Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Environ Sci Pollut Res Int. 2019 Apr;26(10):9435-9442. doi: 10.1007/s11356-019-04373-1. Epub 2019 Feb 8.
This study aims to provide an overview of human studies on the association of exposure to phthalates and insulin resistance. We systematically searched human studies available until 15 January 2018.We conducted a literature search in Scopus, ISI Web of Science, PubMed, Google Scholar, and Cochrane Collaboration. We used the following keywords to identify relevant articles: "phthalate", "phthalate ester", "metabolic syndrome", "insulin resistance", "glucose intolerance", and "diabetes". For analyzing data, we conducted meta-analysis using the Stata software. We appraised each study to examine the sources of heterogeneity, including difference in clinical outcomes and exposure measurements. To determine the robustness and whether some of the factors have the highest impact on the results of the present meta-analysis, several sensitivity analyses were conducted. Sensitivity analysis showed that by removing studies with the highest weight and age groups, no change was observed in heterogeneity. Moreover, with excluding the study conducted in Europe, the results remained unchanged and constant. In addition, the funnel plot and Egger's tests were executed to access publication bias. Both the funnel plots and Egger's test did not show any evidence of publication bias (P = 0.31). In the random effects meta-analysis of all studies (n = 8), the pooled correlation coefficient between phthalate exposure and HOMA-IR was 0.10 (95% CI; 0.07-0.12, P < 0.001), with significant heterogeneity (P < 0.001, I = 85.5%). Our findings revealed positive association between exposure to phthalate metabolites and increased HOMA-IR; this association remained significant even after adjusting the analysis for multiple confounding variables.
本研究旨在提供有关人类暴露于邻苯二甲酸酯与胰岛素抵抗之间关联的研究综述。我们系统地检索了截至 2018 年 1 月 15 日的人类研究。我们在 Scopus、ISI Web of Science、PubMed、Google Scholar 和 Cochrane 协作数据库中进行了文献检索。我们使用以下关键词来识别相关文章：“邻苯二甲酸酯”、“邻苯二甲酸酯酯”、“代谢综合征”、“胰岛素抵抗”、“葡萄糖耐量异常”和“糖尿病”。为了分析数据，我们使用 Stata 软件进行了荟萃分析。我们评估了每项研究，以检查异质性的来源，包括临床结局和暴露测量的差异。为了确定稳健性以及某些因素对本荟萃分析结果的影响最大，我们进行了几项敏感性分析。敏感性分析表明，通过去除权重最高和年龄组最大的研究，异质性没有变化。此外，排除在欧洲进行的研究后，结果仍然不变且稳定。此外，我们还执行了漏斗图和 Egger 检验来评估发表偏倚。漏斗图和 Egger 检验均未显示出发表偏倚的任何证据（P=0.31）。在所有研究（n=8）的随机效应荟萃分析中，邻苯二甲酸酯暴露与 HOMA-IR 之间的合并相关系数为 0.10（95%CI：0.07-0.12，P<0.001），具有显著的异质性（P<0.001，I=85.5%）。我们的研究结果表明，邻苯二甲酸酯代谢物的暴露与 HOMA-IR 的增加之间存在正相关；即使在对多个混杂变量进行分析调整后，这种关联仍然显著。
