Interrelationships Between Walkability, Air Pollution, Greenness, and Body Mass Index.
Interrelationships Between Walkability, Air Pollution, Greenness, and Body Mass Index.
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DOI：
10.1097/ede.0000000000000724
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Laden F
中科院分区：
文献类型：
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作者：
James P;Kioumourtzoglou MA;Hart JE;Banay RF;Kloog I;Laden F
最近的研究将城市环境因素与体重指数（BMI）联系起来；然而，这些因素常常被孤立地考察，而忽略了不同暴露之间的相关性。利用 2006 年居住在美国东北部的护士健康研究参与者的数据，我们使用广义相加模型估计了社区步行能力（人口密度、街道连通性和商业通道的综合结果）、绿化度（来自卫星图像）和环境空气污染（来自卫星时空解析的 PM2.5 预测和来自最多五个最近监测器的二氧化氮加权月平均浓度）与自我报告的 BMI 之间的关联，并使用广义相加模型考虑了线性偏差惩罚样条。在 23,435 名 60-87 岁的女性中，我们在根据年龄、种族以及个人和地区社会经济地位进行调整的单次暴露模型中观察到步行能力与 BMI 以及 PM2.5 和 BMI 之间的非线性关联。当同时对所有暴露进行建模时，只有步行能力和 BMI 之间的关联仍然是非线性和非单调的。在步行能力较低的地区（步行能力指数 <1.8），步行能力的提高与 BMI 的增加相关，而在步行能力较高的地区（步行能力指数 >1.8），步行能力的提高与 BMI 的降低相关。步行能力增加 10 个百分点至 1.8 以上，与 BMI 对数下降 0.84% 相关。步行能力与 BMI 之间的关系仅存在于年轻参与者（<71 岁）中。社区步行适宜性与较低的体重指数呈非线性关系，与空气污染和绿化程度无关。我们的研究结果强调了在调查环境与体重指数之间的关联时考虑相互关联的城市环境因素的非线性混杂因素的重要性。
Recent studies have linked urban environmental factors and body mass index (BMI); however, such factors are often examined in isolation, ignoring correlations across exposures. Using data on Nurses’ Health Study participants living in the Northeastern United States in 2006, we estimated associations between neighborhood walkability (a composite of population density, street connectivity, and business access), greenness (from satellite imagery), and ambient air pollution (from satellite-based spatiotemporally resolved PM2.5 predictions and weighted monthly average concentrations of NO2 from up to five nearest monitors) and self-reported BMI using generalized additive models, allowing for deviations from linearity using penalized splines. Among 23,435 women aged 60–87 years, we observed non-linear associations between walkability and BMI, and PM2.5 and BMI in single-exposure models adjusted for age, race, and individual- and area-level socioeconomic status. When modeling all exposures simultaneously, only the association between walkability and BMI remained non-linear and non-monotonic. Increasing walkability was associated with increasing BMI at lower levels of walkability (walkability index <1.8), while increasing walkability was linked to lower BMI in areas of higher walkability (walkability index >1.8). A 10 percentile increase in walkability right above 1.8 was associated with a 0.84% decrease in log BMI. The relationship between walkability and BMI existed only among younger participants (<71 years old). Neighborhood walkability was non-linearly linked to lower BMI independent of air pollution and greenness. Our findings highlight the importance of accounting for non-linear confounding by interrelated urban environmental factors when investigating associations between the environment and BMI.