The Association between Childhood Exposure to Ambient Air Pollution and Obesity: A Systematic Review and Meta-Analysis

Ambient air pollution, urban green space and childhood overweight and obesity: A health impact assessment for Barcelona, Spain

BACKGROUND

The burden of childhood overweight and obesity attributable to ambient air pollution and a lack of urban green spaces (UGS) remains unknown. This study aimed to estimate the attributable cases of childhood overweight and obesity due to air pollution and insufficient UGS exposure in Barcelona, Spain.

METHODS

We applied a quantitative health impact assessment approach. We collected childhood overweight and obesity prevalence levels and exposure data from 69 spatial basic health zones in Barcelona. We estimated particulate matter (PM2.5) and nitrogen dioxide (NO2) levels using land use regression models, normalized difference vegetation index (NDVI) levels using remote sensing and percentage of green area (%GA) using land use. We estimated relative risks, population attributable fractions, and preventable overweight/obesity cases in children under following scenarios: Compliance of World Health Organization (WHO) air quality guidelines (AQGs) for (1) PM2.5 and (2) NO2; achieving (3) city-target NDVI levels and (4) 25% green area (%GA) recommendations. The analyses were stratified by socioeconomic deprivation index (in quintiles). Uncertainty was quantified using Monte Carlos simulations.

RESULTS

Compliance of WHO AQGs could prevent 0.4% [253 (95%CI, -604; 1086)] and 4.2% [3000 (95%CI, 1009; 4943)] of childhood overweight/obesity cases due to excess PM2.5 and NO2 levels in Barcelona, respectively. Compliance of NDVI and %GA targeted levels could prevent 6% [4094 (95%CI, 1698; 6379)] and 10% [6853 (95%CI, 1440; 12779)] of childhood overweight/obesity cases respectively. The preventable burdens of childhood overweight/obesity cases were slightly higher in middle-class socioeconomic areas due to the higher adverse exposure levels at baseline (high air pollution, less UGS).

DISCUSSION

Compliance with WHO AQGs and achieving UGS targets can reduce childhood overweight and obesity levels in Barcelona, and potentially in other locations as well. This underscores the need for policies that foster healthier urban environments of high environmental quality in order to protect child health.

Urban environment and children's health: An umbrella review of exposure response functions for health impact assessment

BACKGROUND

Urban settlements have become the main living environment. Understanding the impact of urban exposures on human health has therefore become a growing area of research. Up-to-date knowledge about the influence of urban exposures on pregnant women's and children's health is especially relevant, as they are particularly vulnerable to certain external influences.

AIM

This review aims to provide a synthesis of systematic reviews with meta-analyses reporting on an association between the urban environmental risk factors and health outcomes in pregnancy, infants, children and adolescents.

METHODS

We conducted an umbrella review, methodically analysing systematic reviews with meta-analyses, published between January 2016 and December 2022 in PubMed or Scopus. Adhering to the PRISMA checklist, we searched for free text using Medical Subject Headings (MeSH) terms related to air pollution, noise pollution, temperature, green space exposure, built and food environment, health outcomes, children (aged 0-18 years), pregnancy and systematic reviews with meta-analyses. We extracted key characteristics of each included study and assessed the quality of the included studies via the R-AMSTAR 2 tool.

RESULTS

Twenty-four studies met our inclusion criteria and identified 104 associations including 15 exposures and 60 health outcomes. The most frequently studied associations were related to air pollutants, followed by the built and food environment and noise. Birth outcomes (including low birth weight, pre-term birth or stillbirth) were the most commonly affected health outcomes, followed by respiratory outcomes such as asthma or respiratory infections. A total of 45 exposure-response function were reported to be statistically significant, including 10 exposures and 23 health effects.

CONCLUSION

This umbrella review provides an overview of the evidence and availability of exposure response functions between selected urban exposures and child health outcomes. This helps to identify research gaps and to build the basis for health impact assessment.

Inhaling Poor Health: The Impact of Air Pollution on Cardiovascular Kidney Metabolic Syndrome

Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution imposes most of its risk through proximate cardiovascular kidney and metabolic (CKM) etiologies. Indeed, there is compelling evidence linking air pollution to the genesis of insulin resistance, type 2 diabetes, hypertension, and other risk factors. Air pollution frequently coexists with factors such as noise, with levels and risks influenced substantially by additional factors such as social determinants and natural and built environment features. Persistent disparities regarding the impact and new sources of air pollution, such as wildfires attributable to climate change, have renewed the urgency to better understand root sources, characterize their health effects, and disseminate this information for personal protection and policy impacts. In this review, we summarize evidence associating air pollution with cardiovascular health, the impact of air pollution on CKM health, and how interactions with other exposures and personal characteristics may modify these associations. Finally, we discuss new integrated approaches to capture risk from air pollution in the context of an exposomic framework.

EV-miRNA associated with environmental air pollution exposures in the MADRES cohort

Air pollution is a hazardous contaminant, exposure to which has substantial consequences for health during critical periods, such as pregnancy. MicroRNA (miRNA) is an epigenetic mechanism that modulates transcriptome responses to the environment and has been found to change in reaction to air pollution exposure. The data are limited regarding extracellular-vesicle (EV) miRNA variation associated with air pollution exposure during pregnancy and in susceptible populations who may be disproportionately exposed. This study aimed to identify EV-miRNA expression associated with ambient, residential exposure to PM2.5, PM10, NO2, O3 and with traffic-related NOx in 461 participants of the MADRES cohort, a low income, predominantly Hispanic pregnancy cohort based in Los Angeles, CA. This study used residence-based modeled air pollution data as well as Nanostring panels for EVmiRNA extracted with Qiagen exoRNeasy kits to evaluate 483 miRNA in plasma in early and late pregnancy. Average air pollution exposures were considered separately for 1-day, 1-week, and 8-week windows before blood collection in both early and late pregnancy. This study identified 63 and 66 EV-miRNA significantly associated with PM2.5 and PM10, respectively, and 2 miRNA associated with traffic-related NOX (False Discovery Rate-adjusted P-value < .05). Of 103 unique EV-miRNA associated with PM, 92% were associated with lung conditions according to HMDD (Human miRNA Disease Database) evidence. In particular, EV-miRNA previously identified with air pollution exposure also associated with PM2.5 and PM10 in this study were: miR-126, miR-16-5p, miR-187-3p, miR200b-3p, miR486-3p, and miR-582-3p. There were no significant differences in average exposures in early vs late pregnancy. Significant EV-miRNAs were only identified in late pregnancy with an 8-week exposure window, suggesting a vulnerable timeframe of exposure, rather than an acute response. These results describe a wide array of EV-miRNA for which expression is affected by PM exposure and may be in part mediating the biological response to ambient air pollution, with potential for health implications in pregnant women and their children.

The Built Environment and Childhood Obesity

Counseling on physical activity (PA) to promote a child's overall growth, development, and wellness is a routine part of a well child visit. Given less than a quarter of children in the United States ages 6 to 17 years get 60 minutes of PA daily, there is increased focus on the built environment, that is, neighborhood level supports and barriers to PA and risk for obesity. Broad-based consideration of the built environment's contribution to childhood obesity can inform public health prevention strategies at the individual, family, community, and societal levels that promote children's health, especially in high-risk communities.

Going from Primary to Primordial Prevention: Is the Juice Worth the Squeeze?

PURPOSE OF REVIEW

While primary prevention strategies target individuals who are at high risk of cardiovascular disease, there is rising interest towards primordial prevention that focuses on preventing the development of risk factors upstream of disease detection. Therefore, we review the advantages of primordial prevention interventions on minimizing future cardiovascular events.

RECENT FINDINGS

Primordial prevention of atherosclerotic cardiovascular disease involves behavioral, genetic, and environmental strategies, starting from fetal/infant health and continuing throughout childhood and young adulthood. Early interventions focusing on modifiable risk factors such as physical inactivity, non-ideal body weight, smoking, and environmental pollutants are important towards preventing the initial occurrence of risk factors such as hypertension, dyslipidemia, and diabetes to ultimately reduce cardiovascular disease. Implementing primordial prevention strategies early on in life can minimize cardiovascular events and lead to healthy aging in the population. Future studies can further evaluate the effectiveness of various primordial prevention strategies.

Examining the Link between Air Quality (PM, SO2, NO2, PAHs) and Childhood Obesity: A Systematic Review

Background/Objectives: Childhood obesity has emerged as a global health concern with profound implications for long-term health outcomes. In recent years, there has been increasing interest in the potential role of environmental factors in the development of childhood obesity. This comprehensive review aims to elucidate the intricate relationship between various components of air pollution and childhood obesity. Methods: We systematically analyze the existing literature from the past 5 years to explore the mechanistic pathways linking air pollution, including particulate matter (PM), nitrogen oxides (NOx), sulfur dioxide (SO2), and polycyclic aromatic hydrocarbons (PAHs), to childhood obesity. This systematic review examines 33 epidemiological studies on the link between air pollution and childhood obesity, published from 1 January 2018, to 31 January 2024. Results: Studies from counties with low overall air pollution noticed only low to no impact of the exposure to childhood obesity, unlike studies from countries with higher levels of pollution, suggesting that the mitigation of air pollutants can reduce the chance of it being a negative factor for the development of obesity. This relationship was noticed for PM2.5, PM1, PM10, NOx, and SO2 but not for PAHs, which showed a negative effect on children's health across 10 out of 11 studies. Conclusions: This review underscores the need for interdisciplinary approaches to address both environmental and socio-economic determinants of childhood obesity. Efforts aimed at reducing air pollution levels and promoting healthy lifestyle behaviors are essential for safeguarding the health and well-being of children worldwide.

Associations between paediatric obesity, chemical mixtures and environmental factors, in a national cross-sectional study of Canadian children

BACKGROUND

Whilst single chemical exposures are suspected to be obesogenic, the combined role of chemical mixtures in paediatric obesity is not well understood.

OBJECTIVES

We aimed to evaluate the potential associations between chemical mixtures and obesity in a population-based sample of Canadian children.

METHODS

We ascertained biomonitoring and health data for children aged 3-11 from the cross-sectional Canadian Health Measures Survey from 2007 to 2019. Several chemicals of interest were measured in blood or urine and paediatric obesity was defined based on measured anthropometrics. Using quantile-based G computational analysis, we quantified the effects of three chemical mixtures selected a priori. Models were adjusted for sociodemographic and environmental factors identified through a directed acyclic graph. Results are presented through adjusted relative risks (RR) with 95% confidence intervals (95% CI).

RESULTS

We included 9147 children. Of these, 24.1% were overweight or obese. Exposure to the mixture of bisphenol A, acrylamide, glycidamide, metals, parabens and arsenic increased the risk of childhood overweight or obesity by 45% (95% CI 1.09, 1.93), obesity by 109% (95% CI 1.27, 3.42) and central obesity by 82% (95% CI 1.30, 2.56).

CONCLUSIONS

Our findings support the role of early childhood chemical exposures in paediatric obesity and the potential combined effects of chemicals.

The association between air pollution and obesity: an umbrella review of meta-analyses and systematic reviews

The objective of this umbrella review was to investigate comprehensive and synthesized evidence of the association between ambient air pollution and obesity based on the current systematic reviews and meta-analyses. Related studies from databases including PubMed, EMBASE, Web of Science, and the Cochrane Library, published before July 16, 2023, were considered in the analysis. All selected systematic reviews and meta-analyses were included in accordance with PRISMA guidelines. The risk of bias and the methodological quality were evaluated using the AMSTAR 2 tool. The protocol for this umbrella review was documented in PROSPERO with the registration number: CRD42023450191. This umbrella review identified 7 studies, including 5 meta-analyses and 2 systematic reviews, to assess the impacts of air pollutants on obesity. Commonly examined air pollutants included PM1, PM2.5, PM10, NO2, SO2, O3. Most of the included studies presented that air pollution exposure was positively associated with the increased risk of obesity. The impact of air pollution on obesity varied by different ambient air pollutants. This study provided compelling evidence that exposure to air pollution had a positive association with the risk of obesity. These findings further indicate the importance of strengthening air pollution prevention and control. Future studies should elucidate the possible mechanisms and pathways linking air pollution to obesity.

Associations of long-term exposure to air pollution and noise with body composition in children and adults: Results from the LEAD general population study

BACKGROUND

While long-term air pollution and noise exposure has been linked to increasing cardiometabolic disease risk, potential effects on body composition remains unclear. This study aimed to investigate the associations of long-term air pollution, noise and body composition.

METHODS

We used repeated data from the LEAD (Lung, hEart, sociAl, boDy) study conducted in Vienna, Austria. Body mass index (BMI; kg/m2), fat mass index (FMI; z-score), and lean mass index (LMI; z-score) were measured using dual-energy x-ray absorptiometry at the first (t0; 2011-ongoing) and second (t1; 2017-ongoing) examinations. Annual particulate matter (PM10) and nitrogen dioxide (NO2) concentrations were estimated with the GRAMM/GRAL model (2015-2021). Day-evening-night (Lden) and night-time (Lnight) noise levels from transportation were modeled for 2017 following the European Union Directive 2002/49/EC. Exposures were assigned to residential addresses. We performed analyses separately in children/adolescents and adults, using linear mixed-effects models with random participant intercepts and linear regression models for cross-sectional and longitudinal associations, respectively. Models were adjusted for co-exposure, lifestyle and sociodemographics.

RESULTS

A total of 19,202 observations (nt0 = 12,717, nt1 = 6,485) from participants aged 6-86 years (mean age at t0 = 41.0 years; 52.9 % female; mean PM10 = 21 µg/m3; mean follow-up time = 4.1 years) were analyzed. Among children and adolescents (age ≤ 18 years at first visit), higher PM10exposure was cross-sectionally associated with higher FMI z-scores (0.09 [95 % Confidence Interval (CI): 0.03, 0.16]) and lower LMI z-scores (-0.05 [95 % CI: -0.10, -0.002]) per 1.8 µg/m3. Adults showed similar trends in cross-sectional associations as children, though not reaching statistical significance. We observed no associations for noise exposures. Longitudinal analyses on body composition changes over time yielded positive associations for PM10, but not for other exposures.

CONCLUSION

Air pollution exposure, mainly PM10, was cross-sectionally and longitudinally associated with body composition in children/adolescents and adults. Railway/road-traffic noise exposures showed no associations in both cross-sectional and longitudinal analyses.

An Ecological Association Between Air Pollution and Adolescent Obesity Study

OBJECTIVES

The purposes of this study were to assess the association between exposure to particulate matter (PM 2.5 ) and adolescent obesity and to identify and visualize the world areas where the problems of adolescent obesity and air pollution by fine PM are more severe.

METHODS

This is an ecological study, based on publicly available data from a World Health Organization site.

RESULTS

For each increase in air pollution there was an increase in the probability of being in the higher prevalence obesity group (OR = 1.18 (95% CI, 1.06-1.31). High prevalence rates for both adolescent obesity and air pollution by PM 2.5 were identified in several countries, including Venezuela, Algeria, Libya, Saudi Arabia, Iraq, and Oceania islands.

CONCLUSIONS

Efforts by local authorities and world organizations should be focused on the countries with the highest prevalence rates for both conditions.

The Health-Related and Learning Performance Effects of Air Pollution and Other Urban-Related Environmental Factors on School-Age Children and Adolescents-A Scoping Review of Systematic Reviews

PURPOSE OF REVIEW

This scoping review aims to assess the impact of air pollution, traffic noise, heat, and green and blue space exposures on the physical and cognitive development of school-age children and adolescents. While existing evidence indicates adverse effects of transport-related exposures on their health, a comprehensive scoping review is necessary to consolidate findings on various urban environmental exposures' effects on children's development.

RECENT FINDINGS

There is consistent evidence on how air pollution negatively affects children's cognitive and respiratory health and learning performance, increasing their susceptibility to diseases in their adult life. Scientific evidence on heat and traffic noise, while less researched, indicates that they negatively affect children's health. On the contrary, green space exposure seems to benefit or mitigate these adverse effects, suggesting a potential strategy to promote children's cognitive and physical development in urban settings. This review underscores the substantial impact of urban exposures on the physical and mental development of children and adolescents. It highlights adverse health effects that can extend into adulthood, affecting academic opportunities and well-being beyond health. While acknowledging the necessity for more research on the mechanisms of air pollution effects and associations with heat and noise exposure, the review advocates prioritizing policy changes and urban planning interventions. This includes minimizing air pollution and traffic noise while enhancing urban vegetation, particularly in school environments, to ensure the healthy development of children and promote lifelong health.

Understanding the Cardiovascular and Metabolic Health Effects of Air Pollution in the Context of Cumulative Exposomic Impacts

Poor air quality accounts for more than 9 million deaths a year globally according to recent estimates. A large portion of these deaths are attributable to cardiovascular causes, with evidence indicating that air pollution may also play an important role in the genesis of key cardiometabolic risk factors. Air pollution is not experienced in isolation but is part of a complex system, influenced by a host of other external environmental exposures, and interacting with intrinsic biologic factors and susceptibility to ultimately determine cardiovascular and metabolic outcomes. Given that the same fossil fuel emission sources that cause climate change also result in air pollution, there is a need for robust approaches that can not only limit climate change but also eliminate air pollution health effects, with an emphasis of protecting the most susceptible but also targeting interventions at the most vulnerable populations. In this review, we summarize the current state of epidemiologic and mechanistic evidence underpinning the association of air pollution with cardiometabolic disease and how complex interactions with other exposures and individual characteristics may modify these associations. We identify gaps in the current literature and suggest emerging approaches for policy makers to holistically approach cardiometabolic health risk and impact assessment.

Physical activity and menopausal symptoms: evaluating the contribution of obesity, fitness, and ambient air pollution status

OBJECTIVE

The menopausal transition is accompanied by transient symptoms that have been linked to subclinical cardiovascular disease (CVD); CVD has also been linked to air pollution. Physical activity (PA) reduces CVD, improves body composition, and can reduce menopausal symptoms. The purpose of this study was to assess the links between PA and menopausal symptoms and whether obesity, fitness, and air pollution status play a role in this relationship.

METHODS

Women (40-60 y; N = 243; mean [SD] age, 47.8 [5.6] y) from areas with high versus low air pollution enrolled in the Healthy Aging in Industrial Environment Program 4 prospective cohort study completed psychological, cardiorespiratory fitness, body composition, and menopausal status screening followed by a 14-day prospective assessment of menopausal symptoms (Menopause Rating Scale) using a mobile application. Daily PA was assessed objectively across 14 days via Fitbit Charge 3 monitor. General linear mixed models were conducted and controlled for age, menopausal status, day in the study, wear time, and neuroticism.

RESULTS

Peri/postmenopausal women ( β = 0.43, P < 0.001) and those residing in a high-air-pollution environment ( β = 0.45, P < 0.05) reported more somatovegetative symptoms. Hot flashes alone were associated with peri/postmenopausal status ( β = 0.45, P < 0.001), and for women residing in a high-air-pollution environment, lower reporting of hot flashes was observed on days when a woman was more physically active than usual ( β = -0.15, P < 0.001). No associations were found for cardiorespiratory fitness and visceral fat with any of the symptoms.

CONCLUSIONS

PA may enhance resilience to hot flashes, especially when residing in high-air-pollution environments where we also observed higher reporting of somatovegetative menopausal symptoms.

Associations of low levels of air pollution with cardiometabolic outcomes and the role of diet quality in individuals with obesity

BACKGROUND

Exposure to air pollution is associated with adverse cardiometabolic health effects and increased mortality, even at low concentrations. Some of the biological mechanisms through which air pollution can affect cardiometabolic health overlap with health outcomes associated with diet quality and changes in diet.

OBJECTIVE

The objective of this study is to investigate associations of air pollutants at average concentrations below the World Health Organization, 2021 air quality guidelines with cardiometabolic outcomes. Furthermore, potential interaction between air pollutants and diet quality will be assessed.

METHODS

82 individuals with obesity participated in a combined weight loss and weight loss maintenance study for a total of 33 weeks. A secondary analysis was conducted incorporating air pollution measurements. Data were analysed with linear mixed-effects models.

RESULTS

A total of 17 significant associations were observed for single pollutants with 10 cardiometabolic outcomes, predominantly related to blood lipids, hormones, and glucose regulation. Diet quality, as measured by the Baltic Sea Diet score, did not appear to mediate the association of air pollution with cardiometabolic outcomes, however, diet quality was observed to significantly modify the association of PM2.5 with total cholesterol, and the associations of NO and O3 with ghrelin.

DISCUSSION

These findings suggest that exposure to ambient air pollutants, especially particulate matter, at levels below World Health Organization, 2021 air quality guidelines, were associated with changes in cardiometabolic risk factors. Diet may be a personal-level approach for individuals to modify the impact of exposure to air pollution on cardiometabolic health.

Association of air pollution exposure with overweight or obesity in children and adolescents: A systematic review and meta-analysis

Childhood overweight and obesity is a global problem. 38 million children under five years old were reported as being overweight/obese in 2019. However, current evidence regarding the effects of air pollution on children weight status remains scarce and inconsistent. This study aimed to determine the association between air pollutants and the weight status of children and adolescents. Four databases were searched up to August 9, 2023. Adjusted merged odds ratios (ORs), regression coefficients (β), and their 95 % confidence intervals (95 % CIs) were calculated and pooled. A total of 27 studies were included. The results showed that air pollutants had adverse effects on the body weight of children and adolescents. Exposure to PM1, PM2.5, PMcoarse, and PM10 were associated with increased risk of overweight/obesity, with pooled ORs (95 % CI) of 1.23 (1.09, 1.40), 1.18 (1.10, 1.28), 1.04 (1.03, 1.05) and 1.11 (1.06, 1.17) per 10 μg/m3 increment, respectively. Individuals with higher exposure levels to NOX, O3, SO2 and CO (per 10 μg/m3 increment) were associated with 12 %, 6 %, 28 % and 1 % increased odds of being overweight/obese, respectively. With respect to the level of body mass index, the pooled β (95 % CIs) for each 10 μg/m3 increase in PM1, PM2.5, PM10, and NOX exposure were 0.15 (0.12, 0.18), 0.11 (0.06, 0.16), 0.07 (0.03, 0.10), and 0.03 (0.01, 0.04), respectively. PM1 has relatively strong adverse effects on body weight status. The subgroup analysis revealed a significantly increase in the risk of overweight/obesity when the concentrations of PM2.5, PM10, and NO2 exceeded 35 μg/m3, 50 μg/m3, and 40 μg/m3, respectively. Exposure to PM2.5, PM10 and NOX increased the risk of overweight/obesity, especially in Asia. This study provides evidence of the association between air pollution and being overweight/obese in children and adolescents.

Prenatal and postnatal exposure to NO2 and rapid infant weight gain - A population-based cohort study

BACKGROUND

Childhood overweight and obesity is a global public health problem. Rapid infant weight gain is predictive of childhood overweight. Studies found that exposure to ambient air pollution is associated with childhood overweight, and have linked prenatal exposure to air pollution with rapid infant weight gain.

OBJECTIVES

To examine the association between prenatal and postnatal ambient NO2 exposure, a traffic-related marker, with rapid weight gain in infants.

METHODS

We carried out a population-based historical cohort study using data from the Israeli national network of maternal and child health clinics. The study included 474,136 infants born at term with birthweight ≥2500 g in 2011-2019 in central Israel. Weekly averages of NO2 concentration throughout pregnancy (prenatal) and the first 4 weeks of life (postnatal) were assessed using an optimized dispersion model and were linked to geocoded home addresses. We modelled weight gain velocity throughout infancy using the SuperImposition by Translation and Rotation (SITAR) method, a mixed-effects nonlinear model specialized for modelling growth curves, and defined rapid weight gain as the highest velocity tertile. Distributed-lag models were used to assess critical periods of risk and to measure relative risks for rapid weight gain. Adjustments were made for socioeconomic status, population group, subdistrict, month and year of birth, and the alternate exposure period - prenatal or postnatal.

RESULTS

The cumulative adjusted relative risk for rapid weight gain of NO2 exposure was 1.02 (95% confidence intereval [CI] 1.00, 1.04) for exposure throughout pregnancy and 1.02 (95% CI 1.01, 1.04) for exposure during the first four postnatal weeks per NO2 interquartile range increase (7.3 ppb). An examination of weekly associations revealed that the critical period of risk for the prenatal exposure was from mid-pregnancy to birth.

CONCLUSIONS

Prenatal and postnatal exposures to higher concentrations of traffic-related air pollution are each independently associated with rapid infant weight gain, a risk factor for childhood overweight and obesity.

Association between Air Pollution and Lipid Profiles

Dyslipidemia is a critical factor in the development of atherosclerosis and consequent cardiovascular disease. Numerous pieces of evidence demonstrate the association between air pollution and abnormal blood lipids. Although the results of epidemiological studies on the link between air pollution and blood lipids are unsettled due to different research methods and conditions, most of them corroborate the harmful effects of air pollution on blood lipids. Mechanism studies have revealed that air pollution may affect blood lipids via oxidative stress, inflammation, insulin resistance, mitochondrial dysfunction, and hypothalamic hormone and epigenetic changes. Moreover, there is a risk of metabolic diseases associated with air pollution, including fatty liver disease, diabetes mellitus, and obesity, which are often accompanied by dyslipidemia. Therefore, it is biologically plausible that air pollution affects blood lipids. The overall evidence supports that air pollution has a deleterious effect on blood lipid health. However, further research into susceptibility, indoor air pollution, and gaseous pollutants is required, and the issue of assessing the effects of mixtures of air pollutants remains an obstacle for the future.

Urban-rural differences in the association between long-term exposure to ambient particulate matter (PM) and malnutrition status among children under five years old: A cross-sectional study in China

Background

The evidence regarding the relationship between postnatal exposure of air pollution and child malnutrition indicators, as well as the corresponding urban-rural disparities, is limited, especially in low-pollution area of low- and middle-income countries (LMICs). Therefore, our aim was to contrast the effect estimates of varying ambient particulate matter (PM) on malnutrition indicators between urban and rural areas in Tibet, China.

Methods

Six malnutrition indicators were evaluated in this study, namely, Z-scores of height for age (HFA), Z-scores of weight for age (WFA), Z-scores of weight for height (WFH), stunting, underweight, and wasting. Exposure to particles with an aerodynamic diameter ≤2.5 micron (μm) (PM2.5), particles with an aerodynamic diameter ≤10 μm (PM10) and particles with an aerodynamic diameter between 2.5 and 10 μm (PMc) was estimated using satellite-based random forest models. Linear regression and logistic regression models were used to assess the associations between PM and the above malnutrition indicators. Furthermore, the effect estimates of different PM were contrasted between urban and rural areas.

Results

A total of 2511 children under five years old were included in this study. We found long-term exposure to PM2.5, PMc, and PM10 was associated with an increased risk of stunting and a decreased risk of underweight. Of these air pollutants, PMc had the strongest association for Z-scores of HFA and stunting, while PM2.5 had the strongest association for underweight. The results showed that the odds ratio (OR) for stunting were 1.36 (95% confidence interval (CI) = 1.06 to 1.75) per interquartile range (IQR) microgrammes per cubic metre (μg/m3) increase in PM2.5, 1.80 (95% CI = 1.30 to 2.50) per IQR μg/m3 increase in PMc and 1.55 (95% CI = 1.17 to 2.05) per IQR μg/m3 increase in PM10. The concentrations of PM were higher in urban areas, and the effects of PM on malnutrition indicators among urban children were higher than those of rural children.

Conclusions

Our results suggested that PM exposure might be an important trigger of child malnutrition. Further prospective researches are needed to provide important scientific literature for understanding child malnutrition risk concerning postnatal exposure of air pollutants and formulating synthetically social and environmental policies for malnutrition prevention.

Air Pollution, Built Environment, and Early Cardiovascular Disease

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.