Residential greenspace exposure and blood lipid profile: A nationwide longitudinal study

Current evidence for residential greenspace and blood lipid levels was primarily based on single-center cross-sectional studies, with spatial and temporal differences possibly leading to heterogeneous results. This large multicenter community-based study aimed to investigate the longitudinal relationships of residential greenspace with blood lipids.

We included participants aged over 40 years with repeated blood lipid measurements from the China National Stroke Screening Survey (CNSSS) from 2013 to 2019. Greenspace exposure was assessed using the three-month average normalized difference vegetation index (NDVI) with a spatial resolution of 1 km. Linear fixed-effect models examined the associations between greenspace and low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and total cholesterol (TCHO) levels, adjusting for demographic characteristics, lifestyle factors, and chronic diseases history. Air pollution and physical activity were considered as potential mediators.

We included 292,754 participants with 683,759 visits. A 0.1-unit increase in NDVI was significantly associated with a 1.28 % increase in HDL-C (95 % confidence interval [CI]: 1.06 %, 1.51 %), and decreases of 0.63 % in LDL-C (95 % CI: -0.88 %, -0.38 %), and 1.45 % in TCHO (95 % CI: -1.64 %, -1.26 %). These associations were modified by sex, region, residence, history of dyslipidemia, hypertension, smoking and drinking. We observed nonlinear exposure‒response curve (ERC) for the association between greenspace and lipid indicators. Air pollution (PM_2.5, NO₂) partially mediated the associations between residential NDVI and LDL-C, HDL-C, and TCHO. In conclusion, this longitudinal study revealed that greater residential greenspace was associated with favorable blood lipid levels. Air pollution is a significant mediator linking residential greenspace to blood lipids.