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Air Pollution and Body Weight

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 AIR POLLUTION AND BODY
WEIGHT
IS AIR POLLUTION ANOTHER MODIFIABLE RISK
FACTOR FOR WEIGHT GAIN?
Narelle Grant-Stegehuis A/Professor Vicki Kotsirilos
MHSc PhD Candidate AM, MBBS, FACNEM, FASLM
ABSTRACT
Ambient air pollution and obesity are both independent
global public health issues. Ambient air pollution is
well evidenced as a contributor to several chronic
health conditions. Based on observational studies, air
pollution is also recognised as a possible contributor
to obesity and changes in body weight due to its
influence on metabolic changes commencing in utero
and amplifying throughout the lifespan. The aim of
this narrative review is to explore the current research
that focusses on the influence of ambient air pollution
to changes in body weight, and the risk of developing
obesity and Type 2 Diabetes.
Establishing preventative health assessments that
incorporate air pollution exposure are essential to
mitigating a rise in obesity and avoid a public health
crisis.
Keywords: obesity, evolution, exposome, environment,
air pollution, obesogens, pesticides, insecticides,
sociodemographic, insulin resistance, thermogenesis,
T2D.
10 acnem JOURNAL | VOL 42, No 1 | MARCH 2023
ABOUT THE AUTHOR
Narelle Grant-Stegehuis MHSc PhD Candidate
Education Research and Development Manager
Australasian College of Nutritional and
Environmental Medicine
A/Professor Vicki Kotsirilos AM, MBBS, FACNEM,
FASLM
Awarded Honorary Fellowship RACGP, General
Practitioner
METHODOLOGY
A search of Pub Med and Google Scholar literature
search was performed using a combination
of search strategies using keywords “obesity”,
“evolution”, “exposome”, “environment”, “air pollution”,
“obesogens”, “sociodemographic”, “insulin resistance”,
“thermogenesis”, “T2D”, “transgenerational”, “genetic”.
OBESITY INCIDENCE
The incidence of higher-than-normal body weight
and obesity has reached epidemic global proportions,
with the World Health Organisation1 estimating
approximately 2.8 million deaths per year resulting
from obesity related health complications. Ambient air
pollution is well evidenced as a contributor to several
chronic health conditions such as cardiovascular,
respiratory disease and diabetes2.
The causes of being overweight or obese are
multifactorial and usually occur due to an imbalance
between energy intake from the diet and energy
expenditure through physical activities and bodily
functions.3 Risk factors include diet, exercise, and
psychosocial factors, therefore management requires
a multifactorial holistic approach. Obesity contributes
to physical, psychological, social, and metabolic health
problems. Being overweight and obese increases the
risk of chronic diseases, morbidity and mortality3. Excess
body fat contributes to the development of abnormal
biomedical risk factors, such as blood pressure and
blood lipids, increasing the risk of type 2 diabetes3,4.
Adults with a BMI of 25-29.9 are classed as being
overweight, and a BMI above 30 is termed as being
obese 5. Obesity increases the risk of developing type 2
diabetes (T2D)6.
Australia has one of the highest rates of obesity in the
world. According to the Australian Institute for Health
and Welfare, the Overweight and Obesity report (07
Jul 2022), in 2017–2018, 67% of Australians (that is, 2
in 3 people) aged 18 and over were overweight or
obese (36% were overweight but not obese, and 31%
were obese), with higher rates now in adult males
and the older age groups7. There are currently 14
million Australians living with overweight or obesity8. In
2017–2018, 25% (1 in 4) children and adolescents aged
2–17 were overweight or obese in Australia; 17% were
overweight and 8.2% were obese9. The proportion of
being overweight and obese in children varied across
age groups, but on average were equal for males and
females.
AIR POLLUTION AND TYPE 2 DIABETES (T2DM OR T2D)
Ambient air pollution such as Particulate Matter
(PM)2.5 & 10, nitric oxide (NOx), nitrogen dioxide (NO2),
ozone (O3), and polycyclic aromatic hydrocarbons
(PAHS), are now recognised as likely risk factors for the
development of T2D9, 10.
The Global Burden of Disease Study 2019 estimated that
about a fifth of the global burden of type 2 diabetes is
attributable to PM2·5 pollution. 11
This demonstrates the need to consider and include
ambient air pollution exposure assessment within
primary health care models and explore new ways
to assess its impact and implement air pollution
mitigation and preventative interventions to reduce the
incidence of obesity 12and of Type 2 Diabetes.13
A systematic review of high-quality epidemiological
studies demonstrated ambient air pollutant exposure,
especially for PM2.5 & 10, had significant association and
prevalence with the incidence of T2D, and that diabetic
patients may be more vulnerable to air pollutant
exposure.14 The study results found NO2 exposure also
raised T2D prevalence.
acnem JOURNAL | VOL 42, No 1 | MARCH 2023 11
The literature cites biological mechanisms of outdoor
and indoor air pollution with obesity and T2D to include
vascular insulin resistance and metabolic disturbances
caused by inflammation, immune activation, oxidative
stress, metabolic dysregulation, intestinal flora disorders
and genetic polymorphism, commencing in utero 15, 16, 17 .
AMBIENT AIR POLLUTION INCIDENCE AND OBESITY
Epidemiological studies also demonstrate that long
term air pollution exposure may be a contributor to
obesity and risk compounding throughout the lifespan
with intergenerational and demographic influence 18, 19.
Ambient air pollution is a global problem with sources
originating from various sources such as vehicle
emissions, coal fire power stations, industrial activities,
mining smelters, agricultural practices, and natural
disasters 20. Disasters such as bushfires can be natural
or anthropogenic, sudden, or prolonged. They add to
air pollution by way of infrastructure damage and the
release of air pollutants, hazardous materials, and the
formation of toxic gasses 21, 22.
The incidence of disasters such as bushfires are
projected to increase with climate change and
instability 23
A recent systematic review and meta-analysis of
epidemiological studies indicated that air pollution
is correlated with childhood obesity and weight gain,
and is regarded as a probable risk factor, but long
term, large scales studies are still required.24 The
research demonstrated that for obesity the association
was considerable with exposure to the much finer
Particulate Matters: PM10 and PM2.5. A rise in BMI status
was observed with 10 μg/m3 increments in exposure to
PM10, PM2.5, and NO2.
Learning from retrospective data we can anticipate
PM2.5 exposure from wildfires. The Australian 2019/2020
bushfires were unprecedented in intensity and
spread with short-term particulate matter exposure
experienced in new South Wales, Queensland, and
Victoria25 causing substantial health impact. At the time
of writing, no evidence of the long-term health impact
on prediabetes had been studied. According to the
literature there may be in utero effects, including for
maternal gestational diabetes26, 27 .
Air pollution from natural disaster is difficult to predict
and manage, irrespective of government intervention,
highlighting the need for individualised prevention
strategies including monitoring and addressing
modifiable behavioural risk factors and subclinical
markers28, 29 and the implementation of precision-based
allied health interventions.
12 acnem JOURNAL | VOL 42, No 1 | MARCH 2023
BIOLOGICAL MECHANISMS
Animal and cellular studies conclude metabolism
disrupting chemical exposure including toxic pesticides
found in air pollution (obesogens) reduce cellular
metabolic functioning and may directly contribute
to obesity30, 31, 32 with exposure occurring throughout
the lifespan and influencing subsequent generations
through epigenetic influences.
Several mechanisms are suggested to explain the
association between environmental compounds found
in ambient air pollution and diabetes. Causal links may
be associated with biological mechanisms contributing
to the formation of insulin resistance (IR), disordered
glucose homeostasis, prediabetes and diabetes is
provided below:
1. The overproduction of proinflammatory
mediators is key. Mediators activate c-Jun
N-terminal kinase, inhibiting insulin signalling
through insulin receptor substrate proteins33 34.
2. Oxidative stress generation activates
nuclear factor (NF)-KB and insulin signalling
pathways35.
3. Endothelial dysfunction and reduced
peripheral glucose uptake36.
4. White and brown adipose tissue functionality
and vascular pathology impaired by
particulate matter PM2.5 exposure37.
5. Metabolism disrupting chemicals found in
air pollution (obesogens) increase fat mass;
modify the metabolic rate, the gut micro biota
composition, endocrine control of eating
behaviour and may contribute to thyroid
function inhibition (mediator of carbohydrate
and lipid metabolism, fat oxidisation, food
intake and resting metabolism)38.
INTERGENERATIONAL INFLUENCE, MULTIGENERATIONAL
EXPOSURE RISK AND ADAPTATIONS
Obesity can be a long-term recurring health condition,
perpetuated by a number of risk factors including
exposure to outdoor and indoor air pollutants occurring
throughout an individual’s life span and accumulating
over time. As an individual ages, the ability to remove
air pollutants reduces, that may further increase the risk
of obesity later in life39
Metabolism disrupting chemicals found in air pollution
change epigenetic patterns and gene expression in
utero - increasing susceptibility to metabolic disease in
childhood and throughout life40, 41.
CONCLUSION
Addressing air pollution is essential to mitigate its
negative impact on human health and its association
with chronic diseases such as cardiovascular disease
and respiratory diseases. More research is required
particularly to determine the mechanisms, but it
appears there is some research demonstrating an
association of air pollution exposure with obesity and
diabetes. Obesity and T2D are serious and long-term
health conditions that increase the risk of morbidity
and mortality. Exposure to ambient air pollutants
can occur throughout the life span and pollutants
can accumulate in the body over time. Studies have
demonstrated that a higher exposure to chemical
exposure leads to a greater risk of cardiovascular
disease and obesity levels.42
Ambient air pollution contributes to changes in
metabolic factors and body weight influencing the
health of generations. The components of air pollution
are diverse and mechanisms of action are unique to
the individual, indicating the need for a ‘precision’ and
personalised holistic approach to obesity prevention
and management.
Obesity is a public health crisis, which can originate
from metabolic changes commenced in utero and
amplified throughout life stages.
Adoption of a preventative approaches are required
to mitigate the harmful health effects of air pollution to
reduce the incidence of obesity and T2D. By focusing
on lifestyle, behavioural changes and mitigating
environmental influences such as reducing exposure to
and addressing the sources of air pollution and working
with allied health professionals forms a crucial path to
reducing the incidence of global obesity.
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