Ambient air pollution and overweight and obesity in school-aged children in Barcelona, Spain

Background: 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.

Methods: 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 (PM_2.5), <10 μm (PM₁₀) and coarse (PM_coarse) at home. Outdoor levels of NO₂, PM_2.5, 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.

Results: 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, PM_2.5 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 PM_2.5-school comparing tertile 2 vs tertile 1) but were similar in direction.

Conclusions: 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.