Jin Xingyi, Wu Di, Ge Fei, Cui Dan, Jumabieke Ayidana, Wang Xiaoli, Wang Rui, Wang Niannian, Sun Jihan, Liao Wang, Pan Da, Shao Li, Wang Shaokang, Yuan Chunyan, Sun Guiju
Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, 210009, China.
Department of Gynaecology and Obstetrics, Zhongda Hospital, Southeast University, Nanjing, China.
BMC Public Health. 2025 Mar 28;25(1):1187. doi: 10.1186/s12889-025-22381-4.
Prior research has yielded incongruent results about the association between air pollutants and offspring hemoglobin levels, as well as between air pollutants and child development. This may be because previous studies have not taken both air pollution and nutrition into account. This study sought to examine the correlations between postnatal exposure to air pollution (PM, PM, SO, and CO), offspring hemoglobin levels, stunting, and underweight. Furthermore, we investigated whether hemoglobin levels mediate these connections and assessed the moderating influence of dietary supplementation on hemoglobin levels and growth outcomes.
A unified nutrition package intervention study was conducted in western, China between 2016 and 2023. In accordance with WHO guidelines, stunting, underweight, height-for-age z score (HFA), weight-for-age z score (WFA), and anemia status were all defined. A daily average of PM, PM, SO, and CO levels was collected from the National Urban Air Quality Real-Time Dissemination Platform ( http://www.cnemc.cn/sssj/ ) of the China Environmental Monitoring General Station. Linear regression and logistic regression models were used to assess the correlation between air pollution and the above indicators. The mediating role of hemoglobin and the moderating effect of nutritional supplementation were also evaluated.
This study examined the impact of postnatal air pollution exposure on child growth, mediated by hemoglobin levels and moderated by nutritional supplementation (YingYangBao, YYB). Our findings suggest that air pollution negatively affects growth via reduced hemoglobin levels, but extended nutritional supplementation mitigates this effect. A total of 10,766 children under 5 years of age participated in this study. All four air pollutants were associated with reduced hemoglobin levels, but their effects on growth and development were not uniform. Specifically, PM and PM showed stronger negative associations with HFA and WFA, while SO and CO had weaker effects. Air pollution had a greater impact on growth outcomes in anemic children compared to non-anemic children. Hemoglobin levels mediated 13.4% of the effect of air pollution on HFA (VAF = 13.4%, Cohen's f² = 0.15). Furthermore, the duration of YYB moderates the effects of air pollution on hemoglobin and HFA. The direct negative effect of air pollution on HFA was attenuated when the duration of use was > 10 months, whereas in the low use group the pollution effect was enhanced (β=-0.0444, 95%CI: -0.0613, -0.03).
Postnatal exposure to air pollution (PM, PM, SO, CO) increases the risk of stunting, particularly during the critical developmental window of 6-23 months of age. This effect is partially mediated by hemoglobin levels, and YYB can moderate this relationship. These findings highlight the importance of prolonged nutritional interventions in mitigating the adverse effects of air pollution on child growth and development, with significant implications for public health policies targeting air quality and child nutrition in high-pollution regions.
先前的研究在空气污染物与后代血红蛋白水平之间的关联以及空气污染物与儿童发育之间的关联方面得出了不一致的结果。这可能是因为先前的研究没有同时考虑空气污染和营养因素。本研究旨在探讨产后暴露于空气污染（细颗粒物、可吸入颗粒物、二氧化硫和一氧化碳）、后代血红蛋白水平、发育迟缓及体重不足之间的相关性。此外，我们还研究了血红蛋白水平是否介导了这些联系，并评估了膳食补充剂对血红蛋白水平和生长结局的调节作用。
2016年至2023年在中国西部开展了一项统一营养包干预研究。按照世界卫生组织的指南，对发育迟缓、体重不足、年龄别身高Z评分（HFA）、年龄别体重Z评分（WFA）和贫血状况进行了定义。从中国环境监测总站的全国城市空气质量实时发布平台（http://www.cnemc.cn/sssj/）收集细颗粒物、可吸入颗粒物、二氧化硫和一氧化碳水平的日均值。采用线性回归和逻辑回归模型评估空气污染与上述指标之间的相关性。还评估了血红蛋白的中介作用以及营养补充剂的调节作用。
本研究考察了产后空气污染暴露对儿童生长的影响，该影响由血红蛋白水平介导，并受营养补充剂（营养包，YYB）调节。我们的研究结果表明，空气污染通过降低血红蛋白水平对生长产生负面影响，但延长营养补充可减轻这种影响。共有10766名5岁以下儿童参与了本研究。所有四种空气污染物均与血红蛋白水平降低有关，但其对生长发育的影响并不一致。具体而言，细颗粒物和可吸入颗粒物与年龄别身高和年龄别体重的负相关性更强，而二氧化硫和一氧化碳的影响较弱。与非贫血儿童相比，空气污染对贫血儿童的生长结局影响更大。血红蛋白水平介导了空气污染对年龄别身高影响的13.4%（VAF = 13.4%，科恩f² = 0.15）。此外，营养包的使用时长调节了空气污染对血红蛋白和年龄别身高的影响。当使用时长>10个月时，空气污染对年龄别身高的直接负面影响减弱，而在低使用组中，污染影响增强（β = -0.0444，95%CI：-0.0613，-0.03）。
产后暴露于空气污染（细颗粒物、可吸入颗粒物、二氧化硫、一氧化碳）会增加发育迟缓的风险，尤其是在6至23个月的关键发育窗口期。这种影响部分由血红蛋白水平介导，营养包可以调节这种关系。这些发现凸显了长期营养干预在减轻空气污染对儿童生长发育不利影响方面的重要性，对高污染地区针对空气质量和儿童营养的公共卫生政策具有重要意义。
