Green space, air pollution, traffic noise and cardiometabolic health in adolescents: The PIAMA birth cohort

Environ Int. 2019 Oct:131:104991. doi: 10.1016/j.envint.2019.104991. Epub 2019 Jul 11.


Background: Green space has been hypothesized to improve cardiometabolic health of adolescents, whereas air pollution and traffic noise may negatively impact cardiometabolic health.

Objectives: To examine the associations of green space, air pollution and traffic noise with cardiometabolic health in adolescents aged 12 and 16 years.

Methods: Waist circumference, blood pressure, cholesterol and glycated hemoglobin (HbA1c) were measured in subsets of participants of the Dutch PIAMA birth cohort, who participated in medical examinations at ages 12 (n = 1505) and/or 16 years (n = 797). We calculated a combined cardiometabolic risk score for each participant, with a higher score indicating a higher cardiometabolic risk. We estimated exposure to green space (i.e. the average Normalized Difference Vegetation Index (NDVI) and percentages of green space in circular buffers of 300 m and 3000 m), air pollution (by land-use regression models) and traffic noise (using the Standard Model Instrumentation for Noise Assessments (STAMINA) model) at the adolescents' home addresses at the time of the medical examinations. We assessed associations of these exposures with cardiometabolic health outcomes at ages 12 and 16 by multiple linear regression, adjusting for potential confounders.

Results: We did not observe consistent patterns of associations of green space, air pollution and traffic noise with the cardiometabolic risk score, blood pressure, total cholesterol levels, the total/HDL cholesterol ratio and HbA1c. We found inverse associations of air pollution with waist circumference at both age 12 and 16. These associations weakened after adjustment for region, except for particulate matter with a diameter of <2.5 μm (PM2.5) at age 12. The association of PM2.5 with waist circumference at age 12 remained after adjustment for green space and road traffic noise (adjusted difference - 1.42 cm [95% CI -2.50, -0.35 cm] per 1.16 μg/m3 increase in PM2.5).

Conclusion: This study does not provide evidence for beneficial effects of green space or adverse effects of air pollution and traffic noise on cardiometabolic health in adolescents.

Keywords: Blood pressure; Cholesterol; Environmental exposures; Glycated hemoglobin; Waist circumference.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Air Pollution / adverse effects*
  • Blood Pressure
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cholesterol / blood
  • Cohort Studies
  • Environment*
  • Female
  • Hemoglobins / analysis
  • Humans
  • Male
  • Motor Vehicles
  • Netherlands / epidemiology
  • Noise / adverse effects*
  • Risk Assessment
  • Waist Circumference


  • Hemoglobins
  • Cholesterol