Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, USA.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Environ Int. 2015 Mar;76:57-70. doi: 10.1016/j.envint.2014.12.001. Epub 2014 Dec 26.
Over half of the people with diabetes in the world live in Asia. Emerging scientific evidence suggests that diabetes is associated with environmental pollutants, exposures that are also abundant in Asia.
To systematically review the literature concerning the association of persistent organic pollutants (POPs) and non-persistent pesticides with diabetes and diabetes-related health outcomes in Asia.
PubMed and Embase were searched to identify studies published up to November 2014. A secondary reference review of all extracted articles and the National Toxicology Program Workshop on the association of POPs with diabetes was also conducted. A total of 19 articles met the inclusion criteria and were evaluated in this review.
To date, the evidence relating POPs and non-persistent pesticides with diabetes in Asian populations is equivocal. Positive associations were reported between serum concentrations of polychlorinated dibenzodioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), and several organochlorine pesticides (DDT, DDE, oxychlordane, trans-nonachlor, hexachlorobenzene, hexachlorocyclohexane) with diabetes. PCDD/Fs were also associated with blood glucose and insulin resistance, but not beta-cell function. There were substantial limitations of the literature including: most studies were cross-sectional, few studies addressed selection bias and confounding, and most effect estimates had exceptionally wide confidence intervals. Few studies evaluated the effects of organophosphates.
Well-conducted research is urgently needed on these pervasive exposures to inform policies to mitigate the diabetes epidemic in Asia.
全世界超过一半的糖尿病患者生活在亚洲。新出现的科学证据表明，糖尿病与环境污染物有关，而这些污染物在亚洲也很普遍。
系统综述有关持久性有机污染物（POPs）和非持久性农药与亚洲人群糖尿病及糖尿病相关健康结局的关系的文献。
检索 PubMed 和 Embase，以获取截至 2014 年 11 月发表的研究。还对所有提取的文章进行了二次参考文献审查以及国家毒理学计划关于 POPs 与糖尿病关系的研讨会。共有 19 篇文章符合纳入标准并在本综述中进行了评估。
迄今为止，与亚洲人群中 POPs 和非持久性农药与糖尿病的关系的证据尚无定论。有研究报告称，血清中二恶英（PCDD/Fs）、多氯联苯（PCBs）和几种有机氯农药（DDT、DDE、氧氯丹、反式-十氯酮、六氯苯、六氯环己烷）的浓度与糖尿病呈正相关。PCDD/Fs 还与血糖和胰岛素抵抗有关，但与β细胞功能无关。该文献存在诸多局限性，包括：大多数研究为横断面研究，少数研究涉及选择偏倚和混杂因素，且大多数效应估计值的置信区间非常宽。很少有研究评估有机磷酸酯的影响。
迫切需要对这些普遍存在的暴露进行良好设计的研究，以制定政策来减轻亚洲的糖尿病流行。
