普通人群中血清镉与糖尿病之间的关联：一项来自美国国家健康与营养检查调查（1999 - 2020年）的横断面研究。
The association between serum cadmium and diabetes in the general population: A cross-sectional study from NHANES (1999-2020).
作者信息
Gong Rongpeng, Pu Xiaolu, Cheng Zhenqian, Ding Jie, Chen Zhenghao, Wang Yongjun
机构信息
Qinghai University, Xining, Qinghai, China.
Department of Clinical Nutrition, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China.
出版信息
Front Nutr. 2022 Dec 7;9:966500. doi: 10.3389/fnut.2022.966500. eCollection 2022.
BACKGROUND
Associations between serum cadmium and diabetes had been reported in previous studies, however there was still considerable controversy regarding associations. Studies in general population that investigated the effects of serum cadmium on diabetes were currently lacking. We designed this cross-sectional study among U.S. adults under high and low cadmium exposure to assess associations between serum cadmium and diabetes.
METHODS
This cross-sectional study analyzed 52,593 adults who aged more than 20 years and participated in the National Health and Nutrition Examination Survey (NHANES), 1999-2020. The missing values and extreme values in the covariables were filled by multiple interpolation. Univariate logistics regression, multivariate logistics regression and smooth fitting curves were used to analyze the association between serum cadmium and diabetes. Simultaneously, sensitivity analysis was carried out by converting the serum cadmium from continuous variable to categorical variable. The stratification logistics regression model was used to analyze whether there were special groups in each subgroup to test the stability of the results.
RESULTS
In this cross-sectional study, serum cadmium levels were negatively correlated with the occurrence of diabetes in the low serum cadmium exposure group (OR = 0.811, 95% CI 0.698, 0.943; = 0.007). There was no association between serum cadmium level and the occurrence of diabetes in the high serum cadmium exposure group (OR = 1.01, 95% CI 0.982, 1.037; = 0.511). These results were consistent across all the subgroups ( for interaction >0.05).
CONCLUSION
Serum cadmium was negatively associated diabetes among the representative samples of the whole population in the United States under the normal level of serum cadmium exposure. However, there was no association between serum cadmium level and the occurrence of diabetes in the high serum cadmium exposure group. This study promoted an update of new preventative strategy targeting environment for the prevention and control of diabetes in the future.
背景
先前的研究已报道血清镉与糖尿病之间的关联，但关于这种关联仍存在相当大的争议。目前缺乏在一般人群中调查血清镉对糖尿病影响的研究。我们在美国高镉暴露和低镉暴露的成年人中设计了这项横断面研究，以评估血清镉与糖尿病之间的关联。
方法
这项横断面研究分析了52593名年龄超过20岁且参加了1999 - 2020年美国国家健康与营养检查调查（NHANES）的成年人。协变量中的缺失值和极值通过多重插补法进行填补。采用单因素逻辑回归、多因素逻辑回归和平滑拟合曲线分析血清镉与糖尿病之间的关联。同时，通过将血清镉从连续变量转换为分类变量进行敏感性分析。采用分层逻辑回归模型分析各亚组中是否存在特殊群体以检验结果的稳定性。
结果
在这项横断面研究中，低血清镉暴露组中血清镉水平与糖尿病的发生呈负相关（OR = 0.811，95%CI 0.698，0.943；P = 0.007）。高血清镉暴露组中血清镉水平与糖尿病的发生无关联（OR = 1.01，95%CI 0.982，1.037；P = 0.511）。所有亚组的结果均一致（交互作用P>0.05）。
结论
在美国正常血清镉暴露水平下，全人群代表性样本中血清镉与糖尿病呈负相关。然而，高血清镉暴露组中血清镉水平与糖尿病的发生无关联。本研究推动了未来针对糖尿病防控的以环境为目标的新预防策略的更新。
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