Exposure–response relationship of household air pollution on body mass index among women in rural areas of Guatemala, India, Peru and Rwanda: household air pollution intervention network trial

the HAPIN Investigators; Adolphe Ndikubwimana; William Checkley; Yunyun Chen; Thomas Clasen; Carmen Lucía Contreras; Anaite Diaz-Artiga; Ephrem Dusabimana; Lisa de las Fuentes; Shirin Jabbarzadeh; Michael Johnson; Egide Kalisa; Patrick Karakwende; Miles Kirby; Amy E. Lovvorn; John P. McCracken; Florien Ndagijimana; Theoneste Ntakirutimana; Jean Dieu Ntivuguruzwa; Jennifer L. Peel; Ajay Pillarisetti; Victor G. Dávila-Román; Ghislaine Rosa; Sarada S. Garg; Lisa Thompson; Lance A. Waller; Jiantong Wang; Maggie L. Clark; Bonnie N. Young

doi:10.1186/s12889-025-23380-1

Exposure–response relationship of household air pollution on body mass index among women in rural areas of Guatemala, India, Peru and Rwanda: household air pollution intervention network trial

the HAPIN Investigators
, Adolphe Ndikubwimana
, William Checkley
, Yunyun Chen
, Thomas Clasen
, Carmen Lucía Contreras
, Anaite Diaz-Artiga
, Ephrem Dusabimana
, Lisa de las Fuentes
, Shirin Jabbarzadeh
, Michael Johnson
, Egide Kalisa
, Patrick Karakwende
, Miles Kirby
, Amy E. Lovvorn
, John P. McCracken
, Florien Ndagijimana
, Theoneste Ntakirutimana
, Jean Dieu Ntivuguruzwa
, Jennifer L. Peel

Ajay Pillarisetti, Victor G. Dávila-Román, Ghislaine Rosa, Sarada S. Garg, Lisa Thompson, Lance A. Waller, Jiantong Wang, Maggie L. Clark, Bonnie N. Young

University of Rwanda
Johns Hopkins University
Emory University
University of the Valley of Guatemala
Eagle Research Center
Washington University St. Louis
Berkeley Air Monitoring Group
Western University
Harvard University
University of Georgia
Colorado State University
University of California at Berkeley
Liverpool School of Tropical Medicine
Sri Ramachandra Institute of Higher Education and Research

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Background: Household air pollution from burning biomass materials, the main cooking fuel in low- and middle-income countries, may be linked to metabolic dysfunction. We assessed cross-sectional associations between household air pollution and body mass index (BMI), expecting to see increased BMI with higher pollution concentrations.

Methods: We analyzed data from 414 women aged 40 to 79 years who resided in the households using biomass fuel and were enrolled in the multi-country Household Air Pollution Intervention Network (HAPIN) Trial. We explored associations of 24-h average personal exposure to fine particulate matter (PM_2.5), black carbon (BC), and carbon monoxide (CO) with BMI through single pollutant linear and logistic models adjusted for potential confounders (i.e., age, socioeconomic indicators, education, dietary diversity, secondhand smoke exposure, alcohol and grain consumption).Sensitivity analyses explored air pollutants as quartiles, and other variables as potential confounders, such as physical activity, enrollment site, and dietary items. We examined effect modification of research site on the associations.

Results: We observed mixed evidence of associations between household air pollution and BMI in linear regression. There was no association with BMI and PM₂.₅ (1-unit increase in log-transformed PM₂.₅ estimate 0.02 kg/m² [95% CI: -0.51, 0.54]) or CO (1-unit increase in log-transformed CO estimate 0.42 kg/m² [95% CI -0.31, 1.14]). However, a 1-unit increase in log-transformed BC showed an association in the opposite direction as hypothesized (BC estimate -0.59 kg/m² [95% CI -1.17, -0.003]). Using logistic regression models, we found that only CO significantly increased the odds of overweight/obesity: a 1-unit increase in log-transformed CO led to an odds ratio of 1.66 (95% CI: 1.10, 2.51). Effect modification showed inverse association between BC exposure and BMI in Peru.

Conclusions: Evidence suggests a significant association between CO exposure and increased odds of being overweight/obese, whereas impacts of PM_2.5 and BC on BMI had null or inverse effects.

Original language	English
Article number	2163
Journal	BMC Public Health
Volume	25
Issue number	1
DOIs	https://doi.org/10.1186/s12889-025-23380-1
Publication status	Published - 10 Jun 2025
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Biomass cookstove
BMI
Indoor air pollution
Low-and middle-income countries

Access to Document

10.1186/s12889-025-23380-1

s12889-025-23380-1Final published version, 1.03 MBLicence: CC BY-NC-ND

Cite this

the HAPIN Investigators, Ndikubwimana, A., Checkley, W., Chen, Y., Clasen, T., Contreras, C. L., Diaz-Artiga, A., Dusabimana, E., de las Fuentes, L., Jabbarzadeh, S., Johnson, M., Kalisa, E., Karakwende, P., Kirby, M., Lovvorn, A. E., McCracken, J. P., Ndagijimana, F., Ntakirutimana, T., Ntivuguruzwa, J. D., ... Young, B. N. (2025). Exposure–response relationship of household air pollution on body mass index among women in rural areas of Guatemala, India, Peru and Rwanda: household air pollution intervention network trial. BMC Public Health, 25(1), Article 2163. https://doi.org/10.1186/s12889-025-23380-1

@article{4e1bf586fc1d4524bb91bc34290e7044,

title = "Exposure–response relationship of household air pollution on body mass index among women in rural areas of Guatemala, India, Peru and Rwanda: household air pollution intervention network trial",

abstract = "Background: Household air pollution from burning biomass materials, the main cooking fuel in low- and middle-income countries, may be linked to metabolic dysfunction. We assessed cross-sectional associations between household air pollution and body mass index (BMI), expecting to see increased BMI with higher pollution concentrations. Methods: We analyzed data from 414 women aged 40 to 79 years who resided in the households using biomass fuel and were enrolled in the multi-country Household Air Pollution Intervention Network (HAPIN) Trial. We explored associations of 24-h average personal exposure to fine particulate matter (PM2.5), black carbon (BC), and carbon monoxide (CO) with BMI through single pollutant linear and logistic models adjusted for potential confounders (i.e., age, socioeconomic indicators, education, dietary diversity, secondhand smoke exposure, alcohol and grain consumption).Sensitivity analyses explored air pollutants as quartiles, and other variables as potential confounders, such as physical activity, enrollment site, and dietary items. We examined effect modification of research site on the associations. Results: We observed mixed evidence of associations between household air pollution and BMI in linear regression. There was no association with BMI and PM₂.₅ (1-unit increase in log-transformed PM₂.₅ estimate 0.02 kg/m2 [95\% CI: -0.51, 0.54]) or CO (1-unit increase in log-transformed CO estimate 0.42 kg/m2 [95\% CI -0.31, 1.14]). However, a 1-unit increase in log-transformed BC showed an association in the opposite direction as hypothesized (BC estimate -0.59 kg/m2 [95\% CI -1.17, -0.003]). Using logistic regression models, we found that only CO significantly increased the odds of overweight/obesity: a 1-unit increase in log-transformed CO led to an odds ratio of 1.66 (95\% CI: 1.10, 2.51). Effect modification showed inverse association between BC exposure and BMI in Peru. Conclusions: Evidence suggests a significant association between CO exposure and increased odds of being overweight/obese, whereas impacts of PM2.5 and BC on BMI had null or inverse effects.",

keywords = "Biomass cookstove, BMI, Indoor air pollution, Low-and middle-income countries",

author = "\{the HAPIN Investigators\} and Adolphe Ndikubwimana and William Checkley and Yunyun Chen and Thomas Clasen and Contreras, \{Carmen Luc{\'i}a\} and Anaite Diaz-Artiga and Ephrem Dusabimana and \{de las Fuentes\}, Lisa and Shirin Jabbarzadeh and Michael Johnson and Egide Kalisa and Patrick Karakwende and Miles Kirby and Lovvorn, \{Amy E.\} and McCracken, \{John P.\} and Florien Ndagijimana and Theoneste Ntakirutimana and Ntivuguruzwa, \{Jean Dieu\} and Peel, \{Jennifer L.\} and Ajay Pillarisetti and D{\'a}vila-Rom{\'a}n, \{Victor G.\} and Ghislaine Rosa and Garg, \{Sarada S.\} and Lisa Thompson and Waller, \{Lance A.\} and Jiantong Wang and Clark, \{Maggie L.\} and Young, \{Bonnie N.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = jun,

day = "10",

doi = "10.1186/s12889-025-23380-1",

language = "English",

volume = "25",

journal = "BMC Public Health",

issn = "1472-698X",

publisher = "BioMed Central Ltd",

number = "1",

}

the HAPIN Investigators, Ndikubwimana, A, Checkley, W, Chen, Y, Clasen, T, Contreras, CL, Diaz-Artiga, A, Dusabimana, E, de las Fuentes, L, Jabbarzadeh, S, Johnson, M, Kalisa, E, Karakwende, P, Kirby, M, Lovvorn, AE, McCracken, JP, Ndagijimana, F, Ntakirutimana, T, Ntivuguruzwa, JD, Peel, JL, Pillarisetti, A, Dávila-Román, VG, Rosa, G, Garg, SS, Thompson, L, Waller, LA, Wang, J, Clark, ML & Young, BN 2025, 'Exposure–response relationship of household air pollution on body mass index among women in rural areas of Guatemala, India, Peru and Rwanda: household air pollution intervention network trial', BMC Public Health, vol. 25, no. 1, 2163. https://doi.org/10.1186/s12889-025-23380-1

Exposure–response relationship of household air pollution on body mass index among women in rural areas of Guatemala, India, Peru and Rwanda: household air pollution intervention network trial. / the HAPIN Investigators; Ndikubwimana, Adolphe; Checkley, William et al.
In: BMC Public Health, Vol. 25, No. 1, 2163, 10.06.2025.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Exposure–response relationship of household air pollution on body mass index among women in rural areas of Guatemala, India, Peru and Rwanda

T2 - household air pollution intervention network trial

AU - the HAPIN Investigators

AU - Ndikubwimana, Adolphe

AU - Checkley, William

AU - Chen, Yunyun

AU - Clasen, Thomas

AU - Contreras, Carmen Lucía

AU - Diaz-Artiga, Anaite

AU - Dusabimana, Ephrem

AU - de las Fuentes, Lisa

AU - Jabbarzadeh, Shirin

AU - Johnson, Michael

AU - Kalisa, Egide

AU - Karakwende, Patrick

AU - Kirby, Miles

AU - Lovvorn, Amy E.

AU - McCracken, John P.

AU - Ndagijimana, Florien

AU - Ntakirutimana, Theoneste

AU - Ntivuguruzwa, Jean Dieu

AU - Peel, Jennifer L.

AU - Pillarisetti, Ajay

AU - Dávila-Román, Victor G.

AU - Rosa, Ghislaine

AU - Garg, Sarada S.

AU - Thompson, Lisa

AU - Waller, Lance A.

AU - Wang, Jiantong

AU - Clark, Maggie L.

AU - Young, Bonnie N.

PY - 2025/6/10

Y1 - 2025/6/10

N2 - Background: Household air pollution from burning biomass materials, the main cooking fuel in low- and middle-income countries, may be linked to metabolic dysfunction. We assessed cross-sectional associations between household air pollution and body mass index (BMI), expecting to see increased BMI with higher pollution concentrations. Methods: We analyzed data from 414 women aged 40 to 79 years who resided in the households using biomass fuel and were enrolled in the multi-country Household Air Pollution Intervention Network (HAPIN) Trial. We explored associations of 24-h average personal exposure to fine particulate matter (PM2.5), black carbon (BC), and carbon monoxide (CO) with BMI through single pollutant linear and logistic models adjusted for potential confounders (i.e., age, socioeconomic indicators, education, dietary diversity, secondhand smoke exposure, alcohol and grain consumption).Sensitivity analyses explored air pollutants as quartiles, and other variables as potential confounders, such as physical activity, enrollment site, and dietary items. We examined effect modification of research site on the associations. Results: We observed mixed evidence of associations between household air pollution and BMI in linear regression. There was no association with BMI and PM₂.₅ (1-unit increase in log-transformed PM₂.₅ estimate 0.02 kg/m2 [95% CI: -0.51, 0.54]) or CO (1-unit increase in log-transformed CO estimate 0.42 kg/m2 [95% CI -0.31, 1.14]). However, a 1-unit increase in log-transformed BC showed an association in the opposite direction as hypothesized (BC estimate -0.59 kg/m2 [95% CI -1.17, -0.003]). Using logistic regression models, we found that only CO significantly increased the odds of overweight/obesity: a 1-unit increase in log-transformed CO led to an odds ratio of 1.66 (95% CI: 1.10, 2.51). Effect modification showed inverse association between BC exposure and BMI in Peru. Conclusions: Evidence suggests a significant association between CO exposure and increased odds of being overweight/obese, whereas impacts of PM2.5 and BC on BMI had null or inverse effects.

AB - Background: Household air pollution from burning biomass materials, the main cooking fuel in low- and middle-income countries, may be linked to metabolic dysfunction. We assessed cross-sectional associations between household air pollution and body mass index (BMI), expecting to see increased BMI with higher pollution concentrations. Methods: We analyzed data from 414 women aged 40 to 79 years who resided in the households using biomass fuel and were enrolled in the multi-country Household Air Pollution Intervention Network (HAPIN) Trial. We explored associations of 24-h average personal exposure to fine particulate matter (PM2.5), black carbon (BC), and carbon monoxide (CO) with BMI through single pollutant linear and logistic models adjusted for potential confounders (i.e., age, socioeconomic indicators, education, dietary diversity, secondhand smoke exposure, alcohol and grain consumption).Sensitivity analyses explored air pollutants as quartiles, and other variables as potential confounders, such as physical activity, enrollment site, and dietary items. We examined effect modification of research site on the associations. Results: We observed mixed evidence of associations between household air pollution and BMI in linear regression. There was no association with BMI and PM₂.₅ (1-unit increase in log-transformed PM₂.₅ estimate 0.02 kg/m2 [95% CI: -0.51, 0.54]) or CO (1-unit increase in log-transformed CO estimate 0.42 kg/m2 [95% CI -0.31, 1.14]). However, a 1-unit increase in log-transformed BC showed an association in the opposite direction as hypothesized (BC estimate -0.59 kg/m2 [95% CI -1.17, -0.003]). Using logistic regression models, we found that only CO significantly increased the odds of overweight/obesity: a 1-unit increase in log-transformed CO led to an odds ratio of 1.66 (95% CI: 1.10, 2.51). Effect modification showed inverse association between BC exposure and BMI in Peru. Conclusions: Evidence suggests a significant association between CO exposure and increased odds of being overweight/obese, whereas impacts of PM2.5 and BC on BMI had null or inverse effects.

KW - Biomass cookstove

KW - BMI

KW - Indoor air pollution

KW - Low-and middle-income countries

U2 - 10.1186/s12889-025-23380-1

DO - 10.1186/s12889-025-23380-1

M3 - Article

C2 - 40495115

AN - SCOPUS:105007775016

SN - 1472-698X

VL - 25

JO - BMC Public Health

JF - BMC Public Health

IS - 1

M1 - 2163

ER -

Exposure–response relationship of household air pollution on body mass index among women in rural areas of Guatemala, India, Peru and Rwanda: household air pollution intervention network trial

Abstract

UN SDGs

Keywords

Access to Document

Fingerprint

Cite this