Ambient air pollution and childhood obesity from infancy to late childhood: An individual participant data meta-analysis of 10 European birth cohorts

Sarah Warkentin; Serena Fossati; Sandra Marquez; Anne-Marie Nybo Andersen; Sandra Andrusaityte; Demetris Avraam; Ferran Ballester; Tim Cadman; Maribel Casas; Montserrat de Castro; Leda Chatzi; Ahmed Elhakeem; Antonio d'Errico; M. nica Guxens; Regina Grazuleviciene; Jennifer R. Harris; Carmen I. iguez Hernandez; Barbara Heude; Elena Isaevska; Vincent W. V. Jaddoe; Marianna Karachaliou; Aitana Lertxundi; Johanna Lepeule; Rosemary R. C. McEachan; Johanna L. Thorbjørnsrud Nader; Marie Pedersen; Susana Santos; Mariska Slofstra; Euripides G. Stephanou; Morris A. Swertz; Tanja Vrijkotte; Tiffany C. Yang; Mark Nieuwenhuijsen; Martine Vrijheid

doi:10.1016/j.envint.2025.109527

Ambient air pollution and childhood obesity from infancy to late childhood: An individual participant data meta-analysis of 10 European birth cohorts

Sarah Warkentin^*
, Serena Fossati
, Sandra Marquez
, Anne-Marie Nybo Andersen
, Sandra Andrusaityte
, Demetris Avraam
, Ferran Ballester
, Tim Cadman
, Maribel Casas
, Montserrat de Castro
, Leda Chatzi
, Ahmed Elhakeem
, Antonio d'Errico
, M. nica Guxens
, Regina Grazuleviciene
, Jennifer R. Harris
, Carmen I. iguez Hernandez
, Barbara Heude
, Elena Isaevska
, Vincent W. V. Jaddoe

Marianna Karachaliou, Aitana Lertxundi, Johanna Lepeule, Rosemary R. C. McEachan, Johanna L. Thorbjørnsrud Nader, Marie Pedersen, Susana Santos, Mariska Slofstra, Euripides G. Stephanou, Morris A. Swertz, Tanja Vrijkotte, Tiffany C. Yang, Mark Nieuwenhuijsen, Martine Vrijheid

^*Corresponding author for this work

Instituto de Salud Global de Barcelona
Pompeu Fabra University
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública
University of Copenhagen
Vytautas Magnus University
University of Valencia
University of Groningen
University of Southern California
University of Bristol
University of Turin
Utrecht University
Erasmus University Rotterdam
ICREA
Norwegian Institute of Public Health
Université Paris 13
University of Crete
University of the Basque Country
Biogipuzkoa Health Research Institute
Université Grenoble Alpes
Bradford Teaching Hospitals NHS Foundation Trust
Public Health Improvement
University of Porto
University of Amsterdam

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Ambient air pollution may contribute to childhood obesity through various mechanisms. However, few longitudinal studies examined the relationship between pre- and postnatal exposure to air pollution and obesity outcomes in childhood. We aimed to investigate the association between pre- and postnatal exposure to air pollution and body mass index (BMI) and the risk of overweight/obesity throughout childhood in European cohorts. This study included mother–child pairs from 10 European birth cohorts (n = 37111 (prenatal), 33860 (postnatal)). Exposure to nitrogen dioxide (NO₂) and fine particulate matter with aerodynamic diameter < 2.5 µm (PM_2.5) was estimated at the home addresses during pre- and postnatal periods (year prior outcome assessment). BMI z-scores (continuous) and overweight/obesity status (categorical: zBMI≥+2 (<5 years) or ≥+1 (≥5 years) standard deviations) were derived at 0–2, 2–5, 5–9, 9–12 years. Associations between air pollution exposure and zBMI were estimated separately for each pollutant and cohort using linear and logistic longitudinal mixed effects models, followed by a random-effects meta-analysis. The overweight/obesity prevalence ranged from 12.3-40.5 % between cohorts at 0–2 years, 16.7–35.3 % at 2–5 years, 12.5–40.7 % at 5–9 years, and 10.7–43.8 % at 9–12 years. Results showed no robust associations between NO₂ exposure and zBMI or overweight/obesity risk. Exposure to PM_2.5 during pregnancy was associated with 23 % (95%CI 1.05;1.37) higher overweight/obesity risk across childhood, and higher zBMI and overweight/obesity risk at 9–12 years. Heterogeneity between cohorts was considerable (I²:25–89 %), with some cohort-specific associations; e.g., pre- and postnatal exposure to PM_2.5 was associated with lower zBMI across age periods in UK cohorts (ALSPAC and BiB), while postnatal exposure to PM_2.5 and NO₂ was associated with higher zBMI in one Dutch cohort (Generation R). Overall, this large-scale meta-analysis suggests that prenatal PM_2.5 exposure may be associated with adverse childhood obesity outcomes, but provides no evidence to support an effect of postnatal air pollution exposure, although cohort-specific associations were observed.

Original language	English
Article number	109527
Journal	Environment international
Volume	200
DOIs	https://doi.org/10.1016/j.envint.2025.109527
Publication status	Published - 1 Jun 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 11 Sustainable Cities and Communities

Keywords

Air pollution
Child
Meta-analysis
Pediatric obesity
Urban

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Warkentin, S., Fossati, S., Marquez, S., Andersen, A.-M. N., Andrusaityte, S., Avraam, D., Ballester, F., Cadman, T., Casas, M., de Castro, M., Chatzi, L., Elhakeem, A., d'Errico, A., Guxens, M. N., Grazuleviciene, R., Harris, J. R., Hernandez, C. I. I., Heude, B., Isaevska, E., ... Vrijheid, M. (2025). Ambient air pollution and childhood obesity from infancy to late childhood: An individual participant data meta-analysis of 10 European birth cohorts. Environment international, 200, Article 109527. https://doi.org/10.1016/j.envint.2025.109527

@article{888bc92ea0214c719a02ecf75c240ad2,

title = "Ambient air pollution and childhood obesity from infancy to late childhood: An individual participant data meta-analysis of 10 European birth cohorts",

abstract = "Ambient air pollution may contribute to childhood obesity through various mechanisms. However, few longitudinal studies examined the relationship between pre- and postnatal exposure to air pollution and obesity outcomes in childhood. We aimed to investigate the association between pre- and postnatal exposure to air pollution and body mass index (BMI) and the risk of overweight/obesity throughout childhood in European cohorts. This study included mother–child pairs from 10 European birth cohorts (n = 37111 (prenatal), 33860 (postnatal)). Exposure to nitrogen dioxide (NO2) and fine particulate matter with aerodynamic diameter < 2.5 µm (PM2.5) was estimated at the home addresses during pre- and postnatal periods (year prior outcome assessment). BMI z-scores (continuous) and overweight/obesity status (categorical: zBMI≥+2 (<5 years) or ≥+1 (≥5 years) standard deviations) were derived at 0–2, 2–5, 5–9, 9–12 years. Associations between air pollution exposure and zBMI were estimated separately for each pollutant and cohort using linear and logistic longitudinal mixed effects models, followed by a random-effects meta-analysis. The overweight/obesity prevalence ranged from 12.3-40.5 \% between cohorts at 0–2 years, 16.7–35.3 \% at 2–5 years, 12.5–40.7 \% at 5–9 years, and 10.7–43.8 \% at 9–12 years. Results showed no robust associations between NO2 exposure and zBMI or overweight/obesity risk. Exposure to PM2.5 during pregnancy was associated with 23 \% (95\%CI 1.05;1.37) higher overweight/obesity risk across childhood, and higher zBMI and overweight/obesity risk at 9–12 years. Heterogeneity between cohorts was considerable (I2:25–89 \%), with some cohort-specific associations; e.g., pre- and postnatal exposure to PM2.5 was associated with lower zBMI across age periods in UK cohorts (ALSPAC and BiB), while postnatal exposure to PM2.5 and NO2 was associated with higher zBMI in one Dutch cohort (Generation R). Overall, this large-scale meta-analysis suggests that prenatal PM2.5 exposure may be associated with adverse childhood obesity outcomes, but provides no evidence to support an effect of postnatal air pollution exposure, although cohort-specific associations were observed.",

keywords = "Air pollution, Child, Meta-analysis, Pediatric obesity, Urban",

author = "Sarah Warkentin and Serena Fossati and Sandra Marquez and Andersen, \{Anne-Marie Nybo\} and Sandra Andrusaityte and Demetris Avraam and Ferran Ballester and Tim Cadman and Maribel Casas and \{de Castro\}, Montserrat and Leda Chatzi and Ahmed Elhakeem and Antonio d'Errico and Guxens, \{M. nica\} and Regina Grazuleviciene and Harris, \{Jennifer R.\} and Hernandez, \{Carmen I. iguez\} and Barbara Heude and Elena Isaevska and Jaddoe, \{Vincent W. V.\} and Marianna Karachaliou and Aitana Lertxundi and Johanna Lepeule and McEachan, \{Rosemary R. C.\} and \{Thorbj{\o}rnsrud Nader\}, \{Johanna L.\} and Marie Pedersen and Susana Santos and Mariska Slofstra and Stephanou, \{Euripides G.\} and Swertz, \{Morris A.\} and Tanja Vrijkotte and Yang, \{Tiffany C.\} and Mark Nieuwenhuijsen and Martine Vrijheid",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = jun,

day = "1",

doi = "10.1016/j.envint.2025.109527",

language = "English",

volume = "200",

journal = "Environment international",

issn = "0160-4120",

publisher = "Elsevier Limited",

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Warkentin, S, Fossati, S, Marquez, S, Andersen, A-MN, Andrusaityte, S, Avraam, D, Ballester, F, Cadman, T, Casas, M, de Castro, M, Chatzi, L, Elhakeem, A, d'Errico, A, Guxens, MN, Grazuleviciene, R, Harris, JR, Hernandez, CII, Heude, B, Isaevska, E, Jaddoe, VWV, Karachaliou, M, Lertxundi, A, Lepeule, J, McEachan, RRC, Thorbjørnsrud Nader, JL, Pedersen, M, Santos, S, Slofstra, M, Stephanou, EG, Swertz, MA, Vrijkotte, T, Yang, TC, Nieuwenhuijsen, M & Vrijheid, M 2025, 'Ambient air pollution and childhood obesity from infancy to late childhood: An individual participant data meta-analysis of 10 European birth cohorts', Environment international, vol. 200, 109527. https://doi.org/10.1016/j.envint.2025.109527

TY - JOUR

T1 - Ambient air pollution and childhood obesity from infancy to late childhood

T2 - An individual participant data meta-analysis of 10 European birth cohorts

AU - Warkentin, Sarah

AU - Fossati, Serena

AU - Marquez, Sandra

AU - Andersen, Anne-Marie Nybo

AU - Andrusaityte, Sandra

AU - Avraam, Demetris

AU - Ballester, Ferran

AU - Cadman, Tim

AU - Casas, Maribel

AU - de Castro, Montserrat

AU - Chatzi, Leda

AU - Elhakeem, Ahmed

AU - d'Errico, Antonio

AU - Guxens, M. nica

AU - Grazuleviciene, Regina

AU - Harris, Jennifer R.

AU - Hernandez, Carmen I. iguez

AU - Heude, Barbara

AU - Isaevska, Elena

AU - Jaddoe, Vincent W. V.

AU - Karachaliou, Marianna

AU - Lertxundi, Aitana

AU - Lepeule, Johanna

AU - McEachan, Rosemary R. C.

AU - Thorbjørnsrud Nader, Johanna L.

AU - Pedersen, Marie

AU - Santos, Susana

AU - Slofstra, Mariska

AU - Stephanou, Euripides G.

AU - Swertz, Morris A.

AU - Vrijkotte, Tanja

AU - Yang, Tiffany C.

AU - Nieuwenhuijsen, Mark

AU - Vrijheid, Martine

PY - 2025/6/1

Y1 - 2025/6/1

N2 - Ambient air pollution may contribute to childhood obesity through various mechanisms. However, few longitudinal studies examined the relationship between pre- and postnatal exposure to air pollution and obesity outcomes in childhood. We aimed to investigate the association between pre- and postnatal exposure to air pollution and body mass index (BMI) and the risk of overweight/obesity throughout childhood in European cohorts. This study included mother–child pairs from 10 European birth cohorts (n = 37111 (prenatal), 33860 (postnatal)). Exposure to nitrogen dioxide (NO2) and fine particulate matter with aerodynamic diameter < 2.5 µm (PM2.5) was estimated at the home addresses during pre- and postnatal periods (year prior outcome assessment). BMI z-scores (continuous) and overweight/obesity status (categorical: zBMI≥+2 (<5 years) or ≥+1 (≥5 years) standard deviations) were derived at 0–2, 2–5, 5–9, 9–12 years. Associations between air pollution exposure and zBMI were estimated separately for each pollutant and cohort using linear and logistic longitudinal mixed effects models, followed by a random-effects meta-analysis. The overweight/obesity prevalence ranged from 12.3-40.5 % between cohorts at 0–2 years, 16.7–35.3 % at 2–5 years, 12.5–40.7 % at 5–9 years, and 10.7–43.8 % at 9–12 years. Results showed no robust associations between NO2 exposure and zBMI or overweight/obesity risk. Exposure to PM2.5 during pregnancy was associated with 23 % (95%CI 1.05;1.37) higher overweight/obesity risk across childhood, and higher zBMI and overweight/obesity risk at 9–12 years. Heterogeneity between cohorts was considerable (I2:25–89 %), with some cohort-specific associations; e.g., pre- and postnatal exposure to PM2.5 was associated with lower zBMI across age periods in UK cohorts (ALSPAC and BiB), while postnatal exposure to PM2.5 and NO2 was associated with higher zBMI in one Dutch cohort (Generation R). Overall, this large-scale meta-analysis suggests that prenatal PM2.5 exposure may be associated with adverse childhood obesity outcomes, but provides no evidence to support an effect of postnatal air pollution exposure, although cohort-specific associations were observed.

AB - Ambient air pollution may contribute to childhood obesity through various mechanisms. However, few longitudinal studies examined the relationship between pre- and postnatal exposure to air pollution and obesity outcomes in childhood. We aimed to investigate the association between pre- and postnatal exposure to air pollution and body mass index (BMI) and the risk of overweight/obesity throughout childhood in European cohorts. This study included mother–child pairs from 10 European birth cohorts (n = 37111 (prenatal), 33860 (postnatal)). Exposure to nitrogen dioxide (NO2) and fine particulate matter with aerodynamic diameter < 2.5 µm (PM2.5) was estimated at the home addresses during pre- and postnatal periods (year prior outcome assessment). BMI z-scores (continuous) and overweight/obesity status (categorical: zBMI≥+2 (<5 years) or ≥+1 (≥5 years) standard deviations) were derived at 0–2, 2–5, 5–9, 9–12 years. Associations between air pollution exposure and zBMI were estimated separately for each pollutant and cohort using linear and logistic longitudinal mixed effects models, followed by a random-effects meta-analysis. The overweight/obesity prevalence ranged from 12.3-40.5 % between cohorts at 0–2 years, 16.7–35.3 % at 2–5 years, 12.5–40.7 % at 5–9 years, and 10.7–43.8 % at 9–12 years. Results showed no robust associations between NO2 exposure and zBMI or overweight/obesity risk. Exposure to PM2.5 during pregnancy was associated with 23 % (95%CI 1.05;1.37) higher overweight/obesity risk across childhood, and higher zBMI and overweight/obesity risk at 9–12 years. Heterogeneity between cohorts was considerable (I2:25–89 %), with some cohort-specific associations; e.g., pre- and postnatal exposure to PM2.5 was associated with lower zBMI across age periods in UK cohorts (ALSPAC and BiB), while postnatal exposure to PM2.5 and NO2 was associated with higher zBMI in one Dutch cohort (Generation R). Overall, this large-scale meta-analysis suggests that prenatal PM2.5 exposure may be associated with adverse childhood obesity outcomes, but provides no evidence to support an effect of postnatal air pollution exposure, although cohort-specific associations were observed.

KW - Air pollution

KW - Child

KW - Meta-analysis

KW - Pediatric obesity

KW - Urban

UR - https://www.scopus.com/pages/publications/105005085597

U2 - 10.1016/j.envint.2025.109527

DO - 10.1016/j.envint.2025.109527

M3 - Article

C2 - 40378473

SN - 0160-4120

VL - 200

JO - Environment international

JF - Environment international

M1 - 109527

ER -

Ambient air pollution and childhood obesity from infancy to late childhood: An individual participant data meta-analysis of 10 European birth cohorts

Abstract

UN SDGs

Keywords

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