Residential greenness and dyslipidemia risk: Dose-response relations and mediation through BMI and air pollution

Qinjian Wang; Xiaoqing Li; Wenling Zhong; Hongyun Liu; Chuanteng Feng; Chao Song; Bin Yu; Yao Fu; Xi Lin; Yanrong Yin; Tiehui Chen; Jan D Reinhardt; Shujuan Yang

doi:10.1016/j.envres.2022.114810

Residential greenness and dyslipidemia risk: Dose-response relations and mediation through BMI and air pollution

Environ Res. 2023 Jan 15:217:114810. doi: 10.1016/j.envres.2022.114810. Epub 2022 Nov 15.

Authors

Qinjian Wang¹, Xiaoqing Li², Wenling Zhong², Hongyun Liu¹, Chuanteng Feng³, Chao Song¹, Bin Yu⁴, Yao Fu¹, Xi Lin², Yanrong Yin², Tiehui Chen², Jan D Reinhardt⁵, Shujuan Yang⁶

Affiliations

¹ West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
² Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China.
³ West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China.
⁴ Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China.
⁵ Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; Department of Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, China; Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland. Electronic address: [email protected].
⁶ West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China. Electronic address: [email protected].

PMID: 36395867
DOI: 10.1016/j.envres.2022.114810

Abstract

Background: Evidence on associations of residential greenness with dyslipidemia is limited, particularly regarding dose-response relations and mediation.

Objectives: To investigate associations between greenness and dyslipidemia, non-linear dose-response relationships and mediators.

Methods: This cross-sectional study draws on the 2018 Fujian Behavior and Disease Surveillance (FBDS) cohort that used multi-stage stratified random sampling from the general population of Fujian Province, China. Participants with one or more abnormities in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), or low-density lipoprotein cholesterol (LDL-C) were classified as having dyslipidemia. Residential greenness was operationalized as 3-year average of the normalized difference vegetation index (NDVI_500m) and enhanced vegetation index (EVI_500m). A doubly robust approach was used for effect quantification. Dose-response relations were studied with natural cubic splines. Mediation via physical activity (PA), body mass index (BMI), PM_2.5, PM₁₀, SO₂, and NO₂ was also examined.

Results: Data from 43,183 participants were analyzed. Increases in NDVI_500m and EVI_500m residential greenness were associated with decreased dyslipidemia risk and improved blood lipids. Non-linear dose response relationships were discovered. Significant reduction of dyslipidemia risk was observed at levels of EVI_500m > 0.48 and NDVI_500m > 0.65. Joint mediation effects of PA, BMI, PM_2.5, PM₁₀, NO₂, and SO₂ on the associations of NDVI_500m and EVI_500m with dyslipidemia risk were 49.74% and 44.64%, respectively.

Conclusions: Increased residential exposure to greenness was associated with decreased risk of dyslipidemia. A non-linear dose-response relationship between greenness and dyslipidemia suggests that specific thresholds of greenness need to be reached in order to achieve effects. BMI, PM_2.5, and PM₁₀ partially mediated the association.

Keywords: Blood lipid levels; Dose-response relation; Doubly-robust approach; Dyslipidemia; EVI; Mediation analysis; NDVI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollution* / analysis
Body Mass Index
China / epidemiology
Cholesterol
Cross-Sectional Studies
Humans
Nitrogen Dioxide* / analysis
Particulate Matter / analysis

Substances

Nitrogen Dioxide
Particulate Matter
Cholesterol