Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China.
Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China.
Sci Total Environ. 2019 Jun 20;670:41-49. doi: 10.1016/j.scitotenv.2019.03.192. Epub 2019 Mar 14.
Epidemiological studies have shown that exposure to phthalates (PAEs) is associated with type 2 diabetes mellitus (T2DM) and related markers, but limited evidence has been found in Chinese people. Given that China has the highest number of people with DM and Chinese people show relatively higher exposure levels of PAEs, a case-control study was conducted in China to explore the associations of PAE exposure with T2DM and two glycemic indicators, including fasting glucose and glycosylated hemoglobin (HbA1c). Two hundred fifty people with T2DM and 250 controls were recruited in this study. Multivariable logistic regression analyses showed significant positive associations between urinary concentrations of most studied PAE metabolites (mPAEs) and T2DM, with odd ratios comparing extreme mPAEs quartiles ranging from 2.09 to 40.53, whereas two secondary metabolites, mono (2-ethyl-5-carboxypentyl) phthalate and mono [(2-carboxymethyl) hexyl] phthalate showed significant inverse relationships with T2DM. In addition, multivariable linear regression analyses showed that urinary concentrations of mono (2-ethyl-5-hydroxyhexyl) phthalate were positively associated with HbA1c levels in controls (β = 0.013; 95% CI: 0.003, 0.023). A significant positive association was also observed for urinary mono (2-ethylhexyl) phthalate and fasting glucose (β = 0.009; 95% CI: 0.002, 0.016). In the stratified analyses, the significant associations of mPAEs with T2DM were more likely to be observed in the younger people, compared to the older people. The significant positive associations between urinary mPAEs and HbA1c levels were more likely to be found in the lower body mass index (BMI) subgroup. Additionally, urinary specific mPAEs were found to be significantly positively related to fasting glucose in males and the older people. The findings suggest that exposure to PAEs is associated with T2DM, fasting glucose, and HbA1c levels in Chinese people and the associations of exposure to PAEs with T2DM, fasting glucose, and HbA1c may differ between sexes, BMIs, or ages.
流行病学研究表明，邻苯二甲酸酯（PAEs）暴露与 2 型糖尿病（T2DM）和相关标志物有关，但在中国人群中发现的证据有限。鉴于中国是糖尿病患者人数最多的国家，且中国人的 PAEs 暴露水平相对较高，因此在中国进行了一项病例对照研究，以探讨 PAE 暴露与 T2DM 及两个血糖指标（空腹血糖和糖化血红蛋白（HbA1c））的关系。本研究共纳入 250 例 T2DM 患者和 250 例对照者。多变量 logistic 回归分析显示，大多数研究的 PAE 代谢物（mPAEs）尿浓度与 T2DM 呈显著正相关，极端 mPAEs 四分位距的比值范围从 2.09 到 40.53，而两种次要代谢物，单（2-乙基-5-羧基戊基）邻苯二甲酸酯和单[（2-羧甲基）己基]邻苯二甲酸酯与 T2DM 呈显著负相关。此外，多变量线性回归分析显示，对照组中尿中单（2-乙基-5-羟己基）邻苯二甲酸酯浓度与 HbA1c 水平呈正相关（β=0.013；95%CI：0.003，0.023）。尿中单（2-乙基己基）邻苯二甲酸酯和空腹血糖也呈显著正相关（β=0.009；95%CI：0.002，0.016）。在分层分析中，与老年人相比，mPAEs 与 T2DM 的显著相关性更可能在年轻人中观察到。尿 mPAEs 与 HbA1c 水平之间的显著正相关更可能在较低的体重指数（BMI）亚组中发现。此外，在男性和老年人中，尿特定 mPAEs 与空腹血糖呈显著正相关。这些发现表明，PAEs 暴露与中国人群的 T2DM、空腹血糖和 HbA1c 水平有关，PAEs 暴露与 T2DM、空腹血糖和 HbA1c 之间的关系可能因性别、BMI 或年龄而异。
