Kunzi Happyness, Nsanya Mussa K, Kweka Belinda, Malindisa Evangelista, Ngissa Ng Wamba Sitta, Kavishe Bazil Baltazar, Jeremiah Kidola, Olsen Mette Frahm, Krogh-Madsen Rikke, Filteau Suzanne, Friis Henrik, Faurholt-Jepsen Daniel, PrayGod George
Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania.
Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
PLOS Glob Public Health. 2025 May 14;5(5):e0003816. doi: 10.1371/journal.pgph.0003816. eCollection 2025.
The burden of type 2 diabetes is rapidly increasing in low- and middle-income countries (LMICs), but determinants are not well-characterized. Household air pollution (HAP) from indoor biofuel use for cooking has been associated with non-communicable diseases and could be contributing to the increasing burden of diabetes in LMICs, though data are limited. We assessed the association between indoor biofuel use for cooking and glucose metabolism in HIV-infected and HIV-uninfected Tanzanian adults. This cross-sectional analysis included Tanzanian adults with and without HIV, from whom we collected sociodemographic and non-communicable disease risk factor data. The main predictor variable was indoor biofuel use for cooking, established using self-reported cooking location (indoor or outdoor) and fuel type (electricity/gas or biomass fuel), and categorized as minimal or no exposure, moderate exposure, and high exposure. Blood glucose and insulin were measured during oral glucose tolerance tests, allowing computation of outcome variables including markers of β-cell dysfunction (homeostatic model assessment-β, insulinogenic index, oral disposition index), insulin resistance (HOMA-IR and Matsuda index), and pre-diabetes and diabetes status. Logistic regression was used to assess associations, adjusting for age, sex, physical activity, smoking, socioeconomic status, HIV status, and body mass index. Among 1,871 participants (mean age 40.6 ± 11.9 years; 59.8% female), those with moderate and high exposure to HAP had approximately two-fold higher odds of a lower insulinogenic index (adjusted odds ratio [aOR] = 2.13, 95% CI: 1.27-3.57 and aOR = 2.31, 95% CI: 1.39-3.83, respectively) compared to those with minimal or no exposure. HAP was not associated with other markers of β-cell function, insulin resistance, pre-diabetes, or diabetes. In conclusion, HAP is associated with increased risk of β-cell dysfunction among individuals using biofuel for indoor cooking. Longitudinal studies using objective HAP measurements are needed to confirm these findings.
在低收入和中等收入国家（LMICs），2型糖尿病的负担正在迅速增加，但相关决定因素尚未得到充分描述。用于烹饪的室内生物燃料造成的家庭空气污染（HAP）与非传染性疾病有关，可能是导致LMICs糖尿病负担增加的原因之一，不过相关数据有限。我们评估了坦桑尼亚感染HIV和未感染HIV的成年人中，用于烹饪的室内生物燃料使用与葡萄糖代谢之间的关联。这项横断面分析纳入了有HIV和无HIV的坦桑尼亚成年人，我们收集了他们的社会人口统计学和非传染性疾病风险因素数据。主要预测变量是用于烹饪的室内生物燃料使用情况，通过自我报告的烹饪地点（室内或室外）和燃料类型（电/气或生物质燃料）来确定，并分为极少或无暴露、中度暴露和高度暴露。在口服葡萄糖耐量试验期间测量血糖和胰岛素，从而计算出包括β细胞功能障碍标志物（稳态模型评估-β、胰岛素生成指数、口服处置指数）、胰岛素抵抗（HOMA-IR和松田指数）以及糖尿病前期和糖尿病状态等结局变量。采用逻辑回归评估关联，并对年龄、性别、身体活动、吸烟、社会经济地位、HIV状态和体重指数进行了校正。在1871名参与者（平均年龄40.6±11.9岁；59.8%为女性）中，与极少或无暴露的参与者相比，中度和高度暴露于HAP的参与者胰岛素生成指数较低的几率大约高出两倍（校正比值比[aOR]=2.13，95%置信区间：1.27-3.57和aOR=2.31，95%置信区间：1.39-3.83）。HAP与β细胞功能、胰岛素抵抗、糖尿病前期或糖尿病的其他标志物无关。总之，HAP与使用生物燃料进行室内烹饪的个体中β细胞功能障碍风险增加有关。需要使用客观的HAP测量方法进行纵向研究来证实这些发现。
