Associations of residential greenness with peripheral and central obesity in China

doi:10.1016/j.scitotenv.2021.148084

Science of The Total Environment

Volume 791, 15 October 2021, 148084

https://doi.org/10.1016/j.scitotenv.2021.148084 Get rights and content

Highlights

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This is a national cross-sectional study on the greenness-obesity associations.
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The results suggest that greenness is a protective factor for obesity in China.
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Greenness was not only associated with peripheral obesity, but also central obesity.

Abstract

Background

Obesity is a well-known risk factor for public health. Recent studies found that greenness exposure may protect against obesity. However, the accumulated evidence on associations of greenness-obesity is inconsistent and most of them are from developed countries.

Objectives

This study aimed to evaluate the associations of greenness exposure with indicators of peripheral and central obesity.

Methods

This cross-sectional study was based on a Chinese national Sub-Clinical Outcomes of Polluted Air (SCOPA) prospective cohort across 15 provinces, and 5849 participants with average age of 64.7 were included. Surrounding greenness was estimated with the Enhanced Vegetation Index (EVI), which was calculated at each participant's residential addresses within a 250 m buffer. Weight, height and waist circumference (WC) were measured, and body mass index (BMI) and the waist-to-height ratio% (WHtR%) were calculated based on those measurements. The relationships between EVI and obese outcomes were explored using multiple linear regression and logistic regression models.

Results

Non-linear associations were observed between EVI and obese indicators. Participants living in Quartile 3 benefited more than in Quartile 4 compared to the lowest quartile (Quartile 1) of greenness. For peripheral obesity, participants living in Quartile 3 of EVI_250m had 0.86 kg/m² (β −0.86, 95% CI: −1.10, −0.61) lower BMI, and 46% (OR 0.54, 95% CI: 0.44–0.66) lower odds of peripheral obesity than in Quartile 1. For central obesity, participants living in Quartile 3 of EVI_250m had 1.85 cm (β −1.85, 95% CI: −2.54, −1.15) lower waist circumference, 1.12% (β −1.12, 95% CI: −1.56, −0.67) lower waist-to-height ratio% (WHtR%), and 33% (OR 0.67, 95% CI: 0.57–0.78) lower odds of central obesity than in Quartile 1 of EVI_250m.

Conclusions

Higher levels of greenness were statistically significant associated with lower obesity risk.

Graphical abstract

Introduction

The estimated number of obese children and adults was 107.7 million and 603.7 million respectively across 195 countries, and China was one of the countries with the highest levels of obese adult among them in 2015 (Collaborators et al., 2017). The latest report of the Global Burden of Disease 2019 (GBD 2019) indicated that high BMI was the fifth risk of preterm deaths for females, and the sixth for males worldwide (GBD, 2020). Meanwhile, the GBD 2019 also demonstrated that the proportion of the population with high levels of BMI was non-significantly decreasing in any of 204 countries and territories from 1990 to 2019 (GBD, 2020).

Increasing studies reported that exposure to greenness is beneficial to many health outcomes, such as mental health, mortality, birth weight and so on (Fong et al., 2018; James et al., 2015). Recently, some studies also found protective associations between greenness and obesity (Huang et al., 2020a; Huang et al., 2020b; Huang et al., 2020c; James et al., 2017; Klompmaker et al., 2018; Sander et al., 2017; Sarkar, 2017). The underlying mechanisms on greenness-health are still unclear. One of them is biophilia hypothesis, which states that humans have an instinctive need to connect with the natural environment during evolution (Wilson, 1984). It suggested the beneficial effects of stress reduction or attention restoration on human mental or physiological health with nature (Kaplan, 1995; Ulrich et al., 1991). Other potential greenness-healthy mechanisms may be linked to higher levels of physical activities, lower air pollution and more social interactions (Kuo, 2015; Markevych et al., 2017; Ulrich et al., 1991). These potential mechanisms might also drive the associations between greenness and obesity (Kuo, 2015; Luo et al., 2020). Hence, more studies are needed to further examine the greenness-obesity associations.

BMI and waist circumference are both important clinical indicators of obesity. Previous studies mainly focused on peripheral obesity, which was mainly indicated by BMI or overweight/obesity defined based on BMI. On one hand, the results regarding associations on greenness-peripheral obesity were inconsistent, which might be due to the differences in study domains, study designs, exposure assessments methods of greenness, measurements of obese outcomes, covariables included and so on (James et al., 2015; Lachowycz and Jones, 2011; Luo et al., 2020). Some studies found greenness was a protective factor for BMI or the prevalence of peripheral obesity (Klompmaker et al., 2018; Rubin et al., 2005); others found no association or even harmful associations between greenness and peripheral obese indicators (Cummins and Fagg, 2012; Persson et al., 2018). Meanwhile, most greenness-obesity studies were conducted in developed countries, and only a few studies in China (Huang et al., 2020a; Huang et al., 2020c). The relationships between greenness exposure and obesity established in developed countries might be inapplicable in China, since the dietary habits of Chinese, socioeconomic status, urbanization, population density and air pollution levels in China are different from those in developed countries. Therefore, evidence based on the Chinese population is needed to further illustrate the association between greenness and obesity in China.

On the other hand, the evidence for greenness-central obesity is scarce (Huang et al., 2020a; Huang et al., 2020c; Sanders et al., 2015; Sarkar, 2017). BMI alone was inadequate to reflect the obesity-related cardiometabolic risk (Ross et al., 2020). Waist circumference has been recommended as an effective indicator of central obesity in clinical practice routinely since 2017 (Ross et al., 2020). Moreover, previous evidences indicated that abdominal deposition of fat was associated with an increased risk of all-cause mortality, and was a better indicator to reflect cardiometabolic risk compared to the overall obese indicators (Jayedi et al., 2020; Yusuf et al., 2005). Hence, studies are needed to fully explore the associations between greenness and both peripheral and central obesity.

Therefore, the objective of this study was to explore the associations between exposure to greenness and both peripheral and central obese indicators in China based on cross-sectional data from a national cohort.

Section snippets

Study design and population

The analysis was based on the baseline data from the Sub-Clinical Outcomes of Polluted Air (SCOPA) prospective cohort, which is designed to investigate the associations and biological mechanisms between air pollution and health effects in China (Li et al., 2020). The baseline data of SCOPA was collected across 28 districts/counties of 15 provinces with different levels of air pollution from the northeast to the south of mainland China (Li et al., 2020) (Fig. 1). A total of 5864 participants

Descriptive statistics

Table 1 showed the basic descriptions for the participants included in this study at baseline year of 2017. The mean age of the participants was 64.7 years. The mean (SD) values for BMI, waist circumference, and WHtR% were 24.8 kg/m² (3.4), 88.5 cm (10.4) and 54.9%, respectively (Table 1). The prevalence was 17.2% for peripheral obesity, and 55.3% for central obesity among all participants. Overall, 55.6% of the participants lived in the northern region, 73.5% of them took medium level of

Discussion

In this national cross-sectional study in China, we investigated the associations between residential greenness exposure and both peripheral obesity and central obesity. The results suggested that higher exposure to greenness was statistically significantly associated with lower obesity risk.

Conclusions

In conclusion, this national cross-sectional study indicated that higher exposure to greenness was statistically significant with both lower odds of peripheral and central obesity, and also with lower BMI, waist circumference, WHtR%. This study might provide policymakers with scientific evidence on urban planning of more green space, especially for developing countries with rapid urbanization, such as China, which might help reduce the risk of obesity. Meanwhile, regarding the high prevalence

CRediT authorship contribution statement

Lina Zhang: Data curation, Formal analysis, Methodology, Investigation, Writing – original draft, Writing – review & editing. Chen Chen: Data curation, Methodology, Investigation, Visualization, Writing – original draft, Writing – review & editing. Cong Liu: Methodology, Software. Yi Zhang: Data curation, Writing – review & editing. Jianlong Fang: Investigation, Methodology. Jingxiu Han: Investigation, Writing – review & editing. Feng Zhao: Conceptualization, Investigation. Peng Du: Data

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgement

This work was funded by the National Natural Science Foundation of China (92043301, 82030103 and 91843302) and National Key Research and Development Program of China (2018YFC1313600 and 2017YFC0211706). The authors thank Dr. Julian D. Marshall at the University of Washington and Dr. Hao Xu at the University of Tsinghua University for sharing the data of NO_2.

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Higher neighbourhood greenness is associated with beneficial health outcomes, and short-term exposure to air pollution is associated with an elevated risk of stroke onset. However, little is known about their interactions.
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Individuals living in the high-greenness areas had weaker associations between total stroke risk and exposure to NO₂ (low greenness: ER% = 1.765% [95% CI 1.205%–2.328%]; high greenness: ER% = 0.368% [95% CI −0.252% to 0.991%]; P = 0.001), O₃ (low greenness: 0.476% [95% CI 0.246%–0.706%]; high greenness: ER% = 0.085% [95% CI −0.156% to 0.327%]; P = 0.011), and SO₂ (low greenness: 0.632% [95% CI 0.138%–1.129%]; high greenness: ER% = −0.177% [95% CI −0.782% to 0.431%]; P = 0.035).
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The role of residential greenness levels, green land cover types and diversity in overweight/obesity among older adults: A cohort study
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Several studies showed that living in greener areas was inversely associated with overweight/obesity in the elderly, although current conclusions are not entirely consistent. For instance, some researchers showed a significant association between greenness exposure and overweight/obesity (Fan et al., 2022; Huang et al., 2020a; Rubin et al., 2005; Villeneuve et al., 2018; Zhang et al., 2021); some observed null association (Brown et al., 2009; Hobbs et al., 2019; O'Callaghan-Gordo et al., 2020), while others reported an unexpected increase in overweight/obesity risk with greenness exposure (Coombes et al., 2010; Cummins and Fagg, 2012; Dempsey et al., 2018; Gailey et al., 2021; Wilhelmsen et al., 2017). It was also shown that the association between greenness and overweight/obesity might be more complicated than currently thought, highlighting the need for further studies.
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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.
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.
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Air pollution, greenness and risk of overweight among middle-aged and older adults: A cohort study in China
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Citation Excerpt :
Third, because of database limitations, we were not able to adjust potential confounders such as race and dietary habits. This may have influenced the relationship between environmental exposure and the risk of being overweight or obese (Luo et al., 2020; Zhang et al., 2021b). Fourth, study participants were middle-aged and older adults, which may have reduced the generalizability of the findings.
Exposure to air pollution may increase the risk of obesity, but living in greener space may reduce this risk. Epidemiological evidence, however, is inconsistent.
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.
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.
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.
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To explore the association between decreased levels of particulate matter (≤2.5 µm; PM_2.5) due to the implementation of environmental protection policies and the incidence of obesity in adolescents in Chongqing, China through a prospective cohort study.
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Identifying and understanding the risk and protective factors of osteoporosis are essential for improving bone strength. Recently, residential greenness has attracted interest as a modifiable environmental factor with a wide range of benefits for human health (Fong et al., 2018; Twohig-Bennett and Jones, 2018), such as positive effects on metabolism-related diseases (Dong et al., 2021a; Dong et al., 2021b; Yang et al., 2020; Zhang et al., 2021), mental health (Ihlebaek et al., 2018; Liu et al., 2019a; Liu et al., 2019b), and mortality (Barboza et al., 2021; Bauwelinck et al., 2021; Crouse et al., 2017; Ji et al., 2019). Previous studies provide some biological rationale for the mechanisms of greenness's protective effects.
Living near green spaces may benefit various health outcomes. However, no studies have investigated the greenness-bone linkage in the general population. Moreover, to which extent ambient air pollution (AAP), physical activity (PA), and body mass index (BMI) mediate this relationship remains unclear. We aimed to explore the association between greenness and bone strength and the potential mediating roles of AAP, PA, and BMI in Chinese adults.
This cross-sectional analysis enrolled 66,053 adults from the China Multi-Ethnic Cohort in 2018–2019. The normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) were employed to define residential greenness. The calcaneus quantitative ultrasound index (QUI) was used to indicate bone strength. Multiple linear regression models and mediation analyses were used to estimate the residential greenness-bone strength association and potential pathways operating through AAP (represented by PM_2.5 [particulate matter <2.5 μm in diameter]), PA, and BMI. Stratification analyses were performed to identify susceptible populations.
Higher residential exposure to greenness was significantly associated with an increase in QUI, with changes (95% confidence interval) of 3.28 (3.05, 3.50), 3.57 (3.34, 3.80), 2.68 (2.46, 2.90), and 2.93 (2.71, 3.15) for every interquartile range increase in NDVI_500m, NDVI_1000m, EVI_500m, and EVI_1000m, respectively. Sex, urbanicity, annual family income, smoking, and drinking significantly modified the association of greenness-bone strength, with more remarkable associations in males, urban residents, subjects from wealthier families, smokers, and drinkers. For the NDVI_500m/EVI_500m-QUI relationship, the positive mediating roles of PM_2.5 and PA were 6.70%/8.50 and 2.43%/2.69%, respectively, whereas those negative for BMI and PA-BMI were 0.88%/1.06% and 0.05%/0.05%, respectively.
Living in a greener area may predict higher bone strength, particularly among males, urban residents, wealthier people, smokers, and drinkers. AAP, PA, BMI, and other factors may partially mediate the positive association. Our findings underscore the importance of optimizing greenness planning and management policies.
Associations of residential greenness with lung function and chronic obstructive pulmonary disease in China
2022, Environmental Research
Citation Excerpt :
It is because summer is the season with the strongest greenness contrast (Lee et al., 2019). Lastly, we used annual average NDVI values prior to the spirometry within different buffers (250 m and 1250 m) in analyses, which were also used in other studies to represent greenness exposure (Zhang et al., 2021). Finally, we performed mediation analyses to estimate the potential mediation effects of air pollutants in the associations between greenness and respiratory health.
Studies on the association of greenness with respiratory health are scarce in developing countries, and previous studies in China have focused on only one or two indicators of lung function.
The study aims to evaluate the associations of residential greenness with full-spectrum lung function indicators and prevalence of chronic obstructive pulmonary disease (COPD).
This nationwide cross-sectional survey included 50,991 participants from the China Pulmonary Health study. Lung function indicators included four categories: indicators of obstructive ventilatory dysfunction (FEV₁, FVC and FEV₁/FVC); an indicator of large-airway dysfunction (PEF); indicators of small-airway dysfunction (FEF_25–75% and FEV₃/FEV₆); and other indicators. Residential greenness was assessed by the Normalized Difference Vegetation Index (NDVI). Multivariable linear regression models and logistic regression models were used to analyze associations of greenness with lung function and COPD prevalence.
Within the 500 m buffer, an interquartile range (IQR) increase in NDVI was associated with higher FEV₁ (24.76 mL), FVC (16.52 mL), FEV₁/FVC (0.38), FEF_50% (56.34 mL/s), FEF_75% (33.43 mL/s), FEF_25–75% (60.73 mL/s), FEV₃ (18.59 mL), and FEV₆ (21.85 mL). However, NDVI was associated with lower PEF. In addition, NDVI was significantly associated with 10% lower odds of COPD. The stratified analyses found that the associations were only significant in middle-young people, females, and nonsmokers. The associations were influenced by geographic regions.
Residential greenness was associated with better lung function and lower odds of COPD in China. These findings provide a scientific basis for healthy community planning.

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¹: These authors contributed equally to this work.

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Associations of residential greenness with peripheral and central obesity in China

Highlights

Abstract

Background

Objectives

Methods

Results

Conclusions

Graphical abstract

Introduction

Section snippets

Study design and population

Descriptive statistics

Discussion

Conclusions

CRediT authorship contribution statement

Declaration of competing interest

Acknowledgement

Environ. Int.

Sci. Total Environ.

Int. J. Hyg. Environ. Health

Environ. Pollut.

Sci. Total Environ.

Lancet Planet. Health.

J. Environ. Psychol.

Environ. Res.

Environ. Int.

Health Place.

Environ. Res.

Sci. Total Environ.

Health Place.

Environ. Int.

Urban For. Urban Green.

Environ. Int.

Environ. Res.

J. Environ. Psychol.

Environ. Res.

Sci. Total Environ.

Lancet.

Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference

BMJ Open.

Greener neighborhoods, slimmer people? Evidence from 246,920 Australians

Int. J. Obes.

Environmental inequalities among children in Europe–evaluation of scientific evidence and policy implications

Eur. J. Pub. Health

Gardening as a mental health intervention: a review

Ment. Health Rev. J.

Health effects of overweight and obesity in 195 countries over 25 years

N. Engl. J. Med.

Does greener mean thinner? Associations between neighbourhood greenspace and weight status among adults in England

Int. J. Obes.