do not exert their physiological effects in isolation. This study investigated associations between an exposome score to measure the impact of multiple exposures, including diet, physical activity, sleep duration, air pollution, and socioeconomic status, and serum metabolites measured using LC-MS and NMR, compared to the individual components of the score. A general population of 504 children aged 6-9 years at baseline was followed up for eight years. Data were analysed with linear mixed-effects models using the R software. The exposome score was associated with 31 metabolites, of which 12 metabolites were not associated with any individual exposure category. These findings highlight the value of a composite score to predict metabolic changes associated with multiple environmental and lifestyle exposures since childhood.

Identifying the Relationship between PM2.5 and Hyperlipidemia Using Mendelian Randomization, RNA-seq Data and Model Mice Subjected to Air Pollution

Air pollution is an important public health problem that endangers human health. However, the casual association and pathogenesis between particles < 2.5 μm (PM2.5) and hyperlipidemia remains incompletely unknown. Mendelian randomization (MR) and transcriptomic data analysis were performed, and an air pollution model using mice was constructed to investigate the association between PM2.5 and hyperlipidemia. MR analysis demonstrated that PM2.5 is associated with hyperlipidemia and the triglyceride (TG) level in the European population (IVW method of hyperlipidemia: OR: 1.0063, 95%CI: 1.0010-1.0118, p = 0.0210; IVW method of TG level: OR: 1.1004, 95%CI: 1.0067-1.2028, p = 0.0350). Mest, Adipoq, Ccl2, and Pcsk9 emerged in the differentially expressed genes of the liver and plasma of PM2.5 model mice, which might mediate atherosclerosis accelerated by PM2.5. The studied animal model shows that the Paigen Diet (PD)-fed male LDLR-/- mice had higher total cholesterol (TC), TG, and CM/VLDL cholesterol levels than the control group did after 10 times 5 mg/kg PM2.5 intranasal instillation once every three days. Our study revealed that PM2.5 had causality with hyperlipidemia, and PM2.5 might affect liver secretion, which could further regulate atherosclerosis. The lipid profile of PD-fed Familial Hypercholesterolemia (FH) model mice is more likely to be jeopardized by PM2.5 exposure.

Effects of ambient particulate exposure on blood lipid levels in hypertension inpatients

Background

With modernization development, multiple studies of atmospheric particulate matter exposure conducted in China have confirmed adverse cardiovascular health effects. However, there are few studies on the effect of particulate matter on blood lipid levels in patients with cardiovascular disease, especially in southern China. The purpose of this study was to investigate the association between short- and long-term exposure to ambient particulate matter and the levels of blood lipid markers in hypertension inpatients in Ganzhou, China.

Methods

Data on admission lipid index testing for hypertension inpatients which were divided into those with and without arteriosclerosis disease were extracted from the hospital's big data center from January 1, 2016 to December 31, 2020, and air pollution and meteorology data were acquired from the China urban air quality real time release platform from January 1, 2015 to December 31, 2020 and climatic data center from January 1, 2016 to December 31, 2020, with data integrated according to patient admission dates. A semi-parametric generalized additive model (GAM) was established to calculate the association between ambient particulate matter and blood lipid markers in hypertension inpatients with different exposure time in 1 year.

Results

Long-term exposure to particulate matter was associated with increased Lp(a) in three kinds of people, and with increased TC and decreased HDL-C in total hypertension and hypertension with arteriosclerosis. But particulate matter was associated with increased HDL-C for hypertension inpatients without arteriosclerosis, at the time of exposure in the present study. It is speculated that hypertension inpatients without arteriosclerosis has better statement than hypertension inpatients with arteriosclerosis on human lipid metabolism.

Conclusion

Long-term exposure to ambient particulate matter is associated with adverse lipid profile changes in hypertension inpatients, especially those with arteriosclerosis. Ambient particulate matter may increase the risk of arteriosclerotic events in hypertensive patients.

Effects of short-term exposure to gaseous pollutants on metabolic health indicators of patients with metabolic syndrome in Northwest China

Currently few studies have explored the relationship between exposure to gaseous pollutants and metabolic health indicators in patients, especially in patients with metabolic syndrome (Mets). This study collected 15,520 patients with Mets in a prospective cohort of nearly 50,000 people with 7 years of follow-up from 2011 to 2017, and matched air pollutants and meteorological data during the same period. The mixed effects model was used to analyze the relationship between different short exposure windows (1-week, 1-month, 2-month, and 3-month) of gaseous pollutants (SO2, NO2, and O3) and the metabolic health indicators of patients after controlled the confounding factors. Stratified analysis was performed by demographic characteristics and behavioral factors. The effects of gaseous pollutants on patients with different Met components were also analyzed. The results showed that the short-term exposure to SO2, NO2, and O3 had a certain effect on the metabolic health indicators of patients with Mets in different exposure windows, and with the extension of the exposure window period, the effects increased. The stratified analysis showed that gender, age, and life behaviors might modify these detrimental effects. In addition, the effects of gaseous pollutants on metabolic health indicators in G4 and G7 were more obvious than other Met components, and the effects of gaseous pollutants on the level of LDL-C were found to be statistically significant in most components. Therefore, patients with Mets should pay more attention to the influence of gaseous pollutants to take appropriate protection to reduce potential health risk.

Acute cardiorespiratory response to air quality index in healthy young adults

BACKGROUND

Little is known about the acute health impacts of air quality index (AQI) on cardiorespiratory risk factors.

OBJECTIVES

To assess the short-term links of AQI with cardiorespiratory risk factors in young healthy adults.

METHODS

We performed a longitudinal panel study with 4 repeated visits in 40 healthy young adults in Hefei, Anhui Province, China from August to October 2021. Cardiorespiratory factors included systolic blood pressure (BP), diastolic BP (DBP), mean arterial pressure (MAP) and fractional exhaled nitric oxide (FeNO). We collected hourly AQI data from a nearby air quality monitoring site. Linear mixed-effects model was applied to assess the effects of AQI on BP and FeNO.

RESULTS

The study participants (75.0% females) provided 160 pairs of valid health measurements with average age of 24 years. The mean AQI level was 44.43 during the study period. There were significant positive associations of AQI with three BP parameters and FeNO at different lag periods. For example, an interquartile range increase in AQI (26.54 unit) over lag 0-24 h was associated with increments of 6.69 mmHg (95%CI: 2.95-10.44), 5.71 mmHg (95%CI: 3.30-8.13), 6.04 mmHg (95%CI: 3.46-8.62) and 5.67% (95%CI: 1.05%-16.05%) in SBP, DBP, MAP and FeNO, respectively. The results were robust after controlling for PM₁. We did not find effect modifications by gender, BMI, physical activity, or AQI category level on the associations.

CONCLUSIONS

The current findings on associations of AQI with cardiorespiratory factors might add evidence of the acute adverse cardiorespiratory consequences following air pollution.

Therapeutic potential of dopamine agonists in the treatment of type 2 diabetes mellitus

Diabetes is a global health concern that has affected almost 415 million people globally. Bromocriptine is a dopamine D2 agonist, which is a Food and Drug Administration (FDA)-approved drug to treat type 2 diabetes mellitus (T2DM) patients. However, it is considered that a novel treatment therapy is required which can be used in the treatment of diabetes with or without other antidiabetic agents. Dopamine agonists are usually used in neurological disorders like Parkinson's disease (PD), restless leg syndrome, and hyperprolactinemia. However, dopamine agonists including bromocriptine and cabergoline are also effective in reducing the glycemic level in T2DM patients. Bromocriptine was formerly used for the treatment of PD, hyperprolactinemia, and restless leg syndrome, but now it is used for improving glycemic levels as well as reducing free fatty acids and triglycerides. In addition, cabergoline has been found to be effective in glycemic control, but this drug is yet to be approved by the FDA due to its limitations and lack of study. Findings of the clinical trials of bromocriptine have suggested that it reduces almost 0.4-0.8% glycated hemoglobin and cardiovascular risk by 40% in insulin-resistant patients. Moreover, the safe use of bromocriptine in obese T2DM patients makes it a more attractive option as it causes weight loss. Indeed, bromocriptine is a novel therapy for T2DM patients, as its mechanism of action is unique in T2DM patients with minimal adverse effects. This review summarizes the potential of dopamine agonists in the treatment of T2DM.

DNA methylation: a potential mediator between air pollution and metabolic syndrome

Given the global increase in air pollution and its crucial role in human health, as well as the steep rise in prevalence of metabolic syndrome (MetS), a better understanding of the underlying mechanisms by which environmental pollution may influence MetS is imperative. Exposure to air pollution is known to impact DNA methylation, which in turn may affect human health. This paper comprehensively reviews the evidence for the hypothesis that the effect of air pollution on the MetS is mediated by DNA methylation in blood. First, we present a summary of the impact of air pollution on metabolic dysregulation, including the components of MetS, i.e., disorders in blood glucose, lipid profile, blood pressure, and obesity. Then, we provide evidence on the relation between air pollution and endothelial dysfunction as one possible mechanism underlying the relation between air pollution and MetS. Subsequently, we review the evidence that air pollution (PM, ozone, NO2 and PAHs) influences DNA methylation. Finally, we summarize association studies between DNA methylation and MetS. Integration of current evidence supports our hypothesis that methylation may partly mediate the effect of air pollution on MetS.

An air quality index prediction model based on CNN-ILSTM

Air quality index (AQI) is an essential measure of air pollution evaluation, which describes the air pollution degree and its impact on health, so the accurate prediction of AQI is significant. This paper presents an AQI prediction model based on Convolution Neural Networks (CNN) and Improved Long Short-Term Memory (ILSTM), named CNN-ILSTM. ILSTM deletes the output gate in LSTM and improves its input gate and forget gate, and introduces a Conversion Information Module (CIM) to prevent supersaturation in the learning process. ILSTM realizes efficient learning of historical data, improves prediction accuracy, and reduces the training time. CNN extracts the eigenvalues of input data effectively. This paper uses air quality data from 00:00 on January 1, 2017, to 23:00 on June 30, 2021, in Shijiazhuang City, Hebei Province, China, as experimental data sets, and compares this model with eight prediction models: SVR, RFR, MLP, LSTM, GRU, ILSTM, CNN-LSTM, and CNN-GRU to prove the validity and accuracy of CNN-ILSTM prediction model. The experimental results show the MAE of CNN-ILSTM is 8.4134, MSE is 202.1923, R² is 0.9601, and the training time is 85.3 s. In this experiment, the performance of this model performs better than other models.

Prenatal air pollution exposure to diesel exhaust induces cardiometabolic disorders in adulthood in a sex-specific manner

BACKGROUND

Results from observational and experimental studies indicate that exposure to air pollutants during gestation reduces birth weight, whereas little is known on potential cardiometabolic consequences for the offspring at adulthood.

OBJECTIVES

Our aim was to evaluate the long-term effects of gestational exposure to diesel engine exhaust (DE) on adult offspring phenotype in a rabbit model.

METHODS

The protocol was designed to mimic human exposure in large European cities. Females rabbits were exposed to diluted (1 mg/m³) DE (exposed, n = 9) or clean air (controls, n = 7), from 3 days after mating, 2 h/d and 5 d/wk in a nose-only inhalation system throughout gestation (gestation days 3-27). After birth and weaning, 72 offspring (47 exposed and 25 controls) were raised until adulthood (7.5 months) to evaluate their cardio-metabolic status, including the monitoring of body weight and food intake, fasting biochemistry, body composition (iDXA), cardiovascular parameters and glucose tolerance. After a metabolic challenge (high fat diet in males and gestation in females), animals were euthanized for postmortem phenotyping.

RESULTS

Sex-specific responses to maternal exposure were observed in adult offspring. Age-related increases in blood pressure (p = 0.058), glycaemia (p = 0.029), and perirenal fat mass (p = 0.026) as well as reductions in HDL-cholesterol (p = 0.025) and fat-to-body weight ratio (p = 0.011) were observed in exposed males, suggesting a metabolic syndrome. Almost only trends were observed in exposed females with higher triglycerides and decreased bone density compared to control females. Metabolic challenges triggered or amplified some biological responses, especially in females.

CONCLUSIONS

In utero exposure to air pollution predisposed rabbit offspring to cardiometabolic disorders in a sex-specific manner.

Bullying and Being Bullied; How Much Can It Increase the Risk of Depression and Anxiety in Students? A Multilevel Fixed-effect Model Analysis

Background: School violence as a health issue is a global concern. One of the problems that affect the health and well-being of children at school is bullying. Objectives: In this study, we aimed to examine the association of depression and anxiety with bullying among 6 - 19-year-old students in Iran. Methods: This study was conducted in Tehran, Iran, in 2020. A multistage cluster sampling method was used, and 54,550 students aged six to 19 years of both sexes, from urban and rural areas, were selected. Standard questionnaires, according to the WHO recommendations, were used for data collection. Involvement in bullying in the past 12 months and anxiety and depression status in both bully and bullied students were investigated by standard questionnaires. To compare the psychiatric problems and violent behavior, the Wald chi-square test was applied. The multilevel fixed-effect model and logistic multivariate regression were used to adjust the multilevel effects and estimate the odds of anxiety and depression in both bully and bullied students. All statistical analyses were performed at a 95% significance level. Results: Of the total students, 50.9% were males, 29.45% were in the 6 - 10 age group, and 70.55% in the 11 - 19 age group. There was a significant difference in depression and anxiety between boys and girls in both age groups (P < 0.001). Amongst males, 11.7% of the students aged 6 - 10 and 11% of the students aged 11 - 19 and in females, 7.7% aged 6 - 10 and 10.4% aged 11 - 19 had at least four experiences of bullying to others in the last year. The odds ratios for depression in male bullies were 1.3 and 1.5 in 6 - 10 and 11 - 19 age groups, respectively. The odds ratios for depression in bullied males and females were 4.2 and 3.9 in 6 - 10 and 2.9 and 4.3 in 11 - 19 age groups, respectively. Bulling others increased the odds of anxiety to 1.7 and 1.9 in males and 2.1 and 1.9 in females in 6 - 10 and 11 - 19 age groups, respectively. In bullied students, the odds of anxiety were estimated at 2.9 and 2.2 in males and 3.4 and 2.2 in female students respectively, in 6 - 10 and 11 - 19 age groups. Conclusions: There was a significant positive association between psychological disorders (anxiety and depression) and bullying among 6 - 19-year-old students. Victims of bullying were more at risk of depression and anxiety. This health-threatening phenomenon should not be ignored.

Associations of Pre- and Postnatal Air Pollution Exposures with Child Blood Pressure and Modification by Maternal Nutrition: A Prospective Study in the CANDLE Cohort

BACKGROUND

Limited data suggest air pollution exposures may contribute to pediatric high blood pressure (HBP), a known predictor of adult cardiovascular diseases.

METHODS

We investigated this association in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study, a sociodemographically diverse pregnancy cohort in the southern United States with participants enrolled from 2006 to 2011. We included 822 mother-child dyads with available address histories and a valid child blood pressure measurement at 4-6 y. Systolic (SBP) and diastolic blood pressures (DBP) were converted to age-, sex-, and height-specific percentiles for normal-weight U.S. children. HBP was classified based on SBP or DBP ≥ 90 th percentile. Nitrogen dioxide (NO 2 ) and particulate matter ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 ) estimates in both pre- and postnatal windows were obtained from annual national models and spatiotemporal models, respectively. We fit multivariate Linear and Poisson regressions and explored multiplicative joint effects with maternal nutrition, child sex, and maternal race using interaction terms.

RESULTS

Mean PM 2.5 and NO 2 in the prenatal period were 10.8 [standard deviation (SD): 0.9] μ g / m 3 and 10.0 (SD: 2.4) ppb, respectively, and 9.9 (SD: 0.6) μ g / m 3 and 8.8 (SD: 1.9) ppb from birth to the 4-y-old birthday. On average, SBP percentile increased by 14.6 (95% CI: 4.6, 24.6), and DBP percentile increased by 8.7 (95% CI: 1.4, 15.9) with each 2 - μ g / m 3 increase in second-trimester PM 2.5 . PM 2.5 averaged over the prenatal period was only significantly associated with higher DBP percentiles [β = 11.6 (95% CI: 2.9, 20.2)]. Positive associations of second-trimester PM 2.5 with SBP and DBP percentiles were stronger in children with maternal folate concentrations in the lowest quartile (p interaction = 0.05 and 0.07, respectively) and associations with DBP percentiles were stronger in female children (p interaction = 0.05). We did not detect significant association of NO 2 , road proximity, and postnatal PM 2.5 with any outcomes.

CONCLUSIONS

The findings suggest that higher prenatal PM 2.5 exposure, particularly in the second trimester, is associated with elevated early childhood blood pressure. This adverse association could be modified by pregnancy folate concentrations. https://doi.org/10.1289/EHP7486.

The association between ambient air pollution and blood lipids: A longitudinal study in Shijiazhuang, China

BACKGROUND

Few studies have explored the associations between ambient air pollution and blood lipid levels. This study aimed to fill this knowledge gap based on a routine health examination cohort in Shijiazhuang, China.

METHODS

We included 7063 participants who took the routine health examination for 2-3 times at Hebei General Hospital from January 2016 to December 2018. Individual serum levels of cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured. Their three-month average exposure to air pollution prior to the routine health examinations was estimated using inverse distance weighted method. We used linear mixed-effects regression models to examine the associations between air pollution and levels of blood lipids while controlling for age, gender, body mass index (BMI), smoking, alcohol drinking, temperature, humidity, with a random effect for each individual.

RESULTS

Particles with diameters ≤2.5 μm and ≤10 μm (PM_2.5 and PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂) and ozone (O₃) were all positively associated with TC, TG, and LDL-C and negatively associated with HDL-C, in single pollutant models. Each 10 μg/m³ increment of 3-month average PM_2.5 was associated with 0.65% [95% confidence interval (CI): 0.03%-1.28%], 0.56% (95%CI: 0.33%-0.79%) and 0.63% (95%CI: 0.35%-0.91%) increment in TG, TC, and LDL-C, and 0.91% (95%CI: 0.68%-1.13%) decrease in HDL-C. In two-pollutant models, the effects of gaseous pollutants on blood lipids were weakened, while those of PMs were strengthened. Stronger associations were presented in the elderly (≥60 years) and overweight/obese (BMI ≥ 24) participants.

CONCLUSIONS

Ambient air pollution had significantly adverse effects on blood lipid levels, especially in overweight/obese and elderly individuals.

CAPSULE

Significant associations between increased air pollution and worse blood lipid levels were found, especially in overweight/obese and elderly individuals.

Long-term air pollution exposure and self-reported morbidity: A longitudinal analysis from the Thai cohort study (TCS)

BACKGROUND

Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand.

METHODS

This longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005-2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO.

RESULTS

After controlling for potential confounders, we found that an IQR increase in PM10 was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO2 was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O3 and NO2.

CONCLUSIONS

Long-term exposure to air pollution, especially for PM10 and SO2 was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population.

Exposure to ambient air pollution and blood lipids in children and adolescents: A national population based study in China

Few studies have explored the links of air pollution and childhood lipid profiles and dyslipidemias. We aimed to explore this topic in Chinese children and adolescents. This study included 12,814 children aged 7-18 years who participated in a national survey in 2013. Satellite-based spatial-temporal model was used to predict 3-y (2011-2013) average particles with diameters ≤ 1.0 μm (PM₁), ≤2.5 μm (PM_2.5), ≤10 μm (PM₁₀), and nitrogen dioxide (NO₂) concentrations. Generalized linear mixed models were employed to evaluate the relationships of air pollution and total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and dyslipidemias. Every 10 μg/m³ increase in PM₁, PM_2.5, PM₁₀, and NO₂ was related to increases of 6.20% [95% confidence interval (CI): 2.44, 10.10], 5.31% (95%CI: 0.41, 10.44), 3.49% (95%CI: 0.97, 6.08), and 5.25% (95%CI: 1.56, 9.07) in TC, respectively. The odds ratio of hypercholesterolemia associated with a 10 μg/m³ increase in PM₁, PM_2.5, and NO₂ was 2.15 (95%CI: 1.27, 3.65), 1.70 (95%CI: 1.12, 2.60), and 1.43 (95%CI: 1.05, 1.93), respectively. No associations were found for air pollution and other blood lipids. Long-term PM₁, PM_2.5, PM₁₀, and NO₂ exposures were positively associated with TC levels and risk of hypercholesterolemia in children and adolescents.

Prenatal exposure to ambient air pollution and adverse pregnancy outcomes in Ahvaz, Iran: a generalized additive model

OBJECTIVE

There is some evidence about the short-term effects of air pollutants on adverse pregnancy outcomes. The aim of this study was to determine the association between air pollutants and spontaneous abortion, stillbirth, gestational hypertension, preeclampsia, gestational diabetes and macrosomia in Ahvaz, which is one of the most polluted cities in the Middle East.

METHODS

Data on adverse pregnancy outcomes and air pollutants including ozone (O₃), nitric oxide (NO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO), particles with a diameter of less than 10 µm (PM₁₀) and particles with a diameter less than 2.5 µm (PM_2.5) were inquired from the Health Department of Ahvaz Jundishapur University of Medical Sciences and the Environmental Protection Agency of Khuzestan Province for the years 2008-2018. A time series analysis using the generalized additive model (GAM) with up to 6-day lags was used.

RESULTS

The results showed that the SO₂ pollutant on 0, 1, 3, 4, and 6-day lags and PM₁₀ on lag 0 had direct and significant associations with spontaneous abortion. NO, NO₂ and CO on 0-6-day lags, and O₃ on 6-day lags showed direct and significant associations with preeclampsia. NO and NO₂ pollutants showed significant and direct associations with gestational diabetes, during 0- and 6-day lags. NO on 0-, 3- and 4-day lags, CO in all 0-6-day lags and PM_2.5 on 1-, 3-, 5-, and 6-day lags showed direct and significant associations with macrosomia. None of the pollutants showed significant associations with stillbirth or gestational hypertension.

CONCLUSIONS

The results of this study suggest that some air pollutants are associated with spontaneous abortion, preeclampsia, gestational diabetes and macrosomia. This study further emphasizes the need to control ambient air pollution.

Effects of ambient PM2.5 and particle-bound metals on the healthy residents living near an electric arc furnace: A community- based study

Fine particulate matter (PM_2.5) emitted from electric arc furnaces (EAFs) poses health concerns. However, little research has been done on the impact of EAF on the health of community residents. This cross-sectional study conducted a PM_2.5 exposure assessment and health examination of community residents living near an EAF. A total of 965 residents aged 40-90 years were recruited. The residents' exposure to PM_2.5 was categorized according to the distance of their residence from the EAFs (<500, 500-1000, 1000-1500, 1500-2000, and > 2000 m). Average ambient PM_2.5 concentrations were estimated using a hybrid kriging/land-use regression (LUR) model. In addition, we selected two air-sampling sites to monitor the 2-year levels of PM_2.5 and particle-bound metals. A spot urine sample and blood samples were collected and ten heavy metal concentrations in the blood were analyzed. Inflammation- and oxidative stress-related biomarkers were measured. The associations between environmental factors and a biochemical examination were estimated using a generalized linear model. Active air sampling and hybrid kriging/LUR model simulation indicated increased levels of PM_2.5 near the EAF. The metal concentrations in PM_2.5 included Fe, Pb, Mn, Ni, As, Cu, Ni, Zn, and Al, which also significantly increased near the EAF. PM_2.5 levels were significantly associated with an increased total cholesterol-high-density lipoprotein (TC/HDL) ratio. High levels of PM_2.5 and malondialdehyde were associated with a 1.72-fold increased risk of TC/HDL ratio ≥ 4 (95% CI: 1.12-2.65) after adjusting for potential confounding factors. Blood Pb levels were significantly associated with increased systolic and diastolic blood pressure and decreased estimated glomerular filtration rate but negatively associated with distance from the EAF. The results show that people living near EAFs should pay more attention to adverse health problems, including atherogenic dyslipidemia, hypertension, and chronic kidney disease associated with exposure to PM_2.5 and particle-bound metals.

Acute effects of ambient particulate matter on blood pressure in office workers

Exposure to ambient particulate matter with a diameter of <2.5 μm (PM_2.5) has been linked to increases in blood pressure. The aim of this study was to assess the effects of short-term exposure to PM_2.5 on blood pressure in office workers in Beijing, China. A total of 4801 individuals aged 18-60 years underwent an annual medical examination between 2013 and 2017. Levels of air pollutants were obtained from 35 fixed monitoring stations and correlated with the employment location of each participant to predict personal exposure via kriging interpolation. Linear mixed-effects models were used to estimate the changes in blood pressure associated with PM_2.5 exposure at various lag times. After adjusting for personal characteristics and other potential confounders, each interquartile range increase in PM_2.5 was associated with a 0.413-mmHg (95% confidence interval [CI]: 0.252-0.573), 0.171-mmHg (95% CI: 0.053-0.288), 0.278-mmHg (95% CI: 0.152-0.404), and 0.241-mmHg (95% CI: 0.120-0.362) increase in systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure, respectively (p < 0.05). Men, individuals previously diagnosed with hypertension, and subjects working in the northern districts of Beijing had larger changes in blood pressure, and the effect sizes were 0.477-mmHg (95% CI: 0.286-0.669), 0.851-mmHg (95% CI: 0.306-1.397, and 0.672-mmHg (95% CI: 0.405-0.940). The findings suggested that exposure to PM_2.5 had adverse effects on blood pressure, especially among males and hypertensive patients.

Concomitant exposure to area-level poverty, ambient air volatile organic compounds, and cardiometabolic dysfunction: a cross-sectional study of U.S. adolescents

PURPOSE

A key to better understanding the influence of the place of residence on cardiometabolic function is the effect of concomitant exposure to both air pollution and residence in economically marginalized areas. We hypothesized that, among adolescents, the association between air pollution and cardiometabolic function is exacerbated among residents of economically marginalized areas.

METHODS

In this cross-sectional study, individual-level data on cardiometabolic function collected from a representative sample of U.S. adolescents in the National Health and Nutrition Examination Survey (n = 10,415) were merged with data on area-level poverty (U.S. decennial survey and American Community Survey) and air pollution levels (National-Scale Air Toxics Assessment ) using contemporary census-tract identifiers. We excluded respondents who were pregnant, had hypertension or diabetes or using medication for hypertension or diabetes, or with missing data on outcome variables.

RESULTS

We observed a significant interaction between area-level poverty and air pollution. Among residents of high-poverty areas, exposure to high levels of air pollution predicted a 30% elevated odds of cardiometabolic dysfunction (OR = 1.30; 95% CI: 1.04, 1.61), whereas in low-poverty areas, exposure to high levels of air pollution was not associated with elevated odds of cardiometabolic dysfunction (OR = 1.04; 95% CI: 0.85, 1.28).

CONCLUSIONS

Our findings suggest that the cardiometabolic consequences of air pollution are more readily realized among residents of economically marginalized areas. Structural remedies are discussed.

Is long-term PM1 exposure associated with blood lipids and dyslipidemias in a Chinese rural population?

BACKGROUND

Air pollution has been shown to be associated with blood lipid levels. However, studies on long-term ambient particulate matter with aerodynamic diameter ≤1 μm (PM₁) exposure in high-exposure areas are still limited. This study aimed to explore the associations among long-term PM₁ exposure, blood lipids and dyslipidemias.

METHODS

Baseline data of The Henan Rural Cohort study was used in present study, including a total of 39,259 participants aged from 18 to 79 years. Daily levels of PM₁ were estimated by a spatiotemporal model using ground-level measurements of PM₁, satellite remote sensing data and other predictors, according to participants' home addresses. Individual exposure to PM₁ was the 3-year average before baseline investigation. Linear regression and logistic regression models were applied to examine the associations among PM₁, blood lipids ((total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)), and prevalence of dyslipidemias.

RESULTS

The 3-year concentration of PM₁ was 55.7 ± 2.1 μg/m³. Each 1 μg/m³ increment of PM₁ was associated with an increase of 0.21% (95% confidence interval (CI): 0.11%-0.31%) in TC and 0.75% (95% CI: 0.61%-0.90%) in LDL-C, while decrease of 2.68% (95% CI: 2.43%-2.93%) in TG and 0.47% (95% CI: 0.35%-0.59%) in HDL-C. Each 1 μg/m³ increase in PM₁ was associated with 6% (95% CI: 4%-8%), 3% (95% CI: 2%-5%) and 5% (95% CI: 3%-7%) higher risks of hypercholesterolemia, hyperbetalipoproteinemia and hypoalphalipoproteinemia. Sex, age and BMI statistically modified the associations between PM₁ with blood lipid levels and dyslipidemias.

CONCLUSIONS

Higher PM₁ exposure was associated with adverse changes of blood lipid levels and dyslipidemias. Males, older and overweight participants were susceptive to the adverse effects of PM₁.

Traffic-Related Air Pollution and Carotid Plaque Burden in a Canadian City With Low-Level Ambient Pollution

Background

The association between fine particulate matter and cardiovascular disease has been convincingly demonstrated. The role of traffic‐related air pollutants is less clear. To better understand the role of traffic‐related air pollutants in cardiovascular disease development, we examined associations between NO₂, carotid atherosclerotic plaque, and cardiometabolic disorders associated with cardiovascular disease.

Methods and Results

Cross‐sectional analyses were conducted among 2227 patients (62.9±13.8 years; 49.5% women) from the Stroke Prevention and Atherosclerosis Research Centre (SPARC) in London, Ontario, Canada. Total carotid plaque area measured by ultrasound, cardiometabolic disorders, and residential locations were provided by SPARC medical records. Long‐term outdoor residential NO₂ concentrations were generated by a land use regression model. Associations between NO₂, total carotid plaque area, and cardiometabolic disorders were examined using multiple regression models adjusted for age, sex, smoking, and socioeconomic status. Mean NO₂ was 5.4±1.6 ppb in London, Ontario. NO₂ was associated with a significant increase in plaque (3.4 mm² total carotid plaque area per 1 ppb NO₂), exhibiting a linear dose‐response. NO₂ was also positively associated with triglycerides, total cholesterol, and the ratio of low‐ to high‐density lipoprotein cholesterol (P<0.05). Diabetes mellitus mediated the relationship between NO₂ and total carotid plaque area (P<0.05).

Conclusions

Our results demonstrate that even low levels of traffic‐related air pollutants are linked to atherosclerotic plaque burden, an association that may be partially attributable to pollution‐induced diabetes mellitus. Our findings suggest that reducing ambient concentrations in cities with NO₂ below current standards would result in additional health benefits. Given the billions of people exposed to traffic emissions, our study supports the global public health significance of reducing air pollution.

Long-term effects of ambient air pollutants to blood lipids and dyslipidemias in a Chinese rural population

Both air pollution and dyslipidemias contributed to large number of deaths and disability-adjusted life lost years. Long-term air pollution exposure was related to changed blood lipids and risk of dyslipidemias. This study was designed to evaluate relationships between air pollutants, blood lipids and prevalence of dyslipidemias in a Chinese rural population exposed to high-level air pollution based on baseline data of The Henan Rural Cohort study. An amount of 39,057 participants from rural areas in China were included. The 3-year average exposure of air pollutants (PM_2.5, PM₁₀, NO₂) was estimated by a spatiotemporal model. Logistic and linear regression models were employed to explore relationships between air pollutants, blood lipids (TC, TG, HDL-C and LDL-C) and prevalence of dyslipidemias. The three-year concentration of PM_2.5, PM₁₀ and NO₂ was 72.8 ± 2.3 μg/m³, 131.5 ± 5.7 μg/m³and 39.1 ± 3.1 μg/m³, respectively. Overall, increased air pollution exposure was related to increased TC and LDL-C, while decreased TG and HDL-C. Each 1-μg/m³ increment of PM_2.5 was related to 0.10% (0.07%-0.19%) increase in TC, 0.63% (0.50%-0.77%) increase in LDL-C, 2.93% (2.70%-3.16%) decrease in TG, 0.49% (0.38%-0.60%) decrease in HDL-C; and 5.7% (95%CI: 3.7%-7.6%), 4.0% (95%CI: 2.1%-6.0%) and 3.8% (95%CI: 2.5%-5.1%) increase in odds for hypercholesterolemia, hyperbetalipoproteinemia and hypoalphalipoproteinemia, respectively. Stronger associations were found in male and older participants. Findings suggest that air pollutants were associated with changed blood lipid levels and higher risk of dyslipidemias among rural population. Male and elder people should pay more attention to personal safety protection.

Association of urinary polycyclic aromatic hydrocarbons and obesity in children aged 3-18: Canadian Health Measures Survey 2009-2015

Polycyclic aromatic hydrocarbons (PAHs) may contribute to obesity. Childhood obesity is a strong predictor of adult obesity and morbidity; however, the relationship between PAHs and obesity in young children (e.g., aged 3-5) has not been studied. We examined the association between urinary PAH metabolites and measures of obesity in children. We analyzed data from 3667 children aged 3-18 years who participated in the Canadian Health Measures Survey (CHMS, 2009-2015). We ran separate multivariable linear models to estimate the association between quartiles of PAH metabolites and each of body mass index (BMI) percentile, waist circumference (WC), and waist-to-height ratio (WHtR) in the total population, as well as in the age subgroups 3-5, 6-11, and 12-18, adjusting for age, sex, ethnicity, education, income quintile, diet, creatinine, and exposure to environmental tobacco smoke. A multinomial logistic regression model estimated adjusted odds ratios for risk of central obesity. BMI, WC, and WHtR were positively associated with total PAH and naphthalene metabolites in the total population aged 3-18 and in age groups 6-11 and 12-18. In 3-5 year olds, WHtR, but not BMI, was significantly associated with total PAH, naphthalene, and phenanthrene metabolites. Overall, those in the highest quartile for naphthalene or total PAH metabolites had three times greater odds of having central obesity compared with those in the lowest quartile. Urinary PAH metabolites are associated with WHtR, an indicator of central obesity and predictor of health risks associated with obesity, in children as young as 3-5.

Associations of air pollution, obesity and cardiometabolic health in young adults: The Meta-AIR study

OBJECTIVE

Growing evidence indicates exposure to air pollution contributes to obesity and cardiometabolic disease risk in children and adults, however studies are lacking in young adulthood, an important transitional period in the life course. The aim of this study was to examine the associations of short- and long-term regional ambient and near-roadway air pollution (NRAP) exposures on adiposity and cardiometabolic health in young adults aged 17-22 years.

METHODS

From 2014 to 2018, a subset of participants (n = 158) were recruited from the Children's Health Study to participate in the Meta-AIR (Metabolic and Asthma Incidence Research) study to assess obesity (body composition and abdominal adiposity) and cardiometabolic health (fasting glucose, fasting insulin and lipid profiles) measures. Prior 1-month and 1-year average air pollution exposures were calculated from residential addresses. This included nitrogen dioxide (NO₂), ozone (O₃), particulate matter with aerodynamic diameter < 10 μm (PM₁₀), particulate matter with aerodynamic diameter < 2.5 μm (PM_2.5) and NRAP (freeway, non-freeway, and total nitrogen oxides (NO_x)) exposures. Linear regression models examined associations of prior 1-month (short-term) and 1-year (long-term) air pollution exposures on obesity and cardiometabolic factors adjusting for covariates and past childhood air pollution exposures.

RESULTS

In the Meta-AIR study, we conducted a comprehensive analysis with short- and long-term regional ambient and NRAP exposures (in both single- and multi-pollutant models) and obesity- and cardiometabolic-related outcomes and found associations with a few outcomes. A 1 standard deviation (SD) change in long-term NO₂ exposure was associated with a 11.3 mg/dL higher level of total cholesterol (p = 0.04) and 9.4 mg/dL higher level of low-density lipoproteins (LDL)-cholesterol (p = 0.04). Amongst obese participants, associations between long-term NO₂ and total cholesterol and LDL-cholesterol were 4.5 and 9 times larger than the associations in non-obese participants (p_interaction = 0.008 and 0.03, respectively). Additionally, we observed a statistically significant association with increased short-term O₃ exposure and higher triglyceride and very-low-density lipoprotein (VLDL) cholesterol levels (p = 0.04), lower high-density lipoprotein (HDL) cholesterol levels (p = 0.03), and higher hepatic fat levels (p = 0.02). Amongst glucose-related factors, long-term PM_2.5 exposure was associated with higher levels of insulin area under the curve (p = 0.03). There were no other statistically significant associations with short- or long-term air pollutants and BMI, other measures of adiposity, and cardiometabolic outcomes.

CONCLUSION

Higher exposure to regional air pollutants, namely prior 1-year average NO₂, was associated with higher fasting serum lipid measures. These associations were more pronounced in obese participants, suggesting obesity may exacerbate the effects of air pollution exposure on lipid levels in young adults. This study did not find any other associations between short- and long-term ambient and NRAP exposures across a range of other obesity and cardiometabolic indicators. Further studies in young adults are warranted as our study suggests potential deleterious associations of both short- and long-term air pollution exposures and lipid metabolism.

Impaired fasting glucose prevalence surge among Iranian adolescents in a decade: The Tehran Lipid and Glucose Study

PURPOSE

Impaired fasting glucose (IFG) is associated with incident diabetes, cardiovascular risk, and markers of atherosclerosis in early adulthood. We aimed to explore the 10-year change in IFG prevalence among adolescent participants of the Tehran Lipid and Glucose Study, a population-based study from Iran.

METHODS

For our study, we used data on fasting plasma glucose (FPG), anthropometric, and demographic information of 11 to 19-year-old adolescents in study periods I (1999-2005; 1415 boys, 1583 girls) and II (2011-2014; 477 boys, 469 girls). Sex-adjusted and sex-stratified multivariable logistic regression models were used to assess the relationship of the study period (reference: study period I) with IFG.

RESULTS

The prevalence of IFG, general obesity, and central obesity increased from 7%, 13.3%, and 18.8% in study period I to 16.6%, 24%, and 37.4% in study period II; while a favorable trend was seen for blood pressure, triglycerides, and high-density lipoprotein cholesterol. In the fully adjusted model, being older (age group 15-19 vs 11-14 years) and female sex were associated with lower risk. Being overweight and obese increased the risk by risk ratios (confidence interval) of 1.57 (1.17-2.11) and 1.63 (1.15-2.30), respectively. Central adiposity did not remain as an independent risk factor. Nevertheless, study period persisted as a significant factor despite all adjustments [2.20 (1.81-2.68)]. Results in the sex-stratified models were generally the same.

CONCLUSION

Our results demonstrated that the over 2-fold rise in IFG prevalence among adolescents was not solely dependent on general and central obesity.

Particulate matter air pollution and blood glucose in children and adolescents: A cross-sectional study in China

BACKGROUND

The health effects of particulate matter (PM) air pollution on glucose metabolism have been rarely examined in children and adolescents.

OBJECTIVE

We aimed to investigate the associations between long-term PM exposure and blood glucose and prevalence of impaired fasting glucose in a large population of Chinese children and adolescents.

METHODS

In 2013, a total of 11,814 children and adolescents aged 7 to 18 years were recruited from seven provinces/municipalities in China. Fasting blood sample was taken for the measurement of blood glucose. Satellite-based spatial-temporal models were used to estimate exposure to ambient submicrometer particles (PM₁), fine particles (PM_2.5) and thoracic particles (PM₁₀). Cross-sectional analyses were performed using mixed-effects multivariable linear and logistic regression models.

RESULTS

After adjustment for a range of covariates, every 10 μg/m³ increment in PM₁, PM_2.5 and PM₁₀ concentrations was associated with 0.160 [95% confidence interval (CI): 0.039, 0.280], 0.150 (95% CI: 0.044, 0.256) and 0.079 (95% CI: -0.009, 0.167) mmol/L higher blood glucose levels, respectively. PM exposure was also associated with higher prevalence of impaired fasting glucose, but the associations did not reach statistical significance [odds ratio per 10 μg/m³ increment in PM₁, PM_2.5 and PM₁₀: 1.30 (95% CI: 0.86,1.96), 1.20 (95% CI: 0.85,1.69) and 1.08 (95% CI: 0.83,1.41)].

CONCLUSIONS

We found that long-term exposure to PM air pollution was associated with increased levels of blood glucose in children and adolescents. The associations were more evident for PM₁ and PM_2.5.

Effects of ambient particulate matter on fasting blood glucose among primary school children in Guangzhou, China

BACKGROUND

Exposure to ambient particulate matter (PM) has been linked with diabetes and elevated blood glucose in adults. However, there are few reports on the effects of PM on fasting blood glucose (FBG) among children.

OBJECTIVES

The study aimed to assess the associations between medium-term exposure of ambient particles with diameters ≤2.5 μm (PM_2.5), and ≤10 μm (PM₁₀) and FBG in a general population of children, and also to explore the modifying effects of diet.

METHODS

In this cross-sectional study, we enrolled 4234 children (aged 6-13 years) residing in Guangzhou, China, in 2017. Individual PM_2.5 and PM₁₀ exposures during the 186-day period before each physical examination were retrospectively estimated by an inverse distance weighting interpolation and time-weighted approach according to their home address, school address, and activity patterns. Linear mixed effect models were used to examine the relationships between PM_2.5 and PM₁₀ with FBG after adjusting for covariates.

RESULTS

We found that per 10 μg/m³ increase in PM_2.5 and PM₁₀ levels during the 186-day period were associated with 2.3% (95% CI: 1.0%, 3.8%) higher FBG and 0.9% (95% CI: 0.5%, 1.4%) higher FBG, respectively. Stronger effect estimates were observed among subgroups of children with a family history of diabetes, and higher intake of sugar-sweetened beverages (SSBs). Also, we found significant interactions between PM_2.5 concentration and family history of diabetes and SSBs intake on FBG.

CONCLUSIONS

Medium-term exposure to ambient PM_2.5 and PM₁₀ were associated with higher FBG levels in children, and that higher SSBs intake might modify these associations.

Does Air Pollution Affect Health and Medical Insurance Cost in the Elderly: An Empirical Evidence from China

In recent years, the health conditions of the elderly (the middle-aged and the old, which for this study means people over 50 years of age) have deteriorated along with the aggravation of air pollution, which led to the change of medical insurance costs. This phenomenon is particularly prominent in developing countries, such as China. A total of 15,892 research subjects from 56 prefecture-level cities in 23 provinces were collected from the database of China Health and Retirement Longitudinal Survey (CHARLS). We investigated the effects of air pollution, physical health, and medical insurance costs among three mechanisms using logistics and Ordinary Least Squares (OLS) hybrid cross-sectional regression, and we conducted a robust test. Overall, two pollutants, namely, PM10 and NO2, respectively showed an “inverted U-shaped” and “positive U-shaped” influencing path to health. In addition, when we studied the mechanism of air pollution affecting medical insurance costs, we found that air pollution can affect medical insurance costs through affecting self-rated health, and that the impact path is related to different diseases to some extent. At the same time, there was a certain negative correlation between air pollution and medical insurance: The higher the degree of air pollution, the worse the self-rated health, and the fewer opportunities there are to purchase medical insurance. It can be seen that air pollution affects the physical health of middle-aged and elderly people, thus indirectly and negatively affecting the medical insurance cost. Further research also found that the types of air pollutants in southern and northern China showed some differences. Specifically, NO2 and SO2 were the pollutants that harm the health of the elderly in the south and north, respectively.

Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China

IMPORTANCE

Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear.

OBJECTIVES

To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018.

EXPOSURES

Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 μm [PM2.5] and ≤1.0 μm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 μm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]).

MAIN OUTCOMES AND MEASURES

Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods.

RESULTS

Participants included 15 477 adults (47.3% women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8%, and the prevalence of cardiometabolic risk factors ranged from 8.6% (hyperbetalipoproteinemia) to 40.5% (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) μg/m3 (for NO2) to 123.1 (14.6) μg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95% CI, 1.03-1.78] for a 10-μg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95% CI, 1.02-1.09] for a 10-μg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-μg/m3 increase in PM1.0, 1.22 [95% CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95% CI, 0.98-1.16] in participants without hyperbetalipoproteinemia).

CONCLUSIONS AND RELEVANCE

In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.

Association of exposure to Bisphenol A with obesity and cardiometabolic risk factors in children and adolescents

In this study, the association of exposure to Bisphenol A (BPA) with obesity and cardiometabolic risk factors was investigated on 132 children and adolescents aged 6-18 years living in Isfahan, Iran. Potential contributors to BPA exposure were assessed by a questionnaire. Total BPA was detected in urine samples of all participants without significant difference in boys and girls. The mean body mass index (BMI) and waist circumference (WC) increased significantly across the BPA tertiles (p for trend = < 0.001). Similar trend was documented for systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as fasting blood sugar. The risk of obesity was 12.48 times higher in participants in the third tertile of BPA than in others (95% CI: 3.36-46.39, p < 0.001). The current study showed significant association between BPA exposure with obesity and some cardiometabolic risk factors in children and adolescents, however, further longitudinal studies are necessary to evaluate the clinical effects of this finding. Abbreviations: BMI: Body Mass Index; BPA: Bisphenol A; BSTFA: N, O-Bistrifluoroacetamide; CDC: Centers for Disease Control and Prevention; CI: Circumference Interval; DBP: Diastolic Blood Pressure; DLLME: Dispersive liquid-liquid microextraction method; FBS: Fasting Blood Glucose; HDL: high-density lipoprotein cholesterol were; LDL: low-density lipoprotein cholesterol; OR: Odd Ratio; PA: Physical Activity; SBP: Systolic Blood Pressure; TC: total cholesterol; TG: triglycerides; WC: Waist Circumference.

Acute effects of air pollutants on adverse birth outcomes in Changsha, China: A population data with time-series analysis from 2015 to 2017

Evidence for the acute effects of air pollutants on adverse birth outcomes is not yet conclusive. Furthermore, there are no investigations relating to the association between air pollutants and macrosomia. The aim of this study was to determine the relationship between air pollutants and low birth weight, preterm birth, and macrosomia in Changsha. Time-series analysis, using a generalized additive model was applied. Data about the adverse birth outcomes was collected from 78 midwifery institutions. Air pollution data including SO2, NO2, particulate matter <10 μm in diameter (PM10), particulate matter <2.5 μm in diameter (PM2.5), O3, CO, and climate data were respectively collected from the Changsha Environmental Protection Agency and the Changsha Meteorological Bureau from January 2015 to December 2017. During the study period, there were 344,880 live births to be studied. In a single pollutant model, for every increase of 10 μg/m in PM10 and PM2.5, low birth weight increased by 0.12% (95% confidence interval [CI]: 0.01-0.23%) at a lag 06 and 0.44% (95% CI: 0.35-0.53%) at a lag 3, respectively. Preterm birth increased most by 1.60% (95% CI: 1.41-1.80%) at a lag 2 for every increase of 10 μg/m in SO2. The highest increases in macrosomia associated with a 10 μg/m increase in air pollutant were 3.53% (95% CI: 3.41-3.64%) for NO2 at lag 0, 3.33% (95% CI: 3.05-3.60%) for SO2 at lag03. Multi-pollutant models showed that only PM10 increased the low birth weight and preterm birth risk effect by 3.91% (95% CI: 3.67-4.12%) and 0.25% (95% CI: 0.14-0.37%). NO2 increased macrosomia risk by 4.14% (95% CI: 3.97-4.31%) with a 10 μg/m increase. There was no association observed between the air pollutants O3 and CO and adverse birth outcomes. Pregnant women should also take steps to limit their exposure to high levels of air pollutants during the final weeks of pregnancy.

An air quality index-based multistage type-2-fuzzy interval-stochastic programming model for energy and environmental systems management under multiple uncertainties

In this study, a multistage type-2-fuzzy interval-stochastic programming (MTIP) method is developed, which extends upon the existing multistage stochastic programming (MSP) by allowing uncertainties expressed as probabilistic distributions, interval values and type-2 fuzzy sets to be effectively incorporated within the optimization framework. Through coupling air quality index (AQI) with MTIP, an AQI-MTIP model is formulated for energy and environmental systems (EES) management of Tianjin. A number of scenarios based on changed AQIs are examined to analyze the impacts of environmental requirements on the city's energy system. Results indicate that (i) with the improvement of environmental requirement, utilization of clean energies (especially natural gas) is provoked markedly; (ii) PM_2.5 is the primary pollutant, 64.50% of which should be reduced each period to maintain the city's air quality at a health-safe level. These findings can help decision makers adjust energy structure, make effective mitigation strategy, and gain deep insight into the relationship between energy consumption and environmental requirement.

Association of urinary concentrations of phthalate metabolites with cardiometabolic risk factors and obesity in children and adolescents

This study aimed to investigate the association of urinary concentration of phthalate metabolites with obesity and cardiometabolic risk factors in a pediatric population. This study was conducted in 2016 on 242 children and adolescents, aged 6-18 years, living in Isfahan, Iran. Urinary concentration of mono-butyl phthalate (MBP), mono-benzyl phthalate (MBzP), Mono-2-ethylhexyl phthalate (MEHP), Mono-methyl phthalate (MMP), Mono (2-ethyl-5-exohexyl) phthalate (MEOHP), and mono (2-ethyl-5hydroxyhexyl) phthalate (MEHHP) metabolites were determined. The association of these metabolites with obesity and cardiometabolic risk factors was examined using student t-test, linear and logistics regression tests. Of the 242 participants studied, 140 (57.9%) were girls and 102 (42.1%) were boys. The mean (SD) age of the population was 11.34 (2.55) years and no significant difference existed in terms of age (p-value = 0.374). MBzP, MBP, MMP were observed in urine samples of all subjects, and MEHP, MEOHP, and MEHHP were observed in 99.6, 95.87, and 96.28% of the subjects, respectively. Of the total participants, 15.2% (n = 37) were obese and 37.7% (n = 92) were overweight. According to the logistic regression analysis, except MEOHP, all other pollutants were significantly associated with obesity (OR _adjusted >1, p-value ≤ 0.002). A significant association existed between MBP and elevated blood pressure [OR _crude in tertile3 = 4.87 (CI: 1.02-23.32), p-value = 0.024]. MBzP and MEHP were significantly associated with obesity, elevated levels of triglyceride and blood pressure. Increase in MBzP metabolite in the 3rd tertile resulted to about 2.5-fold increase in triglyceride levels than the first tertile [OR _{multivariate adjusted} = 2.7 (CI: 1.23-6.22)]. The findings of this study clearly showed the association between phthalate metabolites with obesity, cardiometabolic risk factors in children and adolescents, however further longitudinal studies are necessary to evaluate the clinical effects of this finding.

Exposure to ambient air pollution and blood lipids in adults: The 33 Communities Chinese Health Study

BACKGROUND

Little information exists on the lipidemic effects of air pollution, particularly in developing countries. We aimed to investigate the associations of long-term exposure to ambient air pollutants with lipid levels and dyslipidemias in China.

METHODS

In 2009, a total of 15,477 participants aged 18-74 years were recruited from the 33 Communities Chinese Health Study conducted in three Northeastern China cities. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured in participants' blood specimens. Three year (2006-08) average air pollution concentrations were assessed using data from 33 communities (particles with diameters ≤1.0 μm (PM₁) and ≤2.5 μm (PM_2.5) were predicted using a spatial statistical model) or 11 air monitoring stations (particles with diameters ≤10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and ozone (O₃)). Associations were evaluated by two-level logistic and generalized linear regression models.

RESULTS

We detected many significant associations between exposure to air pollutants (especially for PM₁ and PM_2.5) and blood lipid levels. Most of the associations suggested deleterious effects on blood lipid markers (e.g., a 10 μg/m³ increase in PM₁ was associated with 1.6% (95% confidence interval (CI): 1.1, 2.0), 2.9% (95% CI: -3.3, 9.3), and 3.2% (95% CI: 2.6, 3.9) higher levels of TC, TG, and LDL-C, respectively, but 1.4% (95% CI: -1.8, -0.9) lower HDL-C levels), although beneficial associations were found for O₃. In analysis with dyslipidemias, all the observed associations suggested deleterious lipidemic effects of air pollutants, and no significant beneficial association was observed for O₃. Stratified analyses showed that the associations were stronger in overweight or obese participants; sex and age modified the associations, but the pattern of effects was mixed.

CONCLUSIONS

Long-term ambient air pollution was associated with both altered lipid profiles and dyslipidemias, especially among overweight or obese participants.

Association of polycyclic aromatic hydrocarbons with cardiometabolic risk factors and obesity in children

A limited body of evidence exists on the association of exposure to polycyclic aromatic hydrocarbons (PAHs) with cardiometabolic risk factors and obesity in children. No study has evaluated these associations in subgroups of children with and without excess weight, and those with and without cardiometabolic risk factors. We aimed to investigate the association between PAH exposure and cardiometabolic risk factors in children independent of their weight status. The secondary aim was to evaluate the obesogen properties of PAHs in children independent of their cardiometabolic risk factors. This study was based on a representative sample of 186 children (aged 6-18 years) living in Isfahan, Iran (2014-2016). We enrolled four groups of participants with and without excess weight and with and without cardiometabolic risk factor. Urinary levels of monohydroxy PAHs (OH-PAHs) were measured twice, six months apart. Logistic regression models were developed to estimate the associations of tertiles of urinary OH-PAH concentrations with cardiometabolic risk factors and excess weight, adjusted for the relevant covariates. The findings in all participants combined showed that increased risk of cardiometabolic risk factors and excess weight was associated with exposure to most of evaluated PAHs. Exposure to 1-hydroxypyrene was associated with higher risk of cardiometabolic risk factors in participants with excess weight. Exposure to 2-Naphtol was also associated with higher risk of cardiometabolic risk factors in both groups, but the associations were not significant (p < 0.1). For participants without cardiometabolic risk factors, exposure to 2-naphtol, 9-phenanthrol, and ∑ OH-PAH was associated with increased risk of obesity. For participants with cardiometabolic risk factors, we observed similar pattern of associations for 2-naphtol and ∑ OH-PAH, but the associations were not statistically significant (p < 0.1). We found that exposure to PAHs could possibly explain, in part, the cardiometabolic risk factors in children with excess weight as well as obesity in children with normal cardiometabolic profile.

Development and testing of the reliability and validity of the adolescent haze related knowledge awareness assessment scale (AHRKAAS)

Background

Haze leads to many direct serious public health impacts. Understanding haze related knowledge can not only help adolescents organize health protection awareness to prevent the harmful effects that haze has on the body, but also promote their normal growth and development.

Methods

By considering, as the theoretical basis, the reasons behind the formation of haze and the underlying mechanisms of the diseases that it causes, in addition to also investigating extensive literature references, our research team developed the Adolescent Haze Related Knowledge Awareness Assessment Scale (AHRKAAS-I). After 6 experts reviewed AHRKAAS-I, and 6 adolescents tested the scale, the research team further revised and improved AHRKAAS-I to form AHRKAAS-II. After which, researchers randomly selected 2 districts from the 20 districts of Baoding, and subsequently randomly selected 2 middle schools from these 2 districts. Conducting a stratified cluster sampling method, considering class as a unit, the research team randomly selected 22 classes. Finally, a total of 1100 adolescents were investigated and 1034 valid questionnaires were recovered. By analyzing the data of 1034 valid questionnaires, the researchers tested the reliability and validity of the scale and obtained the final scale (AHRKAAS).

Results

AHRKAAS Cronbach’s α=0.923, content validity = 0.940, criterion validity = 0.444, and factor cumulative contribution rate = 66.178% by exploratory factor analysis. Using confirmatory factor analysis, Chi square value = 662.780, degrees of freedom = 242, Chi square value/degrees of freedom = 2.739, root-mean-square error of approximation = 0.049, goodness of fit index = 0.929, adjusted goodness of fit index = 0.905, comparative fit index = 0.964, normed fit index = 0.944, and Tueker-Lewis index = 0.955. AHRKAAS consisted of 25 items and 4 dimensions.

Conclusion

AHRKAAS with a good reliability and validity can be used to assess the cognition level of haze related knowledge among the adolescents, help medical workers and coordinators in schools when conducting targeted behavior interventions. Furthermore, it can be used for health guidance for adolescents relating to the health prevention of haze.

Association between Short-Term Exposure to Air Pollution and Dyslipidemias among Type 2 Diabetic Patients in Northwest China: A Population-Based Study

Air pollution exposure may play an adverse role in diabetes. However, little data are available directly evaluating the effects of air pollution exposure in blood lipids of which dysfunction has been linked to diabetes or its complications. We aimed to evaluate the association between air pollution and lipids level among type 2 diabetic patients in Northwest China. We performed a population-based study of 3912 type 2 diabetes patients in an ongoing cohort study in China. Both spline and multiple linear regressions analysis were used to examine the association between short-term exposure to PM₁₀, SO₂, NO₂ and total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). By spline analyses, we observed that the relationship between SO₂ and HDL-C and LDL-C was shown to be non-linear (p_non-lin-association = 0.0162 and 0.000). An inverted U-shaped non-linear relationship between NO₂ and LDL-C was found (p_non-lin-association < 0.0001). A J-shaped non-linear relationship between PM₁₀ and TC, HDL-C (p_non-lin-association = 0.0173, 0.0367) was also revealed. In linear regression analyses, a 10 μg/m³ increment in SO₂ was associated with 1.31% (95% CI: 0.40–2.12%), 3.52% (95% CI: 1.07–6.03%) and 7.53% (95% CI: 5.98–9.09%) increase in TC, TG and LDL-C, respectively. A 10 μg/m³ increment in PM₁₀ was associated with 0.45% (95% CI: 0.08–0.82%), 0.29% (95% CI: 0.10–0.49%) and 0.83% (95% CI: 0.21–1.45%) increase in TC, HDL-C and LDL-C, respectively. For NO₂, an increment of 10 μg/m³ was statistically associated with −3.55% (95% CI: −6.40–0.61%) and 39.01% (95% CI: 31.43–47.03%) increase in HDL-C and LDL-C. The adverse effects of air pollutants on lipid levels were greater in female and elder people. Further, we found SO₂ and NO₂ played a more evident role in lipid levels in warm season, while PM₁₀ appeared stronger in cold season. The findings suggest that exposure to air pollution has adverse effects on lipid levels among type 2 diabetes patients, and vulnerable people may pay more attention on severe air pollution days.

The association between exposure to air pollutants including PM10, PM2.5, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide concentration and the relative risk of developing STEMI: A case-crossover design

BACKGROUND

Unfavorable associations between air pollution and myocardial infarction are broadly investigated in recent studies and some of them revealed considerable associations; however, controversies exists between these investigations with regard to culprit components of air pollution and significance of correlation between myocardial infarction risk and air pollution.

METHODS

The association between exposure to PM₁₀, PM_2.5, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide concentration of background air that residents of Tehran, the capital city of Iran, which is ranked as the most air polluted city of Iran and the relative risk of developing ST-elevation myocardial infarction (STEMI) were investigated by a case-crossover design. Our study included 208 patients admitted with a diagnosis of STEMI and undergone primary percutaneous intervention. Air pollutant concentration was averaged in 24-h windows preceding the time of onset of myocardial infarction for the case period. Besides, the mean level of each element of air pollution of the corresponding time in one week, two weeks and three weeks before onset of myocardial infarction, was averaged separately for each day as one control periods. Thus, 624 control periods were included in our investigation such that. Each patient is matched and compared with him/herself.

RESULTS

The mean level of PM₁₀ in case periods (61.47µg/m³) was significantly higher than its level in control periods (57.86µg/m³) (P-value = 0.019, 95% CI: 1.002-1.018, RR = 1.010). Also, the mean level of PM_2.5 in case periods (95.40µg/m³) was significantly higher than that in control days (90.88µg/m³) (P-value = 0.044, 95% CI: 1.001-1.011, RR = 1.006). The level of other components including NO₂, SO₂, CO and O₃ showed no significant differences between case and control periods. A 10µg/m³ increase in PM₁₀ and PM_2.5 would result in 10.10% and 10.06% increase in STEMI event, respectively. Furthermore, the results of sub-group analysis showed that older patients (equal or more than 60 year-old), diabetic patients, non-hypertensive ones and patients with more than one diseased vessel may be more vulnerable to the harmful effect of particular matters including PM₁₀ and PM_2.5 on development of STEMI.

CONCLUSION

Air pollution is a worldwide pandemic with great potential to cause terrible events especially cardiovascular ones. PM_2.5 and PM₁₀ are amongst ambient air pollutant with a high risk of developing STEMI. Thus, more restrictive legislations should be applied to define a safe level of indoor and outdoor air pollutant production.

Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review

Different elements of the environment have been posited to influence type 2 diabetes mellitus (T2DM). This systematic review summarizes evidence on the environmental determinants of T2DM identified in four databases. It proposes a theoretical framework illustrating the link between environment and T2DM, and briefly discusses some methodological challenges and potential solutions, and opportunities for future research. Walkability, air pollution, food and physical activity environment and roadways proximity were the most common environmental characteristics studied. Of the more than 200 reported and extracted relationships assessed in 60 studies, 82 showed significant association in the expected direction. In general, higher levels of walkability and green space were associated with lower T2DM risk, while increased levels of noise and air pollution were associated with greater risk. Current evidence is limited in terms of volume and study quality prohibiting causal inferences. However, the evidence suggests that environmental characteristics may influence T2DM prevention, and also provides a reasonable basis for further investigation with better quality data and longitudinal studies with policy-relevant environmental measures. This pursuit of better evidence is critical to support health-orientated urban design and city planning.

Providing a Clean Environment for Adolescents: Evaluation of the Tobacco Hazards Prevention Act in Taiwan

Cigarette smoking not only damages the health of adolescents, but also contributes to air pollution. The Tobacco Hazards Prevention Act in Taiwan stipulates that cigarettes should not be sold to persons younger than 18 years. Therefore, schools should actively educate students and raise awareness of the Tobacco Hazards Prevention Act to reduce the level of damage to the health of adolescents and maintain good air quality. This study had two main goals: (1) to evaluate the stipulation that no person shall provide tobacco products to persons under the age of 18 and the effects of counseling strategies on store managers confirming customer ages before tobacco sale in southern Taiwan; and (2) to evaluate the situation of tobacco hazard prevention education conducted by school in southern Taiwan. A cross-sectional design was adopted for this study. Study I: The investigation involved an analysis of 234 retailers including convenience stores (n = 70), grocery stores (n = 83), and betel nut stalls (n = 81). The results indicated that among the 234 retailers, 171 (73.1%) of them routinely failed to confirm the buyers' ages before allowing them to purchase tobacco. The number of retailers who exhibited failure to confirm customer ages before selling tobacco products had decreased from 171 (73.1%) to 59 (25.2%) and that of those who confirmed customer ages before selling tobacco products had increased from 63 (26.9%) to 175 (74.8%) after counseling strategies had been provided, thereby revealing statistical significance (χ² = 11.26, p < 0.001). Study II: A total of 476 (89.1%) participants had received tobacco hazards prevention education and 58 (10.9%) had not. Among the various residential areas, the highest percentage of participants that did not received tobacco hazards prevention education located in the plane regions (8.4%). The government organizations should continue to adopt counseling strategies to reduce the rate of disobedience of the Tobacco Hazards Prevention Act by selling tobacco products to minors. Schools should pay close attention to tobacco hazard prevention education for junior high school students to ensure that such students are adequately educated about tobacco hazard prevention.

Prenatal and early life exposure to traffic pollution and cardiometabolic health in childhood

BACKGROUND

Prenatal exposure to traffic pollution has been associated with faster infant weight gain, but implications for cardiometabolic health in later childhood are unknown.

METHODS

Among 1418 children in Project Viva, a Boston-area pre-birth cohort, we assessed anthropometric and biochemical parameters of cardiometabolic health in early (median age 3.3 years) and mid- (median age 7.7 years) childhood. We used spatiotemporal models to estimate prenatal and early life residential PM_2.5 and black carbon exposure as well as traffic density and roadway proximity. We performed linear regression analyses adjusted for sociodemographics.

RESULTS

Children whose mothers lived close to a major roadway at the time of delivery had higher markers of adverse cardiometabolic risk in early and mid-childhood. For example, total fat mass was 2.1 kg (95%CI: 0.8, 3.5) higher in mid-childhood for children of mothers who lived <50 m vs. ≥200 m from a major roadway. Black carbon exposure and traffic density were generally not associated with cardiometabolic parameters, and PM_2.5 exposure during the year prior was paradoxically associated with improved cardiometabolic profile.

CONCLUSIONS

Infants whose mothers lived close to a major roadway at the time of delivery may be at later risk for adverse cardiometabolic health.

Developmental Exposure to Environmental Chemicals and Metabolic Changes in Children

The incidence of childhood obesity, type 2 diabetes, and other forms of metabolic disease have been rising over the past several decades. Although diet and physical activity play important roles in these trends, other environmental factors also may contribute to this significant public health issue. In this article, we discuss the possibility that widespread exposure to endocrine-disrupting chemicals (EDCs) may contribute to the development of metabolic diseases in children. We summarize the epidemiological evidence on exposure to environmental chemicals during early development and metabolic outcomes in infants and children. Prenatal exposure to EDCs, particularly the persistent organic pollutant DDT and its metabolite DDE, may influence growth patterns during infancy and childhood. The altered growth patterns associated with EDCs vary according to exposure level, sex, exposure timing, pubertal status, and age at which growth is measured. Early exposure to air pollutants also is linked to impaired metabolism in infants and children. As a result of these and other studies, professional health provider societies have called for a reduction in environmental chemical exposures. We summarize the resources available to health care providers to counsel patients on how to reduce chemical exposures. We conclude with a discussion of environmental policies that address chemical exposures and ultimately aim to improve public health.

Air pollution and blood lipid markers levels: Estimating short and long-term effects on elderly hypertension inpatients complicated with or without type 2 diabetes

With the development of society and the economy, many Chinese cities are shrouded in pollution haze for much of the year. Scientific studies have identified various adverse effects of air pollutants on human beings. However, the relationships between air pollution and blood lipid levels are still unclear. The objective of this study is to explore the short and long-term effects of air pollution on eight blood lipid markers among elderly hypertension inpatients complicated with or without type 2 diabetes (T2D). Blood lipid markers which met the pre-established inclusion criteria were exported from the medical record system. Air pollution data were acquired from the official environmental protection website. Associations between the air quality index and the blood lipid indexes were analyzed by one-way ANOVA and further Bonferroni correction. In an exposure time of 7 days or longer, blood lipid markers were somewhat affected by poor air quality. However, the results could not predict whether atherosclerosis would be promoted or inhibited by poorer air condition. Changes of blood lipid markers of hypertension inpatients with or without T2D were not completely the same, but no blood lipid markers had an opposite trend between the two populations. The air quality index was associated with changes to blood lipid markers to some extent in a population of hypertension inpatients with or without T2D. Further studies are needed to investigate the potential mechanism by which air pollutants induce blood lipids changes.

Modeling of the relationship between the environmental air pollution, clinical risk factors, and hospital mortality due to myocardial infarction in Isfahan, Iran

Background:

This study aimed to determine the relationship between the environmental factor, clinical risk factors, and individual variables with mortality due to acute myocardial infarction (MI) in Isfahan.

Materials and Methods:

This cross-sectional study was performed between April 2012 and March 2013. The data on the patients’ mortality due to MI in Isfahan were obtained from the MI National Registry. The international classification system (ICD10: I21-I22) was used to diagnose MI. The air quality indicators and environmental variables were used to measure the air pollution. Multilevel logistic regression in the Stata software was used to determine the factors associated with mortality in patients and odds ratios (ORs) were calculated.

Results:

Six hundred eleven patients with MI were studied during 1-year. 444 (72.2%) patients were male and the rest were female. 4.7% of the patients died due to MI. The mean age at MI incidence was 62.2 ± 13 years. Of the air pollution parameters, PM₁₀ had the maximum mean concentration (49.113 ppm), followed by NO_X, NO, NO₂, CO, SO₂, and O₃. The adjusted OR of mortality was derived 2.07 (95% CI: 1.5-2.85) for right bundle branch block, 1.5 (95% CI: 1.3-1.7) for ST-segment elevation MI, 1.84 (95% CI: 1.13-3) for age, 1.06 (95% CI: 1.01-1.20) for CO, 1.1 (95% CI: 1.03-1.30) for O₃, and 1.04 (95% CI: 1.01-1.4) for SO₂, all of which were considered as the risk factors of mortality. However, OR of mortality was 0.79 for precipitation (95% CI: 0.74-0.84) and 0.52 for angioplasty (95% CI: 0.4-0.68) were considered as protective factors of mortality. The individual characteristics including age, history of MI in the immediate family, hypertension, and diabetes were significantly associated with mortality from MI. The indices of air pollution including SO₂, CO, O₃, and environmental factors such as the precipitation and temperature were the determinants of mortality in patients with MI.

Conclusion:

With regards to the factors associated with mortality from MI reported in this study, air pollution and environmental factors, in addition to the risk factors and predictive factors, should be particularly addressed to control the mortality from MI.

A nationwide report on blood pressure of children and adolescents according to socioeconomic status: The CASPIAN-IV study

Background:

Hypertension is a major leading factor for global burden of diseases. Blood pressure (BP) tracks from childhood to adulthood. So, it is important to investigate its aff ecting factors. In this study we aimed to compare the BP status in the Iranian pediatric population according to the socioeconomic status (SES) of their living area.

Materials and Methods:

In this nationwide study, a representative sample of 14,880 students, aged 6-18 years was chosen by multistage random cluster sampling from 30 provinces in Iran. Anthropometric indices and BP were measured. A validated questionnaire, including the questions of the World Health Organization Global School-based Student Health Survey was completed. Findings were compared across the four regions of the country, categorized based on their elevating SES: Southeast, north-northeast, west, and central.

Results:

Participants consisted of 13,486 children and adolescents, that is, a participation rate of 90.6%, composed of 49.2% girls and 75.6% urban residents. The mean (standard deviation) age of participants was 12.47 (3.36) years. The region with highest SES (central) had the lowest rate of high BP (HBP), that is, 3.0% (95% of confidence interval [CI]: 2.4-3.9), and the region with lowest SES (southeast) had the highest rate, that is, 7.4% (4.4-12.2). The mean (95% CI) values of systolic BP for the four regions from lowest to highest SES were 100.5 (99.6-101.3), 100.9 (100.3-101.4), 101.7 (101.3-102), and 101.7 (101.2-102.1) mmHg. The corresponding mean Diastolic BP values were as follows: 65.4 (64.6-66.1), 63.4 (62.9-63.8), 65.6 (65.3-65.8), and 64.4 (64.0-64.7) mmHg.

Conclusion:

We found significant differences in mean BP and the frequency of HBP according to the SES of the living area. Further studies are necessary to find the underlying factors resulting in such differences.

Trends in health burden of ambient particulate matter pollution in Iran, 1990-2010: findings from the Global Burden of Disease study 2010

This paper aims to report the assessment of trends in deaths and disability-adjusted life years (DALYs) attributed to ambient particulate matter (PM) pollution from 1990 to 2010 by sex and age in Iran. We used the data of the Global Burden of Disease (GBD) 2010 Study, and then we extracted its data on Iran for the years 1990, 2005, and 2010. The proportion of deaths and the DALYs caused by specific risk factors were assessed by using the comparative risk assessment and calculating the attributed burden of exposure level to each risk factor compared with the theoretical minimum level of risk exposure. Uncertainties in distribution of exposure, relative risks, and relevant outcomes calculation were disseminated into the estimates of the attributable deaths and DALYs. We found that the age-standardized death rate attributed to ambient PM pollution decreased to 27.90 cases per 100,000 populations from 1990 to 2010 [86, 95% uncertainty interval (UI) 76-97 to 62; 95% UI 54-71 per 100,000 populations, respectively]. This was mainly because of greater decrease in cardiovascular diseases (CVDs) than in the other diseases attributed to PM pollution. Despite a decrease in the total DALYs and mortality rate attributed to PM pollution, the death percent increased by 6.94%, 95% UI 6.06-7.90% from 1990 to 2010. The number of the DALYs and death in age groups of more than 70 years increased in 2010 compared to that in 1990. The median percent change of the DALYs and death for all age groups shows that the DALYs and death increased by 6% (95% UI 8-19%) and 45% (95% UI 30-60%), respectively, in 2010 in comparison to that in 1990. The increase in the DALYs and mortality attributable to PM pollution emphasizes the necessity of the effective interventions for improving air quality, as well as for increasing the public awareness to reduce the exposure of vulnerable age groups to PM pollution.

Exposure to long-term air pollution and road traffic noise in relation to cholesterol: A cross-sectional study

BACKGROUND

Exposure to traffic noise and air pollution have both been associated with cardiovascular disease, though the mechanisms behind are not yet clear.

OBJECTIVES

We aimed to investigate whether the two exposures were associated with levels of cholesterol in a cross-sectional design.

METHODS

In 1993–1997, 39,863 participants aged 50–64 year and living in the Greater Copenhagen area were enrolled in a population-based cohort study. For each participant, non-fasting total cholesterol was determined in whole blood samples on the day of enrolment. Residential addresses 5-years preceding enrolment were identified in a national register and road traffic noise (Lden) were modeled for all addresses. For air pollution, nitrogen dioxide (NO2) was modeled at all addresses using a dispersion model and PM2.5 was modeled at all enrolment addresses using a land-use regression model. Analyses were done using linear regression with adjustment for potential confounders as well as mutual adjustment for the three exposures.

RESULTS

Baseline residential exposure to the interquartile range of road traffic noise,NO2 and PM2.5 was associated with a 0.58 mg/dl (95% confidence interval: −0.09; 1.25), a 0.68 mg/dl (0.22; 1.16) and a 0.78 mg/dl (0.22; 1.34) higher level of total cholesterol in single pollutant models, respectively. In two pollutant models with adjustment for noise in air pollution models and vice versa, the association between air pollution and cholesterol remained for both air pollution variables (NO2: 0.72 (0.11; 1.34); PM2.5: 0.70 (0.12; 1.28) mg/dl), whereas there was no association for noise (−0.08mg/dl). In three-pollutant models (NO2, PM2.5 and road traffic noise), estimates for NO2 and PM2.5 were slightly diminished (NO2: 0.58 (−0.05; 1.22); PM2.5: 0.57 (−0.02; 1.17) mg/dl).

CONCLUSIONS

Air pollution and possibly also road traffic noise may be associated with slightly higher levels of cholesterol, though associations for the two exposures were difficult to separate.

Can the Air Pollution Index be used to communicate the health risks of air pollution?

The validity of using the Air Pollution Index (API) to assess health impacts of air pollution and potential modification by individual characteristics on air pollution effects remain uncertain. We applied distributed lag non-linear models (DLNMs) to assess associations of daily API, specific pollution indices for PM10, SO2, NO2 and the weighted combined API (APIw) with mortality during 2003-2011 in Guangzhou, China. An increase of 10 in API was associated with a 0.88% (95% confidence interval (CI): 0.50, 1.27%) increase of non-accidental mortality at lag 0-2 days. Harvesting effects appeared after 2 days' exposure. The effect estimate of API over lag 0-15 days was statistically significant and similar with those of pollutant-specific indices and APIw. Stronger associations between API and mortality were observed in the elderly, females and residents with low educational attainment. In conclusion, the API can be used to communicate health risks of air pollution.

An overview on the successes, challenges and future perspective of a national school-based surveillance program: the CASPIAN study

The Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease (CASPIAN) study is implemented in the Islamic Republic of Iran from 2003. The aim of this national school- based surveillance program was to provide accurate data of regular surveys of this program to be reviewing methodology, protocols, data collection and questionnaires of these surveys. Information was obtained from articles and books were published from CASPIAN studies. The CASPIAN studies were repeated every two years, with blood sampling for biochemical factors every four years. Methods and questionnaires of all surveys were similar at their core level and some optional factors added in different surveys. The results of CASPIAN studies represent the public health of Iranian children and adolescents that are useful for policy makers and based on them, intervention programs can set in national and sub-national level.