The available evidence on the effects of ambient air pollution on cardiovascular diseases (CVDs) has increased substantially. In this umbrella review, we summarized the current epidemiological ...evidence from systematic reviews and meta‐analyses linking ambient air pollution and CVDs, with a focus on geographical differences and vulnerable subpopulations. We performed a search strategy through multiple databases including articles between 2010 and 31 January 2021. We performed a quality assessment and evaluated the strength of evidence. Of the 56 included reviews, the most studied outcomes were stroke (22 reviews), all‐cause CVD mortality, and morbidity (19). The strongest evidence was found between higher short‐ and long‐term ambient air pollution exposure and all‐cause CVD mortality and morbidity, stroke, blood pressure, and ischemic heart diseases (IHD). Short‐term exposures to particulate matter <2.5 μm (PM2.5), <10 μm (PM10), and nitrogen oxides (NOx) were consistently associated with increased risks of hypertension and triggering of myocardial infarction (MI), and stroke (fatal and nonfatal). Long‐term exposures of PM2.5 were largely associated with increased risk of atherosclerosis, incident MI, hypertension, and incident stroke and stroke mortality. Few reviews evaluated other CVD outcomes including arrhythmias, atrial fibrillation, or heart failure but they generally reported positive statistical associations. Stronger associations were found in Asian countries and vulnerable subpopulations, especially among the elderly, cardiac patients, and people with higher weight status. Consistent with experimental data, this comprehensive umbrella review found strong evidence that higher levels of ambient air pollution increase the risk of CVDs, especially all‐cause CVD mortality, stroke, and IHD. These results emphasize the importance of reducing the alarming levels of air pollution across the globe, especially in Asia, and among vulnerable subpopulations.
Ambient air pollution may play a role in childhood obesity development, but evidence is scarce, and the modifying role of socioeconomic status (SES) is unclear. We aimed to examine the association ...between exposure to air pollution during early childhood and subsequent risk of developing overweight and obesity, and to evaluate whether SES is a modifier of this association.
This longitudinal study included 416,955 children identified as normal weight between 2-5 years old and registered in an electronic primary healthcare record between 2006 and 2016 in Catalonia (Spain). Children were followed-up until they developed overweight or obesity, reached 15 years of age, died, transferred out, or end of study period (31/12/2018). Overweight and obesity were defined following the WHO reference obtained from height and weight measures. We estimated annual residential census levels of nitrogen dioxide (NO
) and particulate matter <10 μm (PM
), <2.5 μm (PM
), and 2.5-10 μm (PM
) at study entry. We estimated the risk of developing overweight and obesity per interquartile range increase in air pollution exposure with Cox proportional hazard models.
A total of 142,590 (34.2%) children developed overweight or obesity. Increased exposure to NO
, PM
, and PM
was associated with a 2-3% increased risk of developing overweight and obesity (hazard ratio HR per 21.8 μg/m
NO
= 1.03 95% CI: 1.02-1.04; HR per 6.4 μg/m
PM
= 1.02 95% CI: 1.02-1.03; HR per 4.6 µg/m
PM
= 1.02, 95% CI: 1.01-1.02). For all air pollutants, associations were stronger among children living in most compared to least deprived areas.
This study suggests that early life exposure to air pollution may be associated with a small increase in the risk of developing overweight and obesity in childhood, and that this association may be exacerbated in the most deprived areas. Even these small associations are of potential global health importance because air pollution exposure is widespread and the long-term health consequences of childhood obesity are clear.
Experimental studies have reported associations between short-term exposure to natural outdoor environments (NOE) and health benefits. However, they lack insight into mechanisms, often have low ...external and ecological validity, and have rarely focused on people with some psycho-physiological affection. The aim of this study was to use a randomized, case-crossover design to investigate: (i) the effects of unconstrained exposure to real natural and urban environments on psycho-physiological indicators of people with indications of psychological distress, (ii) the possible differential effects of 30 and 30+180 minutes exposures, and (iii) the possible mechanisms explaining these effects.
People (n = 26) with indications of psychological distress were exposed to green (Collserola Natural Park), blue (Castelldefels beach) and urban (Eixample neighbourhood) environments in Catalonia. They were exposed to all environments in groups for a period of 30+180 minutes between October 2013 and January 2014. During the exposure period, participants were instructed to do what they would usually do in that environment. Before, during (at 30 and 30+180 minutes) and after each exposure, several psycho-physiological measures were taken: mood (measured as Total Mood Disturbance, TMD), attention capacity (measured as backwards digit-span task), stress levels (measures as salivary cortisol), systolic and diastolic blood pressure, heart rate, autonomous nervous system (assessed as heart rate variability and the indicators: low frequency power (LF), high frequency power (HF), ratio between LF and HF (LF:HF), and coefficients of component variance of LF, HF, and LF:HF). We also measured several potential mediators: air pollution, noise, physical activity, social interactions, and self-perceived restoration experience.
When compared with responses to urban environment, we found statistically significantly lower TMD -4.78 (-7.77, -1.79) points difference, and salivary cortisol -0.21 (-0.34, -0.08) log nmol/L in the green exposure environment, and statistically significantly lower TMD -4.53 (-7.57, -1.49) points difference, and statistically significant favourable changes in heart rate variability indicators (specifically LF:HF and CCV-LF:HF with around -0.20 points of difference of the indicators) in the blue exposure environment. Physical activity and self-perceived restoration experience partially mediated the associations between NOE and TMD. Physical activity and air pollution partially mediated the associations between NOE and heart rate variability.
This study extends the existing evidence on the benefits of NOE for people's health. It also suggests NOE potential as a preventive medicine, specifically focusing on people with indications of psychological distress.
Clinicaltrials.gov NCT02624921.
Ambient air pollution may increase the risk of overweight and obesity in children. However, available evidence is still scarce and has mainly focused on ambient air pollution exposure occurring at ...home without considering the school environment. The aim of this study is to assess whether exposure to ambient air pollution at home and school is associated with overweight and obesity in primary school children.
We studied 2660 children aged 7–10 years during 2012 in Barcelona. Child weight and height were measured and age- and sex-specific z-scores for body mass index (zBMI) were calculated using the WHO growth reference 2007. Overweight and obesity were defined using the same reference. Land use regression models were used to estimate levels of nitrogen dioxide (NO2), particulate matter <2.5 μm (PM2.5), <10 μm (PM10) and coarse (PMcoarse) at home. Outdoor levels of NO2, PM2.5, elemental carbon (EC), and ultrafine particles (UFP) were measured in the schoolyard. Multilevel mixed linear and ordered logistic models were used to assess the association between ambient air pollution (continuous per interquartile range (IQR) increase and categorical with tertile cutoffs) and zBMI (continuous and ordinal: normal, overweight, obese), after adjusting for socio-demographic characteristics.
An IQR increase in PM10-home (5.6 μg/m3) was associated with a 10% increase in the odds of being overweight or obese (odds ratio (OR) = 1.10; 95% CI = 1.00, 1.22). Children exposed to the highest tertile of UFP-school (>27,346 particles/cm3) had a 30% higher odds of being overweight or obese (OR = 1.30; 95%CI = 1.03, 1.64) compared to the lowest tertile of UFP exposure. We also observed that exposure to NO2, PM2.5 or EC at schools was associated with higher odds of overweight or obese at medium compared to low levels of exposure. Home and school exposures did not show any significant associations with zBMI (except PM2.5-school comparing tertile 2 vs tertile 1) but were similar in direction.
This study suggests that exposure to ambient air pollution, especially at school, is associated with childhood risk for overweight and obesity. A cautious interpretation is warranted because associations were not always linear and because school and home air pollution measurements were not directly comparable.
•Ambient air pollution was evaluated at home and schools in 2660 children.•Most children were exposed to air pollution levels above the WHO recommended levels.•Exposure to air pollution at schools increased the risk of overweight and obesity.
ObjectiveLockdown has impacts on people’s living conditions and mental health. The study aims to assess the relations between social impact and mental health among adults living in Spain during ...COVID-19 lockdown measures, taking a gender-based approach into account.Design, setting and participantsWe conducted a cross-sectional study among adults living in Spain during the lockdown of COVID-19 with an online survey from 8 April to 28 May 2020. The main variable was mental health measured by Generalized Anxiety Disorder Scale for anxiety and the Patient Health Questionnaire for depression. Sex-stratified multivariate ordinal logistic regression models were constructed to assess the association between social impact variables, anxiety and depression.ResultsA total of 7053 people completed this survey. A total of 31.2% of women and 17.7% of men reported anxiety. Depression levels were reported in 28.5% of women and 16.7% of men. A higher proportion of anxiety and depression levels was found in the younger population (18–35 years), especially in women. Poorer mental health was mainly related to fear of COVID-19 infection, with higher anxiety levels especially in women (adjusted ordinal OR (aOR): 4.23, 95% CI 3.68 to 4.87) and worsened economy with higher levels of depression in women (aOR: 1.51, 95% CI 1.24 to 1.84), and perceived inadequate housing to cope with lockdown was especially associated with anxiety in men (aOR: 2.53, 95% CI 1.93 to 3.44).ConclusionThe social impact of the lockdown is related to gender, age and socioeconomic conditions. Women and young people had worse mental health outcomes during lockdown. It is urgent to establish strategies for public health emergencies that include mental health and its determinants, taking a gender-based approach into account, in order to reduce health inequities.
Harmonized data describing simultaneous exposure to a large number of environmental contaminants in-utero and during childhood is currently very limited.
To characterize concentrations of a large ...number of environmental contaminants in pregnant women from Europe and their children, based on chemical analysis of biological samples from mother-child pairs.
We relied on the Early-Life Exposome project, HELIX, a collaborative project across six established population-based birth cohort studies in Europe. In 1301 subjects, biomarkers of exposure to 45 contaminants (i.e. organochlorine compounds, polybrominated diphenyl ethers, per- and polyfluoroalkyl substances, toxic and essential elements, phthalate metabolites, environmental phenols, organophosphate pesticide metabolites and cotinine) were measured in biological samples from children (6–12 years) and their mothers during pregnancy, using highly sensitive biomonitoring methods.
Most of the exposure biomarkers had high detection frequencies in mothers (35 out of 45 biomarkers with >90% detected) and children (33 out of 45 biomarkers with >90% detected). Concentrations were significantly different between cohorts for all compounds, and were generally higher in maternal compared to children samples. For most of the persistent compounds the correlations between maternal and child concentrations were moderate to high (Spearman Rho > 0.35), while for most non-persistent compounds correlations were considerably lower (Spearman Rho < 0.15). For mercury, PFOS and PFOA a considerable proportion of the samples of both mothers and their children exceeded the HBM I value established by The Human Biomonitoring Commission of the German Federal Environment Agency.
Although not based on a representative sample, our study suggests that children across Europe are exposed to a wide range of environmental contaminants in fetal life and childhood including many with potential adverse effects. For values exceeding the HBM I value identification of specific sources of exposure and reducing exposure in an adequate way is recommended. Considerable variability in this “chemical exposome” was seen between cohorts, showing that place of residence is a strong determinant of one's personal exposome. This extensive dataset comprising >100,000 concentrations of environmental contaminants in mother-child pairs forms a unique possibility for conducting epidemiological studies using an exposome approach.
•Children across Europe are exposed to a wide range of environmental contaminants.•Considerable variability in the “chemical exposome” was seen between cohorts.•Significant differences in concentrations between mothers and children were found.
Exposome studies are challenged by exposure misclassification for non-persistent chemicals, whose temporal variability contributes to bias in dose-response functions.
We evaluated the variability of ...urinary concentrations of 24 non-persistent chemicals: 10 phthalate metabolites, 7 phenols, 6 organophosphate (OP) pesticide metabolites, and cotinine, between weeks from different pregnancy trimesters in pregnant women, and between days and between seasons in children.
154 pregnant women and 152 children from six European countries were enrolled in 2014–2015. Pregnant women provided three urine samples over a day (morning, midday, and night), for one week in the 2nd and 3rd pregnancy trimesters. Children provided two urines a day (morning and night), over two one-week periods, six months apart. We pooled all samples for a given subject that were collected within a week. In children, we also made four daily pools (combining morning and night voids) during the last four days of the first follow-up week. Pools were analyzed for all 24 metabolites of interest. We calculated intraclass-correlation coefficients (ICC) and estimated the number of pools needed to obtain an ICC above 0.80.
All phthalate metabolites and phenols were detected in >90% of pools whereas certain OP pesticide metabolites and cotinine were detected in <43% of pools. We observed fair (ICC = 0.40–0.59) to good (0.60–0.74) between-day reliability of the pools of two samples in children for all chemicals. Reliability was poor (<0.40) to fair between trimesters in pregnant women and between seasons in children. For most chemicals, three daily pools of two urines each (for weekly exposure windows) and four weekly pools of 15–20 urines each would be necessary to obtain an ICC above 0.80.
This quantification of the variability of biomarker measurements of many non-persistent chemicals during several time windows shows that for many of these compounds a few dozen samples are required to accurately assess exposure over periods encompassing several trimesters or months.
•Urinary measurement variability can bias dose-response functions.•We evaluated the variability of 24 metabolites in pregnant women and children.•An alternative sampling strategy based on pooled urine is proposed.•The pooling strategy does not solve variability for most of these metabolites.
Evidence suggests that non-binary people have poorer mental and physical health outcomes, compared with people who identify within the gender binomial (man/woman). Research on the impact of the ...COVID-19 pandemic on mental health has been conducted worldwide in the last few months. It has however overlooked gender diversity. The aim of our study was to explore social and health-related factors associated with mental health (anxiety and depression) among people who do not identify with the man/woman binomial during COVID-19 lockdown in Spain. A cross-sectional study with online survey, aimed at the population residing in Spain during lockdown, was conducted. Data were collected between the 8.sup.th of April until the 28.sup.th of May 2020, the time period when lockdown was implemented in Spain. Mental health was measured using the Generalised Anxiety Disorder 7-item (GAD-7) scale for anxiety, and the Patient Health Questionnaire (PHQ-9) for depression. The survey included the question: Which sex do you identify with? The options "Man", "Woman", "Non-binary" and "I do not identify" were given. People who answered one of the last two options were selected for this study. Multivariate regression logistic models were constructed to evaluate the associations between sociodemographic, social and health-related factors, anxiety and depression. Out of the 7125 people who participated in the survey, 72 (1%) identified as non-binary or to not identify with another category. People who do not identify with the man/woman binomial (non-binary/I do not identify) presented high proportions of anxiety (41.7%) and depression (30.6%). Poorer mental health was associated with social-employment variables (e.g., not working before the pandemic) and health-related variables (e.g., poor or regular self-rated health). These findings suggest that social inequities, already experienced by non-binary communities before the pandemic, may deepen due to the COVID-19 pandemic.
•Urban exposures may increase childhood obesity risk.•Multiple exposures have scarcely been studied.•An exposure pattern of high air pollution, noise and traffic was associated with obesity ...risk.•PMcoarse, land use mix, and food environment were separately associated with obesity risk.•Urban exposures were not related to weight-related behaviours in children.
Urban environments are characterised by many factors that may influence children’s lifestyle and increase the risk of childhood obesity, but multiple urban exposures have scarcely been studied.
We evaluated the association between multiple urban exposures and childhood obesity outcomes and weight-related behaviours.
We conducted a cross-sectional study including 2213 children aged 9–12 years in Sabadell, Spain. We estimated ambient air pollution, green spaces, built and food environment, road traffic and road traffic noise at residential addresses through a total of 28 exposure variables in various buffers. Childhood obesity outcomes included body mass index (BMI), waist circumference and body fat. Weight-related behaviours included diet (fast food and sugar-sweetened beverage consumption), physical activity, sedentary behaviour, sleep duration and well-being. Associations between exposures (urban environment) and outcomes (obesity and behaviours) were estimated in single and multiple-exposure regression models and in a hierarchical clustering on principal components (HCPC) analysis.
Forty percent of children were overweight or obese. In single exposure models, very few associations were observed between the urban exposures and obesity outcomes or weight-related behaviours after correction for multiple testing. In multiple exposure models, PMcoarse, denser unhealthy food environment and land use mix were statistically significant associated with childhood obesity outcomes (e.g 17.7 facilities/km2 increase of unhealthy food environment (OR overweight/obesity status) = 1.20 95% CI: 1.01; 1.44). Cluster analysis identified 5 clusters of urban exposures. Compared to the most neutral cluster, the cluster with high air pollution, road traffic, and road noise levels was associated with a higher BMI and higher odds of overweight and obesity (β (zBMI) = 0.17, 95% CI: 0.01, 0.17; OR (overweight/obesity) = 1.36, 95% CI: 0.99, 1.85); the clusters were not associated with the weight-related behaviours.
This systematic study of many exposures in the urban environment suggests that an exposure pattern characterised by higher levels of ambient air pollution, road traffic and road traffic noise is associated with increased childhood obesity risk and that PMcoarse, land use mix and food environment are separately associated with obesity risk. These findings require follow-up in longitudinal studies and different settings.
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