Abstract
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.
Highlights
The prevalence of childhood obesity has more than tripled over the last four decades
An expanding set of chronic diseases has been linked to childhood obesity including increased risk of Abbreviations: BMI z-score, BMI standardized for age and sex; BMI, body mass index; CDC, Centers for Disease Control and Prevention; ESCAPE, European Study of Cohorts for Air Pollution Effects; IOTF, International Obesity Task Force; NDVI, Normalized Difference Vegetation Index; NO2, nitrogen dioxide; NOx, nitrogen oxides; PIAMA, prevention and incidence of asthma and mite allergy birth cohort; PM10, particulate matter with diameter less than 10 μm; PM2.5, particulate matter with diameter less than 2.5 μm; PRISMA, Preferred Reporting Items for systematic Reviews and Meta-Analysis; PROSPERO, International Prospective Register of Systematic Reviews; SO2, sulfur dioxide; STAMINA, Standard Model Instrumentation for Noise Assessments; UK, United Kingdom; WHO, World Health Organization
We focused on environmental factors including traffic noise and air pollution, as well as physical factors potentially driving obesity-related behaviors, including neighborhood walkability, and availability and accessibility of parks and playgrounds
Summary
The prevalence of childhood obesity has more than tripled over the last four decades. Obesity in childhood often persists into adulthood with severe consequences for health. An expanding set of chronic diseases has been linked to childhood obesity including increased risk of Abbreviations: BMI z-score, BMI standardized for age and sex; BMI, body mass index; CDC, Centers for Disease Control and Prevention; ESCAPE, European Study of Cohorts for Air Pollution Effects; IOTF, International Obesity Task Force; NDVI, Normalized Difference Vegetation Index; NO2, nitrogen dioxide; NOx, nitrogen oxides; PIAMA, prevention and incidence of asthma and mite allergy birth cohort; PM10, particulate matter with diameter less than 10 μm; PM2.5, particulate matter with diameter less than 2.5 μm; PRISMA, Preferred Reporting Items for systematic Reviews and Meta-Analysis; PROSPERO, International Prospective Register of Systematic Reviews; SO2, sulfur dioxide; STAMINA, Standard Model Instrumentation for Noise Assessments; UK, United Kingdom; WHO, World Health Organization.
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