Luque-García Leire, García-Baquero Gonzalo, Lertxundi Aitana, Al-Delaimy Wael K, Julvez Jordi, Estarlich Marisa, De Castro Montserrat, Guxens Mònica, Lozano Manuel, Subiza-Pérez Mikel, Ibarluzea Jesús
Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain; Biogipuzkoa Health Research Institute, Environmental Epidemiology and Child Development Group, Paseo Doctor Begiristain s/n, 20014, San Sebastián, Spain; Osakidetza Basque Health Service, Goierri Alto-Urola Integrated Health Organisation, Zumarraga Hospital, 20700, Zumarraga, Spain.
Biogipuzkoa Health Research Institute, Environmental Epidemiology and Child Development Group, Paseo Doctor Begiristain s/n, 20014, San Sebastián, Spain; CEADIR. Faculty of Biology, University of Salamanca, Avda Licenciado Méndez Nieto s/n, 37007, Salamanca, Spain.
Int J Hyg Environ Health. 2025 Jan;263:114475. doi: 10.1016/j.ijheh.2024.114475. Epub 2024 Oct 3.
Epidemiological studies suggest that exposure to greenness during childhood may protect children from developing attention-deficit hyperactivity disorder (ADHD).
We analyzed the effect of both prenatal (pregnancy) and early childhood (4-5-year follow-up) residential greenness exposure and green space availability on ADHD symptoms during childhood (up to the age of 12 years) and further explored the potential mediating role of PM and physical activity in the association.
The study population included participants from the INfancia y Medio Ambiente (INMA) prospective birth cohort (Gipuzkoa, Sabadell, and Valencia). Average Normalized Difference Vegetation Index (NDVI) in buffers of 100-, 300- and 500-m around the residential addresses was used as an indicator of greenness, while green space availability was determined based on the presence of a major green space within 150-m from the residence. Childhood ADHD symptoms were assessed at the 6-8- and 10-12-year follow-ups using Conners Parents Rating Scale-Revised: Short Form.
Although no association was found for the prenatal exposure period, increased early childhood NDVI inversely associated with the OR of clinically significant ADHD symptoms during the 6-8-year follow-up at the 100-m (OR 0.03, 95% CI: 0.003 to 0.44), 300-m (OR 0.04, 95% CI: 0.003 to 0.42) and 500-m (OR 0.08, 95% CI: 0.01 to 0.76) buffers, but exclusively in the context of direct effects. Additionally, the 10-12-year follow-up analysis found moderate to weak evidence of potential total and direct effects of NDVI at both 100- and 300-m buffers on inattention scores, as well as for NDVI at the 300-m buffer on ADHD index scores. The analysis did not reveal evidence of mediation through PM or physical activity.
The evidence suggests that early childhood greenness exposure may reduce the risk of developing ADHD symptoms later in childhood, and that this association is not mediated through PM and physical activity.
流行病学研究表明，儿童时期接触绿色环境可能会保护儿童免受注意力缺陷多动障碍（ADHD）的困扰。
我们分析了产前（孕期）和幼儿期（4 - 5年随访）居住环境的绿色度暴露以及绿地可及性对儿童期（直至12岁）ADHD症状的影响，并进一步探讨了颗粒物（PM）和身体活动在该关联中的潜在中介作用。
研究人群包括来自“儿童与环境”（INMA）前瞻性出生队列（吉普斯夸、萨巴德尔和巴伦西亚）的参与者。以居住地址周围100米、300米和500米缓冲区内的平均归一化植被指数（NDVI）作为绿色度指标，而绿地可及性则根据住所150米范围内是否存在主要绿地来确定。在6 - 8岁和10 - 12岁随访时，使用修订版康纳斯父母评定量表简式对儿童期ADHD症状进行评估。
虽然在产前暴露期未发现关联，但幼儿期NDVI增加与6 - 8岁随访时100米（比值比[OR] 0.03，95%置信区间[CI]：0.003至0.44）、300米（OR 0.04，95% CI：0.003至0.42）和500米（OR 0.08，95% CI：0.01至0.76）缓冲区临床上显著的ADHD症状的OR呈负相关，但仅在直接效应的背景下。此外，10 - 12岁随访分析发现，有中等至微弱的证据表明，100米和300米缓冲区的NDVI对注意力不集中得分有潜在的总体和直接效应，以及300米缓冲区的NDVI对ADHD指数得分有潜在的总体和直接效应。该分析未揭示通过PM或身体活动进行中介的证据。
证据表明，幼儿期接触绿色环境可能会降低儿童后期出现ADHD症状的风险，并且这种关联不是通过PM和身体活动介导的。
