Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
Institute of Psychology, Jagiellonian University, Krakow, Poland.
Obes Rev. 2020 Nov;21(11):e13078. doi: 10.1111/obr.13078. Epub 2020 Jul 16.
Several reviews have been conducted to assess the association between greenspace and overweight or obesity, but the conclusions were inconsistent. However, an updated comprehensive review and meta-analysis is warranted, because several high-quality papers have been published more recently. The objectives of this study are to systematically and quantitatively assess the evidence for a link between greenspace with overweight/obesity and to make specific recommendations for further research. We searched three English language databases, four Chinese language databases and the reference lists of previously published reviews for epidemiological studies on greenspace and overweight/obesity published before January 2020. We developed inclusion criteria, screened the literature and extracted key data from selected papers. We assessed methodological quality and risk of bias, and we graded the credibility of the pooled evidence. We also performed sensitivity analyses. Fifty-seven records met our inclusion criteria and were included in the study. Most studies were cross-sectional designs (81%) and were from developed nations (88%). More than half (55%) of the included studies found beneficial associations between greenspace and overweight/obesity in overall or subpopulations. Our meta-analytical results showed that greater normalized difference vegetation index was associated with lower odds of overweight/obesity in a statistically significant fashion (odds ratio [OR]: 0.88; 95% CI: 0.84, 0.91) but not residential proximity to greenspace (OR: 0.99; 95% CI: 0.99, 1.00), proportion of greenspace (OR: 0.96; 95% CI: 0.85, 1.08) or number of parks in an area (OR: 0.99; 95% CI: 0.97, 1.01). However, we detected high between-study heterogeneity in two of the four meta-analyses, which reduced the credibility of the pooled evidence. Current evidence indicates that there might be an association between greater access to greenspace and lower odds of overweight/obesity. However, additional high-quality studies are needed to more definitively assess the evidence for a causal association.
已有多项综述评估了绿地与超重或肥胖之间的关联，但结论并不一致。然而，由于最近发表了一些高质量的论文，因此需要进行更新的全面综述和荟萃分析。本研究的目的是系统地和定量地评估绿地与超重/肥胖之间关联的证据，并为进一步研究提出具体建议。我们检索了三个英文数据库、四个中文数据库以及之前发表的综述的参考文献，以获取 2020 年 1 月之前发表的关于绿地与超重/肥胖的流行病学研究。我们制定了纳入标准，筛选文献并从入选文献中提取关键数据。我们评估了方法学质量和偏倚风险，并对汇总证据的可信度进行了分级。我们还进行了敏感性分析。符合纳入标准的记录有 57 条，纳入了本研究。大多数研究为横断面设计（81%），且来自发达国家（88%）。超过一半（55%）的纳入研究发现绿地与超重/肥胖之间存在有益的关联，无论是在总体人群还是亚人群中。我们的荟萃分析结果表明，归一化植被差异指数越大，超重/肥胖的几率越低，且具有统计学意义（比值比 [OR]：0.88；95%置信区间 [CI]：0.84，0.91），但与居住临近绿地（OR：0.99；95%CI：0.99，1.00）、绿地比例（OR：0.96；95%CI：0.85，1.08）或一个区域内公园数量（OR：0.99；95%CI：0.97，1.01）无关。然而，我们在四项荟萃分析中的两项中发现了高度的研究间异质性，这降低了汇总证据的可信度。目前的证据表明，更多地接触绿地可能与较低的超重/肥胖几率有关。然而，需要更多高质量的研究来更明确地评估因果关联的证据。
