Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada; Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé. environnement et travail) - UMR_S1085, F-35000, Rennes, France.
Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada.
Environ Res. 2020 May;184:109345. doi: 10.1016/j.envres.2020.109345. Epub 2020 Mar 7.
The body burden of metals and persistent organic pollutants (POPs) is particularly high in populations that rely on fish and other marine species for sustenance. This exposure has been associated with an increased risk of type 2 diabetes, but results remain contrasted.
We studied this association in two Indigenous populations of northern Québec (Canada) with markedly different prevalences of diabetes and levels of exposure to POPs and mercury.
As part of health surveys conducted in 2004-2009, diabetes prevalence and glucose metabolism (glucose, insulin, HOMA-IR, HOMA-B) in non-diabetic fasting adults were assessed using similar protocols in two populations: Inuit from Nunavik (n = 877) and Cree from Eeyou Istchee territory (n = 780). Blood mercury, plasma polychlorinated biphenyls (PCBs), organochlorine (OC) pesticides/metabolites and polybrominated diphenylethers (PBDEs) levels were measured in samples collected at the time of examination. Logistic and linear regressions and restricted cubic splines analyses were conducted adjusting for sex, age, waist circumference, smoking and omega-3 fatty acid content in plasma phospholipids.
Diabetes prevalence was higher in Cree (20%) than in Inuit (7%), whereas environmental exposure was 2 to 3-fold greater in Inuit than in Cree participants. In the range of exposure common to the two populations, we observed similar linear increases in the risk of diabetes with increasing contaminant exposure. Among Cree participants, fasting glucose was positively associated with plasma PBDE level, and HOMA-B negatively associated with concentrations of ∑PCBs, dichlorodiphenyldichloroethylene, PBDEs and ∑OC pesticides. Among Inuit participants, a trend towards reduced insulin secretion was observed in association with most contaminants, but the relation was nonlinear (greater reduction at intermediate levels of exposure). A significant increase in fasting glucose levels was observed at elevated blood mercury levels (>16 μg/L).
The observed association between POPs exposure and diabetes risk in the two populations studied should be confirmed using prospective design. Our results suggest the need for additional research on the physiopathological process through which POPs exposure may induce type 2 diabetes in these Indigenous populations.
以鱼类和其他海洋物种为主要食物来源的人群，其体内的金属和持久性有机污染物（POPs）含量往往较高。这种暴露与 2 型糖尿病风险的增加有关，但结果仍存在差异。
我们在加拿大魁北克省北部两个具有明显不同糖尿病患病率和 POPs 及汞暴露水平的原住民群体中研究了这种关联。
作为 2004-2009 年健康调查的一部分，我们使用相似的方案评估了非糖尿病禁食成年人的糖尿病患病率和葡萄糖代谢（血糖、胰岛素、HOMA-IR、HOMA-B）：努纳武特的因纽特人（n=877）和伊魁特地区的克里人（n=780）。在检查时采集的血液样本中测量了血汞、血浆多氯联苯（PCBs）、有机氯（OC）杀虫剂/代谢物和多溴联苯醚（PBDEs）的水平。使用逻辑回归和线性回归以及受限立方样条分析，调整了性别、年龄、腰围、吸烟和血浆磷脂中ω-3 脂肪酸含量。
克里人的糖尿病患病率（20%）高于因纽特人（7%），而因纽特人的环境暴露水平是克里人的 2-3 倍。在两个群体共有的暴露范围内，我们观察到随着污染物暴露的增加，糖尿病的风险呈相似的线性增加。在克里参与者中，空腹血糖与血浆 PBDE 水平呈正相关，HOMA-B 与 ∑PCBs、二氯二苯二氯乙烯、PBDEs 和 ∑OC 杀虫剂的浓度呈负相关。在因纽特参与者中，观察到随着大多数污染物的暴露，胰岛素分泌呈下降趋势，但这种关系是非线性的（在中等暴露水平下降更大）。在血液汞水平升高（>16μg/L）时，空腹血糖水平显著升高。
在研究的两个群体中，观察到的 POPs 暴露与糖尿病风险之间的关联应使用前瞻性设计加以证实。我们的研究结果表明，需要进一步研究 POPs 暴露如何通过生理病理过程在这些原住民群体中引发 2 型糖尿病。
