Urban green space and obesity in older adults: Evidence from Ireland

The relationship between natural environments and obesity: a systematic review

More than 100 million children and 13% of the adult population suffer from obesity globally. People with obesity experience higher risks of chronic illness, poor mental health outcomes, and premature death. Exposure to natural environments, including green spaces, encourages regular physical activity and cardiovascular exercise to combat obesity. This systematic review, based on the health lifestyle theory, explores previous research on the relationship between natural environments and obesity. We reviewed studies (N = 11) published between 2018 and 2023 examining the relationship between participants (N = 1,225,680) across seven countries. Two overarching areas of impact emerged: environmental health factors (air pollution) and social factors (socioeconomic status and food availability). Although many studies suggested that exposure to green spaces correlated with a lower incidence of obesity, few studies identified possible external factors to explain the relationship between green space and obesity. Implications for future policy legislation, clinical interventions, and research are presented.

Sex-specific associations of environmental exposures with prevalent diabetes and obesity - Results from the KORA Fit study

Promising evidence suggests a link between environmental factors, particularly air pollution, and diabetes and obesity. However, it is still unclear whether men and women are equally susceptible to environmental exposures. Therefore, we aimed to assess sex-specific long-term effects of environmental exposures on metabolic diseases. We analyzed cross-sectional data from 3,034 participants (53.7% female, aged 53-74 years) from the KORA Fit study (2018/19), a German population-based cohort. Environmental exposures, including annual averages of air pollutants [nitrogen oxides (NO2, NOx), ozone, particulate matter of different diameters (PM10, PMcoarse, PM2.5), PM2.5abs, particle number concentration], air temperature and surrounding greenness, were assessed at participants' residences. We evaluated sex-specific associations of environmental exposures with prevalent diabetes, obesity, body-mass-index (BMI) and waist circumference using logistic or linear regression models with an interaction term for sex, adjusted for age, lifestyle factors and education. Further effect modification, in particular by urbanization, was assessed in sex-stratified analyses. Higher annual averages of air pollution, air temperature and greenness at residence were associated with diabetes prevalence in men (NO2: Odds Ratio (OR) per interquartile range increase in exposure: 1.49 [95% confidence interval (CI): 1.13, 1.95], air temperature: OR: 1.48 [95%-CI: 1.15, 1.90]; greenness: OR: 0.78 [95%-CI: 0.59, 1.01]) but not in women. Conversely, higher levels of air pollution, temperature and lack of greenness were associated with lower obesity prevalence and BMI in women. After including an interaction term for urbanization, only higher greenness was associated with higher BMI in rural women, whereas higher air pollution was associated with higher BMI in urban men. To conclude, we observed sex-specific associations of environmental exposures with metabolic diseases. An additional interaction between environmental exposures and urbanization on obesity suggests a higher susceptibility to air pollution among urban men, and higher susceptibility to greenness among rural women, which needs corroboration in future studies.

Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence.

METHODS

This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors.

RESULTS

Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90).

CONCLUSIONS

Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

Association between UGS patterns and residents' health status: A report on residents' health in China's old industrial areas

BACKGROUND

Old industrial areas have low quality and spatial differentiation of urban green space (UGS), which makes it difficult to meet the public's physical activity needs and leads to increased health risks. The purpose of this study is to explore the equity of UGS patterns in old industrial areas and its internal relationship with residents' health status.

METHODS

This study selecteds relevant indicators to evaluate the equity of UGS patterns in the Harbin area and used linear regression analysis to explore the correlation between attributes of old industrial areas and UGS patterns. Additionally, this study explored the spatial correlation of UGSs using Moran's index and hotspot analysis. Finally, a report on residents' health was generated through a questionnaire survey, using linear regression analysis to explore the factors affecting residents' self-rated health and the significance of their correlation.

RESULTS

The results showed that there is an excess supply around the core industrial zone in the west, while the rural areas in the south face a serious shortage of supply. The significance between the factors representing age and income in industrial attributes and UGS pattern was less than 0.05. We observed that residents' self-rated health was positively affected by the intensity of physical activity (low intensity B = 2.073, medium intensity B = 2.359, high intensity B = 2.512) and the frequency of physical activity (B = 1.174). Ages (B = -0.597) and three generations living together (B = -3.191), which represent the industrial attributes, had a negative impact on residents' self-rated health.

CONCLUSION

To a certain extent, industrial attributes aggravate the mismatch of UGS patterns, leading to abnormal areas in spatial clustering. The quality of UGS in the old industrial zone is low and the movement is not strong; thus, the population characteristics and income have become the important factors affecting the health of residents.

Current methods for evaluating people's exposure to green space: A scoping review

People's exposure to green space is a critical link between urban green space and urban residents' health. Since green space may affect human health through multiple pathways regarding diverse human health outcomes, the measurement of people's exposure to green space must be tailored to concrete study contexts and research questions. In this scoping review, we systematically categorized the available green space representations and metrics in the last two decades that can be used to derive people's exposure to green space regarding different research topics. A three-phase systematic review was conducted after a generalized search of relevant research articles from the three most-used publication databases, namely Scopus, the Web of Science, and PubMed. We identified 260 research articles that particularly discuss green space representations and metrics. We further developed a multi-pathway framework to articulate the complicated context issues in green space studies. We categorized the most relevant green space representations and metrics into five groups, including green space indices, the delineation, inventory, and usage of green space, the spatiotemporal evolution of green space, the attributes and components of green space, and the green space landscape and fragmentation. Finally, we discussed the inter-conversion between different green space representations and metrics, the "mobility-turn" in green space studies and how it may affect the derivation of people's exposure to green space, and other potential methodological issues in measuring people's exposure to green space. Our scoping review provides the most comprehensive framework and categories for deriving people's exposure to green space to date, which may strongly support a broad range of studies that concern green space's health effects.

Associations of residential greenness and ambient air pollution with overweight and obesity in older adults

OBJECTIVE

This study aimed to examine the impact of greenness and fine particulate matter <2.5 μm (PM2.5 ) on overweight/obesity among older adults in China.

METHODS

A total of 21,355 participants aged ≥65 years were included from the Chinese Longitudinal Healthy Longevity Survey between 2000 and 2018. Normalized difference vegetation index (NDVI) with a radius of 250 m and PM2.5 in a 1 × 1-km grid resolution were calculated around each participant's residence. Cox proportional hazards models were used to estimate the effects of NDVI and PM2.5 on overweight/obesity. Interaction and mediation analyses were conducted to explore combined effects.

RESULTS

The study observed 1895 incident cases of overweight/obesity over 109,566 person-years. For every 0.1-unit increase in NDVI the hazard ratio of overweight/obesity was 0.91 (95% CI: 0.88-0.95), and for every 10-μg/m3 increase in PM2.5 the hazard ratio was 1.11 (95% CI: 1.07-1.14). The effect of NDVI on overweight/obesity was partially mediated by PM2.5 , with a relative mediation proportion of 20.10% (95% CI: 1.63%-38.57%).

CONCLUSIONS

Greenness exposure appears to lower the risk of overweight/obesity in older adults in China, whereas PM2.5 , acting as a mediator, partly mediated this protective effect.

Association of Public Sports Space Perception with Health-Related Quality of Life in Middle-Aged and Older Adults-Evidence from a Survey in Shandong, China

Creating a healthy living environment for middle-aged and older adults is a key strategy for countries to address the aging challenge, but the effects of such an environment on the health-related quality of life (HRQoL) of middle-aged and older adults remain underexplored. This study aimed to examine the link between public sports facilities and the HRQoL of middle-aged and older adult residents in communities. A total of 1169 respondents (average age: 66.84; male: 46.19%) were selected from the Shandong, China. This study measured respondents 'physical activity (PA) using the International Physical Activity Questionnaire, the HRQoL of respondents using the 36-item Short Form Health Survey, and the Public Sports Space Perception Scale for respondents' public sports space perception. Correlation analysis and logistic regression analysis were employed to test the relationship among public sports space perception, physical activity (PA), and HRQoL. The mediating role of PA was conducted using the PROCESS macro for SPSS. The results revealed that public sports space perception only influenced the HRQoL of middle-aged and older adults through light-intensity PA (PCS: B  =  0.09, 95% CI 0.01, 0.03; MCS: B  =  0.02, 95% CI 0.01, 0.05) among light-intensity PA, moderate-intensity PA, vigorous-intensity PA., and this mediation model varied across different age groups of middle-aged and older adults. Moreover, digital inclusion only moderated the psychological aspect of HRQoL of middle-aged and older adults (p < 0.05). This study provided empirical evidence for enhancing the HRQoL of middle-aged and older adults and offered useful insights for the planning and design of public sports facilities and the formulation of health management policies for middle-aged and older adults.

Effect of built environment on BMI of older adults in regions of different socio-economic statuses

Background

Numerous studies have ignored the influence of underdeveloped urban surroundings on the physical health of China's ageing population. Lanzhou is a typical representative of a less developed city in China.

Methods

This study investigated the relationship between body mass index (BMI) and built environment amongst older adults in regions of different socio-economic statuses (SES) using data from medical examinations of older adults in Lanzhou, as well as calculating community built environment indicators for regions of different SES based on multiple linear regression models.

Results

Results showed that age and underlying disease were negatively associated with overall older adult BMI in the study buffer zone. Land use mix, number of parks and streetscape greenery were positively associated with older adult BMI. Street design and distance to bus stops were negatively connected in low SES regions, but population density and street design were negatively correlated in high SES areas.

Conclusion

These findings indicate that the built environment of SES regions has varying impacts on the BMI of older persons and that planners may establish strategies to lower the incidence of obesity amongst older adults in different SES locations.

Comparison of static and dynamic exposures to air pollution, noise, and greenness among seniors living in compact-city environments

GPS technology and tracking study designs have gained popularity as a tool to go beyond the limitations of static exposure assessments based on the subject's residence. These dynamic exposure assessment methods offer high potential upside in terms of accuracy but also disadvantages in terms of cost, sample sizes, and types of data generated. Because of that, with our study we aim to understand in which cases researchers need to use GPS-based methods to guarantee the necessary accuracy in exposure assessment. With a sample of 113 seniors living in Barcelona (Spain) we compare their estimated daily exposures to air pollution (PM2.5, PM10, NO2), noise (dB), and greenness (NDVI) using static and dynamic exposure assessment techniques. Results indicate that significant differences between static and dynamic exposure assessments are only present in selected exposures, and would thus suggest that static assessments using the place of residence would provide accurate-enough values across a number of exposures in the case of seniors. Our models for Barcelona's seniors suggest that dynamic exposure would only be required in the case of exposure to smaller particulate matter (PM2.5) and exposure to noise levels. The study signals to the need to consider both the mobility patterns and the built environment context when deciding between static or dynamic measures of exposure assessment.

The role of residential greenness levels, green land cover types and diversity in overweight/obesity among older adults: A cohort study

BACKGROUND

Few studies have investigated the effects of greenness exposure, green land cover types and diversity and their interaction with particulate matter (PM) to adiposity.

METHOD

Cohort data were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Baseline data on greenness levels, green land cover types and diversity were assessed by the Normalized Difference Vegetation Index (NDVI), three greenery types (trees, shrublands and grassland) and Shannon's diversity index, respectively. Body mass index (BMI) and waist circumference (WC) were separately used as dependent variables and represented for peripheral overweight/obesity and central obesity, respectively. The mixed Cox model with random intercept was used to estimate the effects of greenness levels, types and diversity on overweight/obesity using single and multiple exposure models. We also examined the interaction of PM and the aforementioned indicators on overweight/obesity on both additive and multiplicative scales.

RESULTS

Single exposure models showed that higher levels of residential greenness, tree coverage and ratio of trees to shrublands/grassland were inversely associated with peripheral overweight/obesity and central obesity. An increase in shrublands, grassland and diversity of green was related to lower odds of peripheral overweight/obesity. Multiple exposure models confirmed the association between greenness levels and peripheral overweight/obesity. Males, educated participants and elderly who lived in southern regions and areas with cleaner air environments acquired more benefits from greenspace exposure. Single and multiple exposure models indicated that an antagonistic effect of increasing PM and decreasing greenness levels on peripheral overweight/obesity and central obesity. Single exposure models showed the potential interaction of tree coverage, ratio of trees to grassland and PM_2.5 exposures on the risk of peripheral overweight/obesity.

CONCLUSION

Increasing residential greenness and diversity of green were associated with healthy weight status. The relationship between greenery and overweight/obesity varied, and the effects of greenspace exposure on overweight/obesity were associated with air pollution.

Air pollution, greenness and risk of overweight among middle-aged and older adults: A cohort study in China

BACKGROUND

Exposure to air pollution may increase the risk of obesity, but living in greener space may reduce this risk. Epidemiological evidence, however, is inconsistent.

METHODS

Using data from the China Health and Retirement Longitudinal Study (2011-2015), we conducted a nationwide cohort study of 7424 adults. We measured overweight/obesity according to body mass index. We used annual average ground-level air pollutants, including ozone (O₃), nitrogen dioxide (NO2), and particulate matter with aerodynamic diameters ≤2.5 μm (PM_2.5), to demonstrate air pollution levels. We used the Normalized difference vegetation index (NDVI) to measure greenness exposure. We used time-varying Cox proportional hazard regression models to analyze the connections among air pollution, greenness, and the development of overweight/obesity in middle-aged and older adults in China. We also conducted mediation analyses to examine the mediating effects of air pollution.

RESULTS

We found that lower risk of overweight/obesity was associated with more greenness exposure and lower levels of air pollution. We identified that an interquartile increment in NDVI was correlated with a lower hazard ratio (HR) of becoming overweight or obese (HR = 0.806, 95% confidence interval [CI]: 0.754-0.862). Although a 10 μg/m³ increase in PM_2.5 and NO₂ was correlated with higher risks (HR = 1.049, 95% CI = 1.022-1.075, HR = 1.376, 95% CI = 1.264-1.499). Effects of PM_2.5 on being overweight or obese were stronger in men than in women. According to the mediation analysis, PM_2.5 and NO₂ mediated 8.85% and 19.22% of the association between greenness and being overweight or obese.

CONCLUSIONS

An increased risk of being overweight or obese in middle-aged and older adults in China was associated with long-term exposure to higher levels of PM_2.5 and NO₂. This risk was reduced through NDVI exposure, and the associations were partially mediated by air pollutants. To verify these findings, fine-scale studies are needed.

Relationship between the Duration of Urban Nature and a Lower Waist-Hip Ratio

Obesity is a prevalent health issue. Evidence suggests that the availability of urban nature may reduce the risks of obesity. However, several knowledge gaps remain. This study explores the relationships between the dose (distance, duration and frequency) of urban nature and demographic factors towards obesity risks among people in Thailand. A total of 111 participants in three urban and peri-urban nature locations answered a survey regarding their distance from green spaces, frequency of visits, and duration of their typical stay, as well as their socio-demographics, and waist-hip ratio (WHR). The results suggested that at least 1-2 h per typical visit to nature predicted low-risk WHR in women. Male participants are more likely to have a high-risk WHR. Increasing age predicted low-risk WHR. Spending more time in green spaces predicted lower odds of high-risk WHR, while distance did not predict the odds. This research is one of the first to study the relationship between time spent in nature and obesity, and one of the first nature and health studies conducted in Thailand. Given that Thailand is one of the countries most affected by obesity in Southeast Asia, this study is relevant and essential. Future research should explore the quality factors of the park with longer duration of stay.

The Influence of Green Space on Obesity in China: A Systematic Review

INTRODUCTION

This study systematically reviewed scientific evidence concerning the influence of green space on obesity in China.

METHODS

Keyword and reference search was conducted in PubMed, Web of Science, Scopus, EBSCO, and CNKI. Predetermined selection criteria included study designs: experimental and observational studies; subjects: people of all ages; exposures: green space (i.e., any open land partly or entirely covered with grass, trees, shrubs, or other vegetation); outcomes: body weight status (e.g., body mass index [BMI], overweight, or obesity); and country: China.

RESULTS

Ten studies met the selection criteria and were included in the review. All studies adopted a cross-sectional design. Overall greenness measures were found to be inversely associated with BMI, overweight, and obesity in most included studies. Street greenness, which measures the perceived greenness at the eye level on streets, was found to be inversely associated with BMI and obesity. By contrast, mixed results were observed for the relationship between green space accessibility and weight outcomes. Air quality was found to mediate the relationship between greenness and obesity. The influence of green space on obesity tended to vary by residents' gender, age, and socioeconomic status. Boys, women, older residents, and those with lower education or household income were more likely to benefit from greenness exposure.

CONCLUSION

The literature on green space exposure in relation to obesity in China remains limited. Longitudinal and quasi-experimental studies are warranted to assess the causal link between green space and obesity. Future measures should better capture the self-perception, quality, and attractiveness of green space. The underlying pathways through which green space affects residents' weight outcomes should be further elucidated.

Types and spatial contexts of neighborhood greenery matter in associations with weight status in women across 28 U.S. communities

Excess body weight is a risk factor for many chronic diseases. Studies have identified neighborhood greenery as supportive of healthy weight. However, few have considered plausible effect pathways for ecosystem services (e.g., heat mitigation, landscape aesthetics, and venues for physical activities) or potential variations by climate. This study examined associations between weight status and neighborhood greenery that capture ecosystem services most relevant to weight status across 28 U.S. communities. Weight status was defined by body mass index (BMI) reported for 6591 women from the U.S. Sister Study cohort. Measures of greenery within street and circular areas at 500 m and 2000 m buffer distances from homes were derived for each participant using 1 m land cover data. Street area was defined as a 25 m-wide zone on both sides of street centerlines multiplied by the buffer distances, and circular area was the area of the circle centered on a home within each of the buffer distances. Measures of street greenery characterized the pedestrian environment to capture physically and visually accessible greenery for shade and aesthetics. Circular greenery was generated for comparison. Greenery types of tree and herbaceous cover were quantified separately, and a combined measure of tree and herbaceous cover (i.e., aggregate greenery) was also included. Mixed models accounting for the clustering at the community level were applied to evaluate the associations between neighborhood greenery and the odds of being overweight or obese (BMI > 25) with adjustment for covariates selected using gradient boosted regression trees. Analyses were stratified by climate zone (arid, continental, and temperate). Tree cover was consistently associated with decreased odds of being overweight or obese. For example, the adjusted odds ratio [AOR] was 0.92, 95% Confidence Interval [CI]: 0.88-0.96, given a 10% increase in street tree cover at the 2000 m buffer across the 28 U.S. communities. These associations held across climate zones, with the lowest AOR in the arid climate (AOR: 0.74, 95% CI: 0.54-1.01). In contrast, associations with herbaceous cover varied by climate zone. For the arid climate, a 10% increase in street herbaceous cover at the 2000 m buffer was associated with lower odds of being overweight or obese (AOR: 0.75, 95% CI: 0.55-1.03), whereas the association was reversed for the temperate climate, the odds increased (AOR: 1.19, 95% CI: 1.05-1.35). Associations between greenery and overweight/obesity varied by type and spatial context of greenery, and climate. Our findings add to a growing body of evidence that greenery design in urban planning can support public health. These findings also justify further defining the mechanism that underlies the observed associations.

Associations between Nature Exposure and Health: A Review of the Evidence

There is extensive empirical literature on the association between exposure to nature and health. In this narrative review, we discuss the strength of evidence from recent (i.e., the last decade) experimental and observational studies on nature exposure and health, highlighting research on children and youth where possible. We found evidence for associations between nature exposure and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies provide evidence of protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure and increased levels of physical activity and decreased risk of cardiovascular disease, and longitudinal observational studies are beginning to assess long-term effects of nature exposure on depression, anxiety, cognitive function, and chronic disease. Limitations of current knowledge include inconsistent measures of exposure to nature, the impacts of the type and quality of green space, and health effects of duration and frequency of exposure. Future directions include incorporation of more rigorous study designs, investigation of the underlying mechanisms of the association between green space and health, advancement of exposure assessment, and evaluation of sensitive periods in the early life-course.

Obesity and Natural Spaces in Adults and Older People: A Systematic Review

BACKGROUND

Obesity is an important public health issue that has increased globally in the last decade and continues to be one of the main causes of morbidity and premature mortality. An accumulating body of evidence suggests that contact with nature is a valuable resource for the promotion of a more active lifestyle and seems to have a central role in maintaining a healthy weight. The authors conducted a systematic review to summarize the findings of studies that investigated the relationship between natural spaces and obesity.

METHODS

Following Primary Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was conducted using 11 databases for studies fully available in English and published between 2010 and 2020, with adults (18-64 y) and/or older people (≥65 y).

RESULTS

Fifty studies were found that met all the inclusion criteria. The majority (68%) of papers found that higher availability and less distance to green and blue spaces are associated with lower levels of adiposity. These associations were positive, even after adjusting for the demographic and socioeconomic factors.

CONCLUSIONS

Exploring the characteristics of green and blue spaces seems to be a promising tool for urban planning and health policies. The authors suggest the implementation of exercise programs in contact with nature for future interventions.

A cross-sectional study of the impact of school neighbourhood on children obesity and body composition

Schools' neighbourhoods provide an important environmental context that may influence the risk of obesity among children. The aim of this study was to assess the effect of neighbourhood surrounding schools on obesity and body composition in schoolchildren. Data on 845 children aged 7 to 12 years old from 20 primary schools were considered. Anthropometric measurements and bioelectrical impedance analysis were performed to assess body mass index (BMI) and characterize body composition. Land use characteristics were quantified within a 500-m buffer zone around schools. Mixed-effect models measured the effects of school neighbourhood on obesity and body composition. The results showed a tendency between green urban areas around schools and lower values of BMI and better body composition parameters compared with built areas, being BMI z-scores CDC, and body fat percentage significantly higher in-built than in green urban areas (β = 0.48, 95% CI 0.05; 0.90, and β = 2.56, 95% CI 0.39; 4.73, respectively).Conclusion: Our findings suggest that the school neighbourhood has an effect on BMI and body fat percentage in schoolchildren. These results may contribute to the creation of healthier cities and help reduce health expenses by focusing on prevention programmes towards the expansion of green spaces. What is Known: • Living in greener areas has been associated with healthy weight outcomes and to the lower impact of obesogenic urban environments. • The school environment may be especially important for youth health outcomes. What is New: • Neighbourhoods around schools may affect child health, specifically the development of obesity. • The presence of urban green areas around school may promote a framework of lifestyle or behaviours conducive to achieving a healthy weight.

Walking-friendly built environments and objectively measured physical function in older adults

BACKGROUND

Few studies have examined the associations between urban design attributes and older adults' physical function. Especially, it is not well known how built-environment attributes may influence physical function in Asian cities. The aim of this study was to examine associations between objectively measured environmental attributes of walkability and objectively assessed physical function in a sample of Japanese older adults.

METHODS

Cross-sectional data collected in 2013 from 314 older residents (aged 65-84 years) living in Japan were used. Physical function was estimated from objectively measured upper- and lower-body function, mobility, and balance by a trained research team member. A comprehensive list of built-environment attributes, including population density, availability of destinations, intersection density, and distance to the nearest public transport station, were objectively calculated. Walk Score as a composite measure of neighborhood walkability was also obtained.

RESULTS

Among men, higher population density, availability of destinations, and intersection density were significantly associated with better physical function performance (1-legged stance with eyes open). Higher Walk Score was also marginally associated with better physical function performance (1-legged stance with eyes open). None of the environmental attributes were associated with physical function in elderly women.

CONCLUSION

Our findings indicate that environmental attributes of walkability are associated with the physical function of elderly men in the context of Asia. Walking-friendly neighborhoods can not only promote older adults' active behaviors but can also support their physical function.

Greenspace with overweight and obesity: A systematic review and meta-analysis of epidemiological studies up to 2020

Several reviews have been conducted to assess the association between greenspace and overweight or obesity, but the conclusions were inconsistent. However, an updated comprehensive review and meta-analysis is warranted, because several high-quality papers have been published more recently. The objectives of this study are to systematically and quantitatively assess the evidence for a link between greenspace with overweight/obesity and to make specific recommendations for further research. We searched three English language databases, four Chinese language databases and the reference lists of previously published reviews for epidemiological studies on greenspace and overweight/obesity published before January 2020. We developed inclusion criteria, screened the literature and extracted key data from selected papers. We assessed methodological quality and risk of bias, and we graded the credibility of the pooled evidence. We also performed sensitivity analyses. Fifty-seven records met our inclusion criteria and were included in the study. Most studies were cross-sectional designs (81%) and were from developed nations (88%). More than half (55%) of the included studies found beneficial associations between greenspace and overweight/obesity in overall or subpopulations. Our meta-analytical results showed that greater normalized difference vegetation index was associated with lower odds of overweight/obesity in a statistically significant fashion (odds ratio [OR]: 0.88; 95% CI: 0.84, 0.91) but not residential proximity to greenspace (OR: 0.99; 95% CI: 0.99, 1.00), proportion of greenspace (OR: 0.96; 95% CI: 0.85, 1.08) or number of parks in an area (OR: 0.99; 95% CI: 0.97, 1.01). However, we detected high between-study heterogeneity in two of the four meta-analyses, which reduced the credibility of the pooled evidence. Current evidence indicates that there might be an association between greater access to greenspace and lower odds of overweight/obesity. However, additional high-quality studies are needed to more definitively assess the evidence for a causal association.

Establishing associations between residential greenness and markers of adiposity among middle-aged and older Chinese adults through multilevel structural equation models

OBJECTIVES

Residential greenness may prevent overweight/obesity, but the matter has not been investigated among middle-aged and older adults in China. This study 1) assessed associations between residential greenness and markers of adiposity among middle-aged and older Chinese adults and 2) investigated physical activity, sedentary behaviours, particulate matter (PM) with a diameter of <2.5 μm (PM_2.5) concentrations, and perennial mean temperature as mediators of the associations.

METHODS

We used data from the World Health Organization's Study on Global Ageing and Adult Health (SAGE) between 2007 and 2010. Overweight/obesity and abdominal obesity were measured by body mass index and waist circumference. Exposure to neighbourhood greenness was measured by the normalized difference vegetation index (NDVI). Multilevel structural equation models were fitted to investigate the associations between neighbourhood greenness, the four potential mediators, and the prevalence of overweight/obesity and central obesity.

RESULTS

The results showed that greenness was inversely associated with the odds of overweight/obesity (odds = 0.73, 95% confidence interval (CI) 0.58-0.92) and abdominal adiposity (odds = 0.55, 95% CI 0.33-0.91). The greenness-overweight/obesity association varied significantly by sex and age, and the greenness-central obesity varied significantly by sex, age, and education. We found some indication that PM_2.5 concentrations had a suppressive effect on the greenness-adiposity associations. There was no evidence that physical activity, sedentary behaviours, and perennial mean temperature mediated the associations between neighbourhood greenness and markers of adiposity.

CONCLUSIONS

Exposure to higher levels of residential greenness was associated with lower odds of overweight/obesity and abdominal obesity among middle-aged and older Chinese adults. However, underlying mechanisms explaining these associations remain unclear requiring longitudinal studies and natural experiments.

Factors Affecting Canine Obesity Seem to Be Independent of the Economic Status of the Country-A Survey on Hungarian Companion Dogs

Simple Summary

Obesity is an ever-growing epidemic among people and their pets. Recently, more and more studies investigated the risk factors of dog obesity, but most of them only included data from high-income Western countries. We surveyed Hungarian dog owners about their dogs’ body conditions and social and demographic factors that might affect it. Factors affecting canine body condition seem to be similar to those of high-GDP (Gross Domestic Product) countries, suggesting that these findings are more or less universal. Older dogs are more likely to be overweight/obese than younger ones. Joint activity and sports performed with the owner, even on a hobby level decrease the likelihood of obesity, and the main source of calories (kibble, human leftovers, or raw food) also had an effect on body condition. These findings support that the main risk factors of dog obesity are the ones controlled by the caretakers of dogs, therefore it is important to educate dog owners about how they can prevent the development of this condition.

Abstract

For a companion dog, the most important environmental factor is the owner, who is responsible for providing everything that is necessary for the health and welfare of the dog. Still, one of the most often compromised measures of an average companion dog is its body condition, with overweight and obese animals representing a growing welfare problem around the world. Using an extensive online survey that was distributed among Hungarian dog owners, we wanted to know whether those obesogenic factors that were identified mostly in high-GDP countries’ pet dog populations would hold their relevance in a much lower average income country as well. We found several associations between the body condition of canine companions and various demographics, environmental and behavioral factors. Older dogs reportedly had an accelerating propensity for being overweight. Joint activity and performing dog sports both reduced the likelihood of being an overweight dog. Main food types also had significant associations with the body condition of dogs—meanwhile, the feeding of commercial dog food (kibble) and/or leftovers of human meals coincided with being overweight, dogs that were fed (fully, or at least partly) with raw food were less likely overweight. In the case of owner-reported behavioral problems, the food-related issues (stealing food, overeating, etc.) were clustered to a dimension together with problem behaviors such as excessive barking and overt aggression. Beyond showing a good agreement with earlier surveys on associated factors with canine obesity, our study revealed some interesting new details that could be used in the prevention of overweight problems in dogs.

Characterising urban green space density and footpath-accessibility in models of BMI

Background

While exposure to urban green spaces has been associated with various physical health benefits, the evidence linking these spaces to lower BMI, particularly among older people, is mixed. We ask whether footpath availability, generally unobserved in the existing literature, may mediate exposure to urban green space and help explain this volatility in results. The aim of this study is to add to the literature on the association between urban green space and BMI by considering alternative measures of urban green space that incorporate measures of footpath availability.

Methods

We conduct a cross-sectional study combining data from The Irish Longitudinal Study on Ageing and detailed land use information. We proxy respondents’ exposure to urban green spaces at their residential addresses using street-side and area buffers that take account of the presence of footpaths. Generalised linear models are used to test the association between exposure to several measures of urban green space and BMI.

Results

Relative to the third quintile, exposure to the lowest quintile of urban green space, as measured within a 1600 m footpath-accessible network buffer, is associated with slightly higher BMI (marginal effect: 0.80; 95% CI: 0.16–1.44). The results, however, are not robust to small changes in how green space is measured and no statistically significant association between urban green spaces and BMI is found under other variants of our regression model.

Conclusion

The relationship between urban green spaces and BMI among older adults is highly sensitive to the characterisation of local green space. Our results suggest that there are some unobserved factors other than footpath availability that mediate the relationship between urban green spaces and weight status.

Association of exposure to air pollution and green space with ovarian reserve hormones levels

Exposure to air pollution has been associated with adverse health effects while exposure to greenspace has been associated with public health benefits. However, the available evidence on the association of exposure to air pollution with ovarian reserve markers is still scarce, with no study on such an association with greenspace exposure. Therefore, this study aimed to investigate the association of exposure to particulate matter with diameter of less than 1, 2.5 and 10 μm (PM₁, PM_2.5, PM₁₀), traffic indicators (distance from women's residence to major roads and total street length in different buffers around women's residential address) and greenspace indicators (residential surrounding greenspace and distance to green spaces) with serum levels of anti-müllerian hormone (AMH) and follicle stimulating hormone (FSH) as markers of ovarian reserve. This cross-sectional study was based on 67 women residing in Sabzevar, Iran (2018). Basal serum levels of FSH and AMH were measured by the enzyme-linked immunosorbent assays (ELISA). Land use regression models were used to estimate PMs concentrations at residential addresses and the average of normalized difference vegetation index (NDVI) in different buffers was used to characterize residential surrounding greenspace. Multiple linear regression models were developed to estimate the association of AMH and FSH with exposure to air pollution, traffic, and greenspace (one at a time) controlled for relevant covariates. In fully adjusted models, there was an inverse association between exposure to PM₁, PM_2.5 as well as total street length in 100 m buffer around women's residence and AMH level (β = -0.89, 95% confidence interval (CI): -1.43, -0.35, P-value ≤ 0.01, β = -1.11, 95% CI: -1.67, -0.55, P-value ≤ 0.01 and β = -0.76, 95% CI: -1.48, -0.50, P-value = 0.03, respectively). Moreover, increase in distance from home to nearest major road as well as residential surrounding greenspace (100 m buffer) and decrease in residential distance to a green space larger than 5000 m² were associated with increase in serum level of AMH. However, we did not observe any significant association between exposure to air pollution, traffic, and greenspace with FSH level. Overall, our findings supported a beneficial association of exposure to greenspace and detrimental association of exposure to air pollution with ovarian reserve.

The impact of green spaces on mental health in urban settings: a scoping review

BACKGROUND

Our planet is currently experiencing the largest wave of urban growth in history, with 55% of the world's population (4.2 billion people) currently living in urban areas, a figure set to rise to 70% by 2050. Primary care is the first point of treatment for most mental health disorders. Since the urban environment and health are intrinsically linked, it is useful to examine the effectiveness of Nature-Based Solutions in addressing mental health.

AIMS

The aim of this scoping review was to examine "How urban green spaces can improve mental health and wellbeing among patients attending general practice and primary care?"

METHODS

The scoping review framework comprised a five-stage process developed by Arksey and O'Malley.

RESULTS

Twenty-five studies were included in the review, mostly cross-sectional studies. A wide range of mental health outcomes were identified. Out of the 25 included studies, 23 showed positive associations between mental health and green space characteristics.

CONCLUSION

Our findings suggest that while green spaces are associated with positive mental health outcomes, most studies were cross-sectional in nature and provided limited evidence for association. Furthermore, the population samples used in most of the studies were taken from national survey data and were not specifically primary care patients. Further studies that assess primary care patients specifically are warranted.

Demographic Inequities in Health Outcomes and Air Pollution Exposure in the Atlanta Area and its Relationship to Urban Infrastructure

Environmental burdens such as air pollution are inequitably distributed with groups of lower socioeconomic statuses, which tend to comprise of large proportions of racial minorities, typically bearing greater exposure. Such groups have also been shown to present more severe health outcomes which can be related to adverse pollution exposure. Air pollution exposure, especially in urban areas, is usually impacted by the built environment, such as major roadways, which can be a significant source of air pollution. This study aims to examine inequities in prevalence of cardiovascular and respiratory diseases in the Atlanta metropolitan region as they relate to exposure to air pollution and characteristics of the built environment. Census tract level data were obtained from multiple sources to model health outcomes (asthma, chronic obstructive pulmonary disease, coronary heart disease, and stroke), pollution exposure (particulate matter and nitrogen oxides), demographics (ethnicity and proportion of elderly residents), and infrastructure characteristics (tree canopy cover, access to green space, and road intersection density). Conditional autoregressive models were fit to the data to account for spatial autocorrelation among census tracts. The statistical model showed areas with majority African-American populations had significantly higher exposure to both air pollutants and higher prevalence of each disease. When considering univariate associations between pollution and health outcomes, the only significant association existed between nitrogen oxides and COPD being negatively correlated. Greater percent tree canopy cover and green space access were associated with higher prevalence of COPD, CHD, and stroke. Overall, in considering health outcomes in connection with pollution exposure infrastructure and ethnic demographics, demographics remained the most significant explanatory variable.

Urban residential greenness and adiposity: A cohort study in Stockholm County

BACKGROUND

Increasing evidence suggests that exposure to residential greenness is associated with positive health outcomes among urban populations. However, few studies have considered effects on adiposity development in a longitudinal setting.

OBJECTIVES

This study aimed to explore the association between long-term exposure to urban residential greenness and markers of adiposity.

METHODS

A cohort of 5126 adults from five municipalities in Stockholm County was examined clinically at baseline (1992-1998) and follow-up (2002-2006) after on average nine years. Time-weighted average exposure to urban greenness was estimated by Normalized Difference Vegetation Index (NDVI) within 100 m, 250 m, and 500 m buffers around the residential addresses of each participant. Multiple linear and Poisson regression models were used to estimate associations between greenness and change in weight and waist circumference as well as risk of overweight, obesity and central obesity. Co-exposures to air pollution, traffic noise and distance to water were also examined.

RESULTS

In women, higher levels of residential greenness were associated with a reduced increase in waist circumference during follow-up (β = -0.11 cm/year, 95% CI -0.14; -0.08 per one interquartile range increase in NDVI) and decreased risk for central obesity (IRR = 0.88: 95% CI 0.79; 0.99) in the 500 m buffer. No associations were observed for men or with regard to weight development or the risk of developing overweight or obesity. Exposure to low NDVI levels in combination with high NO_x from road traffic and transportation noise as well as long distance to water rendered statistically significant increases in waist circumference in both sexes.

CONCLUSION

Higher long-term exposure to greenness was associated with a reduced increase in waist circumference and lower risk of central adiposity in women but not in men. In both sexes, low NDVI exposure in combination with other environmental risk factors appeared particularly harmful.

Associations between Body Mass Index and Urban "Green" Streetscape in Cleveland, Ohio, USA

Public health researchers are increasingly interested in assessing the impact of neighborhood environment on physical activities and chronic health issues among humans. Walkable streets and proximity to green space have long been believed to promote active lifestyles in cities, which contribute to positive health outcomes among residents. Traditionally, urban environmental metrics were calculated at the area level to describe the physical environment of neighborhoods. However, considering the fact that streets are the basic unit for human activities in cities, it is important to understand how the streetscape environment can influence human health conditions. In this study, we investigated the influence of street greenery and walkability on body mass index in Cleveland, Ohio, USA. Different from the area level and overhead view greenery metrics, we used the green view index calculated from the Google Street View to represent the amount of street greenery. The Walk Score was used to indicate the walkability of neighborhoods also at the street level. Statistical analysis results show that the Walk Score has a more significant association with decreased BMI for males than females and the street greenery has a more significant association with decreased BMI for females than males in Cleveland, Ohio. The results of this study would provide a reference for designing gender-specific healthy cities.

Coastal blue space and depression in older adults

This paper tests whether higher exposure to coastal blue space is associated with lower risk of depression using data from The Irish Longitudinal Study on Ageing (TILDA), a nationally representative longitudinal study of people aged fifty and over in Ireland. We contribute to the literature on blue space and health by (i) using scores from the Center for Epidemiologic Studies Depression Scale (CES-D) to measure depression outcomes (ii) using new measures of coastal blue space visibility (iii) studying the association in an older population (iv) using data from Ireland. Our results indicate that exposure to coastal blue space is associated with beneficial mental health outcomes: TILDA respondents with the highest share of sea view visibility have lower depression (CES-D) scores, while distance from coastline is not statistically significant when views and proximity are both included in the model. This finding supports the idea that the primary channel through which coastal blue space operates to reduce depression scores is visual rather than related to physical proximity.

Relationship Between the Built Environment and Body Mass Index in a Rural Context: A Cross-Sectional Study from Vermont

Objective

To evaluate the association between a marker of urban development (commercial building density) and body mass index (BMI) in a predominantly rural context.

Methods

A cross-sectional analysis of two geocoded datasets from Vermont. The first includes subjects from the Vermont Diabetes Information System (VDIS), an extensively attributed dataset of adult diabetics (n = 610); the second was the complete driver's license records for Vermont (n = 401,367). The dependent variable was BMI, measured objectively for the VDIS data and self-reported for the driver's license data. The explanatory variable was commercial buildings per hectare within 250 m of the home address used as a proxy for walkability. We regressed BMI against density in both datasets, controlling for age and gender; a separate regression was run for the VDIS data, controlling for a number of additional confounders related to health, activity, diet, and income.

Results

All models demonstrated a significant positive relationship between BMI and commercial building density. For the three VDIS data models, coefficients of density were +0.75, +0.79, and +0.90, all of which indicate an approximate ¾ kg/m² increase in BMI for each additional commercial facility per hectare (p < 0.01). For the driver’s license data, the coefficient was +0.16, which also indicates an increase in BMI with increasing density (p < 0.01).

Discussion

We found that BMI displays a positive association with commercial building density in Vermont, which is inconsistent with previous findings. The difference may be due to the unique rural focus of this study. Other characteristics of rural life may be associated with lower incidence of obesity and should be studied further.