Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
Environ Res. 2019 Jul;174:35-45. doi: 10.1016/j.envres.2019.04.017. Epub 2019 Apr 19.
Persistent organic pollutants (POPs) have been associated with type 2 diabetes (T2D), but causality is uncertain.
Within longitudinal population-based data from northern Sweden, we assessed how POPs associated with T2D prospectively and cross-sectionally, and further investigated factors related to individual changes in POP concentrations.
For 129 case-controls pairs matched by age, sex and date of sampling, plasma concentrations of hexachlorobenzene (HCB), dichlorodiphenyl-dichloroethylene (p,p'-DDE), dioxin-like (DL) polychlorinated biphenyl congeners (PCB-118 and PCB-156), and non-dioxin like (NDL-PCB: PCB-74, -99, -138 -153, -170, -180, -183 and PCB-187) were analyzed twice (baseline and follow-up, 9-20 years apart). The cases received their T2D diagnose between baseline and follow-up. Prospective (using baseline data) and cross-sectional (using follow-up data) odds ratios (ORs) for T2D on lipid standardized POPs (HCB, p,p'-DDE, ∑DL-PCBs, ∑NDL-PCBs) were estimated using conditional logistic regression, adjusting for body mass index (BMI) and plasma lipids. The influence of BMI, weight-change, and plasma lipids on longitudinal changes in POP concentrations were evaluated among non-diabetic individuals (n = 306).
POPs were associated with T2D in both the prospective and cross-sectional assessments. Of a standard deviation increase in POPs, prospective ORs ranged 1.42 (95% CI: 0.99, 2.06) for ∑NDL-PCBs to 1.55 (95% CI: 1.01, 2.38) for HCB (p < 0.05 only for HCB), and cross-sectional ORs ranged 1.62 (95% CI: 1.13; 2.32) for p,p'-DDE to 2.06 (95% CI: 1.29, 3.28) for ∑DL-PCBs (p < 0.05 for all POPs). In analyses of non-diabetic individuals, higher baseline BMI, decreased weight and decreased plasma lipid concentrations were associated with a slower decrease of POPs. Cases had, besides a higher BMI, reduced cholesterol and weight gain at follow-up compared to controls, which can explain the higher ORs in the cross-sectional assessments.
The association between POPs and T2D was confirmed, but an indication that individuals body fat history might influence POP-T2D associations weakens the epidemiological support for a causal association. It also warrants studies based on other exposure metrics than biomonitoring. In addition, we note that a cross-sectional design overestimates the ORs if T2D cases have successfully intervened on weight and/or blood lipids, as changes in these factors cause changes in POPs.
持久性有机污染物 (POPs) 与 2 型糖尿病 (T2D) 有关，但因果关系尚不确定。
在来自瑞典北部的基于人群的纵向人群数据中，我们评估了 POPs 如何前瞻性和横断面地与 T2D 相关，并且进一步研究了与个体 POP 浓度变化相关的因素。
对于 129 对年龄、性别和采样日期匹配的病例对照，我们分析了血浆中六氯苯 (HCB)、二氯二苯二氯乙烯 (p,p'-DDE)、类二恶英 (DL) 多氯联苯同系物 (PCB-118 和 PCB-156) 和非二恶英类 (NDL-PCB：PCB-74、-99、-138-153、-170、-180、-183 和 PCB-187) 的浓度，共进行了两次分析（基线和随访，相隔 9-20 年）。病例在基线和随访之间接受了 T2D 诊断。使用条件逻辑回归，根据体重指数 (BMI) 和血浆脂质，估计 T2D 前瞻性（使用基线数据）和横断面（使用随访数据）的脂质标准化 POPs（HCB、p,p'-DDE、∑DL-PCBs、∑NDL-PCBs）的比值比 (OR)。在非糖尿病个体（n=306）中评估了 BMI、体重变化和血浆脂质对 POP 浓度纵向变化的影响。
POPs 在前瞻性和横断面评估中均与 T2D 相关。在 POPs 标准偏差增加的情况下，前瞻性 OR 范围从∑NDL-PCBs 的 1.42（95%CI：0.99，2.06）到 HCB 的 1.55（95%CI：1.01，2.38）（仅 HCB 有统计学意义），横断面 OR 范围从 p,p'-DDE 的 1.62（95%CI：1.13；2.32）到∑DL-PCBs 的 2.06（95%CI：1.29，3.28）（所有 POPs 均有统计学意义）。在非糖尿病个体的分析中，较高的基线 BMI、体重减轻和血浆脂质浓度降低与 POP 下降速度较慢相关。与对照组相比，病例在随访时的 BMI 较高，胆固醇和体重增加，这可以解释横断面评估中更高的 OR。
POPs 与 T2D 之间的关联得到了证实，但个体体脂史可能影响 POP-T2D 关联的证据削弱了因果关联的流行病学支持。这也需要基于生物监测以外的其他暴露指标进行研究。此外，我们注意到，如果 T2D 病例成功干预了体重和/或血脂，那么横断面设计会高估 OR，因为这些因素的变化会导致 POP 的变化。
