e-Repositori UPF :: Articles (Barcelona Institute for Global Health (ISGlobal)

Enviaments recents

Associations between light at night and mental health: A systematic review and meta-analysis
(Elsevier, 2025) Deprato, Andy; Haldar, Prasun; Navarro, José Francisco; Harding, Barbara N.; Lacy, Paige; Maidstone, Robert; Moitra, Saibal; Palomar Cros, Anna; Durrington, Hannah; Kogevinas, Manolis; Moitra, Subhabrata; Adan, Ana
Light at night (LAN) disrupts the circadian rhythm by altering the natural light-dark cycle. With increasing interest in the relationship between LAN and mental health, there is value in an updated systematic review and meta-analysis considering prominent mental health conditions that also critically appraises LAN exposure assessment. We conducted a systematic review of six databases, two registries, and Google Scholar to identify studies examining the associations between indoor and outdoor LAN exposure (high vs. low exposure) and mental health outcomes (depression, bipolar disorder, anxiety, and schizophrenia), completing inverse-variance random-effects meta-analyses. Nineteen studies with a total population of 556,861 were included in the review. LAN exposure was associated with increased odds of depression prevalence (odds ratio [OR]: 1.18; 95 % confidence interval [CI]: 1.09 to 1.28), with stronger associations for bedside (OR: 1.45; 95 % CI: 1.03 to 2.04) or wrist-measured indoor LAN (OR: 1.30; 95 % CI: 1.22 to 1.38) than satellite-measured outdoor LAN exposure (OR: 1.10; 95 % CI: 1.04 to 1.17) and in older adults (OR: 1.56; 95 % CI: 1.24 to 1.96) compared to general adults (OR: 1.16; 95 % CI: 1.06 to 1.28) or youth (OR: 1.07; 95 % CI: 0.99 to 1.16). LAN exposure was also associated with an increased prevalence of bipolar disorder (OR: 1.19; 95 % CI: 1.08 to 1.31) and anxiety (OR: 1.10; 95 % CI: 1.02 to 1.20) and increased incidence of anxiety (hazard ratio [HR]: 1.08; 95 % CI: 1.02 to 1.15) and schizophrenia (HR: 1.55; 95 % CI: 1.01 to 2.39); however, the incidence of depression did not achieve statistical significance (HR: 1.53; 95 % CI: 0.98 to 2.38). Overall, our results suggest that LAN exposure influences adverse mental health conditions, with differences in results appreciated for depression prevalence depending on how LAN exposure was measured. Additional research is needed on the effects of LAN given its undoubted interest in the prevention and treatment of mental disorders.
Heat-related mortality in Europe during 2024 and health emergency forecasting to reduce preventable deaths
(Nature Research, 2025) Janoš, Tomáš; Quijal-Zamorano, Marcos; Shartova, Natalia; Gallo, Elisa; Méndez Turrubiates, Raúl Fernando; Beltrán Barrón, Nadia Denisse; Peyrusse, Fabien; Ballester, Joan
Successive record-breaking summer temperatures, both globally and in Europe, raise the urgent question of how to better protect vulnerable populations. Here we quantified the heat-related mortality burden during the summers of 2022-2024, and assessed the forecast skill of a new generation of continental-wide, impact-based early warning systems during health emergencies. We fitted epidemiological models with the newly created, format-homogeneous daily mortality database of the EARLY-ADAPT project, covering 654 contiguous regions across 32 European countries, which represents the entire urban and rural population of 539 million people. We estimated 62,775 (95% confidence interval = 36,765-84,379) heat-related deaths in 2024, largely exceeding the burden in 2023 (50,798; 29,442-68,610), but somewhat smaller than that of 2022 (67,873; 38,465-92,455). We demonstrated that health emergencies can be forecast with high confidence at least 1 week in advance, even for highly vulnerable regions and population subgroups. These findings have implications for public health agencies and end users, given that the adoption of the system would enable reliable heat-health emergency alerts within the time window that is relevant for stakeholders to take effective actions to reduce preventable deaths.
Do the health benefits of the Mediterranean diet increase with a higher proportion of whole plant-based foods?
(Springer, 2025) López-Moreno, Miguel; Fresán, Ujué
Purpose of Review: This review aims to explore the potential health effects of increasing the proportion of whole plant-based foods within a Mediterranean diet (MedDiet), summarize the available evidence, and provide recommendations for future research on this topic. Recent Findings: Replacing animal-based foods by whole plant-based foods may enhance the health benefits of diets. Beyond evidence on individual food substitutions, an emerging body of literature points out that adopting a plant-forward Mediterranean diet may further amplify the positive health effects of the overall dietary pattern. Additionally, although the MedDiet is recognized as an environmentally sustainable pattern, a fully plant-based version could further reduce its environmental impact and resource use compared to an omnivorous diet. Summary: The MedDiet is widely recognized for its health benefits, particularly in the prevention of cardiovascular diseases and other chronic conditions. These benefits are largely attributed to its emphasis on whole, plant-based foods. Although evidence is limited, current findings suggest that reducing the animal-based content of the traditional MedDiet, along with the increase in whole plant-based food, could lead to enhanced health benefits. Furthermore, the reduction in environmental pollution and resources overused could contribute to broader public health and sustainability. Long-term randomized controlled trials are needed to confirm these findings and provide a more comprehensive understanding of the comparative health effects of these dietary patterns.
Analysis methods for diagnosing rare neurodevelopmental diseases with episignatures: a systematic review of the literature
(MDPI, 2025) Alegret-García, Albert; Cáceres, Alejandro; Sevilla-Porras, Marta; Pérez Jurado, Luis Alberto; González, Juan Ramón
Background: Rare diseases (RDs) and neurodevelopmental disorders (NDDs) remain under-researched due to their low prevalence, leaving significant gaps in diagnostic strategies. Beyond next-generation sequencing, epigenetic profiling and particularly episignatures have emerged as a promising complementary diagnostic tool and for reclassifying variants of uncertain significance (VUS). However, clinical implementation remains limited, hindered by non-standardized methodologies and restricted data sharing that impede the development of sufficiently large datasets for robust episignature development. Methods: We conducted a systematic literature review following PRISMA 2020 guidelines to identify all studies reporting episignatures published between 2014 and 2025. The review summarizes methodological approaches used for episignature detection and implementation, as well as reports of epimutations. Results: A total of 108 studies met the inclusion criteria. All but three employed Illumina methylation arrays, mostly 450 K and EPIC versions for patient sample analysis. Three main methodological phases were identified: data quality control, episignature detection, and classification model training. Despite methodological variability across these stages, most studies demonstrated high predictive capabilities, often relying on methodologies developed by a small number of leading groups. Conclusions: Epigenetic screening has significant potential to improve diagnostic yield in RDs and NDDs. Continued methodological refinement and collaborative standardization efforts will be crucial for its successful integration into clinical practice. Nevertheless, key challenges persist, including the need for secure and ethical data-sharing frameworks, external validation, and methodological standardization.
Development and comparison of reference equations for the six-minute walk test in spanish healthy adults aged 45-85 years
(Elsevier, 2025) Gimeno Santos, Elena, 1980-; García Aymerich, Judith
Objectives: (i) To develop sex-specific reference equations to predict distance walked (6MWD) in the 6-minute walk test (6MWT), in healthy subjects aged 45-85 years, from different geographic areas of Spain; and (ii) to compare developed equations with previously published in a large sample of COPD patients. Methods: First, a cross-sectional multicentre sample of randomly selected healthy subjects from 17 Spanish hospitals and universities performed two 6MWT. Linear regression and fractional polynomial modelling were used to develop the equations. Second, the developed equations were applied to 715 COPD patients from Spanish primary care centres and hospitals, and the % predicted 6MWD obtained was compared with previously published equations using Dunnett's multiple comparisons test. Results: 568 healthy subjects were included (51% females, mean (SD) age 62 (11) years), walked a 6MWD of 615 (113) and 557 (93)m in males and females, respectively. The developed equations included age, weight and height, and explained 43% and 51% of the 6MWD variance for males and females, respectively. In the COPD sample (n=715, 14% females, 68 (9) years, FEV1 61 (18) % predicted, 6MWD 464 (97)m), only 1 out of 9 previously published equations for males, and 6 out of 9 for females predicted 6MWD values similar to those of the newly developed Spanish reference equations. Conclusions: The newly developed reference equations provide a more valid prediction of 6MWD in Spanish adults with COPD compared to previously published equations. We suggest their use in future research and clinical practice for the Spanish adult population.
Spatial Bayesian distributed lag non-linear models with R-INLA
(Oxford University Press, 2025) Quijal-Zamorano, Marcos; Martínez Beneito, Miguel Ángel; Ballester, Joan; Marí Dell'Olmo, Marc, 1978-
Initial evaluation of a new cervical screening strategy combining human papillomavirus genotyping and automated visual evaluation: the Human Papillomavirus-Automated Visual Evaluation Consortium
(Oxford University Press, 2025) Befano, Brian; Sanjosé Llongueras, Silvia de; PAVE Consortium
The HPV-Automated Visual Evaluation Consortium is validating a cervical screening strategy enabling accurate cervical screening in resource-limited settings. A rapid, low-cost human papillomavirus (HPV) assay permits sensitive HPV testing of self-collected vaginal specimens; HPV-negative women are reassured. Triage of positive participants combines HPV genotyping (4 groups in order of cancer risk) and visual inspection assisted by automated cervical visual evaluation that classifies cervical appearance as severe, indeterminate, or normal. Together, the combination predicts which women have precancer, permitting targeted management to those most needing treatment. We analyzed CIN3+ yield for each HPV-Automated Visual Evaluation risk level (HPV genotype crossed by automated cervical visual evaluation classification) from 9 clinical sites (Brazil, Cambodia, Dominican Republic, El Salvador, Eswatini, Honduras, Malawi, Nigeria, and Tanzania). Data from 1832 HPV-positive participants confirmed that HPV genotype and automated cervical visual evaluation classification strongly and independently predict risk of histologic CIN3+. The combination of these low-cost tests provided excellent risk stratification, warranting pre-implementation demonstration projects.
Daily digital biomarkers in the follow-up and clustering of patients with asthma
(Taylor & Francis, 2025) Sousa Pinto, Bernardo; Antó i Boqué, Josep Maria; Bousquet, Jean
Background and Research question: We aimed to assess whether levels of digital biomarkers can reflect monthly patterns of asthma control Study design and methods: We performed a longitudinal study on patients with asthma and comorbid rhinitis who filled >26 days of data in a month in the MASK-air® app and who reported at least 1 day of treatment with an inhaled corticosteroid with or without a long-acting ß-agonist (ICS ± LABA). We applied k-means cluster analysis to define clusters of months according to daily asthma control and medication use. Clusters were compared using digital biomarkers (visual analogue scale [VAS] on asthma symptoms and electronic daily asthma control score [e-DASTHMA]). We compared patients who did not switch with patients who switched their ICS ± LABA. Results: We assessed 243 patients and 1358 months. We identified three clusters of poor asthma control despite high ICS ± LABA adherence, one cluster of poor asthma control and poor ICS ± LABA adherence, one cluster of good asthma control and high ICS ± LABA adherence and one cluster of good asthma control despite poor ICS ± LABA adherence. These clusters displayed relevant differences in VAS asthma and e-DASTHMA levels. Similar clusters were found in `non-switchers¿ versus "switchers". Conclusion: Levels of digital biomarkers reflect asthma control patterns and might be used to monitor patients with asthma.
Mapping alterations in the local synchrony of the cerebral cortex in Prader Willi syndrome
(Elsevier, 2025) Blanco Hinojo, Laura, 1981-; Pujol, Jesús; Martínez-Vilavella, Gerard; Giménez Palop, Olga; Casamitjana, Laia; Cobo, Jesús; Pareja, Rocío; Esteba-Castillo, Susanna; Deus, Joan; Caixàs, Assumpta
Individuals with Prader Willi syndrome (PWS) often exhibit behavioral difficulties characterized by deficient impulse regulation and obsessive-compulsive features resembling those observed in obsessive-compulsive disorder. The genetic configuration of PWS aligns with molecular and neurophysiological findings suggesting dysfunction in the inhibitory gamma-aminobutyric acid (GABA) interneuron system may contribute to its clinical manifestation. In the cerebral cortex, this dysfunction is expressed as desynchronization of local neural activity. We used functional connectivity MRI to examine potential alterations in the local synchrony of the cerebral cortex in PWS. Whole-brain functional connectivity maps were generated using iso-distance average correlation (IDAC) measures in 22 patients with PWS and 22 control participants. Patients with PWS showed reduced local connectivity (weaker synchrony) in frontal areas, including the orbitofrontal cortex, ventral medial and lateral frontal regions, the anterior cingulate cortex, and sensory areas. The presence of obsessive-compulsive symptoms was significantly associated with the degree of functional structure alteration in part of the orbitofrontal and sensory cortices. In addition, abnormally heightened functional connectivity (stronger synchrony) was identified in the posterior cingulate cortex and the bilateral angular gyri, core components of the default mode network, with distance-dependent effects. Our findings of cortical synchrony alterations indicate a degree of overlap with the anatomy of the alterations previously observed in primary obsessive-compulsive disorder, while also suggesting the implication of GABAergic dysfunction in the pathophysiology of the disorder. Our observations may support the rational development of more specific therapeutic strategies in the treatment of behavioral disinhibition characteristic of PWS.
Environmental exposures and long COVID in a prospective population-based study in Catalonia (COVICAT study)
(National Institute of Environmental Health Sciences (NIEHS), 2024) Saucy, Apolline; Espinosa, Ana; Iraola Guzmán, Susana; Castaño Vinyals, Gemma; Harding, Barbara N.; Karachaliou, Marianna; Ranzani, Otavio; Cid Ibeas, Rafael de; García Aymerich, Judith; Kogevinas, Manolis
Evolution, trade-offs and optimization of the environmental impact of school meal dietary recommendations
(Elsevier, 2025) Benito-Cobeña, Júlia; Batlle-Bayer, Laura; Bach-Faig, Anna; Giner, Maria Pilar; Salvador, Gemma; Manera, Maria; Blanquer, Maria; Vila, Laura; Roca, Mercè; Fresán, Ujué
Transitioning to healthy diets with low environmental impact is crucial for achieving sustainable food systems and reducing health issues. Promoting healthy dietary habits and raising awareness are key actions in this shift, with governments playing a significant role through public procurement and food-based dietary guidelines. Specifically, school dietary guidelines can foster sustainable eating behaviors among children. This article examines Catalonia, a North-East Spanish region, where the Public Health Agency (ASPCAT) has issued school dietary guidelines since 2005, updated in 2012, 2017, and 2020. The goal of this study was to assess the progressive changes in the environmental impacts of school menus for children aged 7-12 years following the four versions of ASPCAT guidelines. Additionally, it aimed to identify trade-offs among various environmental metrics, pinpoint food groups contributing most to environmental impacts, and propose strategies to further reduce the environmental impact of school meals. The Life Cycle Assessment (LCA) methodology was applied. Inventories were obtained from Agribalyse v3.2 database, and characterized through sixteen individual environmental indicators and the composite one from the Product Environmental Footprint v3.1 methodology. Results showed a decrease in environmental impacts with each guideline update. Menus aligned with the 2020 guidelines had 23 % lower environmental impacts compared to those based on the 2017 guidelines, and 40 % lower than those based on the 2005 guidelines. All individual environmental indicators showed reductions in 2020 compared to 2005, ranging from 5 % to 52 %. Second dishes, mainly meat and fish, contributed most to environmental impacts. Replacing meat and fish with plant-based proteins, combined with a more diversified cereal intake, could reduce dietary environmental impacts by approximately 50 %. By identifying major contributors and suggesting potential improvements, our findings can contribute to the revision of the guidelines of Spain for healthy and sustainable school meals.
Which device is most suitable for measuring heart rate variability in the field? A comparative evaluation of two leading options
(Wolters Kluwer (LWW), 2025) Krummenacher, Maryline; Tarvainen, Mika; Montet, Estelle; Turner, Michelle C.; Guseva Canu, Irina
Objective: The aim of the study was to compare the Polar H10 and Bittium Faros™ heart rate variability monitors for use in occupational and environmental health research, considering data collection, storage, transfer, resource needs, and limitations. Methods: A literature review, device testing, and expert interviews were conducted to assess device performance and usability. Results: Polar H10 is affordable, records RR intervals for up to 20 hours offline, and requires a smartwatch and app for extended storage. Bittium Faros™ is a certified electrocardiogram monitor that records full waveforms, supports long measurements, and enables automatic data transfer. Both devices can be worn with a chest strap, but placement issues may affect data quality. Patch electrodes improve stability but may cause skin irritation. Conclusions: This assessment highlights key device differences to guide HRV monitor selection for occupational and environmental epidemiological studies.
Association of maternal thyroglobulin with gestational thyroid function and offspring IQ and brain morphology
(Oxford University Press, 2025) Mulder, Tessa A.; Guxens Junyent, Mònica; Rebagliato, Marisa; Dineva, Mariana; Bath, Sarah C.; Hunziker, Sandra; Sunyer Deu, Jordi; Delgado-Saborit, Juana Maria; Irizar, Amaia; Lertxundi, Nerea; Muetzel, Ryan L.; Tiemeier, Henning; Peeters, Robin P.; Korevaar, Tim I. M.
Background: Low maternal urinary iodine concentration (UIC) during pregnancy is associated with adverse offspring neurodevelopment. Thyroglobulin (Tg) has been suggested as a more sensitive biomarker than UIC of long-term iodine status, but associations of Tg with neurodevelopment and the possible mediating role of thyroid function remain unknown. Aim: To study whether maternal Tg is associated with (1) maternal and newborn thyroid function and (2) offspring IQ and brain morphology. Methods: Participants were selected from 2 population-based prospective cohorts: Generation R (the Netherlands, iodine-sufficient) and INfancia y Medio Ambiente (Spain, mildly iodine-deficient) with maternal Tg and thyroid function data in the first half of pregnancy or in cord blood, early childhood IQ (age 4.5 and 6 years), late childhood IQ (age 9 and 13), or brain morphology at 10 years. Associations of Tg with TSH, free T4 (FT4), IQ, and brain morphology were studied with multivariable linear regression. Results: (1) Tg was associated with lower TSH (-0.12 [-0.16; -0.08]) and higher FT4 (0.08 [0.05; 0.12]) in pregnancy (n = 4367) but not with cord blood TSH or FT4 (n = 2008). (2) Tg was associated with lower IQ in early childhood (β [95% confidence interval]: -0.06 [-0.10; -0.01], n = 2919) but not with IQ (n = 2503) or brain morphology (n = 1180) in later childhood. None of the associations of Tg with the studied outcomes differed by the iodine-to-creatinine ratio (ie, effect modification) or changed when adjusted for thyroid function. Conclusion: Higher Tg is associated with lower IQ in early childhood and higher thyroid function during pregnancy but not with IQ or brain morphology in later childhood. Further research should determine the value of Tg in addition to UIC for defining iodine status.
Does nature make us less lonely? Analysis in Bulgaria's five largest cities
(Elsevier, 2025) Markevych, Iana; Baumbach, Clemens; Helbich, Marco; Burov, Angel; Dimitrova, Donka; Nieuwenhuijsen, Mark J.; Dzhambov, Angel M.
Background: Loneliness is prevalent and increases risks of disease and premature death. We aimed to investigate whether greater exposure to nature is associated with less loneliness in urban Bulgarian adults, and whether the association was modified by sociodemographic factors. Methods: The analytic sample comprised 3604 adults from a cross-sectional population-based survey conducted in 2023 in the five largest Bulgarian cities. Loneliness was self-reported with a single item on a seven-point Likert scale. Availability of nature was assessed by several GIS-derived indicators: normalised difference vegetation index (NDVI), tree cover density, urban green space, all in a 300 m buffer around home, and distance to blue space. Self-reported nature indicators included domestic garden, green space and blue space quality, green space and blue space window view, and time spent in green and blue space. Adjusted negative binomial regressions with random intercept for city district were used to assess associations with loneliness. We further checked effect modification by city type, sex, age, relationship, employment status and education. Results: Residing in areas with more urban green space, higher green space quality, and green space window view and spending more time in green and blue space were associated with lower loneliness scores. Living in low or high compared to medium level NDVI settings or in areas with higher tree cover density was associated with higher loneliness scores. Sociodemographic factors modified some of these associations. Conclusions: Our findings underscore the importance of extending and improving structured urban green spaces in Bulgarian cities.
Stability of cytokine and immunoglobulin concentrations in the general population: prepandemic basal concentrations and intraindividual changes until the COVID-19 pandemic
(Frontiers, 2025) Gasull Panadès, Magda; Pumarega Rodríguez, José Antonio; Aguilar, Ruth; Campi, Laura; Prieto-Merino, David; Villar García, Judit; Rius, Cristina; Bolúmar, Francisco; Trasande, Leonardo; Dobaño, Carlota; Moncunill, Gemma; Porta Serra, Miquel
Background: While there is wide evidence on concentrations of cytokines in patients attending health care facilities, evidence is scant on physiological, basal concentrations of cytokines in the general population and across sociodemographic groups, as well as on their potential stability over time. Furthermore, from a public health perspective it is remarkable that no studies have analyzed intraindividual changes in such concentrations from before the COVID-19 pandemic until its outbreak. Objectives: To investigate: (a) prepandemic concentrations of cytokines and immunoglobulins to viral exposures in a general, non-institutionalized population, and their associated sociodemographic variables; (b) the intraindividual change in such concentrations between a prepandemic period (2016-17) and the initial pandemic period (2020-21); and (c) whether such change was similar in participants who in 2020-21 were SARS-CoV-2 seronegative and seropositive, and between participants who did and did not develop COVID-19. Methods: We conducted a prospective cohort study in 240 individuals from the general population of Barcelona, Spain. Thirty cytokines and 31 immunoglobulins were measured in paired serum samples collected in 2016-17 and 2020-21 in the same individuals. Results: The median value of the relative intraindividual change in cytokine concentrations between 2016 and 2020 was <15% for 29 of the 30 cytokines. A substantial number of participants had an intraindividual increase or decrease ≥15% in some cytokines. No major differences in intraindividual changes of cytokine and immunoglobulin levels between 2016 and 2020 were observed between participants who did and did not develop COVID-19. Conclusion: We provide novel information on physiological, basal ex-vivo concentrations of cytokines and immunoglobulins in a general population, which should be relevant for clinical practice and public health. Intraindividual changes in cytokines and immunoglobulins during the 4 years from 2016-17 to 2020-21 were moderate, and they did not differ between participants who in 2020-21 were SARS-CoV-2 seropositive and seronegative, nor between participants who did and did not develop COVID-19 disease. These findings are also novel and relevant for medicine and public health. In particular, the stability in the biomarkers is relevant to assess the role of the immunological and inflammatory state (measured through baseline levels of cytokines and immunoglobulins) in the development of SARS-CoV-2 seropositivity and COVID-19 disease, as well as in the susceptibility to other infections and pathologies.
Temporal change of outdoor RF-EMF levels in four European countries: a microenvironmental measurement study
(Elsevier, 2025) Beláčková, Lea; Fernandes Veludo, Adriana; Aminzadeh, Reza; Van Bladel, Han; Griffon, Vincent; Cardis, Elisabeth; Dongus, Stefan; Eeftens, Marloes; Guxens Junyent, Mònica; Joseph, Wout; Llobet, Patricia de; Mazet, Paul; Van Torre, Patrick; Thielens, Arno; Vermeulen, Roel; Wiart, Joe; Röösli, Martin; Huss, Anke
Introduction: Over the past two decades, the amount of transmitted mobile data has increased rapidly. It is unknown whether the implementation of the new technologies enabling this has resulted in changes of outdoor radio-frequency electromagnetic fields (RF-EMF) exposure. Therefore, microenvironmental measurements were used to investigate temporal trends in RF-EMF exposure between 2016 and 2023, in the Netherlands, Switzerland, Belgium and Spain, following a similar protocol across campaigns. Microenvironmental measurements refer to exposure measurements performed at predefined small areas that have been differentiated with a specific function in that particular area. This allowed us to compare exposure trends between countries and years. Methods: The data was collected as part of the ACCEDERA (2016-2018), ETAIN (2023), and GOLIAT (2023) projects, walking repeatedly the same routes with RF-EMF exposimeters. Identical microenvironments were identified in each country and measurements of the exposure from mobile base stations, mobile phones and the total exposure were compared across years. Results: Comparing measurements between 6 and 14 unique microenvironments in each country, our data did not suggest significant changes in the exposure from the mobile base station origin (total downlink exposure) between baseline measurements in 2016 to follow up and 2023 for the four countries. Across all countries and years the median values of the mobile base station exposure ranged from 0.11 mW/m2 (Switzerland, 2023) to 0.62 mW/m2 (Netherlands, 2018). There was no consistent trend in the individual microenvironments across the countries. Conclusions: Our measurements of RF-EMF outdoor exposure levels across included microenvironment groups do not indicate change in exposure levels between 2016 and 2023 despite an increase in mobile data traffic by a factor of 8 in Western Europe1.
Meet-in-the-middle meets multi-omics identifying molecular signatures of environmental drivers of childhood overweight
(Elsevier, 2025) Wang, Congrong; Sunyer Deu, Jordi; Borràs, Eva; Sabidó Aguadé, Eduard, 1981-; González, Juan Ramón; Vives Usano, Marta, 1990-; Estivill, Xavier, 1955-; Casas Sanahuja, Maribel; Nieuwenhuijsen, Mark J.; Bustamante Pineda, Mariona; Maitre, Léa; Vrijheid, Martine; Alfano, Rossella
Background: Obesity is a multi-cause chronic disease recognized across the lifespan, with childhood obesity prevalence rising over the past decades. Although exposome-wide association studies have identified early-life environmental drivers of child obesity, and explored the multi-omics signatures of the exposome of children, it is understudied whether the combined effects of multiple exposures are potentially mediated by multi-omics. Methods: Within the Human Early Life Exposome (HELIX) project, 1041 mother-child pairs were surveyed for a wide range of environmental exposures including over 354 prenatal and childhood exposures. Multi-omics molecular features were measured during childhood, encompassing the blood methylome and transcriptome, plasma proteins and urinary and serum metabolites. Exposome and multi-omics features were integrated into latent factors by Multi-omics Factor Analysis, based on which structural equation modelling was used to assess whether multi-omics mediated associations between exposome and child body mass index (BMI). Results: Key findings included: (i) prenatal nutrition, exercise, and passive smoking influencing BMI via DNA methylation of HOXA5 and Tenascin XB; (ii) childhood exposure to PCBs and phenols linked with BMI through inflammation and coagulation pathways; and (iii) childhood PCB and dietary exposures associated with BMI via immune pathways. Conclusions: This novel untargeted workflow elucidated biological mechanisms linking environmental exposures to child obesity, potentially supporting targeted public health interventions.
Exposure-response functions of the correlated environmental exposures green space, noise, and air pollution for quantifying mortality burden in health impact assessment
(Elsevier, 2025) Chen, Xuan; Gehring, Ulrike; Dyer, Georgia M. C.; de Hoogh, Kees; Khomenko, Sasha; Khreis, Haneen; Mueller, Natalie, 1988-; Vermeulen, Roel; Williams, Harry; Zapata-Diomedi, Belén; Nieuwenhuijsen, Mark J.; Hoek, Gerard
Objective: Environmental health impact assessments (HIA)on green space, air pollution (fine particulate matter (PM2.5) or nitrogen dioxide (NO2)), and noise use exposure-response functions (ERF) based on single-exposure models from epidemiological studies, not accounting for potential confounding by other commonly correlated exposures. We assessed differences in ERFs between single- and multi-exposure models for calculation of joint health impacts in HIA. Methods: We systematically searched cohort studies that reported both single- and multi-exposure models for associations of long-term exposure to any combination of the following exposures green space, PM2.5, NO2, and noise, with all-cause mortality. For each exposure, pooled hazard ratios (HRs) were calculated by meta-analyses and compared between single- and two-exposure models. The joint effects of two exposures in each exposure pair were expressed as joint HRs calculated by multiplying the individual HRs. Coefficient differences were calculated, and population attributable fractions (PAF) were used to estimate joint health impacts. Results: Eleven studies were identified, examining associations between multiple exposures and mortality in the general population. The studies show substantial variability in exposure levels and correlations between exposures. For most exposure pairs, adjusting for a second exposure resulted in moderately attenuated HRs compared to single-exposure models. The mortality PAFs estimated from joint single-exposure model HRs were higher than those from two-exposure models, indicating an overestimation of mortality burden when not accounting for other co-exposures. For example, when adjusted for green space or noise, the mortality HRs for PM2.5 were attenuated from 1.071 to 1.061 and 1.072 to 1.055, respectively. As for PAFs, for the green space-PM2.5 pair, the single-exposure model PAF (0.090) was 18.4% higher than the two-exposure model (0.076). For all exposure pairs, the joint PAFs of two-exposure models were higher than the PAFs from the single-exposure models for each exposure individually. Conclusion: The pooled coefficient differences from this study can be used to adjust single-exposure ERFs from meta-analyses and allow the calculation of combined impacts from multiple environmental exposures, making HIA estimates more robust and realistic.
Dietary patterns and exposure to non-persistent endocrine-disrupting chemicals during pregnancy
(Elsevier, 2025) Warkentin, Sarah; Márquez, Sandra; Vespalcová, Hana; Knox, Bethany; Gascon Merlos, Mireia, 1984-; Güil Oumrait, Núria; González-Palacios, Sandra; Gomez Roig, Maria Dolores; Lassale, Camille; Llurba, Elisa; Rolland, Matthieu; Sakhi, Amrit Kaur; Thomsen, Cathrine; Vioque, Jesus; Bustamante Pineda, Mariona; Sunyer Deu, Jordi; Vrijheid, Martine
Background: Exposure to non-persistent endocrine disrupting chemicals (EDCs) is widespread, causing various adverse health effects, especially during pregnancy. Diet is a major source of EDCs and the identification of dietary patterns that give rise to higher exposure levels is crucial. We aimed to explore the relationship between dietary patterns during pregnancy and exposure to non-persistent EDCs. Methods: We included 640 pregnant women from the Barcelona Life Study Cohort (BiSC), Spain. Using food frequency questionnaires (2nd trimester), we estimated ultraprocessed food (UPF) consumption and Mediterranean diet adherence, and derived data-driven dietary patterns. Metabolites of phthalates, 1,2-cyclohexane dicarboxylic acid di(isononyl) ester (DINCH), chlorpyrifos and pyrethroid, polycyclic aromatic hydrocarbons (PAHs, including phenanthrenes), and organophosphates, and parent compounds of phenols and parabens were measured in weekly urine pools (3rd trimester). Associations between dietary patterns and EDCs were evaluated through multivariable linear regressions. Results: Higher compliance with a "Vegetarian" pattern or the Mediterranean diet was associated with lower levels of some of the phthalate metabolites (e.g., di-iso-nonyl phthalates [Geometric mean ratio (GMR) per unit increases in the "Vegetarian" score = 0.97, 95 %CI 0.95, 1.00]). Conversely, "Western" and "Animal protein" patterns, and UPF intake were associated with higher PAHs (e.g., "Western" and 2-Hydroxynaphthalene [GMR(95 %CI) 1.07(1.01, 1.13)]), pesticides (e.g., "Animal protein" and 3-Phenoxybenzoic acid [1.15(1.01, 1.32]), and phthalates metabolites levels (e.g., UPF and Monoethyl phthalate [1.05(1.01, 1.09)]). No association remained significant after correcting for multiple testing. Conclusions: Following a plant-based diet may help reduce the exposure to certain phthalate and organophosphate metabolites, whereas higher consumption of foods from animal origin and high in fat/sugar/salt may increase exposure to PAHs, pesticides, and phthalates metabolites in pregnancy.
Adherence to the 3+30+300 urban green space rule and mental health, physical activity, and overweight: A population-based study in the Netherlands
(Elsevier, 2025) Helbich, Marco; Browning, Matthew H. E. M.; Voets, Dirk; Dadvand, Payam
Background: The 3+30+300 guideline aims to establish a standard for healthier cities to enhance population health through the provision of trees and green space; however, little empirical evidence to support its effectiveness is available. Objectives: We aimed to 1) evaluate the adherence to the 3+30+300 urban green space rule in the Netherlands; 2) examine the associations between the 3+30+300 rule (and its components) and adults' health and behavioral outcomes; and 3) assess possible effect modifications by age, sex, income, and urbanicity. Methods: We used population-based health survey data for 2022 from the Netherlands. Adults' general health, psychological complaints, anxiety and depression symptoms, psychological resilience, physical activity, and overweight were assessed alongside the 3+30+300 rule at the residential addresses. Covariate-adjusted mixed effects logistic regressions estimated the associations of health and behavioral outcomes with the 3+30+300 components-individually and jointly. Subgroup analyses based on age, sex, income, and urbanicity were also conducted. Results: Of the 180,949 respondents, 16.4 % met the 3+30+300 rule. Respondents meeting the 3+30+300 rule were significantly less likely to be overweight and were significantly more likely to be physically active than those not meeting the rule. Neither meeting the 3+30+300 rule nor its components showed any association with other health or behavioral outcomes. We found no notable effect modification by age, sex, income, and urbanicity. Conclusions: Our findings suggest that meeting the 3+30+300 green space rule may promote certain health benefits, particularly by supporting better weight management and higher physical activity levels, though its role in mental health remains inconclusive.

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