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Evidence concerning exposure to air pollution and visual impairment is scarce. We evaluated the associations of ambient air pollution with visual impairment and visual acuity levels in Chinese schoolchildren. We recruited 61,995 children from 7 provinces/municipalities across China. Concentrations of air pollutants (i.e., particulate matter with an aerodynamic diameter of ≤ 1.0 µm [PM 1 ], ≤ 2.5 µm [PM 2.5 ], and 10 µm [PM 10 ] as well as nitrogen dioxides [NO 2 ]) were measured using machine learning methods. Visual acuity levels were measured using standard protocols. We used SAS PROC SURVEYLOGISTIC to assess the association between air pollution and visual impairment. An interquartile range increase in PM 1 , PM 2.5 , PM 10 , and NO 2 was associated with a 1.133- (95% CI, 1.035-1.240), 1.267- (95% CI, 1.082-1.484), 1.142- (95% CI, 1.019-1.281), and 1.276-fold (95% CI, 1.173-1.388) increased odds of visual impairment, and the associations were stronger in children being boys, older, living in rural areas, and born to parents who had a lower educational level or smoked, compared to their counterparts. These results suggest that exposure to air pollution were positively associated with the odds of visual impairment, and the association may be modified by children's age, sex, and residential area as well as parental education level and cigarette smoking. ga1 • A total of 61,995 Children from 7 Chinese provinces/municipalities were recruited. • Visual acuity was measured according to standard protocol. • Concentrations of four air pollutants were measured using machine-learning methods. • Air pollution was significantly associated with higher odds of visual impairment. • The association may be modified by both demographic and lifestyle factors. [ABSTRACT FROM AUTHOR]

• Few studies have explored the effects of air pollution on metabolic syndrome (MetS) in children. • We studied 9,897 Chinese children in a national cross-sectional study. • Long-term exposures to PM 2.5 , PM 10 , and NO 2 were positively associated with MetS. • PM 1 and NO 2 were related to elevated risk of fasting blood glucose and abdominal obesity. The prevalence of metabolic syndrome (MetS) rapidly increased over the past decades. However, little evidence exists about the effects of long-term exposure to ambient air pollution on MetS in children and adolescents. This study aims to assess the association between long-term ambient air pollution and the prevalence of MetS in a large population of Chinese children and adolescents. In 2013, a total of 9,897 children and adolescents aged 10 to 18 years were recruited from seven provinces/municipalities in China. MetS was defined based on the recommendation by the International Diabetes Federation (IDF). Satellite based spatio-temporal models were used to estimate exposure to ambient air pollution (including particles with diameters ≤1.0 µm (PM 1), ≤2.5 µm (PM 2.5), and ≤10 µm (PM 10), and nitrogen dioxide (NO 2)). Individual exposure was calculated according to 94 schools addresses. After adjustment for a range of covariates, generalized linear mixed-effects models were utilized to evaluate the associations between air pollutants and the prevalence of MetS and its components. In addition, several stratified analyses were examined according to sex, weight status, outdoor physical activity time, and sugar-sweetened beverages (SSBs) intake. The prevalence of MetS was 2.8%. The odds ratio of MetS associated with a 10 μg/m3 increase in PM 1 , PM 2.5 , PM 10 and NO 2 was 1.20 (95%CI: 0.99, 1.46), 1.31 (95%CI: 1.05, 1.64), 1.32 (95%CI: 1.08, 1.62), and 1.33 (95%CI: 1.03, 1.72), respectively. Regarding the MetS components, we observed associations between all pollutants and abdominal obesity. In addition, long-term PM 1 and NO 2 exposures were associated with the prevalence of elevated fasting blood glucose. Stratified analyses detected that the associations between air pollutants and the prevalence of MetS were stronger in boys (P interaction < 0.05). We found that long-term exposure to PM 2.5 , PM 10 , and NO 2 were positively associated with the prevalence of MetS in children and adolescents. Our findings may have certain public health implications for some comprehensive strategy of environment improvement and lifestyles changes in order to reduce the burden of non-communicable disease. [ABSTRACT FROM AUTHOR]