Body mass index and association with use of and distance from places for physical activity and active leisure among schoolchildren in Brazil. Cross-sectional study

Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence.

METHODS

This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors.

RESULTS

Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90).

CONCLUSIONS

Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

The influence of neighborhood safety and built environment on childhood obesity: isolated and combined effect of contextual factors

This study aims to analyze the isolated and combined effect of objective measures concerning neighborhood safety, food, and physical activity environments on students' obesity. This is a cross-sectional study conducted with 9- and 10-year-old children enrolled in the municipal education network of a Brazilian metropolis. Environment objective measures comprised neighborhood unsafety (annual criminality and road traffic accident rates), availability of public parks and spaces for physical activity practicing, and index of establishments that predominantly sell ultra-processed food. Euclidean buffers of 1,000m around the children's house were used as eligible geographic units. This study adopted the Principal Component Analysis and Generalized Estimation Equation models. Stratified analyses were conducted based on neighborhood unsafety and on child's family income. In total, 717 students were assessed, 12.2% of them were children with obesity. The latent variable of the obesogenic environment (deduced by environment unsafety rates and the index of establishments that predominantly sell ultra-processed food) was a risk factor for obesity in children with lower socioeconomic levels (OR = 2.37; 95%CI: 1.06-5.19). Public parks and spaces for physical activity practicing were protective factors against childhood obesity only in locations recording the lowest environment unsafety rates (OR = 0.30; 95%CI: 0.09-0.94). Based on our findings, social conditions change the effect of the environment on childhood obesity, reinforcing the relevance of inter-sectoral policies and strategies against this condition.

Impacts of Urban Blue-Green Space on Residents' Health: A Bibliometric Review

Urban blue-green space (UBGS), as an important component of the urban environment, is found to closely relate to human health. An extensive understanding of the effects of UBGS on human health is necessary for urban planning and intervention schemes towards healthy city development. However, a comprehensive review and discussion of relevant studies using bibliometric methods is still lacking. This paper adopted the bibliometric method and knowledge graph visualization technology to analyze the research on the impact of UBGS on residents' health, including the number of published papers, international influence, and network characteristics of keyword hotspots. The key findings include: (1) The number of articles published between 2001 and 2021 shows an increasing trend. Among the articles collected from WoS and CNKI, 38.74% and 32.65% of the articles focus on physical health, 38.32% and 30.61% on mental health, and 17.06% and 30.61% on public health, respectively. (2) From the analysis of international partnerships, countries with high levels of economic development and urbanization have closer cooperation than other countries. (3) UBGS has proven positive effects on residents' physical, mental, and public health. However, the mediating effects of UBGS on health and the differences in the health effects of UBGS on different ages and social classes are less studied. Therefore, this study proposes several future research directions. First, the mediating effect of UBGS on health impacts should be further examined. Furthermore, the interactive effects of residents' behaviors and the UBGS environment should be emphasized. Moreover, multidisciplinary integration should be strengthened. The coupling mechanism between human behavior and the environment should also be studied in depth with the help of social perception big data, wearable devices, and human-computer interactive simulation. Finally, this study calls for developing health risk monitoring and early warning systems, and integrating health impact assessment into urban planning, so as to improve residents' health and urban sustainability.

The built environment as determinant of childhood obesity: A systematic literature review

We evaluated the epidemiological evidence on the built environment and its link to childhood obesity, focusing on environmental factors such as traffic noise and air pollution, as well as physical factors potentially driving obesity-related behaviors, such as neighborhood walkability and availability and accessibility of parks and playgrounds. Eligible studies were (i) conducted on human children below the age of 18 years, (ii) focused on body size measurements in childhood, (iii) examined at least one built environment characteristic, (iv) reported effect sizes and associated confidence intervals, and (v) were published in English language. A z test, as alternative to the meta-analysis, was used to quantify associations due to heterogeneity in exposure and outcome definition. We found strong evidence for an association of traffic-related air pollution (nitrogen dioxide and nitrogen oxides exposure, p < 0.001) and built environment characteristics supportive of walking (street intersection density, p < 0.01 and access to parks, p < 0.001) with childhood obesity. We identified a lack of studies that account for interactions between different built environment exposures or verify the role and mechanism of important effect modifiers such as age.

Why a New Research Agenda on Green Spaces and Health Is Needed in Latin America: Results of a Systematic Review

(1) Background: Increasing and improving green spaces have been suggested to enhance health and well-being through different mechanisms. Latin America is experiencing fast population and urbanization growth; with rising demand for interventions to improve public health and mitigate climate change. (2) Aim: This study aimed to review the epidemiological evidence on green spaces and health outcomes in Latin America. (3) Methods: A systematic literature review of green spaces and health outcomes was carried out for studies published in Latin America before 28 September 2020. A search strategy was designed to identify studies published in Medline via PubMed and LILACS. The search strategy included terms related to green spaces combined with keywords related to health and geographical location. No time limit for the publication was chosen. The search was limited to English, Spanish, Portuguese, and French published articles and humans’ studies. (4) Findings: This systematic review found 19 epidemiological studies in Latin America related to green spaces and health outcomes. Nine studies were conducted in Brazil, six in Mexico, three in Colombia, and one in Chile. In terms of study design, 14 were cross-sectional studies, 3 ecological, and 2 cohort studies. The population included among the studies ranged from 120 persons to 103 million. The green space definition used among studies was green density or proximity (eight studies), green presence (five studies), green spaces index (four studies), and green space visit (two studies). The health outcomes included were mental health (six studies), overweight and obesity (three studies), quality of life (three studies), mortality (two studies), cardiorespiratory disease (one study), disability (one study), falls (one study), and life expectancy (one study). Eleven studies found a positive association between green spaces and health, and eight studies found no association. (5) Conclusion: This systematic review identified 19 epidemiological studies associating green spaces and health outcomes in Latin America. Most of the evidence suggests a positive association between green spaces and health in the region. However, most of the evidence was supported by cross-sectional studies. Prioritizing longitudinal studies with harmonized exposure and outcome definitions and including vulnerable and susceptible populations is needed in the region.

Determining Factors in the Use of Urban Parks That Influence the Practice of Physical Activity in Children: A Systematic Review

The design and/or remodelling of urban parks is a good health strategy to alleviate the lack of physical activity (PA) in children and, consequently, the different health problems derived from this. The main objective of the present study was to obtain a systematic review of the design features and characteristics that influence users' visits to urban parks and the PA engagement in them. A literature search was carried out in the Web of Science (WOS) and Scopus databases during the months of June and July 2020. After considering and applying inclusion criteria, the final review sample was formed of 31 scientific papers published between 2010-2020. The results obtained in the review lead us to conclude that the needs of the population (children and family members who care for them) and socio-economic context of the area in which they are built must be considered when constructing and/or remodelling parks. Involving community members in playground renovations can have a positive effect on park use and PA engagement in children.

Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities

Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.

Systematic review of the community environment for physical activity in young people - an update to the Report Card Brazil

abstract – The aim of this study was to update a systematic review on the relationship between the environment and physical activity among Brazilian children and adolescents. The search for articles for this review was performed in the MEDLINE, LILACS / BIREME, and SCIELO databases. For this update, only articles published in 2018 and 2019 were used. Descriptors were defined in English and Portuguese. The Boolean used for the advanced search was used, with 3 main blocks: environment, physical activity, and population. Additional filters were used in accordance with the structure of a database. In all, 5 articles were included in this systematic review, 4 with a population-based sample and 1 with a school-based sample. Among the selected studies, 4 were carried out in the southern region of Brazil (2 in Santa Catarina; 1 in Rio Grande do Sul; 1 in Paraná) and the other article was carried out with a national sample. The research period ranged between 2012 and 2017, with a sample size ranging from 38 volunteers to 102,072 participants. The environmental indicators found were road safety, the existence and use of spaces for the practice of physical activity, the characteristics of the school, and the possibility of practice in the school environment. It was concluded that environmental indicators can enhance the practice of physical activity among young Brazilians, requiring public policies that develop environmental projects to promote physical activity.

Prevalence of overweight and obesity in Brazilian children and adolescents: a systematic review

abstract It is important to know about overweight and obesity situation of Brazilian children and adolescents. The present study aims to update scientific production, through a systematic review, on the prevalence and factors associated with overweight and obesity in Brazilian children and adolescents. Nine databases were verified, and 1,316 references were examined from 2018 to 2019. The electronic search was conducted by three independent researchers. All review steps followed a strategy based on PRISMA. 40 studies were included in this systematic review. Most studies use the World Health Organization classification criteria. The prevalence of overweight in Brazilian children and adolescents varies from 8.8% to 22.2% (boys: 6.2% to 21%; girls: 6.9% to 27.6%). The prevalence of obesity varied from 3.8% to 24% (boys: 2.4% to 28.9%; girls: 1.6% to 19.4%). It was observed that the socioeconomic factors (sex, skin color, economic level, region, mother's educational level, living in a rented house and without access to the internet), hereditary/genetic (family history of dyslipidemia and overweight and rs9939609 genotype) and behavioral (physical activity, screen time, eating habits, perceived body weight, health vulnerability, presence of a result close to home, alcoholic beverages, cigarette consumption) were associated with the outcome. It is concluded that the prevalence of overweight and obesity among Brazilian children and adolescents are worrisome and most of the factors associated with the outcomes are subject to change from the adoption of a healthy lifestyle.