Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
Environ Res. 2024 Jul 1;252(Pt 3):118965. doi: 10.1016/j.envres.2024.118965. Epub 2024 Apr 18.
Promising evidence suggests a link between environmental factors, particularly air pollution, and diabetes and obesity. However, it is still unclear whether men and women are equally susceptible to environmental exposures. Therefore, we aimed to assess sex-specific long-term effects of environmental exposures on metabolic diseases. We analyzed cross-sectional data from 3,034 participants (53.7% female, aged 53-74 years) from the KORA Fit study (2018/19), a German population-based cohort. Environmental exposures, including annual averages of air pollutants [nitrogen oxides (NO, NO), ozone, particulate matter of different diameters (PM, PM, PM), PMabs, particle number concentration], air temperature and surrounding greenness, were assessed at participants' residences. We evaluated sex-specific associations of environmental exposures with prevalent diabetes, obesity, body-mass-index (BMI) and waist circumference using logistic or linear regression models with an interaction term for sex, adjusted for age, lifestyle factors and education. Further effect modification, in particular by urbanization, was assessed in sex-stratified analyses. Higher annual averages of air pollution, air temperature and greenness at residence were associated with diabetes prevalence in men (NO: Odds Ratio (OR) per interquartile range increase in exposure: 1.49 [95% confidence interval (CI): 1.13, 1.95], air temperature: OR: 1.48 [95%-CI: 1.15, 1.90]; greenness: OR: 0.78 [95%-CI: 0.59, 1.01]) but not in women. Conversely, higher levels of air pollution, temperature and lack of greenness were associated with lower obesity prevalence and BMI in women. After including an interaction term for urbanization, only higher greenness was associated with higher BMI in rural women, whereas higher air pollution was associated with higher BMI in urban men. To conclude, we observed sex-specific associations of environmental exposures with metabolic diseases. An additional interaction between environmental exposures and urbanization on obesity suggests a higher susceptibility to air pollution among urban men, and higher susceptibility to greenness among rural women, which needs corroboration in future studies.
有证据表明，环境因素（尤其是空气污染）与糖尿病和肥胖之间存在关联。然而，目前尚不清楚男性和女性是否同样容易受到环境暴露的影响。因此，我们旨在评估环境暴露对代谢疾病的长期性别特异性影响。我们分析了来自德国基于人群的科拉健康研究（2018/19 年）的 3034 名参与者（53.7%为女性，年龄为 53-74 岁）的横断面数据。环境暴露包括空气中污染物（氮氧化物[NOₓ]、臭氧、不同直径的颗粒物[PM₁₀、PM₂.₅、PM₁₋₁₀]、PM 吸收、颗粒数浓度）、空气温度和周围绿化程度的年平均值，在参与者的住所进行评估。我们使用具有性别交互项的逻辑或线性回归模型，调整年龄、生活方式因素和教育水平后，评估环境暴露与糖尿病、肥胖、体重指数（BMI）和腰围的流行率之间的性别特异性关联。在按性别分层分析中进一步评估了特定的效应修饰，特别是城市化的影响。较高的住所年平均空气污染、空气温度和绿化程度与男性糖尿病患病率有关（NO：暴露每增加一个四分位距的比值比（OR）：1.49 [95%置信区间（CI）：1.13，1.95]；空气温度：OR：1.48 [95%-CI：1.15，1.90]；绿化：OR：0.78 [95%-CI：0.59，1.01]），但与女性无关。相反，较高的空气污染、温度和缺乏绿化与女性较低的肥胖患病率和 BMI 有关。纳入城市化的交互项后，仅较高的绿化与农村女性较高的 BMI 有关，而较高的空气污染与城市男性较高的 BMI 有关。总之，我们观察到环境暴露与代谢疾病之间存在性别特异性关联。环境暴露与城市化之间的额外相互作用与肥胖有关，表明城市男性对空气污染的敏感性更高，而农村女性对绿化的敏感性更高，这需要在未来的研究中得到证实。
