Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China.
Department of Epidemiology, Saint Louis University, Saint Louis, MO, USA.
Lancet Planet Health. 2018 Feb;2(2):e64-e73. doi: 10.1016/S2542-5196(18)30001-9. Epub 2018 Feb 9.
Health effects of air pollution on diabetes have been scarcely studied in developing countries. We aimed to explore the associations of long-term exposure to ambient particulate matter (PM) and gaseous pollutants with diabetes prevalence and glucose-homoeostasis markers in China.
Between April 1 and Dec 31, 2009, we recruited a total of 15 477 participants aged 18-74 years using a random number generator and a four-staged, stratified and cluster sampling strategy from a large cross-sectional study (the 33 Communities Chinese Health Study) from three cities in Liaoning province, northeastern China. Fasting and 2 h insulin and glucose concentrations and the homoeostasis model assessment of insulin resistance index and β-cell function were used as glucose-homoeostasis markers. Diabetes was defined according to the American Diabetes Association's recommendations. We calculated exposure to air pollutants using data from monitoring stations (PM with an aerodynamic diameter of 10 μm or less [PM], sulphur dioxide, nitrogen dioxide, and ozone) and a spatial statistical model (PM with an aerodynamic diameter of 1 μm or less [PM] and 2·5 μm or less [PM]). We used two-level logistic regression and linear regression analyses to assess associations between exposure and outcomes, controlling for confounders.
All the studied pollutants were significantly associated with increased diabetes prevalence (eg, the adjusted odds ratios associated with an increase in IQR for PM, PM, and PM were 1·13, 95% CI 1·04-1·22; 1·14, 1·03-1·25; and 1·20, 1·12-1·28, respectively). These air pollutants were also associated with higher concentrations of fasting glucose (0·04-0·09 mmol/L), 2 h glucose (0·10-0·19 mmol/L), and 2 h insulin (0·70-2·74 μU/L). No association was observed for the remaining biomarkers. Stratified analyses indicated greater effects on the individuals who were younger (<50 years) or overweight or obese.
Long-term exposure to air pollution was associated with increased risk of diabetes in a Chinese population, particularly in individuals who were younger or overweight or obese.
The National Key Research and Development Program of China, the National Natural Science Foundation of China, the Fundamental Research Funds for the Central Universities, the Guangdong Province Natural Science Foundation, the Career Development Fellowship of Australian National Health and Medical Research Council, and the Early Career Fellowship of Australian National Health and Medical Research Council.
空气污染对糖尿病的健康影响在发展中国家鲜有研究。本研究旨在探索中国大气颗粒物（PM）和气态污染物长期暴露与糖尿病患病率及血糖稳态标志物之间的关联。
2009 年 4 月 1 日至 12 月 31 日，我们采用随机数字生成法和四阶段、分层和聚类抽样策略，从中国东北地区辽宁省的三个城市的一项大型横断面研究（33 社区中国健康研究）中招募了总计 15477 名年龄在 18-74 岁之间的参与者。空腹和 2 小时胰岛素及血糖浓度以及稳态模型评估的胰岛素抵抗指数和β细胞功能被用作血糖稳态标志物。根据美国糖尿病协会的建议，我们将糖尿病定义为空腹血糖受损或糖尿病。我们使用监测站的数据（空气动力学直径为 10μm 或以下的颗粒物[PM]、二氧化硫、二氧化氮和臭氧）和空间统计模型（空气动力学直径为 1μm 或以下的颗粒物[PM]和 2.5μm 或以下的颗粒物[PM]）计算污染物暴露情况。我们采用两水平逻辑回归和线性回归分析来评估暴露与结局之间的关联，并控制混杂因素。
所有研究中的污染物均与糖尿病患病率升高显著相关（例如，与 PM、PM 和 PM 每增加一个 IQR 相关的校正比值比分别为 1.13、95%CI 1.04-1.22；1.14、1.03-1.25；1.20、1.12-1.28）。这些空气污染物还与空腹血糖（0.04-0.09mmol/L）、2 小时血糖（0.10-0.19mmol/L）和 2 小时胰岛素（0.70-2.74μU/L）浓度升高相关。其余的生物标志物未观察到关联。分层分析表明，对年龄较小（<50 岁）、超重或肥胖的个体影响更大。
在中国人群中，长期暴露于空气污染与糖尿病风险增加相关，尤其是在年龄较小或超重或肥胖的个体中。
中国国家重点研发计划、中国国家自然科学基金、中央高校基本科研业务费、广东省自然科学基金、澳大利亚国家健康与医学研究理事会职业发展奖学金、澳大利亚国家健康与医学研究理事会早期职业发展奖学金。
