Long-term PM2.5 exposure and early-onset diabetes: Does BMI link this risk?

Yalan Li; Jingjing Wu; Haibo Tang; Xinru Jia; Jie Wang; Changjiang Meng; Wei Wang; Shiqi Liu; Hong Yuan; Jingjing Cai; Jiangang Wang; Yao Lu

doi:10.1016/j.scitotenv.2023.169791

Long-term PM_2.5 exposure and early-onset diabetes: Does BMI link this risk?

Sci Total Environ. 2024 Feb 25:913:169791. doi: 10.1016/j.scitotenv.2023.169791. Epub 2024 Jan 3.

Authors

Yalan Li¹, Jingjing Wu¹, Haibo Tang², Xinru Jia¹, Jie Wang¹, Changjiang Meng¹, Wei Wang¹, Shiqi Liu¹, Hong Yuan¹, Jingjing Cai³, Jiangang Wang⁴, Yao Lu⁵

Affiliations

¹ Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
² Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Metabolic and Bariatric Surgery, The Third Xiangya Hospital, Central South University, Changsha, China.
³ Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China.
⁴ Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China. Electronic address: 395896584@qq.com.
⁵ Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China; Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London SE1 9NH, UK. Electronic address: luyao0719@163.com.

PMID: 38176550
DOI: 10.1016/j.scitotenv.2023.169791

Abstract

Objective: Limited studies investigated the association between high-level fine particulate matter (PM_2.5) pollution and early-onset diabetes, leaving the possible metabolic mechanisms unclear. We assessed the association of cumulative PM_2.5 exposure with diabetes, including early-onset, in high-pollution areas of China and explored whether metabolic factors mediated this association.

Methods: 124,204 participants (≥18 years) from 121 counties in Hunan province, China, were enrolled between 2005 and 2020, with follow-up until 2021. The ground-level air pollution concentrations at each participant's residence were calculated using a high-quality dataset in China. The independent association of PM_2.5 with incident diabetes and early-onset diabetes was assessed by Cox proportional hazards models. Restricted cubic splines were utilized to establish the exposure-response relationships. The role of metabolism-related mediators was estimated by mediation analysis.

Results: During a median follow-up of 8.47 (IQR, 6.65-9.82) years, there were 3650 patients with new-onset diabetes. Each 1 μg/m³ increase in the level of cumulative PM_2.5 exposure was positively related to an increased incidence of diabetes (HR 1.177, 95 % CI 1.172-1.181) among individuals in the PM_2.5 > 50 μg/m³ group after adjusting for multiple variables. The relationship of the PM_2.5 dose-response curve for diabetes was non-linear. Significant associations between PM_2.5 exposure and early-onset diabetes risk were observed, with this risk showing an increase with the earlier age of early diabetes onset. Males, young individuals (≤45 years), and those with a lower body mass index (BMI <24 kg/m²) appeared to be more susceptible to diabetes. Moreover, change in BMI significantly mediated 31.06 % of the PM_2.5-diabetes relationship.

Conclusions: Long-term cumulative PM_2.5 exposure increased the risk of early-onset diabetes, which is partially mediated by BMI. Sustained air pollution control measures, priority protection of vulnerable individuals, and effective management of BMI should be taken to reduce the burden of diabetes.

Keywords: Air pollution; Diabetes; Early-onset; Fine particulate matter.

MeSH terms

Air Pollutants* / adverse effects
Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
Body Mass Index
Diabetes Mellitus* / epidemiology
Environmental Exposure / analysis
Humans
Male
Particulate Matter / adverse effects
Particulate Matter / analysis

Substances

Air Pollutants
Particulate Matter