Association of long-term air pollution exposure with the risk of prediabetes and diabetes: Systematic perspective from inflammatory mechanisms, glucose homeostasis pathway to preventive strategies

Yayuan Mei; Ang Li; Jiaxin Zhao; Quan Zhou; Meiduo Zhao; Jing Xu; Runkui Li; Yanbing Li; Kai Li; Xiaoyu Ge; Chen Guo; Yongjie Wei; Qun Xu

doi:10.1016/j.envres.2022.114472

Association of long-term air pollution exposure with the risk of prediabetes and diabetes: Systematic perspective from inflammatory mechanisms, glucose homeostasis pathway to preventive strategies

Environ Res. 2023 Jan 1;216(Pt 1):114472. doi: 10.1016/j.envres.2022.114472. Epub 2022 Oct 7.

Authors

Yayuan Mei¹, Ang Li¹, Jiaxin Zhao¹, Quan Zhou¹, Meiduo Zhao¹, Jing Xu¹, Runkui Li², Yanbing Li¹, Kai Li¹, Xiaoyu Ge¹, Chen Guo³, Yongjie Wei⁴, Qun Xu⁵

Affiliations

¹ Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China.
² College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, 100049, China; State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China.
³ State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environment Sciences, Beijing, 100012, China.
⁴ State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environment Sciences, Beijing, 100012, China. Electronic address: weiyj@craes.org.cn.
⁵ Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China. Electronic address: xuqun@ibms.cams.cn.

PMID: 36209785
DOI: 10.1016/j.envres.2022.114472

Abstract

Background: Limited evidence suggests the association of air pollutants with a series of diabetic cascades including inflammatory pathways, glucose homeostasis disorder, and prediabetes and diabetes. Subclinical strategies for preventing such pollutants-induced effects remain unknown.

Methods: We conducted a cross-sectional study in two typically air-polluted Chinese cities in 2018-2020. One-year average PM₁, PM_2.5, PM₁₀, SO₂, NO₂, and O₃ were calculated according to participants' residence. GAM multinomial logistic regression was performed to investigate the association of air pollutants with diabetes status. GAM and quantile g-computation were respectively performed to investigate individual and joint effects of air pollutants on glucose homeostasis markers (glucose, insulin, HbA1c, HOMA-IR, HOMA-B and HOMA-S). Complement C3 and hsCRP were analyzed as potential mediators. The ABCS criteria and hemoglobin glycation index (HGI) were examined for their potential in preventive strategy.

Results: Long-term air pollutants exposure was associated with the risk of prediabetes [Prevalence ratio for O₃ (PR_O₃) = 1.96 (95% CI: 1.24, 3.03)] and diabetes [PR_PM₁ = 1.18 (95% CI: 1.05, 1.32); PR_PM_2.5 = 1.08 (95% CI: 1.00, 1.16); PR_O₃ = 1.35 (95% CI: 1.03, 1.74)]. PM₁, PM₁₀, SO₂ or O₃ exposure was associated with glucose-homeostasis disorder. For example, O₃ exposure was associated with increased levels of glucose [7.67% (95% CI: 1.75, 13.92)], insulin [19.98% (95% CI: 4.53, 37.72)], HOMA-IR [34.88% (95% CI: 13.81, 59.84)], and decreased levels of HOMA-S [-25.88% (95% CI: -37.46, -12.16)]. Complement C3 and hsCRP played mediating roles in these relationships with proportion mediated ranging from 6.95% to 60.64%. Participants with HGI ≤ -0.53 were protected from the adverse effects of air pollutants.

Conclusion: Our study provides comprehensive insights into air pollutant-associated diabetic cascade and suggests subclinical preventive strategies.

Keywords: Air pollutant; Glucose homeostasis markers; Mediation analysis; Mixture effect; Prediabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / analysis
Air Pollutants* / toxicity
Air Pollution* / adverse effects
Air Pollution* / analysis
C-Reactive Protein
China / epidemiology
Complement C3
Cross-Sectional Studies
Diabetes Mellitus* / chemically induced
Diabetes Mellitus* / epidemiology
Environmental Exposure / adverse effects
Environmental Exposure / analysis
Glucose
Homeostasis
Humans
Insulins*
Nitrogen Dioxide / toxicity
Particulate Matter / analysis
Particulate Matter / toxicity
Prediabetic State* / chemically induced
Prediabetic State* / etiology

Substances

Complement C3
C-Reactive Protein
Air Pollutants
Glucose
Particulate Matter
Insulins
Nitrogen Dioxide