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

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 NDVImax 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.