Association of walkability and NO2 with metabolic syndrome: A cohort study in China

Background: Epidemiological studies have reported an association between traffic-related pollution with risk of metabolic syndrome (MetS). However, evidence from prospective studies on the association of walkability and nitrogen dioxide (NO2) with MetS is still scarce. We, therefore, aimed to evaluate the association of long-term exposure to NO2 and walkability with hazards of incident MetS.Methods: A total of 17,965 participants without MetS diagnosed within one year at baseline were included in our study from a population-based prospective cohort in Yinzhou District, Ningbo, Zhejiang Province, China. Par-ticipants were followed up by the regional Health Information System (HIS) until December 15, 2021. MetS was defined based on the criteria of Chinese Diabetes Society (CDS2004). We used walkscore tools, calculating with amenity categories and decay functions, and spatial-temporal land-use regression (LUR) models to estimate walkability and NO2 concentrations. We used Cox proportional hazards regression models to examine the as-sociation of walkability and NO2 with hazards of MetS incidence reporting with hazard ratios (HRs) and 95% confidence intervals (CIs).Results: Overall, we followed up 77,303 person-years and identified 4040 incident cases of MetS in the entire cohort. Higher walkability was inversely associated with incident MetS (HR = 0.94, 95 % CI: 0.91-0.99), whereas NO2 was positively associated with MetS incidence (HR = 1.07, 95 %CI: 1.00-1.15) per interquartile range increment in two-exposure models. Furthermore, we found a significant multiplicative interaction between walkability and NO2. Stronger associations were observed for NO2 and incident MetS among men, smokers, drinkers and participants who aged < 60 years and had higher levels of income.Conclusion: In summary, we found living in areas with lower walkability and higher concentrations of NO2 were associated with increased incidence of MetS. The beneficial effect of higher walkability may be attenuated by exposure to NO2.

Automated summary

This study aimed to evaluate the association of long-term exposure to nitrogen dioxide (NO2) and walkability with the risk of incident metabolic syndrome (MetS). The results showed that living in areas with lower walkability and higher NO2 concentrations was associated with an increased risk of developing MetS.