Greenspace in relation to childhood undernutrition: A cross-sectional study in 49 low- and middle-income countries

Jia-Xin Li; Daniel B. Odo; Matthew H. E. M. Browning; Yi-Dan Zhang; Ya-Na Luo; Li-Xin Hu; Hui-Ling Qiu; Yu-Ting Xie; Gang-Long Zhou; Yuanzhong Zhou; Mingdeng Xiang; Shujun Fan; Zhoubin Zhang; Xiaoguang Zou; Guang-Hui Dong; Luke D. Knibbs; Bo-Yi Yang

doi:10.59717/j.xinn-med.2025.100141

The Innovation Medicine > 2025 Vol. 3 > No. 3 > 100141

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Greenspace in relation to childhood undernutrition: A cross-sectional study in 49 low- and middle-income countries

1.
Department of Occupational and Environmental Health, School of Public Health, Sun Yat Sen University, Guangzhou 510080, China
2.
Allergy and Lung Health Unit, School of Population and Global health, The University of Melbourne, Melbourne, VIC 3010, Australia
3.
National Centre for Epidemiology and Population Health (NCEPH), the Australian National University (ANU), Canberra, ACT 2601, Australia
4.
College of Health Sciences, Arsi University, Asela 304, Ethiopia
5.
Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, SC 29634, USA
6.
Barcelona Institute for Global Health, ISGlobal, Barcelona 08002, Spain; Universitat Pompeu Fabra (UPF), Barcelona 08002, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain
7.
School of Public Health, Zunyi Medical University, Zunyi 563060, China
8.
State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou 510080, China
9.
Department of Environmental Health, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
10.
Institute of Public Health, Guangzhou Medical University and Guangzhou Center for Disease Control and Prevention, Guangzhou 510182, China
11.
Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), Kashgar City 844000, China
12.
School of Public Health, The University of Sydney, NSW 2006, Australia
13.
Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW 2050, Australia
14.
These authors contributed equally

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Corresponding authors: yangby23@mail.sysu.edu.cn (B.Y.); luke.knibbs@sydney.edu.au (L.K.)
Received Date: January 28, 2025

Accepted Date: July 01, 2025

Published Online: July 02, 2025

The Innovation Medicine 3(3), https://doi.org/10.59717/j.xinn-med.2025.100141 | Cite this article

GRAPHICAL ABSTRACT

GRAPHICAL ABSTRACT

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PUBLIC SUMMARY

PUBLIC SUMMARY
1. The large and multiple-country study estimates the effects of greenspace on childhood undernutrition.
  
  Living in greenner areas may lower the odds of childhood undernutrition in less developed countries.
  
  Findings indicate greenspace may protect child health, supporting greener policies to fight undernutrition.

ABSTRACT

ABSTRACT

Evidence suggests greenspace may support child nutrition by increasing food availability, reducing environmental hazards, and enhancing microbial diversity, but evidence on the topic is scarce. We used Demographic and Health Surveys (DHS) data from 49 low- and middle-income countries (LMICs) to study the association between greenspace and undernutrition among children aged <5 years. Undernutrition included stunting, underweight and wasting, as determined by z-scores of World Health Organization (WHO) thresholds. A total of 512,013, 509,012, and 507,546 children were included for stunting, underweight, and wasting analysis, respectively. Greenspace was assessed using annual maximum and average values of normalized difference vegetation index (NDVI) as well as proportions of different green land covers, including forest, shrubland, grassland, wetland, and these four combined. Weighted logistic models were constructed to examine the association between greenspace and childhood undernutrition. After adjusting for confounders, we observed that all greenspace indicators were significantly associated with reduced odds of childhood undernutrition. For example, participants in the highest tertile of NDVI_max and greenland levels had 17% (95% confidence interval (CI): 13-20%) and 26% (95% CI: 23-28%) lower odds of stunting, respectively, compared to the lowest tertile. The child’s sex, age, place of residence, household wealth level, and maternal education modified the associations, but the pattern was mixed. In summary, the study indicates that children living in greener areas may have lower odds of developing undernutrition. Enhancing greenspace may improve children’s nutrition status in less developed countries.

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Li J., Odo D., Browning M., et al. (2025). Greenspace in relation to childhood undernutrition: A cross-sectional study in 49 low- and middle-income countries. The Innovation Medicine 3:100141. https://doi.org/10.59717/j.xinn-med.2025.100141

Li J., Odo D., Browning M., et al. (2025). Greenspace in relation to childhood undernutrition: A cross-sectional study in 49 low- and middle-income countries. The Innovation Medicine 3:100141. https://doi.org/10.59717/j.xinn-med.2025.100141

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Greenspace in relation to childhood undernutrition: A cross-sectional study in 49 low- and middle-income countries

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