2 型糖尿病与饮用水中慢性砷暴露的关系：孟加拉国的一项横断面研究。
Association between type 2 diabetes and chronic arsenic exposure in drinking water: a cross sectional study in Bangladesh.
机构信息
Centre for Clinical Epidemiology & Biostatistics-CCEB, The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
出版信息
Environ Health. 2012 Jun 7;11:38. doi: 10.1186/1476-069X-11-38.
BACKGROUND
Chronic exposure to high level of inorganic arsenic in drinking water has been associated with Type 2 Diabetes (T2D). Most research has been ecological in nature and has focused on high levels of arsenic exposure with few studies directly measuring arsenic levels in drinking water as an index of arsenic exposure. The effect of low to moderate levels of arsenic exposure on diabetes risk is largely unknown thus our study is adding further knowledge over previous works.
METHODS
This cross sectional study was conducted in 1004 consenting women and men from 1682 eligible participants yielding a participation rate of 60%. These participants are aged >30 years and were living in Bangladesh and had continuously consumed arsenic-contaminated drinking water for at least 6 months. T2D cases were diagnosed using glucometer following the new diagnostic criteria (Fasting Blood Glucose > 126 mg/dl) from the WHO guideline (WHO 2006), or a self-reported physician diagnosis of type 2 diabetes. Association between T2D and chronic arsenic exposure was estimated by multiple logistic regression with adjustment for age, sex, education, Body Mass Index (BMI) and family history of T2D.
RESULTS
A total of 1004 individuals participated in the study. The prevalence of T2D was 9% (95% CI 7-11%). After adjustment for diabetes risk factors, an increased risk of type 2 diabetes was observed for arsenic exposure over 50 μg/L with those in the highest category having almost double the risk of type 2 diabetes (OR=1.9 ; 95% CI 1.1-3.5). For most levels of arsenic exposure, the risk estimates are higher with longer exposure; a dose-response pattern was also observed.
CONCLUSIONS
These findings suggest an association between chronic arsenic exposure through drinking water and T2D. Risks are generally higher with longer duration of arsenic exposure. The risk of T2D is highest among those who were exposed to the highest concentration of arsenic for more than 10 years.
背景
长期饮用高浓度无机砷饮用水与 2 型糖尿病（T2D）有关。大多数研究都是基于生态学性质的，主要关注高砷暴露水平，很少有研究直接测量饮用水中的砷水平作为砷暴露的指标。因此，我们的研究进一步增加了对低至中度砷暴露对糖尿病风险影响的认识。
方法
这项横断面研究在孟加拉国的 1682 名合格参与者中，对 1004 名同意参与的女性和男性进行了研究，参与率为 60%。这些参与者年龄大于 30 岁，并且至少连续 6 个月饮用含砷饮用水。T2D 病例的诊断采用血糖仪，按照 WHO 指南（WHO 2006 年）的新诊断标准（空腹血糖>126mg/dl），或自我报告的 2 型糖尿病医生诊断。使用多因素逻辑回归模型，在调整年龄、性别、教育程度、体重指数（BMI）和 T2D 家族史等因素后，估计 T2D 与慢性砷暴露之间的关系。
结果
共有 1004 人参与了这项研究。T2D 的患病率为 9%（95%CI7-11%）。在调整了糖尿病危险因素后，发现砷暴露量超过 50μg/L 与 2 型糖尿病风险增加相关，最高组的 2 型糖尿病风险几乎增加了一倍（OR=1.9；95%CI1.1-3.5）。对于大多数砷暴露水平，暴露时间越长，风险估计值越高；也观察到了剂量-反应关系。
结论
这些发现表明，通过饮用水摄入慢性砷暴露与 T2D 之间存在关联。随着砷暴露时间的延长，风险通常会增加。在暴露于最高浓度砷超过 10 年的人群中，T2D 的风险最高。
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