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. 2025 Mar 5;25(1):872.
doi: 10.1186/s12889-025-22050-6.

Nitrogen dioxide exposure attenuates or even reverses the association between physical activity and fasting plasma glucose levels in non-diabetic elderly Chinese adults

Chen Zhang #  1   2 , Qingsi Wu #  1   3 , Xuqiu Cheng #  2 , Ziwei Tian #  2 , Junzhe Li  2 , Qiang Liu  2 , Yan Zhang  2 , Xianwei Guo  2 , Guimei Chen  4 , Huaibiao Li  5 , Changliu Liang  5 , Bing Hu  5 , Dongmei Zhang  4 , Chunmei Liang  1 , Jie Sheng  6 , Fangbiao Tao  7 , Jun Wang  8 , Yuyou Yao  9 , Linsheng Yang  10   11
Affiliations

Nitrogen dioxide exposure attenuates or even reverses the association between physical activity and fasting plasma glucose levels in non-diabetic elderly Chinese adults

Chen Zhang et al. BMC Public Health. .

Abstract

Background: The combined effects of physical activity (PA) and nitrogen dioxide (NO2) on fasting plasma glucose (FPG) levels have rarely been studied. This study aimed to examine whether long-term exposure to NO2 attenuates the association between PA and FPG levels in non-diabetic older adults.

Methods: A total of 2600 non-diabetic elderly Chinese adults were included in this cross-sectional study. PA data were collected using the International Physical Activity Questionnaire (IPAQ). The Space-Time Extra-Trees model was utilized to estimate the annual concentration of NO2. General linear regression models were used to assess independent and interaction associations of long-term exposure to NO2 and PA with FPG levels. An interaction plot was employed to enhance the visual representation of the interaction.

Results: A 0.32 µg/m3 increase in the 3-year average NO2, corresponding to one interquartile range (IQR), was positively associated with FPG levels (β = 0.099 mmol/L, 95% CI: 0.069-0.130). PA exhibited a negative, albeit non-significant, association with FPG levels (β = -0.027 mmol/L, 95% CI: -0.069, 0.015). A statistically significant interaction between PA and NO2 on FPG levels was observed (Pfor interaction = 0.016). The interaction plots revealed that the beneficial effects of PA on FPG levels were attenuated or even reversed as NO2 concentrations increased, with a threshold for reversal at 33.02 µg/m3.

Conclusions: Long-term exposure to NO2 attenuates or reverses the beneficial effects of PA on FPG levels in non-diabetic older adults. Therefore, further action is imperative to reduce air pollution and thereby enhance the benefits of PA on FPG levels.

Keywords: Fasting plasma glucose; Nitrogen dioxide; Non-diabetic older adults; Physical activity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All research procedures are conducted in accordance with the Helsinki Declaration, which has been approved by the Biomedical Ethics Board at Anhui Medical University (No. 20190288). All individual participants provided written informed consent at enrollment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Estimated effect [β(95%CI)] of PA on FPG levels altered by 3-y average NO2 exposure. The NO2 was treated as continuous variables and standardized according to their interquartile ranges. The PA was treated as continuous variables and standardized according to interquartile range after ln-transformation.The IQR of 3-y average NO2 is 0.32 μg/m3. The IQR of PA after ln-transformationis 2.90. Models were adjusted for gender, age, education level, economic condition, marital status, occupation, region, smoking status, drinking status, AIDI score, BMI, hyperlipidemia, and hypertension. Abbreviations: NO2, nitrogen dioxide; FPG, fasting plasma glucose; PA, physical activity; CI, confidence interval
Fig. 2
Fig. 2
Effect estimates [β (95% CI)] for the associations of NO2 exposure or PA with FPG levels using linear regression models by different age groups (60–70,70–80 and > 80 years), gender (male and female) and BMI (< 18.5,18.5–23.4 and > 23.4 kg/m2). The NO2 was treated as continuous variables and standardized according to their interquartile ranges. The PA was treated as continuous variables and standardized according to interquartile range after ln-transformation. The IQR of 3-y average NO2 is 0.32 µg/m3. The IQR of PA after ln-transformation is 2.90. Adjusted for gender, age, education level, economic condition, marital status, occupation, region, smoking status, drinking status, AIDI score, BMI, hyperlipidemia, hypertension, and PA (or NO2). All subgroup analyses were adjusted for the remaining covariates. Abbreviations: NO2, nitrogen dioxide; FPG, fasting plasma glucose; PA, physical activity; CI, confidence interval
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