Abstract
Background/Aim: Overweight and obesity are associated with increased risk of coronary heart disease, stroke, respiratory disease, cancer and all cause mortality. The association between green spaces and reduced risk of overweight/obesity has been previously studied, but results are not consistent. We studied the association between surrounding greenness and residential proximity to green areas and overweight/obesity in Spain. Methods: 8112 study participants between 20-85 years old were recruited between 2008-13 from 23 hospitals in 12 provinces of Spain, as part of the multi-case control Spain study (MCC-Spain). We geocoded the current residence of each participant, and assigned different indicators of exposure to natural outdoor environments: access to urban green areas according to Urban Atlas; access to agricultural areas according to CORINE Land Cover 2006 and surrounding greenness according to the average of the Normalized Difference Vegetation Index. We used multinomial logistic mixed-effects models with a random effect for hospital and adjusted for potential confounders. We also explored the potential modifier effect of individual socio-economic status, degree of urbanization and sex. Results : Access to urban green areas seemed to slightly reduce the risk of overweight/obesity after adjusting for age, sex, case-control status, education, socioeconomic status at individual and area level and degree of urbanization of place of residence [overweight: RRR (95%CI)=0.93 (0.79 – 1.09), obesity: IRR(95%CI)=0.89 (0.73-1.08)]. The protective effect of urban green spaces was more pronounced in densely populated areas. On the contrary, access to agricultural areas seemed to increase the risk [overweight: adjusted RRR (95%CI)=1.13 (0.97-1.32), obesity: adjusted IRR(95%CI)= 1.08 (0.9-1.3)]. No effect was observed for surrounding greenness [overweight: adjusted RRR (95%CI)= 0.97 (0.91-1.04), obesity: adjusted IRR(95%CI)= 0.97 (0.89-1.05)]. Conclusions: No clear association was observed between access to green spaces and overweight/obesity. The suggested effects however, were depended on land-use.
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