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PM2.5-hypertension association were well documented in adults, while the effects of life-course exposure to PM2.5 on adulthood hypertension remained unclear. This study aimed to investigate the associations between life-course exposure to ambient PM2.5 and incident hypertension in adulthood in Asia. We included 4272 participants with 17,814 medical visits from two open cohorts in Taiwan and Hong Kong between 2000 and 2018. We used a satellite-based model to assess 2-year average PM2.5 exposure at a resolution of 1 km2. A linear mixed model was used to examine the association with blood pressure. A Cox regression model with time-dependent covariates was used to examine the overall association with the development of hypertension in adulthood. Life-course mixed models were used to examine the effects of PM2.5 exposure at different life stages on blood pressure and hypertension. For every 10 μg/m3 increase in PM2.5, the overall risk of adulthood hypertension increased by 40% (95% confidence interval [CI] 8–80%). The health effects of PM2.5 exposure at different life-stages on incident hypertension were generally independent of each other. In critical model, the risk of developing hypertension increased 23%, 27%, and 55% for each 10 μg/m3 increase in PM2.5 exposure during school age, adolescence, and adulthood, respectively. Similar associations were found between life-course PM2.5 exposure and blood pressure. Association between PM2.5 and adulthood hypertension can be traced back to childhood. Our study suggests that life-course control of air pollution exposure should be implemented to alleviate the huge burden of adulthood hypertension. [ABSTRACT FROM AUTHOR]

Background: Exercise may increase the inhalation and deposition of air pollutants, which may counteract its beneficial effects. We thus examined the combined effects of chronic exposure to fine particulate matter (PM2.5) and habitual exercise on the risk of death from cancer in Taiwan.Patients and Methods: A total of 384 128 adults (≥18 years of age) were recruited for a medical screening programme between 2001 and 2016, yielding 842 384 medical-examination records. All participants were followed up until 31 May 2019. Vital data were obtained from the National Death Registry of Taiwan and the ambient PM2.5 exposure was estimated using a satellite-based spatiotemporal model. Information on habitual exercise was collected using a standard self-administered questionnaire. The time-dependent Cox-regression model was used to evaluate the combined effects.Results: A greater amount of habitual exercise was associated with lower risk of death from cancer, whilst a higher level of PM2.5 exposure was associated with a higher risk of death from cancer. The inverse associations of habitual exercise with death from cancer were not modified by chronic exposure to PM2.5. The participants in the group with a high level of exercise and a low level of PM2.5 exposure exhibited a 35% lower risk of death from cancer than those in the group with a low level of exercise and a high level of PM2.5 exposure (95% confidence interval: 28%, 42%).Conclusions: Increased levels of exercise and reduced exposure levels of PM2.5 are associated with a lower risk of death from cancer. Habitual exercise reduces the risk of death from cancer regardless of the levels of chronic PM2.5 exposure. Our results indicate that habitual exercise is a suitable health-promotion strategy even for people who reside in moderately polluted regions. [ABSTRACT FROM AUTHOR]

Background: Exercise may exacerbate the adverse health effects of air pollution by increasing the inhalation of air pollutants. We investigated the combined effects of long-term exposure to fine particle matter (PM2.5) and habitual exercise on deaths from natural causes in Taiwan.Methods: We recruited 384 130 adults (aged ≥ 18 yr) with 842 394 medical examination records between 2001 and 2016, and followed all participants until May 31, 2019. We obtained vital data from the National Death Registry of Taiwan. We estimated PM2.5 exposure using a satellite-based spatiotemporal model, and collected information on exercise habits using a standard self-administered questionnaire. We analyzed the data using a Cox regression model with time-dependent covariates.Results: A higher level of habitual exercise was associated with a lower risk of death from natural causes, compared with inactivity (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.80-0.88 for the moderate exercise group; HR 0.65, 95% CI 0.62-0.68 for the high exercise groups), whereas a higher PM2.5 exposure was associated with a higher risk of death from natural causes compared with lower exposure (HR 1.02, 95% CI 0.98-1.07, and HR 1.15, 95% CI 1.10-1.20, for the moderate and high PM2.5 exposure groups, respectively). Compared with inactive adults with high PM2.5 exposure, adults with high levels of habitual exercise and low PM2.5 exposure had a substantially lower risk of death from natural causes. We found a minor, but statistically significant, interaction effect between exercise and PM2.5 exposure on risk of death (HR 1.03 95% CI 1.01-1.06). Subgroup analyses, stratified by PM2.5 categories, suggested that moderate and high levels of exercise were associated with a lower risk of death in each PM2.5 stratum, compared with inactivity.Interpretation: Increased levels of exercise and reduced PM2.5 exposure are associated with a lower risk of death from natural causes. Habitual exercise can reduce risk regardless of the levels of PM2.5 exposure. Our results suggest that exercise is a safe health improvement strategy, even for people residing in relatively polluted regions. [ABSTRACT FROM AUTHOR]

Background: There is limited information on the association between habitual physical activity (PA) and renal function.Objective: To report the longitudinal association between self-reported habitual PA and measures of renal function in a large cohort in Taiwan.Methods: A total of 199 421 participants (aged ≥20 years) were selected from a Taiwan cohort between 1996 and 2014. All participants underwent at least two standardised medical examinations between 1996 and 2014. Self-administrated questionnaires were used to collect information on habitual PA. We used a generalised linear mixed model to investigate the associations between habitual PA and yearly change in estimated glomerular filtration rate (eGFR). The Cox proportional hazard regression model was used to investigate the associations between habitual PA and incident chronic kidney disease (CKD).Results: Participants had a median follow-up duration of 4.2 years (0.2-18.9). The yearly mean (±SD) decrease in eGFR in participants with baseline very low-PA, low-PA, moderate-PA and high-PA was 0.46±1.01, 0.36±0.97, 0.30±0.94 and 0.27±0.91 mL/min/1.73 m2, respectively. Relative to the participants with very low-PA, the coefficients of yearly eGFR change were -43.93 (95% CI -79.18 to -8.68), 35.20 (95% CI -2.56 to 72.96) and 53.56 (95% CI 10.42 to 96.70) µL/min/1.73 m2, respectively, for the participants with low-PA, moderate-PA and high-PA, after controlling for a wide range of covariates. Relative to the very low-PA participants, those who had low-PA, moderate-PA and high-habitual PA had HRs of 0.93 (95% CI 0.88 to 0.98), 0.94 (95% CI 0.89 to 0.99) and 0.91 (95% CI 0.85 to 0.96) to develop CKD, respectively, after controlling for the covariates.Conclusions: A higher level of habitual PA is associated with a smaller decrease in the level of eGFR and a lower risk of developing CKD. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) increases a person's inhalation of air pollutants due to greater ventilation, possibly leading to larger adverse health effects. This study aims to investigate the combined effects of long-term exposure to fine particulate matter (PM2.5) and habitual PA on lung function in adults.Methods: This was a longitudinal cohort study that included 278,065 Taiwan residents with an age of 20 years old or above who joined a standard medical screening programme between 2001 and 2014. Each participant received at least one medical examination (including spirometric, blood, and urinary tests and a standard self-administered questionnaire survey) during the study period. We estimated the 2-year average PM2.5 concentrations at each participant's address using a new physical model based on observational data. Information on the participants' PA was collected using the standard self-administrated questionnaire. Generalised linear mixed models were used to investigate the combined effects of PM2.5 and PA on pulmonary function. We also performed stratified analyses by different levels of PM2.5 exposure and habitual PA.Results: Each 10 MET-h increase in PA was associated with a higher level of 0.20%, 0.16%, and 0.19% in forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and maximum mid-expiratory flow (MMEF), respectively, after adjusting for PM2.5 exposure and a wide range of covariates including age, sex education, body mass index, lifestyles, and health conditions. Each 10 μg/m3 increase in PM2.5 was associated with a lower FVC, FEV1, and MMEF (2.43%, 2.78% and 3.10%, respectively). Negative interactions were observed, and PM2.5 exposure was associated with a greater reduction in lung function among the participants with higher PA levels.Conclusions: We found significant negative interaction effects between long-term exposure to PM2.5 and habitual PA, suggesting that the increased intake of PM2.5 due to PA may attenuate the benefits of habitual PA on lung function. However, the PA benefits generally remained stable at different stratum of PM2.5 in the stratified analyses, and habitual PA may still be recommended to people residing in relatively polluted regions. [ABSTRACT FROM AUTHOR]

Despite increasing concerns about the detrimental effects of air pollution on respiratory health, limited evidence is available on these effects in the Hong Kong population, especially in children. In this prospective cohort study between 2012 and 2017, we aimed to investigate the associations between exposure to air pollution (concentrations of fine particulate matter [PM 2.5 ] and nitrogen dioxide [NO 2 ]) and respiratory health (lung function parameters and respiratory diseases and symptoms) in schoolchildren. We recruited 5612 schoolchildren aged 6–16 years in Hong Kong. We estimated the annual average concentrations of ambient PM 2.5 and NO 2 at each participant's address using spatiotemporal models. We conducted spirometry tests on all participants to measure their lung function parameters and used a self-administered questionnaire to collect information on their respiratory diseases and symptoms and a wide range of covariates. Linear mixed models were used to investigate the associations between exposure to air pollution and lung function. Mixed-effects logistic regression models with random effects were used to investigate the associations of exposure to air pollution with respiratory diseases and symptoms. In all of the participants, every 5-μg/m3 increase in the ambient PM 2.5 concentration was associated with changes of − 13.90 ml (95 % confidence interval [CI]: −23.65 ml, −4.10 ml), − 4.20 ml (−15.60 ml, 7.15 ml), 27.20 ml/s (−3.95 ml/s, 58.35 ml/s), and − 19.80 ml/s (−38.35 ml/s, −1.25 ml/s) in forced expiratory volume in 1 s, forced vital capacity, peak expiratory flow, and maximal mid-expiratory flow, respectively. The corresponding lung function estimates for every 5-μg/m3 increase in the ambient NO 2 concentration were − 2.70 ml (−6.05 ml, 0.60 ml), − 1.40 ml (−5.40 ml, 2.60 ml), − 6.60 ml/s (−19.75 ml/s, 6.55 ml/s), and − 3.05 ml/s (−11.10 ml/s, 5.00 ml/s), respectively. We did not observe significant associations between PM 2.5 /NO 2 exposure and most respiratory diseases and symptoms. Stratified analyses by sex and age showed that the associations between exposure to air pollution and lung function parameters were stronger in male participants and older participants (11–14 year old group) than in female participants and younger participants (6–10 year old group), respectively. Our results suggest that chronic exposure to air pollution is detrimental to the respiratory health of schoolchildren, especially that of older boys. Our findings reinforce the importance of air pollution mitigation to protect schoolchildren's respiratory health. [Display omitted] • This study investigated air pollution and respiratory health in school children. • PM 2.5 level was associated with a lower FEV1/MMEF and a higher risk of sinusitis. • NO 2 was associated with a higher risk of allergic rhinitis. • Air pollution was associated with adverse respiratory health in children. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To examine the association between white blood cell count (WBC) and metabolic syndrome (MS) in an older Chinese population. Methods: Three thousand and twenty men and 7256 women aged 50–85 years were recruited and received a medical check-up including measurement of complete blood count, blood pressure, obesity indices, fasting total, LDL-, HDL-cholesterol, triglycerides, glucose and c-reactive protein (CRP). Information on socioeconomic and lifestyle factors was also collected. Results: Vascular risk factors including waist circumference, body mass index, triglyceride, total-, LDL-cholesterol, CRP and systolic and diastolic blood pressures were all positively associated with WBC in both men and women (p from 0.0085 to <0.001). The risk of MS increased significantly with higher total WBC, with adjusted odds ratios (95% confident interval) for second and third tertiles of 1.86 (1.43, 2.42), 2.56 (1.98, 3.32) in men and 1.67 (1.46, 1.90), 2.66 (2.34, 3.03) in women, respectively. Neutrophil and lymphocyte were strongly correlated with total WBC and showed similar association with the MS. Conclusion: There is a strong relationship between total WBC, neutrophil and lymphocyte and the constellation of MS components and associated vascular risk in this older Chinese population. [Copyright &y& Elsevier]

Habitual exercise may amplify the respiratory uptake of air pollutants in the lung, exacerbating the adverse effects of air pollution. However, it is unclear whether this can reduce the health benefits of habitual exercise (referred to as leisure-time exercise). Thus, the combined effects of habitual exercise and chronic exposure to ambient fine particulate matter 2.5 on cardiovascular mortality were examined among adults in Taiwan. A total of 384,128 adults were recruited between 2001 and 2016 and followed up to May 31, 2019. Participants' vital status was obtained by matching their unique identification numbers with records of cardiovascular death in the National Death Registry of Taiwan. A time-varying Cox regression model was used to analyze the data. Analyses were conducted in 2021. Cardiovascular death risks were inversely associated with habitual exercise and positively associated with chronic exposure to particulate matter 2.5. The beneficial effects of habitual exercise on cardiovascular mortality were not modified by chronic exposure to particulate matter 2.5. Inactive participants with high particulate matter 2.5 exposure exhibited a 123% higher risk of cardiovascular death than high-exercise-group participants exposed to low levels of particulate matter 2.5 (95% CI=89, 163). High level of habitual exercise combined with low exposure level of ambient particulate matter 2.5 is associated with the lowest risk of cardiovascular death. A higher level of habitual exercise is associated with a lower risk of cardiovascular death at all levels of particulate matter 2.5 exposure studied. The results indicate that habitual exercise is a safe health promotion strategy even for people residing in relatively polluted regions. [ABSTRACT FROM AUTHOR]

Background: To investigate the associations between long-term exposure to ambient air pollution and age at menopause and the risk of early menopause in two Asian cohorts.Methods: A total of 53,167 female adults were enrolled from two ongoing cohorts, one each in Taiwan and Hong Kong, between 2003 and 2018, yielding 200,000 person-years of follow-up. We performed a Cox regression model with time-dependent covariates to investigate associations between air pollution and menopause.Results: The mean age at baseline and at natural menopause was 34.4 and 51.0 years, respectively. In the single-pollutant models, we found that increase in PM2.5 and NO2 was associated a younger age at menopause [hazard ratios (HRs) (95% confidence interval, CI): 1.16 (1.09-1.23) and 1.04 (1.01-1.06), respectively, for each 10 µg/m3 increase in air pollution]. In the multiple-pollutant models, the NO2-menopause associations were attenuated after adjusting for PM2.5 and O3, whereas the associations of menopause with PM2.5 and O3 remained stable. Similar associations were observed for the risk of early menopause (age at menopause ≤ 45 years).Conclusions: Long-term exposure to ambient air pollution was associated with the age at menopause and the risk of early menopause. More effective strategies to mitigate air pollution are required. [ABSTRACT FROM AUTHOR]

Osteoporosis is an important public health challenge given its high prevalence in western populations and the prevalence has shown an upward trend in recent decades in Asia. However, epidemiological evidence on the association between bone mineral density (BMD) and mortality risk in the Asian population is sparse. The Cox proportional hazards model and cause-specific hazard models were used to investigate the association of BMD with the risk of all-cause mortality and cause-specific mortality. The present study comprised of 3,332,207 person-years with a median follow-up of 14.6 years. 27,508 participants (15,967 men and 11,541 women) died among 233,397 participants (112,348 men and 121,049 women) during the follow-up period. Compared to those with normal BMD level, both men and women with low BMD had a significantly higher risk of all-cause, cardiovascular disease (CVD), and cancer mortality after adjusting for the covariates. [For men with osteoporosis: all-cause: 1.37 (1.27–1.49); CVD: 1.28 (1.08–1.52); cancer: 1.29 (1.12–1.49); For women with osteoporosis: all-cause: 1.72 (1.63–1.82); CVD: 1.85 (1.64–2.08); cancer: 1.47 (1.35–1.61)]. The P for interactions for BMD with sex were significant for all-cause and CVD mortality. The adverse effects of BMD on the risk of all-cause and CVD were higher in women than in men [men vs. women: all-cause: 1.37 (1.27–1.49) vs. 1.72 (1.63–1.82); CVD: 1.28 (1.08–1.52) vs. 1.85 (1.64–2.08)]. In the nonlinear dose-response analyses, the association between BMD increments and all-cause mortality risk shows an L-shaped pattern in men and a similar U-shaped trend in women (P for non-linear association: <0.001). Likewise, a similar L-shaped association was observed between BMD levels and cancer mortality risk in men. Low BMD had an increased risk of all-cause, CVD, and cancer mortality in both men and women. Women had a stronger positive association between low BMD and an increased risk of all-cause and CVD mortality compared to men. • Provided additional epidemiological evidence on the associations of BMD with mortality risks in Asian populations. • Low BMD levels had a significantly higher risk of all-cause, cardiovascular disease (CVD), and cancer mortality. • The adverse effects of BMD on the risk of all-cause and CVD were higher in women than in men. [ABSTRACT FROM AUTHOR]

The long-term joint impacts of fine particulate matter (PM 2.5), nitrogen dioxide (NO 2), and ozone (O 3) on mortality are inconclusive. To bridge this research gap, we included 283,568 adults from the Taiwan MJ cohort between 2005 and 2016 and linked with the mortality data until 31 May 2019. Participants' annual average exposures to PM 2.5 , NO 2 , and O 3 were estimated using satellite-based spatial-temporal models. We applied elastic net-regularised Cox models to construct a weighted environmental risk score (WERS) for the joint effects of three pollutants on non-accidental, cardiovascular, and cancer mortality and evaluated the contribution of each pollutant. The three pollutants jointly raised non-accidental mortality risk with a WERS hazard ratio (HR) of 1.186 (95% CI: 1.118–1.259) per standard deviation increase in each pollutant and weights of 72.8%, 15.2%, and 12.0% for PM 2.5 , NO 2 , and O 3 , respectively. The WERS increased cardiovascular death risk [HR: 1.248 (1.042–1.496)], with PM 2.5 as the first contributor and O 3 as the second. The WERS also elevated the cancer death risk [HR: 1.173 (1.083–1.270)], where PM 2.5 played the dominant role and NO 2 ranked second. Coordinated control of these three pollutants can optimise the health benefits of air quality improvements. [Display omitted] • Long-term PM 2.5 , NO 2 , and O 3 exposures jointly increase the risk of non-accidental, cardiovascular, or cancer mortality. • PM 2.5 makes the largest contribution to the increased risk of non-accidental, cardiovascular, or cancer mortality. • NO 2 plays the secondary role in elevating the risk of non-accidental or cancer mortality. • O 3 increases cardiovascular mortality risk as the second contributor among the three pollutants. [ABSTRACT FROM AUTHOR]

Evidence of the effects of long-term exposure to fine particulate matter (PM 2.5) air pollution on the development of dyslipidaemia is limited. This study aimed to investigate the association between long-term exposure to ambient PM 2.5 and incident dyslipidaemia in a large cohort. We studied 66,702 participants aged ≥18 years belonging to a cohort from a standard medical examination programme conducted in Taiwan between 2001 and 2014. The PM 2.5 concentration at each participant's address was estimated using a satellite-based spatiotemporal model at a high resolution (1 km2). A time-varying Cox regression model was used to examine the association between long-term exposure to ambient PM 2.5 and the development of dyslipidaemia. Additionally, sensitivity analyses were conducted to examine the stability of these associations. Compared with participants exposed to the 1st tertile of PM 2.5 , participants exposed to the 2nd and 3rd tertiles of PM 2.5 had respective hazard ratios of 1.02 [95% confidence interval (CI): 0.98–1.06] and 1.08 (95%CI: 1.04–1.13) for incident dyslipidaemia. Sensitivity analyses generally yielded similar results. Long-term exposure to ambient PM 2.5 is associated with a higher risk of dyslipidaemia. Global strategies for reducing air pollution are needed to prevent the development of dyslipidaemia. • This is the largest longitudinal cohort study consisting of 66,702 adults. • The mean PM 2.5 was 27.0 μg/m3 and the interquartile range was 9.6 μg/m3 with a range of 5.8–50.3 μg/m3 • Ambient PM 2.5 is associated with a higher risk of dyslipidaemia. [ABSTRACT FROM AUTHOR]

Background: We investigated the combined effects of chronic PM2.5 exposure and habitual exercise on the decline of renal function and the incidence of chronic kidney disease (CKD) in a large cohort in Taiwan.Methods: The present data analysis included a total of 108,615 participants aged 18 years or above who were recruited between 2001 and 2016. All participants underwent at least two medical examinations. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The incident of eGFR decline ≥30% was defined as a decline in eGFR of ≥30% during the study period, while the incident CKD was defined as an eGFR <60 mL/min/1.73 m2 or a newly self-reported physician-diagnosed CKD in the subsequent visits. The satellite-based spatiotemporal model was used to estimate PM2.5 exposure at each participant's address. Information on habitual exercise was collected using a standard self-administered questionnaire. The Cox regression model with time-dependent covariates was used for data analyses.Results: Higher habitual exercise was associated with lower risks of renal function decline and CKD development, whereas higher PM2.5 exposure was associated with higher risks of renal function decline and CKD development. We found no significant interaction effect between PM2.5 and habitual exercise, with an HR (95% CI) of 1.02 (0.97, 1.07) for incident eGFR decline ≥30% and 1.00 (0.95, 1.05) for CKD development. Compared to participants with inactive-exercise and high-PM2.5, participants with high-exercise and low-PM2.5 had 74% and 61% lower risks of renal function decline and CKD development, respectively.Conclusion: Increased habitual exercise and reduced PM2.5 exposures are associated with lower risks of renal function decline and CKD development. Habitual exercise reduces risks of renal function decline and CKD development regardless of the levels of chronic PM2.5 exposure. Our study suggests that habitual exercise is a safe approach for kidney health improvement even for people residing in relatively polluted areas and should be promoted. [ABSTRACT FROM AUTHOR]