Dietary Intake Modifies the Association between Air Pollution and Chronic Diseases: A Systematic Review and Meta-analysis
Abstract
Interaction effects between dietary factors and air pollutants remain inconsistent. This systematic review and meta-analysis examined whether dietary intake modifies the air pollution-chronic disease risk association. This study searched PubMed, Embase, Web of Science, and the Cochrane from inception to May 2026. A total of 51 observational studies (cohort, case-control, and cross-sectional), comprising 9,956,549 participants, that examined the modifying effect of dietary intake on the association between air pollution exposure and chronic disease risk through stratified analyses were included. Stratum-specific pooled odds ratios (pORs) per 5 μg/m3 pollutant increase were estimated using random-effects models, whereas effect modification was assessed using deft analysis by pooling study-specific within-study interaction estimates. Particulate matter (PM) increased cardiovascular disease risk by 7%, attenuated by greater adherence to healthy dietary patterns (HDPs, P-int X) increased chronic respiratory disease risk by 20% and 7%, respectively, attenuated by omega-3 (n-3) fatty acids (P-int = 0.002, pOR 1.05 compared with 1.09), and amplified by unhealthy dietary patterns (UDPs) and ω-6 fatty acids. PM and NOX increased metabolic disorder risk by 19% and 13%, respectively, attenuated by HDPs (PM: P-int X: P-int X exposure and chronic disease risk. This review was registered in PROSPERO as CRD420251148066.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 9,956,549 participants or records.
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