Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Department of Epidemiology, Boston University School of Public Health, Boston, USA.
Environ Int. 2022 Jan;158:106920. doi: 10.1016/j.envint.2021.106920. Epub 2021 Oct 7.
Cadmium exposure has been associated with increased diabetes risk in several studies, though there is still considerable debate about the magnitude and shape of the association.
To perform a systematic review and meta-analysis of observational studies investigating the relation between cadmium exposure and risk of type 2 diabetes and prediabetes, and to summarize data on the magnitude and shape of the association.
After conducting an online literature search through October 1, 2021, we identified 42 eligible studies investigating the association between cadmium exposure and risk of diabetes and prediabetes.
We included studies that assessed cadmium exposure through biomarker levels; examined type 2 diabetes or prediabetes among outcomes; and reported effect estimates for cadmium exposure for meta-analysis only.
Studies were evaluated using ROBINS-E risk of bias tool. We quantitively assessed the relation between exposure and study outcomes using one-stage dose-response meta-analysis with a random effects meta-analytical model.
In the meta-analysis, comparing highest-versus-lowest cadmium exposure levels, summary relative risks (RRs) for type 2 diabetes were 1.24 (95% confidence interval 0.96-1.59), 1.21 (1.00-1.45), and 1.47 (1.01-2.13) for blood, urinary, and toenail matrices, respectively. Similarly, there was an increased risk of prediabetes for cadmium concentrations in both urine (RR = 1.41, 95% CI: 1.15-1.73) and blood (RR = 1.38, 95% CI: 1.16-1.63). In the dose-response meta-analysis, we observed a consistent linear positive association between cadmium exposure and diabetes risk, with RRs of 1.25 (0.90-1.72) at 2.0 µg/g of creatinine. Conversely for blood cadmium, diabetes risk appeared to increase only above 1 µg/L. Prediabetes risk increased up to approximately 2 µg/g creatinine above which it reached a plateau with RR of 1.42 (1.12-1.76) at 2 µg/g creatinine.
This analysis provides moderate-certainty evidence for a positive association between cadmium exposure (measured in multiple matrices) and risk of both diabetes and prediabetes.
已有多项研究表明，镉暴露与糖尿病风险增加有关，但关于这种关联的程度和形态仍存在很大争议。
对观察性研究进行系统评价和荟萃分析，调查镉暴露与 2 型糖尿病和糖尿病前期风险之间的关系，并总结关联程度和形态的数据。
截至 2021 年 10 月 1 日，我们通过在线文献搜索确定了 42 项符合条件的研究，这些研究调查了镉暴露与糖尿病和糖尿病前期风险之间的关系。
我们纳入了通过生物标志物水平评估镉暴露的研究；以 2 型糖尿病或糖尿病前期为结局；并且仅报告了用于荟萃分析的镉暴露的效应估计值。
使用 ROBINS-E 风险偏倚工具评估研究。我们使用具有随机效应荟萃分析模型的一阶剂量-反应荟萃分析定量评估暴露与研究结局之间的关系。
在荟萃分析中，与最高镉暴露水平相比，血液、尿液和趾甲基质中 2 型糖尿病的汇总相对风险（RR）分别为 1.24（95%置信区间 0.96-1.59）、1.21（1.00-1.45）和 1.47（1.01-2.13）。同样，尿液（RR=1.41，95%CI：1.15-1.73）和血液（RR=1.38，95%CI：1.16-1.63）中镉浓度升高与糖尿病前期风险增加有关。在剂量-反应荟萃分析中，我们观察到镉暴露与糖尿病风险之间存在一致的线性正相关，肌酐 2.0μg/g 时 RR 为 1.25（0.90-1.72）。相反，对于血液中的镉，糖尿病风险似乎仅在 1μg/L 以上才会增加。糖尿病前期风险在肌酐 2μg/g 以上增加到约 2μg/g 时达到平台，RR 为 1.42（1.12-1.76）。
这项分析提供了中等确定性证据，表明镉暴露（在多个基质中测量）与 2 型糖尿病和糖尿病前期风险均呈正相关。
