TY - JOUR

T1 - Green spaces and respiratory, cardiometabolic, and neurodevelopmental outcomes

T2 - An individual-participant data meta-analysis of >35.000 European children

AU - Fernandes, Amanda

AU - Avraam, Demetris

AU - Cadman, Tim

AU - Dadvand, Payam

AU - Guxens, Mònica

AU - Binter, Anne Claire

AU - Pinot de Moira, Angela

AU - Nieuwenhuijsen, Mark

AU - Duijts, Liesbeth

AU - Julvez, Jordi

AU - De Castro, Montserrat

AU - Fossati, Serena

AU - Márquez, Sandra

AU - Vrijkotte, Tanja

AU - Elhakeem, Ahmed

AU - McEachan, Rosemary

AU - Yang, Tiffany

AU - Pedersen, Marie

AU - Vinther, Johan

AU - Lepeule, Johanna

AU - Heude, Barbara

AU - Jaddoe, Vincent W.V.

AU - Santos, Susana

AU - Welten, Marieke

AU - El Marroun, Hanan

AU - Mian, Annemiek

AU - Andrušaitytė, Sandra

AU - Lertxundi, Aitana

AU - Ibarluzea, Jesús

AU - Ballester, Ferran

AU - Esplugues, Ana

AU - Torres Toda, Maria

AU - Harris, Jennifer R.

AU - Lucia Thorbjørnsrud Nader, Johanna

AU - Moirano, Giovenale

AU - Maritano, Silvia

AU - Catherine Wilson, Rebecca

AU - Vrijheid, Martine

N1 - Publisher Copyright: © 2024 The Authors

PY - 2024

Y1 - 2024

N2 - Studies evaluating the benefits and risks of green spaces on children's health are scarce. The present study aimed to examine the associations between exposure to green spaces during pregnancy and early childhood with respiratory, cardiometabolic, and neurodevelopmental outcomes in school-age children. We performed an Individual-Participant Data (IPD) meta-analysis involving 35,000 children from ten European birth cohorts across eight countries. For each participant, we calculated residential Normalized Difference Vegetation Index (NDVI) within a 300 m buffer and the linear distance to green spaces (meters) during prenatal life and childhood. Multiple harmonized health outcomes were selected: asthma and wheezing, lung function, body mass index, diastolic and systolic blood pressure, non-verbal intelligence, internalizing and externalizing problems, and ADHD symptoms. We conducted a two-stage IPD meta-analysis and evaluated effect modification by socioeconomic status (SES) and sex. Between-study heterogeneity was assessed via random-effects meta-regression. Residential surrounding green spaces in childhood, not pregnancy, was associated with improved lung function, particularly higher FEV1 (β = 0.06; 95 %CI: 0.03, 0.09 I2 = 4.03 %, p < 0.001) and FVC (β = 0.07; 95 %CI: 0.04, 0.09 I2 = 0 %, p < 0.001) with a stronger association observed in females (p < 0.001). This association remained robust after multiple testing correction and did not change notably after adjusting for ambient air pollution. Increased distance to green spaces showed an association with lower FVC (β = −0.04; 95 %CI: −0.07, −0.02, I2 = 4.8, p = 0.001), with a stronger effect in children from higher SES backgrounds (p < 0.001). No consistent associations were found between green spaces and asthma, wheezing, cardiometabolic, or neurodevelopmental outcomes, with direction of effect varying across cohorts. Wheezing and neurodevelopmental outcomes showed high between-study heterogeneity, and the age at outcome assessment was only associated with heterogeneity in internalizing problems. This large European meta-analysis suggests that childhood exposure to green spaces may lead to better lung function. Associations with other respiratory outcomes and selected cardiometabolic and neurodevelopmental outcomes remain inconclusive.

AB - Studies evaluating the benefits and risks of green spaces on children's health are scarce. The present study aimed to examine the associations between exposure to green spaces during pregnancy and early childhood with respiratory, cardiometabolic, and neurodevelopmental outcomes in school-age children. We performed an Individual-Participant Data (IPD) meta-analysis involving 35,000 children from ten European birth cohorts across eight countries. For each participant, we calculated residential Normalized Difference Vegetation Index (NDVI) within a 300 m buffer and the linear distance to green spaces (meters) during prenatal life and childhood. Multiple harmonized health outcomes were selected: asthma and wheezing, lung function, body mass index, diastolic and systolic blood pressure, non-verbal intelligence, internalizing and externalizing problems, and ADHD symptoms. We conducted a two-stage IPD meta-analysis and evaluated effect modification by socioeconomic status (SES) and sex. Between-study heterogeneity was assessed via random-effects meta-regression. Residential surrounding green spaces in childhood, not pregnancy, was associated with improved lung function, particularly higher FEV1 (β = 0.06; 95 %CI: 0.03, 0.09 I2 = 4.03 %, p < 0.001) and FVC (β = 0.07; 95 %CI: 0.04, 0.09 I2 = 0 %, p < 0.001) with a stronger association observed in females (p < 0.001). This association remained robust after multiple testing correction and did not change notably after adjusting for ambient air pollution. Increased distance to green spaces showed an association with lower FVC (β = −0.04; 95 %CI: −0.07, −0.02, I2 = 4.8, p = 0.001), with a stronger effect in children from higher SES backgrounds (p < 0.001). No consistent associations were found between green spaces and asthma, wheezing, cardiometabolic, or neurodevelopmental outcomes, with direction of effect varying across cohorts. Wheezing and neurodevelopmental outcomes showed high between-study heterogeneity, and the age at outcome assessment was only associated with heterogeneity in internalizing problems. This large European meta-analysis suggests that childhood exposure to green spaces may lead to better lung function. Associations with other respiratory outcomes and selected cardiometabolic and neurodevelopmental outcomes remain inconclusive.

KW - Cardiometabolic

KW - Child

KW - Green space

KW - Lung function

KW - Neurodevelopment

KW - Respiratory

U2 - 10.1016/j.envint.2024.108853

DO - 10.1016/j.envint.2024.108853

M3 - Journal article

C2 - 38963986

AN - SCOPUS:85197308998

VL - 190

JO - Environment international

JF - Environment international

SN - 0160-4120

M1 - 108853

ER -