Mengying Wang1,2, Tao Zhou2, Qiying Song2,3, Hao Ma2, Yonghua Hu1, Yoriko Heianza2, Lu Qi2,4,5. 1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. 2. Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. 3. Department of Child Healthcare, Maternal-Fetal Medicine Institute, Bao'an Maternity and Child Health Hospital, Jinan University, Guangzhou, China. 4. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 5. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Recent studies suggest potential interactions of air pollutants with dietary factors and genetic susceptibility on mortality risk; however, evidence from prospective studies is still lacking. We aimed to assess the association between air pollution and mortality, and investigate the modification effects of a healthy diet and genetic susceptibility. METHODS: A total of 386 937 participants were enrolled from 2006 to 2010 and followed up to 2018 in the UK Biobank study. The annual average air pollutant concentrations of particulate matter (PM) with diameters ≤2.5 (PM2.5), ≤10 (PM10) and between 2.5 and 10 µm (PM2.5-10) and nitrogen oxides (NO2 and NOx) were calculated and linked to participants' residential addresses. Healthy dietary patterns were evaluated by a healthy diet score (HDS) based on intakes of vegetables, fruit, fish, unprocessed red meat and processed meat. We also calculated genetic risk score (GRS) of the lifespan. We examined potential interactions by setting variable cross-product terms of air pollutants with diets or GRS in the models. RESULTS: We identified 11 881 deaths [2426 from cardiovascular diseases (CVD), 1211 from coronary heart disease (CHD) and 466 from stroke] during a median follow-up of 8.9 years. We found that PM2.5 [hazard ratio (HR), 1.27; 95% CI, 1.05-1.55], PM10 (HR, 1.18; 95% CI, 1.04-1.34), NO2 (HR, 1.05; 95% CI, 1.01-1.08), and NOx (HR, 1.02; 95% CI, 1.01-1.03) were associated with all-cause mortality. PM2.5 was also associated with increased risks of CVD mortality (HR, 1.68; 95% CI, 1.10-2.56) and CHD mortality (HR, 2.08; 95% CI, 1.16-3.75). In addition, we found that adherence to healthy dietary patterns modified associations of PM2.5, NO2 and NOx with all-cause mortality (P-interaction = 0.006, 0.006 and 0.02, respectively). Among the individual dietary components, vegetable intakes showed interactions with PM2.5, NO2 and NOx (P-interaction = 0.007, 0.004 and 0.02, respectively). The associations between air pollutants and increased risks of all-cause mortality were attenuated among participants with higher vegetable intakes. We did not observe interactions between air pollutants and HDS on CVD, CHD or stroke mortality (P-interaction > 0.05). Besides, we did not find interactions between air pollutants and genetic risk for lifespan on mortality risk. CONCLUSION: This study provides evidence linking long-term exposure to various air pollutants to the risk of all-cause, CVD and CHD mortality, and the potential attenuation of a healthy diet, especially high vegetable intakes, on such relations. Our findings highlight the importance of adherence to a healthy diet in lowering ambient air-pollution-related mortality risk.
BACKGROUND: Recent studies suggest potential interactions of air pollutants with dietary factors and genetic susceptibility on mortality risk; however, evidence from prospective studies is still lacking. We aimed to assess the association between air pollution and mortality, and investigate the modification effects of a healthy diet and genetic susceptibility. METHODS: A total of 386 937 participants were enrolled from 2006 to 2010 and followed up to 2018 in the UK Biobank study. The annual average air pollutant concentrations of particulate matter (PM) with diameters ≤2.5 (PM2.5), ≤10 (PM10) and between 2.5 and 10 µm (PM2.5-10) and nitrogen oxides (NO2 and NOx) were calculated and linked to participants' residential addresses. Healthy dietary patterns were evaluated by a healthy diet score (HDS) based on intakes of vegetables, fruit, fish, unprocessed red meat and processed meat. We also calculated genetic risk score (GRS) of the lifespan. We examined potential interactions by setting variable cross-product terms of air pollutants with diets or GRS in the models. RESULTS: We identified 11 881 deaths [2426 from cardiovascular diseases (CVD), 1211 from coronary heart disease (CHD) and 466 from stroke] during a median follow-up of 8.9 years. We found that PM2.5 [hazard ratio (HR), 1.27; 95% CI, 1.05-1.55], PM10 (HR, 1.18; 95% CI, 1.04-1.34), NO2 (HR, 1.05; 95% CI, 1.01-1.08), and NOx (HR, 1.02; 95% CI, 1.01-1.03) were associated with all-cause mortality. PM2.5 was also associated with increased risks of CVD mortality (HR, 1.68; 95% CI, 1.10-2.56) and CHD mortality (HR, 2.08; 95% CI, 1.16-3.75). In addition, we found that adherence to healthy dietary patterns modified associations of PM2.5, NO2 and NOx with all-cause mortality (P-interaction = 0.006, 0.006 and 0.02, respectively). Among the individual dietary components, vegetable intakes showed interactions with PM2.5, NO2 and NOx (P-interaction = 0.007, 0.004 and 0.02, respectively). The associations between air pollutants and increased risks of all-cause mortality were attenuated among participants with higher vegetable intakes. We did not observe interactions between air pollutants and HDS on CVD, CHD or stroke mortality (P-interaction > 0.05). Besides, we did not find interactions between air pollutants and genetic risk for lifespan on mortality risk. CONCLUSION: This study provides evidence linking long-term exposure to various air pollutants to the risk of all-cause, CVD and CHD mortality, and the potential attenuation of a healthy diet, especially high vegetable intakes, on such relations. Our findings highlight the importance of adherence to a healthy diet in lowering ambient air-pollution-related mortality risk.
Authors: Rob Beelen; Massimo Stafoggia; Ole Raaschou-Nielsen; Zorana Jovanovic Andersen; Wei W Xun; Klea Katsouyanni; Konstantina Dimakopoulou; Bert Brunekreef; Gudrun Weinmayr; Barbara Hoffmann; Kathrin Wolf; Evangelia Samoli; Danny Houthuijs; Mark Nieuwenhuijsen; Anna Oudin; Bertil Forsberg; David Olsson; Veikko Salomaa; Timo Lanki; Tarja Yli-Tuomi; Bente Oftedal; Geir Aamodt; Per Nafstad; Ulf De Faire; Nancy L Pedersen; Claes-Göran Östenson; Laura Fratiglioni; Johanna Penell; Michal Korek; Andrei Pyko; Kirsten Thorup Eriksen; Anne Tjønneland; Thomas Becker; Marloes Eeftens; Michiel Bots; Kees Meliefste; Meng Wang; Bas Bueno-de-Mesquita; Dorothea Sugiri; Ursula Krämer; Joachim Heinrich; Kees de Hoogh; Timothy Key; Annette Peters; Josef Cyrys; Hans Concin; Gabriele Nagel; Alex Ineichen; Emmanuel Schaffner; Nicole Probst-Hensch; Julia Dratva; Regina Ducret-Stich; Alice Vilier; Françoise Clavel-Chapelon; Morgane Stempfelet; Sara Grioni; Vittorio Krogh; Ming-Yi Tsai; Alessandro Marcon; Fulvio Ricceri; Carlotta Sacerdote; Claudia Galassi; Enrica Migliore; Andrea Ranzi; Giulia Cesaroni; Chiara Badaloni; Francesco Forastiere; Ibon Tamayo; Pilar Amiano; Miren Dorronsoro; Michail Katsoulis; Antonia Trichopoulou; Paolo Vineis; Gerard Hoek Journal: Epidemiology Date: 2014-05 Impact factor: 4.822
Authors: Cathie Sudlow; John Gallacher; Naomi Allen; Valerie Beral; Paul Burton; John Danesh; Paul Downey; Paul Elliott; Jane Green; Martin Landray; Bette Liu; Paul Matthews; Giok Ong; Jill Pell; Alan Silman; Alan Young; Tim Sprosen; Tim Peakman; Rory Collins Journal: PLoS Med Date: 2015-03-31 Impact factor: 11.069
Authors: Lauren Pinault; Michael Tjepkema; Daniel L Crouse; Scott Weichenthal; Aaron van Donkelaar; Randall V Martin; Michael Brauer; Hong Chen; Richard T Burnett Journal: Environ Health Date: 2016-02-11 Impact factor: 5.984
Authors: Hakim-Moulay Dehbi; Marta Blangiardo; John Gulliver; Daniela Fecht; Kees de Hoogh; Zaina Al-Kanaani; Therese Tillin; Rebecca Hardy; Nish Chaturvedi; Anna L Hansell Journal: Environ Int Date: 2016-12-07 Impact factor: 9.621
Authors: Nay Aung; Mihir M Sanghvi; Filip Zemrak; Aaron M Lee; Jackie A Cooper; Jose M Paiva; Ross J Thomson; Kenneth Fung; Mohammed Y Khanji; Elena Lukaschuk; Valentina Carapella; Young Jin Kim; Patricia B Munroe; Stefan K Piechnik; Stefan Neubauer; Steffen E Petersen Journal: Circulation Date: 2018-08-02 Impact factor: 29.690
Authors: C Arden Pope; Jacob S Lefler; Majid Ezzati; Joshua D Higbee; Julian D Marshall; Sun-Young Kim; Matthew Bechle; Kurtis S Gilliat; Spencer E Vernon; Allen L Robinson; Richard T Burnett Journal: Environ Health Perspect Date: 2019-07-24 Impact factor: 9.031