Mamtani Manju, Curran Joanne E, Blangero John, Kulkarni Hemant
South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX 78520, USA.
J Diabetes Res. 2016;2016:7269896. doi: 10.1155/2016/7269896. Epub 2015 Dec 20.
Background. An epidemiological association between exposure to phthalates and type 2 diabetes (T2D) is known. However, the potential role of environmental phthalates in the complications of T2D is unknown. Methods. Using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2010, we studied the association of 12 urinary phthalate metabolites with self-reported eye affliction/retinopathy in 1,004 participants with diabetes. Data from retinal imaging was used to validate this outcome. Independence of the phthalates→T2D association was studied by adjusting for age, sex, race, marital status, educational attainment, poverty income ratio, physical activity, glycated hemoglobin levels, total serum cholesterol, serum high-density lipoprotein cholesterol, serum triglycerides, blood pressure, duration of diabetes, total calorie intake, and obesity. Results. Self-reported eye affliction/retinopathy had 82% accuracy with Cohen's kappa of 0.31 (p < 0.001). Urinary mono-n-octyl phthalate (MOP) was independently associated with the likelihood of self-reported eye affliction/retinopathy in subjects with T2D after accounting for all the confounders. This significance of this association was robust to the potential misclassification in cases and controls of retinopathy. Further, a significant dose-response relationship between MOP and self-reported eye affliction/retinopathy was demonstrable. Conclusions. We show a novel epidemiological link between the environment and diabetic complications in NHANES 2001-2010 participants.
背景。已知邻苯二甲酸盐暴露与2型糖尿病（T2D）之间存在流行病学关联。然而，环境邻苯二甲酸盐在T2D并发症中的潜在作用尚不清楚。方法。利用2001 - 2010年美国国家健康与营养检查调查（NHANES）的数据，我们研究了12种尿邻苯二甲酸酯代谢物与1004名糖尿病患者自我报告的眼部疾病/视网膜病变之间的关联。视网膜成像数据用于验证这一结果。通过调整年龄、性别、种族、婚姻状况、教育程度、贫困收入比、身体活动、糖化血红蛋白水平、总血清胆固醇、血清高密度脂蛋白胆固醇、血清甘油三酯、血压、糖尿病病程、总热量摄入和肥胖情况，研究邻苯二甲酸酯→T2D关联的独立性。结果。自我报告的眼部疾病/视网膜病变的准确率为82%，科恩kappa系数为0.31（p < 0.001）。在考虑所有混杂因素后，尿单正辛基邻苯二甲酸酯（MOP）与T2D患者自我报告眼部疾病/视网膜病变的可能性独立相关。这种关联的显著性对于视网膜病变病例和对照中的潜在错误分类具有稳健性。此外，MOP与自我报告的眼部疾病/视网膜病变之间存在显著的剂量反应关系。结论。我们在2001 - 2010年NHANES参与者中发现了环境与糖尿病并发症之间的一种新的流行病学联系。
