Does underweight amplify the relationship between short-term particulate matter exposure and blood pressure in children and adolescents: a large cross-sectional study in a metropolis of China

Overweight/obesity modified the effects of ambient particulate matter (PM) exposure on blood pressure (BP). This study aims to assess whether interaction of underweight and short-term PM exposure on BP exists in Chinese children. A cross-sectional analysis including 144,513 children aged 6 to 17 years in 2016 Health Promotion Program for Children and Adolescents of Suzhou, China, was performed. Daily concentrations of inhalable PM (PM₁₀) and fine PM (PM_2.5) were extracted from air monitoring stations close to students' schools. We applied generalized linear mixed-effects models to estimate the interactions. Estimated changes (95% confidence intervals (CIs)) of systolic BP (SBP), diastolic BP (DBP), and odds ratios (ORs) (95% CIs) for prevalence of HBP were calculated. Significant interactions between PM and underweight on BP and prevalence of high BP (HBP) were observed. For example, at lag 6, the ORs (95% CIs) for HBP by each 10 μg/m³ changes of PM_2.5 were 1.066 (1.039, 1.093) and 1.036 (1.028, 1.043) among underweight and normal weight subjects, respectively; these values for PM₁₀ were 1.048 (1.031, 1.065) and 1.025 (1.021, 1.030). At lag 5, the increases of SBP for PM_2.5 were 0.32 (95% CI 0.22, 0.43) mmHg and 0.23 (95% CI 0.29, 0.26) mmHg, while changes of DBP were 0.27 (95% CI 0.18, 0.35) mmHg and 0.19 (95% CI 0.16, 0.21) mmHg among underweight and normal weight subjects, respectively. Stratified analyses demonstrated that these interactions were only obtained in males. Effects of short-term PM exposure on BP and prevalence of HBP are enhanced in underweight children and adolescents.