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The association between long-term air pollution exposure and Chinese visceral adiposity index: A nationwide study of middle-aged and older adults

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Jun 16, 2025 version files 1.70 MB

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Abstract

Air pollution has been closely linked to diabetes, metabolic disorders, and cardiovascular diseases; visceral adiposity is a common high-risk factor for these conditions. However, the potential role of air pollution on visceral adiposity remains unclear. In this study, we investigated the association between exposure to multiple air pollutants and visceral adiposity using the Chinese visceral adiposity index (cVAI) in middle-aged (45 - 60 years) and older (> 60 years) Chinese adults. We conducted a cross-sectional study using data from 7,552 participants aged ≥45 years from the 2015 China Health and Retirement Longitudinal Study 2015. Data related to air pollution exposure levels, including particulate matter with an aerodynamic diameters ≤ 2.5 μm (PM2.5), particulate matter with an aerodynamic diameters ≤ 10 μm (PM10), nitrogen dioxide (NO2), ozone (O3), and sulfur dioxide (SO2), were acquired from the ChinaHighAirPollution dataset. Restricted cubic spline analysis was then used to investigate potential non-linear associations. Weighted quantile sum (WQS) regression was also used to address co-exposure to multiple pollutants and identify the relative contributions of each pollutant. Compared to the lowest quantile, exposure to the highest quartile levels of PM2.5, PM10, NO2, O3, and SO2 was associated with a significant increase in cVAI (all p for trend <0.0001). Males and smokers exhibited stronger associations between air pollutant exposure and cVAI(p for interaction < 0.05). Specifically, smokers in the highest quartile of PM2.5 exposure had a β coefficient of 16.89(95%CI:11.00,22.78), while males had a β coefficient of 14.38(95%CI:9.68,19.07), indicating significantly higher risks of increased visceral adiposity in these groups. WQS analysis identified NO2 and PM2.5 as the primary contributors to increased cVAI. This study is the first to reveal that air pollution, particularly PM2.5 and NO2, was significantly associated with increased visceral adiposity in middle-aged and older Chinese adults, especially for high-risk groups, such as males and smokers. It highlights the urgent need for public health policies to reduce air pollution exposure to mitigate the risk of visceral adiposity and its associated metabolic disorders.