Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
German Center for Diabetes Research, Munich-Neuherberg, Germany.
Environ Health Perspect. 2020 Dec;128(12):127013. doi: 10.1289/EHP7311. Epub 2020 Dec 23.
Air pollution contributes to type 2 diabetes and cardiovascular diseases, but its relevance for other complications of diabetes, in particular distal sensorimotor polyneuropathy (DSPN), is unclear. Recent studies have indicated that DSPN is also increasingly prevalent in obesity.
We aimed to assess associations of air pollutants with prevalent and incident DSPN in a population-based study of older individuals with high rates of type 2 diabetes and obesity.
Cross-sectional analyses on prevalent DSPN were based on 1,075 individuals 62-81 years of age from the German Cooperative Health Research in the Region of Augsburg (KORA) F4 survey (2006-2008). Analyses on incident DSPN included 424 individuals without DSPN at baseline (KORA F4), of whom 188 had developed DSPN by the KORA FF4 survey (2013-2014). Associations of annual average air pollutant concentrations at participants' residences with prevalent and incident DSPN were estimated using Poisson regression models with a robust error variance adjusting for multiple confounders.
Higher particle number concentrations (PNCs) were associated with higher prevalence [risk ratio (RR) per interquartile range (IQR) (95% CI: 1.01, 1.20)] and incidence [1.11 (95% CI: 0.99, 1.24)] of DSPN. In subgroup analyses, particulate (PNC, , , , and ) and gaseous (, ) pollutants were positively associated with prevalent DSPN in obese participants, whereas corresponding estimates for nonobese participants were close to the null [e.g., for an IQR increase in PNC, (95% CI: 1.05, 1.31) vs. 1.06 (95% CI: 0.95, 1.19); ]. With the exception of , corresponding associations with incident DSPN were positive in obese participants but null or inverse for nonobese participants, with [e.g., for PNC, (95% CI: 1.08, 1.51) vs. 1.03 (95% CI: 0.90, 1.18); ].
Both particulate and gaseous air pollutants were positively associated with prevalent and incident DSPN in obese individuals. Obesity and air pollution may have synergistic effects on the development of DSPN. https://doi.org/10.1289/EHP7311.
空气污染可导致 2 型糖尿病和心血管疾病，但它与糖尿病的其他并发症（尤其是远端感觉运动性多发性神经病，DSPN）的关系尚不清楚。最近的研究表明，DSPN 在肥胖人群中也越来越普遍。
我们旨在评估在一个以老年人为基础的研究中，空气污染物与高发生率 2 型糖尿病和肥胖人群中普遍存在和新发性 DSPN 的关联。
在德国奥格斯堡合作健康研究地区（KORA）F4 调查（2006-2008 年）中，对 1075 名年龄在 62-81 岁之间的个体进行了 DSPN 的横断面分析。对新发性 DSPN 的分析包括基线时无 DSPN 的 424 名个体（KORA F4），其中 188 名个体在 KORA FF4 调查（2013-2014 年）中发展为 DSPN。使用泊松回归模型估计参与者居住地的年平均空气污染物浓度与普遍存在和新发性 DSPN 的关联，该模型具有稳健的误差方差调整，以考虑多种混杂因素。
较高的颗粒物数浓度（PNC）与较高的流行率（每四分位距的风险比（RR）[95%置信区间（CI）：1.01，1.20]）和发病率（1.11 [95%CI：0.99，1.24]）有关。在亚组分析中，颗粒物质（PNC， ， ， ， 和 ）和气体污染物（ ， ）与肥胖参与者的普遍 DSPN 呈正相关，而对于非肥胖参与者，相应的估计值接近零（例如，PNC 的 IQR 增加 1 个单位，RR 为 1.05 [95%CI：1.01，1.11]）。除了 之外，与新发性 DSPN 的关联在肥胖参与者中为正，但在非肥胖参与者中为零或负，RR 为 1.03 [95%CI：0.90，1.18]）。
颗粒物质和气体空气污染物均与肥胖个体的普遍存在和新发性 DSPN 呈正相关。肥胖和空气污染可能对 DSPN 的发展具有协同作用。https://doi.org/10.1289/EHP7311.
