Mercury exposure in young adulthood and incidence of diabetes later in life: the CARDIA Trace Element Study

Associations of heavy metal exposure with diabetic retinopathy in the U.S. diabetic population: a cross-sectional study

Background

Mounting evidence suggests a correlation between heavy metals exposure and diabetes. Diabetic retinopathy (DR) is a prevalent and irreversible complication of diabetes that can result in blindness. However, studies focusing on the effects of exposure to heavy metals on DR remain scarce. Thus, this study aimed to investigate the potential correlation between heavy metals exposure and DR.

Methods

A total of 1,146 diabetics from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 were included in this study. Heavy metal levels were measured via urine testing. Weighted logistic regression, Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS) regression, and restricted cubic spline (RCS) were utilized to investigate the potential relationships between exposure to 10 heavy metals and DR. Finally, subgroup analysis was conducted based on the glycemic control status.

Results

Among the 1,146 participants, 239 (20.86%) were diagnosed with DR. Those with DR had worse glycemic control and a higher prevalence of chronic kidney disease compared to those without DR. Moreover, both the WQS regression and BKMR models demonstrated a positive relationship between exposure to mixed heavy metals and the risk of DR. The results of weighted logistic regression revealed a positive correlation between cobalt (Co) and antimony (Sb) exposure and the risk of DR (OR = 1.489, 95%CI: 1.064-2.082, p = 0.021; OR = 1.475, 95% CI: 1.084-2.008, p = 0.014), while mercury (Hg) exposure was found to promote DR exclusively in the group with good glycemic control (OR = 1.509, 95% CI: 1.157-1.967, p = 0.003). These findings were corroborated by the results of the RCS analysis.

Conclusion

Heavy metal exposure is associated with an increased risk of DR, especially Sb, Co, and Hg exposure. Nevertheless, well-designed prospective studies are warranted to validate these findings.

Association of serum metal levels with type 2 diabetes: A prospective cohort and mediating effects of metabolites analysis in Chinese population

Several studies have suggested an association between exposure to various metals and the onset of type 2 diabetes (T2D). However, the results vary across different studies. We aimed to investigate the associations between serum metal concentrations and the risk of developing T2D among 8734 participants using a prospective cohort study design. We utilized inductively coupled plasmamass spectrometry (ICP-MS) to assess the serum concentrations of 27 metals. Cox regression was applied to calculate the hazard ratios (HRs) for the associations between serum metal concentrations on the risk of developing T2D. Additionally, 196 incident T2D cases and 208 healthy control participants were randomly selected for serum metabolite measurement using an untargeted metabolomics approach to evaluate the mediating role of serum metabolite in the relationship between serum metal concentrations and the risk of developing T2D with a nested casecontrol study design. In the cohort study, after Bonferroni correction, the serum concentrations of zinc (Zn), mercury (Hg), and thallium (Tl) were positively associated with the risk of developing T2D, whereas the serum concentrations of manganese (Mn), molybdenum (Mo), barium (Ba), lutetium (Lu), and lead (Pb) were negatively associated with the risk of developing T2D. After adding these eight metals, the predictive ability increased significantly compared with that of the traditional clinical model (AUC: 0.791 vs. 0.772, P=8.85×10-5). In the nested casecontrol study, a machine learning analysis revealed that the serum concentrations of 14 out of 1579 detected metabolites were associated with the risk of developing T2D. According to generalized linear regression models, 7 of these metabolites were significantly associated with the serum concentrations of the identified metals. The mediation analysis showed that two metabolites (2-methyl-1,2-dihydrophthalazin-1-one and mestranol) mediated 46.81% and 58.70%, respectively, of the association between the serum Pb concentration and the risk of developing T2D. Our study suggested that serum Mn, Zn, Mo, Ba, Lu, Hg, Tl, and Pb were associated with T2D risk. Two metabolites mediated the associations between the serum Pb concentration and the risk of developing T2D.

Inhalation exposure to toxic heavy metals in nail salon technicians and health risk assessment using Monte Carlo simulation

OBJECTIVE

Nail salons offer a developing and diverse occupation for many women, especially the new generation. Due to the increasing apprehension surrounding heavy metals in dust caused by filing nails containing dried nail polish, the present study was designed aimed to health risk assessment of heavy metals in breathing zone of nail salon technicians (NSTs).

METHODS

This is a cross-sectional study that was conducted in NSTs. The concentration of Cadmium (Cd), Lead (Pb), Nickel (Ni), Chromium (Cr) and Manganese (Mn)in breathing zone of 20 NSTs was determined using ICP-OES.

RESULTS

The metal concentrations were in the following order: Mn > Pb > Ni > Cr > Cd with corresponding arithmetic mean values of0.008, 0.0023, 0.0021, 0.001 and 0.0006 mg m-3, respectively, which are exceeded the recommended levels stated in the indoor air guidelines. The average lifetime carcinogenic risk (LCR) for Cr, Cd, Ni and Pb was calculated 0.0084, 0.00054, 0.00026 and 1.44 E - 05, respectively. The LCR values of all metals (except Pb) exceeded the acceptable level set by the USEPA. The mean of Hazard quotients (HQ) for Mn, Cd, Cr, Ni and Pb were calculated to be23.7, 4.74, 2.19, 0.51 and 0.0.24, respectively. The sensitivity analysis showed that, the exposure frequency (EF) for Cr and Ni had the strong effects on generation of both LCR and HQ. Furthermore, the concentrations of Mn, Cd and Pb had strong impacts on the HQ generation and the concentration of Cd and Pb had main effects on LCR generation.

CONCLUSION

To effectively reduce pollutant concentration, it is recommended to install a ventilation system near nail salon work tables and conduct continuous monitoring and quality control of nail products.

Exposure to volatile organic compounds is a risk factor for diabetes: A cross-sectional study

Currently, more studies showed that environmental chemicals were associated with the development of diabetes. However, the effect of volatile organic compounds (VOCs) on diabetes remained uncertain and needed to be studied. This cross-sectional study examined whether exposure to low levels of VOCs was associated with diabetes, insulin resistance (TyG index) and glucose-related indicators (FPG,HbA1c, insulin) in the general population by using the NHANES dataset (2013-2014 and 2015-2016). We analyzed the association between urinary VOC metabolism (mVOCs) and these indicators in 1409 adults by multiple linear regression models or logistic regression models, further Bayesian kernel machine regression (BKMR) models were performed for mixture exposure analysis. The results showed positive associations between multiple mVOCs and diabetes, TyG index, FPG, HbA1c and insulin, respectively. Among them, HPMMA concentration in urine was significantly positively correlated with diabetes and related indicators (TyG index, FPG and HbA1c), and the concentration of CEMA was significantly positively correlated with insulin. The positive association of mVOCs with diabetes and its related indicators was more significant in the female group and in the 40-59 years group. Thus, our study suggested that exposure to VOCs affected insulin resistance and glucose homeostasis, further affecting diabetes levels, which had important public health implications.

Effects of low doses of methylmercury (MeHg) exposure on definitive endoderm cell differentiation in human embryonic stem cells

Fetal development is one of the most sensitive windows to methylmercury (MeHg) toxicity. Laboratory and epidemiological studies have shown a dose-response relationship between fetal MeHg exposure and neuro performance in different life stages from infants to adults. In addition, MeHg exposure has been reported to be associated with disorders in endoderm-derived organs, such as morphological changes in liver cells and pancreatic cell dysfunctions. However, the mechanisms of the effects of MeHg on non-neuronal organs or systems, especially during the early development of endoderm-derived organs, remain unclear. Here we determined the effects of low concentrations of MeHg exposure during the differentiation of definitive endoderm (DE) cells from human embryonic stem cells (hESCs). hESCs were exposed to MeHg (0, 10, 100, and 200 nM) that covers the range of Hg concentrations typically found in human maternal blood during DE cell induction. Transcriptomic analysis showed that sub-lethal doses of MeHg exposure could alter global gene expression patterns during hESC to DE cell differentiation, leading to increased expression of endodermal genes/proteins and the over-promotion of endodermal fate, mainly through disrupting calcium homeostasis and generating ROS. Bioinformatic analysis results suggested that MeHg exerts its developmental toxicity mainly by disrupting ribosome biogenesis during early cell lineage differentiation. This disruption could lead to aberrant growth or dysfunctions of the developing endoderm-derived organs, and it may be the underlying mechanism for the observed congenital diseases later in life. Based on the results, we proposed an adverse outcome pathway for the effects of MeHg exposure during human embryonic stem cells to definitive endoderm differentiation.

Environment-wide association study of elevated liver enzymes: results from the Korean National Environmental Health Survey 2018-2022

Background

Environmental exposure is characterized by low concentration, chronic, and complex exposure. Traditional epidemiological studies show limitations in reflecting these characteristics since they usually focus on a single or very limited number of exposure factors at a time. In this study, we adopted the methodology of environment-wide association study (EWAS) to figure out the association of human liver function with various environmentally hazardous substances.

Methods

We analyzed 2,961 participants from the Korean National Environmental Health Survey Cycle 4 (2018-2020). Using generalized linear model (GLM) analysis, we analyzed the association of 72 variables with 3 liver function indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma glutamyl transferase [GGT]). Finally, we visualized our results with Manhattan plot.

Results

In GLM analysis, perfluorooctanesulfonate were positively associated with ALT (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.39-3.46; p adjusted = 0.0147) and perfluorodecanoic acid showed positive association with GGT (OR: 2.73; 95% CI: 1.36-5.5; p adjusted = 0.0256). Plasma mercury showed positive association with GGT (OR: 1.45; 95% CI: 1.14-1.84; p adjusted = 0.0315). Using a plastic container while keeping food in the refrigerator was associated with elevated GGT compared to using a glass container (OR: 1.51; 95% CI: 1.16-1.95; p adjusted = 0.0153). 2-ethyl-5-oxohexyl phthalate, showed a negative trend with all 3 indices, with AST (OR: 0.54; 95% CI: 0.39-0.73; p adjusted = 0.00357), ALT (OR: 0.5; 95% CI: 0.34-0.75; p adjusted = 0.036), GGT (OR: 0.55; 95% CI: 0.4-0.76; p adjusted = 0.00697). Bisphenol S and frequent use of sunblock cream showed negative association with ALT (OR: 0.77; 95% CI: 0.66-0.89), and GGT (OR: 0.25; 95% CI: 0.11-0.55), respectively.

Conclusions

We conducted an exploratory study on environmental exposure and human liver function. By using EWAS methodology, we identified 7 factors that could have potential association with liver function.

An evaluation of the effects of mixed heavy metals on prediabetes and type 2 diabetes: epidemiological and toxicogenomic analysis

The link between mixed heavy metals (mercury, lead, and cadmium), prediabetes, and type 2 diabetes mellitus (T2DM), especially molecular mechanisms, is poorly understood. Thus, we aimed to identify the association between mixed heavy metals and T2DM and its components using a data set from the Korean National Health and Nutrition Examination Survey. We further analyzed the main molecular mechanisms implicated in T2DM development induced by mixed heavy metals using in-silico analysis. Our findings observed that serum mercury was associated with prediabetes, elevated glucose, and ln2-transformed glucose when using different statistical methods. "AGE-RAGE signaling pathway in diabetic complications", "non-alcoholic fatty liver disease", "metabolic Syndrome X", and three miRNAs (hsa-miR-98-5p, hsa-let-7a-5p, and hsa-miR-34a-5p) were listed as the most important molecular mechanisms related to T2DM development caused by mixed heavy metals. These miRNA sponge structures were created and examined, and they may be beneficial in the treatment of T2DM. The predicted cutoff values for three heavy metal levels linked to T2DM and its components were specifically identified. Our results imply that chronic exposure to heavy metals, particularly mercury, may contribute to the development of T2DM. To understand the changes in the pathophysiology of T2DM brought on by a combination of heavy metals, more research is required.

Association between heavy metal mercury in body fluids and tissues and diabetes mellitus: a systematic review and meta-analysis

Background

Recent studies have shown that the relationship between mercury exposure and diabetes is controversial. The aim of this study is to determine the relationship between mercury exposure and diabetes using a systematic review and meta-analysis approach.

Methods

We systematically searched PubMed, Web of Science, Cochrane, and Embase databases for cross-sectional, case-control, or cohort studies assessing the correlation between mercury exposure and diabetes in any population. Details of each included study were extracted using a pre-designed Excel spreadsheet. Quality assessment of cohort and case-control studies used the Newcastle-Ottawa Scale (NOS), whereas cross-sectional studies were assessed by the Agency for Healthcare Research and Quality (AHRQ) scale. Meta-analyses were performed using random-effects models to calculate the pooled odds ratio (OR), standardized mean difference (SMD), and their 95% confidence intervals (CIs). Subgroup and sensitivity analyses were employed to assess heterogeneity sources. Begg's and Egger's tests were used to evaluate publication bias.

Results

Our meta-analysis included 8 eligible articles, comprising a total of 40,891 subjects, reporting mercury OR and/or concentrations. Among the included studies, one was a case control, one was a cohort study, and the rest were cross-sectional studies. Two studies were rated as high quality and six as medium quality. The results revealed no link between mercury exposure and diabetes (OR: 1.11, 95% CI: 0.80, 1.55, n=6, I²=73.7%; and SMD: 0.41, 95% CI: -0.32, 1.14, n=3, I²=88.7%). In the stratified male and female subgroups, the pooled OR was 0.71 (95% CI: 0.57, 0.90, n=3, I²=0.0%), 1.11 (95% CI: 0.69, 1.79, n=3, I²=67.7%). The Begg's test results revealed no significant publication bias (P=0.06), but the Egger's test results did (P=0.013). The sensitivity analysis confirmed the stability of our results.

Conclusions

No significant relationship was observed between mercury and diabetes mellitus. However, more well-designed studies on mercury exposure and diabetes risk are still needed, particularly on the type of mercury (i.e., elemental, inorganic, and organic), exposure time and dose, type of biological specimen, and the population's sex and age.

Folate, Vitamin B6, and Vitamin B12 Status in Association With Metabolic Syndrome Incidence

IMPORTANCE

The associations of B vitamin status with metabolic syndrome (MetS) incidence among the US population remain unclear.

OBJECTIVE

To investigate intakes and serum concentrations of folate, vitamin B6, and vitamin B12 in association with MetS risk in a large US cohort.

DESIGN, SETTING, AND PARTICIPANTS

This prospective study included Black and White young adults in the US who were enrolled from 1985 to 1986 and studied until 2015 to 2016. Diet was assessed using a validated diet history at examination years 0, 7, and 20. Serum concentrations of folate, vitamin B6, and vitamin B12 were assayed at examination years 0, 7, and 15 in a subset of 1430 participants. MetS was ascertained by clinic and laboratory measurements and self-reported medication use. Data were analyzed between January and July 2021.

EXPOSURES

Intakes and serum levels of folate, vitamin B6, and vitamin B12.

MAIN OUTCOMES AND MEASURES

Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% CIs for the associations of energy-adjusted B vitamin intakes or serum B vitamin levels with incident MetS.

RESULTS

The study included 4414 participants, with 2225 Black individuals (50.4%) and 2331 women (52.8%). The mean (SD) age at baseline was 24.9 (3.6) years. A total of 1240 incident MetS cases occurred during the 30 years (mean [SD], 22.1 [9.5] years) of follow-up. Compared with the lowest quintile of each energy-adjusted B vitamin intake, the HRs for incident MetS in the highest quintile were 0.39 (95% CI, 0.31-0.49) for folate (P for trend < .001), 0.61 (95% CI, 0.46-0.81) for vitamin B6 (P for trend = .002), and 0.74 (95% CI, 0.58-0.95) for vitamin B12 (P for trend = .008) after adjustment for potential confounders. Similarly, significant inverse associations were observed in the subset with serum data on these B vitamins (folate: HR, 0.23; 95% CI, 0.17-0.33; P for trend < .001; vitamin B6: HR, 0.48; 95% CI, 0.34-0.67; P for trend < .001; and vitamin B12: HR, 0.70; 95% CI, 0.51-0.96; P for trend = .01).

CONCLUSIONS AND RELEVANCE

This prospective cohort study found that intakes and serum concentrations of folate, vitamin B6, and vitamin B12 were inversely associated with incident MetS among Black and White young adults in the US.

Puzzling relationship between levels of toxic metals in blood and serum levels of reproductive hormones: Benchmark dose approach in cross-sectional study

Reproductive disorders and infertility have become more common recently among the general population. Toxic metals are known as endocrine disruptors and as they are widespread in nature they may be linked to reproductive problems. This study was conducted as a cross-sectional study and its aim was to examine the dose–response relationship between cadmium, arsenic, mercury, chromium and nickel and serum hormone levels of testosterone (women) and estradiol and progesterone (men) using the Benchmark dose approach (BMD). Blood samples were collected from 218 women and 217 men digested in a microwave, and the levels of the tested metals were determined by atomic absorption spectrophotometry (AAS) or inductively coupled plasma-mass spectrometry (ICP-MS). Dose–response analysis was performed in PROAST software (version 70.1). The model averaging method was used to calculate the Benchmark dose interval (BMDI). A dose–response relationship has been established between all metals and hormones. The narrowest BMDI was found for the As-testosterone and Hg-testosterone. Levels estimated to produce the extra risk of testosterone serum levels disturbances of 10% were lower than median levels measured in the general population. Moreover, this research suggests the possibility of use of the BMD approach in analyzing data pool generated from extensive human-biomonitoring studies.

Serum hsa-circ-0025244 as a biomarker in Chinese occupational mercury-exposed population and mediate apoptosis through JNK/p38 MAPK signaling pathway

BACKGROUND

circRNAs have been recognized as biomarkers of numerous diseases. We would like to explore the expression pattern and molecular mechanisms of circRNAs in the Chinese occupational mercury-exposed population.

METHODS

The workers from a thermometer manufacturing plant and lamp factory in Jiangsu province of China were recruited in 2016. Blood samples were collected from the subjects with chronic mercury poisoning group, mercury absorption group, and the healthy controls. The differentially expressed circRNAs (DECRs) between the three groups were screened from serum samples using a circRNA microarray. The significant DECRs were validated by qRT-PCR, and their respective diagnostic values for mercury poisoning and mercury absorption were analyzed by receiver operating characteristic (ROC) curves. For in vitro experiments, 293T cells were treated with different doses of HgCl₂ to determine the half-lethal concentration. The cells were transfected with the siRNA construct or expression plasmid of circRNA. The expression levels of JNK, p38, and caspase family proteins were analyzed by Western blotting.

RESULTS

hsa_circ_0025244 was up-regulated in the mercury poisoning and absorption groups compared to the control group (P < 0.05), and positively correlated with the urine mercury levels (P < 0.05). The area under the ROC curve (AUC) of hsa_circ_0025244 for diagnosing occupational mercury poisoning was 0.748, indicating moderate accuracy (P < 0.001). Moreover, the diagnostic accuracy of occupational mercury absorption was high (P < 0.001) with an AUC of 0.918. Knockdown of hsa_circ_0025244 in 293T cells significantly reduced the expression levels of JNK/p38, and caspase family proteins compared to that in the control cells (P < 0.01), and its overexpression led to opposite effects (P < 0.05).

CONCLUSIONS

hsa_circ_0025244 is a potential biomarker for mercury exposure and mediates mercury-induced apoptosis in 293T cells by activating the JNK/p38 MAPK signaling pathway.

Validation of in vivo toenail measurements of manganese and mercury using a portable X-ray fluorescence device

BACKGROUND AND OBJECTIVE

Toenail metal concentrations can be used as an effective biomarker for exposure to environmental toxicants. Typically toenail clippings are measured ex vivo using inductively coupled plasma mass spectrometry (ICP-MS). X-ray fluorescence (XRF) toenail metal measurements done on intact toenails in vivo could be used as an alternative to alleviate some of the disadvantages of ICP-MS. In this study, we assessed the ability to use XRF to measure toenail metal concentrations in real-time without having to clip the toenails (i.e., in vivo) in two occupational settings for exposure assessment of manganese and mercury.

MATERIALS AND METHODS

The portable XRF method used a 3-min in vivo measurement of toenails prior to clipping and was assessed against ICP-MS measurement of toenail clippings taken immediately after the XRF measurement and work history for a group of welders (n = 16) assessed for manganese exposure and nail salon workers (n = 10) assessed for mercury exposure.

RESULTS AND CONCLUSIONS

We identified that in vivo XRF metal measurements were able to discern exposure to manganese in welders and mercury in nail salon workers. We identified significant positive correlations between ICP-MS of clippings and in vivo XRF measures of both toenail manganese (R = 0.59, p = 0.02) and mercury (R = 0.74, p < 0.001), as well as between in vivo XRF toenail manganese and work history among the welders (R = 0.55, p = 0.03). We identified in vivo XRF detection limits to be 0.5 µg/g for mercury and 2.6 µg/g for manganese. Further work should elucidate differences in the timing of exposure using the in vivo XRF method over toenail clippings and modification of measurement time and x-ray setting to further decrease the detection limit. In vivo portable, XRF measurements can be used to effectively measure toenail Mn and Hg in occupational participants in real-time during study visits and at a fraction of the cost.

Methylmercury Induces Mitochondria- and Endoplasmic Reticulum Stress-Dependent Pancreatic β-Cell Apoptosis via an Oxidative Stress-Mediated JNK Signaling Pathway

Methylmercury (MeHg), a long-lasting organic pollutant, is known to induce cytotoxic effects in mammalian cells. Epidemiological studies have suggested that environmental exposure to MeHg is linked to the development of diabetes mellitus (DM). The exact molecular mechanism of MeHg-induced pancreatic β-cell cytotoxicity is still unclear. Here, we found that MeHg (1-4 μM) significantly decreased insulin secretion and cell viability in pancreatic β-cell-derived RIN-m5F cells. A concomitant elevation of mitochondrial-dependent apoptotic events was observed, including decreased mitochondrial membrane potential and increased proapoptotic (Bax, Bak, p53)/antiapoptotic (Bcl-2) mRNA ratio, cytochrome c release, annexin V-Cy3 binding, caspase-3 activity, and caspase-3/-7/-9 activation. Exposure of RIN-m5F cells to MeHg (2 μM) also induced protein expression of endoplasmic reticulum (ER) stress-related signaling molecules, including C/EBP homologous protein (CHOP), X-box binding protein (XBP-1), and caspase-12. Pretreatment with 4-phenylbutyric acid (4-PBA; an ER stress inhibitor) and specific siRNAs for CHOP and XBP-1 significantly inhibited their expression and caspase-3/-12 activation in MeHg-exposed RIN-mF cells. MeHg could also evoke c-Jun N-terminal kinase (JNK) activation and reactive oxygen species (ROS) generation. Antioxidant N-acetylcysteine (NAC; 1mM) or 6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid (trolox; 100 μM) markedly prevented MeH-induced ROS generation and decreased cell viability in RIN-m5F cells. Furthermore, pretreatment of cells with SP600125 (JNK inhibitor; 10 μM) or NAC (1 mM) or transfection with JNK-specific siRNA obviously attenuated the MeHg-induced JNK phosphorylation, CHOP and XBP-1 protein expression, apoptotic events, and insulin secretion dysfunction. NAC significantly inhibited MeHg-activated JNK signaling, but SP600125 could not effectively reduce MeHg-induced ROS generation. Collectively, these findings demonstrate that the induction of ROS-activated JNK signaling is a crucial mechanism underlying MeHg-induced mitochondria- and ER stress-dependent apoptosis, ultimately leading to β-cell death.

Lead, mercury, and cadmium exposures are associated with obesity but not with diabetes mellitus: Korean National Environmental Health Survey (KoNEHS) 2015-2017

BACKGROUND

Associations of heavy metal exposures with obesity and obesity-related traits have been suggested, while those with nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus (DM) are often inconsistent.

METHODS

This study included 3787 adults aged ≥19 years who participated in the Korean National Environmental Health Survey 2015-2017, and investigated the association of toxic heavy metals with metabolic diseases. Lead (Pb), mercury (Hg), and cadmium (Cd) were measured either in urine (uHg, uCd) or total blood (bPb, bHg). Body mass index (BMI) was calculated, and DM cases were identified through a self-answered medication history. Hepatic Steatosis Index (HSI) as a surrogating index of NAFLD, was calculated using hepatic enzyme measurements, including aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

RESULTS

Adults in the highest quartile of bPb, bHg, and uHg showed significantly elevated odds of obesity (BMI ≥25 kg/m²), compared to the lowest quartile (OR 1.58 for bPb, 1.92 for bHg, and 1.81 for uHg). HSI was positively correlated with bHg, uHg, and uCd concentrations. The odds of NAFLD (HSI ≥36) were also increased with increasing quartile of bHg, uHg, and uCd concentrations. For DM, bPb showed a significant negative association, while bHg and uCd exhibited non-monotonic and inconclusive associations.

CONCLUSIONS

Among the general adult population of Korea, both Pb and Hg exposures were associated with an increased risk of obesity. In addition, both Hg and Cd exposures were associated with increased odds of NAFLD. These metals, however, were not associated with an increased risk of DM.

Environmental risk factors of type 2 diabetes-an exposome approach

Type 2 diabetes is one of the major chronic diseases accounting for a substantial proportion of disease burden in Western countries. The majority of the burden of type 2 diabetes is attributed to environmental risks and modifiable risk factors such as lifestyle. The environment we live in, and changes to it, can thus contribute substantially to the prevention of type 2 diabetes at a population level. The 'exposome' represents the (measurable) totality of environmental, i.e. nongenetic, drivers of health and disease. The external exposome comprises aspects of the built environment, the social environment, the physico-chemical environment and the lifestyle/food environment. The internal exposome comprises measurements at the epigenetic, transcript, proteome, microbiome or metabolome level to study either the exposures directly, the imprints these exposures leave in the biological system, the potential of the body to combat environmental insults and/or the biology itself. In this review, we describe the evidence for environmental risk factors of type 2 diabetes, focusing on both the general external exposome and imprints of this on the internal exposome. Studies provided established associations of air pollution, residential noise and area-level socioeconomic deprivation with an increased risk of type 2 diabetes, while neighbourhood walkability and green space are consistently associated with a reduced risk of type 2 diabetes. There is little or inconsistent evidence on the contribution of the food environment, other aspects of the social environment and outdoor temperature. These environmental factors are thought to affect type 2 diabetes risk mainly through mechanisms incorporating lifestyle factors such as physical activity or diet, the microbiome, inflammation or chronic stress. To further assess causality of these associations, future studies should focus on investigating the longitudinal effects of our environment (and changes to it) in relation to type 2 diabetes risk and whether these associations are explained by these proposed mechanisms.

Environmental chemical exposure dynamics and machine learning-based prediction of diabetes mellitus

BACKGROUND

With dramatically increasing prevalence, diabetes mellitus has imposed a tremendous toll on individual well-being. Humans are exposed to various environmental chemicals, which have been postulated as underappreciated but potentially modifiable diabetes risk factors.

OBJECTIVES

To determine the utility of environmental chemical exposure in predicting diabetes mellitus.

METHODS

A total of 8501 eligible participants from NHANES 2005-2016 were randomly assigned to a discovery (N = 5953) set and a validation (N = 2548) set. We applied random forest (RF) and least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation in the discovery set to select features, and built an optimal model to predict diabetes mellitus, blood insulin, fasting plasma glucose (FPG) and 2-h plasma glucose after oral glucose tolerance test (2-h PG after OGTT).

RESULTS

The machine learning model using LASSO regression predicted diabetes with an area under the receiver operating characteristics (AUROC) of 0.80 and 0.78 in the discovery set and validation set, respectively. The linear model predicted blood insulin level with an R² of 0.42 and 0.40 in the discovery set and validation set, respectively. For FPG, the discovery set and validation set yielded an R² of 0.16 and 0.15, respectively. For 2-h PG after OGTT, the discovery set and validation set yielded an R² of 0.18 and 0.17, respectively.

CONCLUSION

We used environmental chemical exposure, constructed machine learning models and achieved relatively accurate prediction for diabetes, emphasizing the predictive value of widespread environmental chemicals for complicated diseases.

Mercury Exposure and Risk of Type 2 Diabetes: A Systematic Review and Meta-Analysis

METHODS

Scopus and PubMed databases were systematically searched from their inception to November 2021 to obtain pertinent studies. Standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the difference in Hg levels between people with and without T2DM. The association of the Hg exposure with T2DM was assessed using a random-effects model by pooling the odds ratios (ORs) and 95% CIs.

RESULTS

A total of 17 studies, with 42,917 participants, aged ≥18 years, were analyzed. Overall, Hg levels were significantly higher in T2DM patients compared with non-T2DM controls (SMD = 1.07; 95%CI = 0.59 to 1.55, P ≤ 0.001), with significant heterogeneity across studies (I² = 96.1%; P=≤0.001). No significant association was found between Hg exposure and risk of T2DM in the overall analysis and subgroup analysis based on the source of sample and study design. However, higher exposure to Hg was related to reduced risk of T2DM in men (OR = 0.71; 95%CI = 0.57 to 0.88), but not in women. No significant evidence for publication bias was detected.

CONCLUSIONS

Although the Hg level in T2DM is significantly higher than that of nondiabetics, there was no association between Hg exposure and the overall risk of T2DM. Nevertheless, our study shows that higher exposure to Hg might reduce the risk of T2DM in men.

Metabolic Syndrome and Endocrine Disrupting Chemicals: An Overview of Exposure and Health Effects

Increasing prevalence of metabolic syndrome (MetS) is causing a significant health burden among the European population. Current knowledge supports the notion that endocrine-disrupting chemicals (EDCs) interfere with human metabolism and hormonal balance, contributing to the conventionally recognized lifestyle-related MetS risk factors. This review aims to identify epidemiological studies focusing on the association between MetS or its individual components (e.g., obesity, insulin resistance, diabetes, dyslipidemia and hypertension) and eight HBM4EU priority substances (bisphenol A (BPA), per- and polyfluoroalkyl substances (PFASs), phthalates, polycyclic aromatic hydrocarbons (PAHs), pesticides and heavy metals (cadmium, arsenic and mercury)). Thus far, human biomonitoring (HBM) studies have presented evidence supporting the role of EDC exposures on the development of individual MetS components. The strength of the association varies between the components and EDCs. Current evidence on metabolic disturbances and EDCs is still limited and heterogeneous, and mainly represent studies from North America and Asia, highlighting the need for well-conducted and harmonized HBM programmes among the European population. Rigorous and ongoing HBM in combination with health monitoring can help to identify the most concerning EDC exposures, to guide future risk assessment and policy actions.

Associations of total blood mercury and blood methylmercury concentrations with diabetes in adults: An exposure-response analysis of 2005-2018 NHANES

OBJECTIVE

To examine the exposure-response relationship between mercury exposure and diabetes in adults, and to explore the possible effect modifications by selenium and omega-3 fatty acids.

METHODS

Biomarker data (total blood mercury and blood methylmercury) from individuals ≥20 years of age were obtained from the 2005-2018 NHANES. Diabetes was defined through questionnaires, fasting plasma glucose, 2 -h plasma glucose and hemoglobin A_1c levels. The exposure-response relationship between mercury exposure and diabetes was assessed with logistic regression and restricted cubic splines.

RESULTS

Comparing the highest to lowest quartile of exposure, the multivariable-adjusted odds ratio (95 % CI) of diabetes was 0.76 (0.63-0.92) with total blood mercury and 0.82 (0.66-1.00) with blood methylmercury. The inverse associations between total blood mercury [0.55 (0.40-0.77)] and blood methylmercury [0.61 (0.38-0.97)] and diabetes were observed among individuals having higher intakes of selenium (P_{for interaction}<0.05). Trends toward lower odds of diabetes with mercury exposure were mainly confined to individuals having higher intakes of omega-3 fatty acid, but the interactions were not significant. The inverse associations between total blood mercury and blood methylmercury and diabetes remained in sensitivity analyses after excluding patients with hypertension that may change their dietary intake of fish. Exposure-response analyses showed an initial decrease in odds of diabetes followed by a platform or a weaker decrease beyond 3 μg/L of total blood mercury and methylmercury concentrations, respectively.

CONCLUSIONS

Total blood mercury and blood methylmercury concentrations were inversely associated with diabetes in adults, and the associations were modified by selenium.

Relationship between gestational diabetes and serum trace element levels in pregnant women from Eastern Iran: a multivariate approach

The prevalence of gestational diabetes mellitus (GDM) has increased over the recent decades. Exposure to environmental contaminants may be a risk factor for the development of GDM, but this is heavily dependent on particular circumstances. Studies on various areas linking various factors are therefore needed. We examined the associations between serum trace element levels and incidents of GDM among 102 pregnant women (diabetic n = 60 and healthy n = 42) living in Birjand (Iran). Blood serum samples were analyzed for concentrations of elements linked to particulate matter air pollution such as As, Cd, Cu, Hg, Mn, Ni, V, and Zn. Concentrations of As (8.58 vs. 3.15 μg/L), Cd (6.74 vs. 0.52 μg/L), and Hg (2.60 vs. 0.90 μg/L) were significantly higher in women with GDM. Risk difference (RD) estimation showed that As, 0.516 (0.355, 0.677); Cd, 0.719 (0.534, 0.904); and Hg, 0.505 (0.276, 0.735) increase GDM probability, while V lower that risk, -0.139 (-0.237, -0.042). With the principal component analysis, we were able to separate subjects according to their GDM status based on element levels. Such classification revealed very high efficiency with a true positive rate of 93%, according to linear discriminant analysis. GDM subjects presented higher levels of As, Cd, and Hg, indicating that these elements may disturb insulin metabolism and promote the development of GDM. Therefore, we conclude that systematic monitoring of trace elements followed by multivariate modeling in women planning pregnancy should be carried out to prevent the development of GDM.

Intakes of Fish and Long-chain n-3 Polyunsaturated Fatty Acid Supplements During Pregnancy and Subsequent Risk of Type 2 Diabetes in a Large Prospective Cohort Study of Norwegian Women

OBJECTIVE

To investigate associations between intakes of total fish, lean fish, fatty fish, and long-chain n-3 polyunsaturated fatty acid (LCn-3PUFA) supplements and risk of type 2 diabetes in women after pregnancy. Furthermore, we sought to compare the estimated intakes of methylmercury (MeHg) and sum of dioxins and dioxin-like polychlorinated biphenyls (dl-PCBs) with tolerable weekly intakes (TWI).

RESEARCH DESIGN AND METHODS

Women free of diabetes at baseline (n = 60,831) who participated in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa) were prospectively evaluated for incident type 2 diabetes, identified on the basis of medication usage >90 days after delivery, ascertained through the Norwegian Prescription Database. Dietary intake data were obtained with a validated 255-item food-frequency questionnaire (FFQ), which assessed habitual diet during the first 4-5 months of pregnancy. Intakes of MeHg and sum of dioxins and dl-PCBs were derived with use of a contaminant database and the FFQ.

RESULTS

Median age was 31 years (interquartile range 27, 34) at time of delivery, and follow-up time was 7.5 years (6.5, 8.5). Type 2 diabetes occurred in 683 (1.1%) participants. Multivariable Cox regression analyses identified lower risk of type 2 diabetes with increasing energy-adjusted lean fish intake, 25 g/1,000 kcal (25 g/1,000 kcal: hazard ratio 0.71, 95% CI 0.53-0.95, P = 0.022). However, in stratified analyses, a lower risk was found only in women with prepregnancy BMI ≥25 kg/m2. There were no associations between intake of total fish, fatty fish, or LCn-3PUFA supplements and type 2 diabetes. MeHg intake was low, but the intake of the sum of dioxins and dl-PCBs (picograms of toxic equivalents/kilograms of body weight/week) exceeded the TWI set by the European Food Safety Authority (EFSA) for the majority of participants.

CONCLUSIONS

Intake of lean fish, but not fatty fish or LCn-3PUFA supplements, was associated with lower risk of pharmacologically treated type 2 diabetes in Norwegian women who were overweight or obese. Fatty fish, which contain dioxins and dl-PCBs, did not increase the risk of type 2 diabetes, but the exceedance of the EFSA TWI for dioxins and dl-PCBs is a health concern.

The relationship between dietary exposure to persistent organic pollutants from fish consumption and type 2 diabetes among First Nations in Canada

OBJECTIVE

We previously examined the associations between dietary dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs) intake from fish consumption and type 2 diabetes (T2D) prevalence in Ontario and Manitoba. This study aims to further explore the relationship in a regionally representative sample of First Nations adults living on-reserve across Canada.

METHODS

Dietary, health and lifestyle data collected by the cross-sectional First Nations Food, Nutrition and Environment Study (2008-2018) were analyzed. This participatory study included 6091 First Nations adult participants who answered questions on T2D. The consumption of locally caught fish was estimated with a food frequency questionnaire. A total of 551 samples from 96 fish species were collected and analyzed for the presence of DDE and PCBs. The associations between fish and dietary DDE/PCBs intake with self-reported T2D were investigated using multiple logistic regression models adjusted for confounders.

RESULTS

Dietary exposure to DDE (>2.11 ng/kg/bw) and PCBs (>1.47 ng/kg/bw) vs no exposure was positively associated with T2D with ORs of 2.33 (95% CI: 1.24-4.35) for DDE and 1.43 (95% CI: 1.01-3.59) for PCBs. The associations were stronger among females (DDE OR = 3.11 (1.41-6.88); PCBs OR = 1.76 (1.10-3.65)) and older individuals (DDE OR = 2.64 (1.12-6.20); PCBs OR = 1.44 (1.01-3.91)) as compared with males and younger participants. Also, significant dose-response relationships were found for fish consumption in females only.

CONCLUSION

This study confirms our previous findings that dietary DDE/PCBs exposure may increase the risk of T2D. The effect of DDE/PCBs from fish consumption is driven by geographical differences in DDE/PCBs concentrations in fish and by the amount of fish consumed, and is more prominent in females than in males.

Exposure to heavy metals from point pollution sources and risk of incident type 2 diabetes among women: a prospective cohort analysis

Heavy metal exposures may contribute to diabetes risk but prospective studies are uncommon. We analyzed the Australian Longitudinal Study on Women's Health (three cohorts aged 18-23, 45-50, or 70-75 at baseline in 1996, N = 34,191) merged with emissions data for 10 heavy metals (As, Be, Co, Cr, Cu, Hg, Mn, Ni, Pb, Zn) from the National Pollutant Inventory. Over 20-year follow-up, 2,584 women (7.6%) reported incident diabetes. Cox proportional hazards regression models showed that women aged 45-50 at baseline had higher diabetes risk in association with exposure to total air emissions, total water emissions, all individual metals air emissions, and six individual water emissions. After correction for false discovery rate, nine of 11 air emissions and five water emissions remained significant. Associations were not observed for land-based emissions, or for younger or older cohorts. Emissions were dominated by mining, electricity generation and other metals-related industrial processes.

Calcium Intake Is Inversely Related to Risk of Obesity among American Young Adults over a 30-Year Follow-Up

BACKGROUND

Calcium (Ca) is an essential nutrient that may play an important role in weight maintenance through its involvement in energy or lipid metabolism. However, little is known about the long-term associations of Ca intake with obesity risk.

OBJECTIVES

We aimed to prospectively examine the association between cumulative Ca intake and the incidence of obesity among American young adults over 30 y of follow-up.

METHODS

Participants were from the CARDIA (Coronary Artery Risk Development in Young Adults) study. A total of 4097 of 5115 black and white individuals aged 18-30 y at baseline in 1985-1986 were included in the current analysis. Dietary and supplemental Ca intake was assessed by the validated interview-based CARDIA diet history at baseline and exam years 7 and 20. Incident cases of obesity were identified when BMI was ≥30 kg/m2 for the first time since baseline. A survival analysis was performed using Cox proportional hazards regression models to estimate the HRs and corresponding 95% CIs for obesity incidence during follow-up.

RESULTS

During a 30-y follow-up (mean ± SD: 20 ± 10 y), 1675 participants developed obesity. Cumulative total Ca intake (dietary plus supplemental Ca) was inversely associated with incidence of obesity in multivariable-adjusted analysis [quintile (Q)5 (highest intake) compared with Q1 (lowest intake): HR: 0.68; 95% CI: 0.56, 0.82; P-trend < 0.01]. This inverse association persisted among Ca supplement users (Q5 compared with Q1: HR: 0.53; 95% CI: 0.40, 0.70; P-trend < 0.01), but was not seen among nonusers.

CONCLUSIONS

Following a cohort of Americans from young adulthood to midlife, an inverse association between calcium intake and obesity incidence was observed. Further studies are needed to confirm our findings.

Heterogeneity of Associations between Total and Types of Fish Intake and the Incidence of Type 2 Diabetes: Federated Meta-Analysis of 28 Prospective Studies Including 956,122 Participants

The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction (p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01-1.03, I2 = 61%) for total fish, 1.04 (1.01-1.07, I2 = 46%) for fatty fish, and 1.02 (1.00-1.04, I2 = 33%) for lean fish. In men, all associations were null. In women, we observed variation by geographical location: IRRs for total fish were 1.03 (1.02-1.04, I2 = 0%) in the Americas and null in other regions. In conclusion, we found evidence of a neutral association between total fish intake and type 2 diabetes in men, but there was a modest positive association among women with heterogeneity across studies, which was partly explained by geographical location and types of fish intake. Future research should investigate the role of cooking methods, accompanying foods and environmental pollutants, but meanwhile, existing dietary regional, national, or international guidelines should continue to guide fish consumption within overall healthy dietary patterns.

Diet: A Source of Endocrine Disruptors

BACKGROUND

Food is indispensable for human life and determines the health and wellbeing of the consumer. As food is the source of energy for humans, it also emerges as one of the most important sources of exposure to deleterious chemicals both natural and synthetic. The food exposed chemicals cause a number of detrimental health effects in humans, with endocrine disruption being of serious concern amongst these effects. Such chemicals disrupting the health of endocrine system are known as endocrine-disrupting chemicals (EDCs). The food exposed EDCs need to be identified and classified to effectuate a cautious consumption of food by all and especially by vulnerable groups.

AIM

The aim of the present review was to discuss food as a source of exposure to common endocrine disruptors in humans. This review presents the occurrence and levels of some of the critical endocrine disruptors exposed through frequently consumed diets.

METHODS

The major source of data was PubMed, besides other relevant publications. The focus was laid on data from the last five years, however significant earlier data was also considered.

CONCLUSION

The food as a source of endocrine disruptors to humans cannot be neglected. It is highly imperative for the consumer to recognize food as a source of EDCs and make informed choices in the consumption of food items.

Associations between metabolic syndrome and four heavy metals: A systematic review and meta-analysis

Four most concerned heavy metal pollutants, arsenic, cadmium, lead, and mercury may share common mechanisms to induce metabolic syndrome (MetS). However, recent studies exploring the relationships between MetS and metal exposure presented inconsistent findings. We aimed to clarify the relationship between heavy metal exposure biomarkers and MetS using a meta-analysis and systematic review approach. Literature search was conducted in international and the Chinese national databases up to June 2020. Of selected studies, we extracted the relevant data and evaluated the quality of each study's methodology. We then calculated the pooled effect sizes (ESs), standardized mean differences (SMDs), and their 95% confidence intervals (CIs) using a random-effect meta-analysis approach followed by stratification analyses for control of potential confounders. Involving 55,536 participants, the included 22 articles covered 52 observational studies reporting ESs and/or metal concentrations on specific metal and gender. Our results show that participants with MetS had significantly higher levels of heavy metal exposure [pooled ES = 1.16, 95% CI: 1.09, 1.23; n = 42, heterogeneity I2 = 75.6%; and SMD = 0.22, 95% CI: 0.15, 0.29; n = 32, I2 = 94.2%] than those without MetS. Pooled ESs in the subgroups stratified by arsenic, cadmium, lead, and mercury were 1.04 (95% CI: 0.97, 1.10; n = 8, I2 = 61.0%), 1.10 (0.95, 1.27; 11, 45.0%), 1.21 (1.00, 1.48; 12, 82.9%), and 1.26 (1.06, 1.48; 11, 67.7%), respectively. Pooled ESs in the subgroups stratified by blood, urine, and the other specimen were 1.22 (95% CI: 1.08, 1.38; n = 26, I2 = 75.8%), 1.06 (1.00, 1.13; 14, 58.1%), and 2.41 (1.30, 4.43; 2, 0.0%), respectively. In conclusion, heavy metal exposure was positively associated with MetS. Further studies are warranted to examine the effects of individual metals and their interaction on the relationship between MetS and heavy metals.

Urinary metal mixtures and longitudinal changes in glucose homeostasis: The Study of Women's Health Across the Nation (SWAN)

BACKGROUND

Epidemiologic studies on associations between metals and insulin resistance and β-cell dysfunction have been cross-sectional and focused on individual metals.

OBJECTIVE

We assessed the association of exposure to metal mixtures, based on assessment of 15 urinary metals, with both baseline levels and longitudinal changes in homeostatic model assessments for insulin resistance (HOMA-IR) and β-cell function (HOMA-β).

METHODS

We examined 1262 women, aged 45-56 years at baseline (1999-2000), who were followed through 2015-2016, from the Study of Women's Health Across the Nation. Urinary concentrations of 15 metals (arsenic, barium, cadmium, cobalt, cesium, copper, mercury, manganese, molybdenum, nickel, lead, antimony, tin, thallium, and zinc) were determined at baseline. HOMA-IR and HOMA-β were repeatedly measured over 16 years of follow-up. A two-stage modeling was used to account for correlations in dependent and independent variables: In stage-1, linear mixed effects models were used to estimate the participant-specific baseline HOMA levels from random intercepts and participant-specific rates of changes from random slopes. In stage-2, adaptive elastic-net (AENET) models were fit to identify components of metal mixtures associated with participant-specific baseline levels and rates of changes in HOMA-IR and HOMA-β, respectively. An environmental risk score (ERS) was used to integrate metal mixture effects from AENET results.

RESULTS

In multivariable adjusted AENET models, urinary zinc was associated with higher HOMA-IR at baseline, whereas molybdenum was associated with lower HOMA-IR at baseline. The estimated changes in baseline HOMA-IR for one standard deviation increase in log-transformed urinary metal concentrations were 5.76% (3.05%, 8.55%) for zinc and -3.25% (-5.45%, -1.00%) for molybdenum, respectively. Urinary zinc was also associated with lower HOMA- β at baseline. Arsenic was associated with a slightly faster rate of decline in HOMA-β in the AENET model evaluating associations between metals and rate of changes. Significant associations of ERS with both HOMA-IR and HOMA-β at baseline were observed. ERS for the rate of changes was not calculated and examined in relation to rates of changes in HOMA-IR and HOMA-β because only a single metal was selected by AENET.

CONCLUSION

Exposure to metal mixtures may be exerting effects on insulin resistance and β-cell dysfunction, which might be mechanisms by which metal exposures lead to elevated diabetes risks.

Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study

OBJECTIVE

To prospectively examine intakes of folate, vitamin B₆, and vitamin B₁₂ in relation to diabetes incidence in a large U.S. cohort.

RESEARCH DESIGN AND METHODS

A total of 4,704 American adults aged 18-30 years and without diabetes were enrolled in 1985-1986 and monitored until 2015-2016 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary assessment was conducted by a validated dietary history questionnaire at baseline, in 1992-1993, and in 2005-2006. The cumulative average intakes of folate, vitamin B₆, and vitamin B₁₂ were used in the analyses. Incident diabetes was ascertained by plasma glucose levels, oral glucose tolerance tests, hemoglobin A_1c concentrations, and/or antidiabetic medications.

RESULTS

During 30 years (mean 20.5 ± 8.9) of follow-up, 655 incident cases of diabetes occurred. Intake of folate, but not vitamin B₆ or vitamin B₁₂, was inversely associated with diabetes incidence after adjustment for potential confounders. Compared with the lowest quintile of total folate intake, the multivariable-adjusted hazard ratios (95% CI) in quintiles 2-5 were 0.85 (0.67-1.08), 0.78 (0.60-1.02), 0.82 (0.62-1.09), and 0.70 (0.51-0.97; P _trend = 0.02). Higher folate intake was also associated with lower plasma homocysteine (P _trend < 0.01) and insulin (P _trend < 0.01). Among supplement users, folate intake was inversely associated with serum C-reactive protein levels (P _trend < 0.01).

CONCLUSIONS

Intake of folate in young adulthood was inversely associated with diabetes incidence in midlife among Americans. The observed association may be partially explained by mechanisms related to homocysteine level, insulin sensitivity, and systemic inflammation.

Urinary metals and incident diabetes in midlife women: Study of Women's Health Across the Nation (SWAN)

INTRODUCTION

Environmental exposure to metals may play a role in the pathogenesis of diabetes; however, evidence from human studies is limited. We prospectively evaluated the associations of 20 urinary metal concentrations and their mixtures with incident diabetes in the Study of Women's Health Across the Nation, a multisite, multiethnic cohort study of midlife women.

RESEARCH DESIGN AND METHODS

The sample included 1237 white, black, Chinese and Japanese-American women, aged 45-56 years, free of diabetes at baseline (1999-2000) who were followed through 2016. Concentrations of 20 metals (arsenic, barium, beryllium, cadmium, cobalt, chromium, cesium, copper, mercury, manganese, molybdenum, nickel, lead, antimony, tin, thallium, uranium, vanadium, tungsten and zinc) were measured in urine specimens at baseline. Incident diabetes was identified annually by fasting glucose ≥126 mg/dL, self-reported doctor-diagnosed diabetes, or self-reported use of antidiabetic medications. A non-parametric clustering method, k-means clustering, was used to identify subgroups with different exposure patterns to metal mixtures.

RESULTS

After multivariable adjustment, the HR (95% CI) for diabetes associated with each doubling increase in urinary metal concentrations was 1.19 (1.10 to 1.30) for arsenic and 1.20 (1.05 to 1.37) for lead, in Cox proportional hazards models after controlling for multiple comparisons. A doubling in urinary excretion of zinc was associated with higher risk of diabetes (adjusted HR 1.31, 95% CI 1.11 to 1.53). Two distinct exposure patterns to metal mixtures-'high' versus 'low'-were identified. Participants assigned to the 'high' pattern had higher overall concentrations of all metals compared with those classified into the 'low' pattern. Adjusted HR for diabetes associated with 'high' pattern compared with 'low' was 1.42 (1.08 to 1.87).

CONCLUSIONS

Higher urinary concentrations of arsenic and lead, increased urinary excretion of zinc, as well as higher overall exposure to metal mixtures were associated with elevated risk of diabetes. Future studies should further investigate the underlying mechanisms.

Toxicity of mercury: Molecular evidence

Minamata disease in Japan and the large-scale poisoning by methylmercury (MeHg) in Iraq caused wide public concerns about the risk emanating from mercury for human health. Nowadays, it is widely known that all forms of mercury induce toxic effects in mammals, and increasing evidence supports the concern that environmentally relevant levels of MeHg could impact normal biological functions in wildlife. The information of mechanism involved in mercurial toxicity is growing but knowledge gaps still exist between the adverse effects and mechanisms of action, especially at the molecular level. A body of data obtained from experimental studies on mechanisms of mercurial toxicity in vivo and in vitro points to that disruption of the antioxidant system may play an important role in the mercurial toxic effects. Moreover, the accumulating evidence indicates that signaling transduction, protein or/and enzyme activity, and gene regulation are involving in mediating toxic and adaptive response to mercury exposure. We conducted here a comprehensive review of mercurial toxic effects on wildlife and human, in particular synthesized key findings of molecular pathways involved in mercurial toxicity from the cells to human. We discuss the molecular evidence related mercurial toxicity to the adverse effects, with particular emphasis on the gene regulation. The further studies relying on Omic analysis connected to adverse effects and modes of action of mercury will aid in the evaluation and validation of causative relationship between health outcomes and gene expression.

Toenail Metal Exposures in Fishermen from Bodo City, Nigeria

We conducted exposure assessment using toenails from 20 fishermen living in Bodo City, a community of the Niger delta region in Nigeria. This community has been affected by over 4000 oil spills and environmental disasters. Fishing is the primary source of food and income for individuals in this community. Previous research in Bodo City found elevated metal levels in fish. Toenails were used as a biomarker to investigate the feasibility for use in risk assessment studies in developing countries. The toenails collected had significantly higher manganese levels (median 5.8 µg/g) and lead levels (median 0.98 µg/g) than those reported in more developed countries, comparable levels to those from other low-middle incomes countries. These exposure levels are likely a direct result of exposures from the environmental disasters the community has experienced and would be related to increased risks for many diseases previously associated with heavy metal exposures.

The chemical exposome of type 2 diabetes mellitus: Opportunities and challenges in the omics era

Type 2 diabetes mellitus (T2DM) is a global silent killer, with > 450 million affected adults worldwide. A diverse array of non-modifiable risk factors such as family history, age (> 45 yrs), race/ethnicity, genetics, and history of gestational diabetes and modifiable risk factors such as physical inactivity, high body fat, body weight, high blood pressure, and high cholesterol for progression of prediabetes to T2DM. Given, that the modern world human population is constantly exposed to multiple stressors in the form of physical (i.e., sound, weather etc.) and chemical environment (i.e., diet, pollutants etc.), industrialization, and modernization has led to form a basis for exposomal correlation with T2DM incidence. Over the past decade, there have been emerging reports on association of levels of persistent organic pollutants (POPs), phthalates, antibiotics, drugs, air pollution, pesticides, and heavy metals with T2DM. In this review, we discuss the well known chemical exposome that has been associated with T2DM; the tools and approaches to capture this chemical exposome, and future opportunities and challenges in this exciting area of research. We further provide a window of thoughts, whether omics technologies can help fill in the gaps to help provide high throughput exposomics datasets in an unbiased manner to help understand T2DM pathophysiology in the context of industrialization, drastic lifestyle changes, urbanization, and pollution. We also discuss and provide guidelines/call to action for future exposomics studies investigating the association of T2DM with exposomes in the context of both epidemiological and experimental approaches.

Multiple metal concentrations and gestational diabetes mellitus in Taiyuan, China

BACKGROUND

The association between multiple metal concentrations and gestational diabetes mellitus (GDM) is poorly understood.

METHODS

A total of 776 women with GDM and an equal number of controls were included in the study. Concentrations of metals in participants' blood (nickel (Ni), arsenic (As), cadmium (Cd), antimony (Sb), thallium (Tl), mercury (Hg), lead (Pb)) were measured using inductively coupled plasma-mass. We used unconditional logistical regression models to estimate the associations between metals and GDM. We also employed weighted quantile sum (WQS) regression and principal components analysis (PCA) to examine metal mixtures in relation to GDM.

RESULTS

An increased risk of GDM was associated with As (OR = 1.49, 95% CI: 1.11, 2.01 for the 2nd tertile vs. the 1st tertile) and Hg (OR = 1.43, 95% CI: 1.09, 1.88 for the 3rd tertile vs. the 1st tertile). In WQS analysis, the WQS index was significantly associated with GDM (OR = 1.20, 95% CI: 1.02, 1.41). The major contributor to the metal mixture index was Hg (69.2%), followed by Pb (12.8%), and As (11.3%). Based on PCA, the second principal component, which was characterized by Hg, Ni, and Pb, was associated with an increased risk of GDM (OR = 1.46, 95% CI: 1.02, 2.08 for the highest quartile vs. the lowest quartile).

CONCLUSIONS

Our study results suggest that high metal levels are associated with an increased risk of GDM, and this increased risk is mainly driven by Hg and, to a lesser extent, by Ni, Pb, and As.

In utero exposure to mercury and childhood overweight or obesity: counteracting effect of maternal folate status

BACKGROUND

Low-dose mercury (Hg) exposure has been associated with cardiovascular diseases, diabetes, and obesity in adults, but it is unknown the metabolic consequence of in utero Hg exposure. This study aimed to investigate the association between in utero Hg exposure and child overweight or obesity (OWO) and to explore if adequate maternal folate can mitigate Hg toxicity.

METHODS

This prospective study included 1442 mother-child pairs recruited at birth and followed up to age 15 years. Maternal Hg in red blood cells and plasma folate levels were measured in samples collected 1-3 days after delivery (a proxy for third trimester exposure). Adequate folate was defined as plasma folate ≥ 20.4 nmol/L. Childhood OWO was defined as body mass index ≥ 85% percentile for age and sex.

RESULTS

The median (interquartile range) of maternal Hg levels were 2.11 (1.04-3.70) μg/L. Geometric mean (95% CI) of maternal folate levels were 31.1 (30.1-32.1) nmol/L. Maternal Hg levels were positively associated with child OWO from age 2-15 years, independent of maternal pre-pregnancy OWO, diabetes, and other covariates. The relative risk (RR = 1.24, 95% CI 1.05-1.47) of child OWO associated with the highest quartile of Hg exposure was 24% higher than those with the lowest quartile. Maternal pre-pregnancy OWO and/or diabetes additively enhanced Hg toxicity. The highest risk of child OWO was found among children of OWO and diabetic mothers in the top Hg quartile (RR = 2.06; 95% CI 1.56-2.71) compared to their counterparts. Furthermore, adequate maternal folate status mitigated Hg toxicity. Given top quartile Hg exposure, adequate maternal folate was associated with a 34% reduction in child OWO risk (RR = 0.66, 95% CI 0.51-0.85) as compared with insufficient maternal folate. There was a suggestive interaction between maternal Hg and folate levels on child OWO risk (p for interaction = 0.086).

CONCLUSIONS

In this US urban, multi-ethnic population, elevated in utero Hg exposure was associated with a higher risk of OWO in childhood, and such risk was enhanced by maternal OWO and/or diabetes and reduced by adequate maternal folate. These findings underscore the need to screen for Hg and to optimize maternal folate status, especially among mothers with OWO and/or diabetes.

Effects of Methylmercury and Theaflavin Digallate on Adipokines in Mature 3T3-L1 Adipocytes

Diabetes is a contributor to morbidity across the globe and is often associated with obesity, metabolic syndrome and other inflammatory diseases associated with aging. In addition to genetic and lifestyle factors, environmental factors such as metals and persistent organic pollutants may increase the severity or lower the threshold of these conditions. In cell culture, methylmercury is toxic to adipocytes and may impact adipokine secretions. In this study, we determined the effects of different concentrations of theaflavin digallate on methylmercury exposed 3T3-L1 adipocytes in cell culture. Secretions of resistin, adiponectin and lipid peroxidation product, 4-hydroxynonenal (4-HNE) were monitored using ELISA assays. Cell morphology of methylmercury and theaflavin-3,3'-digallate treated adipocytes was assessed using Lipid (Oil Red O) staining. Exposure to methylmercury increased the levels of resistin and adiponectin as well as 4-HNE when compared to the control cells. Methylmercury treated cells resulted in smaller number of adipocytes and clumped lipid droplets. These results suggest that methylmercury induces reactive oxygen species leading to development of an inflammatory response. Theaflavin-3,3'-digallate reduced the impact of methylmercury by maintaining the adipocytes morphology and secretion patterns of adiponectin, resistin and 4-hydroxynonenal. With this experimental model system other anti-inflammatory and signaling agents could be tested at the biochemical level before eventually leading to studies in animal models.

Parabens exposure in early pregnancy and gestational diabetes mellitus

BACKGROUND

Widespread exposure to parabens has been a concern, especially among pregnant women. Only one study reported that parabens are associated with glucose levels among pregnant women. However, studies on parabens exposure and gestational diabetes mellitus (GDM) are lacking.

OBJECTIVES

This study investigated whether exposure to parabens in early pregnancy is related to GDM.

METHODS

We conducted a prospective study of 1087 pregnant women from a single tertiary medical center between 2014 and 2015 in Wuhan, China. Parabens [methyl paraben (MeP), ethylparaben (EtP), propylparaben (PrP), butylparaben (BuP), and benzylparaben (BzP)] concentrations were measured in spot urine samples collected between 8 and 16 gestational weeks. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel (IADPSG) recommendations. We used the Poisson regression with a robust error variance with generalized estimating equations (GEE) estimation analyses to evaluate associations between parabens exposure and GDM risk.

RESULTS

A total of 103 (9.5%) women were diagnosed with GDM. We evaluated the associations of GDM risk with urinary MeP, EtP, and PrP (detection rate: >90%), but not with BuP and BzP due to the relatively low detection rate (<50%). After adjustment for potential confounders, urinary EtP was associated with GDM. The risk ratios (RRs) = 1.12 (95% CI: 0.63, 2.01) for the second quartile, RRs = 1.11 (95% CI: 0.64, 1.93) for the third quartile, and RRs = 1.70 (95% CI: 1.02, 2.82) for the highest quartile, compared with the lowest quartile. There was no evidence of associations between urinary MeP or PrP and GDM.

CONCLUSIONS

To the best of our knowledge, this is the first report of an association between urinary paraben levels in early pregnancy and GDM. Our findings suggest that exposure to EtP may increase the risk of GDM.

Type 2 diabetes occurrence and mercury exposure - From the National Nutrition and Health Survey in Taiwan

BACKGROUND

The global prevalence of type 2 diabetes continues to increase in both developed and developing countries. Environmental exposure to mercury may be an important and modifiable risk factor for type 2 diabetes. However, the epidemiological results are controversial.

OBJECTIVES

This study aimed to examine the association between blood mercury levels and prevalence of type 2 diabetes.

METHODS

A total of 646 adult participants were selected from the National Nutrition and Health Survey in Taiwan (NAHSIT) 2005-2008. The participants were interviewed using structured questionnaires to record data on basic demographics, socioeconomic status, lifestyle, medical history, and 24-h dietary recall. Specimens of blood and urine were collected at the health examination. Type 2 diabetes was defined as a fasting blood glucose level ≥ 126 mg/dL or intake of hypoglycemic medications. The mercury concentration in red blood cells (RBC-Hg) was quantified by cold vapor atomic absorption spectrometry.

RESULTS

Participants with type 2 diabetes had a significantly higher RBC-Hg than those without type 2 diabetes. A significant association between the RBC-Hg and prevalence of type 2 diabetes was observed [odds ratio (OR): 1.64; 95% confidence intervals: 1.14-2.35] after potential confounders were well considered, including age, sex, body mass index (BMI), hypertension, total cholesterol, saltwater fish consumption, geographical strata, seasonality and hemoglobin (Hb) level.

CONCLUSION

Our findings showed that elevated RBC-Hg is significantly associated with type 2 diabetes prevalence. Future research, particularly for longitudinal cohort studies with suitable specimens, needs to be performed to verify our findings.

Association of blood mercury levels during pregnancy with infant birth size by blood selenium levels in the Japan Environment and Children's Study: A prospective birth cohort

BACKGROUND

It is necessary to determine whether there are adverse health effects of prenatal exposure to long-term, low levels of mercury and selenium. However, there are limited that reports on the association between mercury levels by selenium levels and birth size. Therefore, we examined whether maternal mercury levels during pregnancy had any effect on infant birth size, and size, and whether selenium levels influenced this relationship.

OBJECTIVES

To examine the association between mercury and selenium levels during pregnancy with infant birth size.

METHODS

The Japan Environment and Children's Study is a prospective birth cohort conducted between 2011 and 2014. Total mercury levels and total selenium levels in maternal blood during the second and third trimesters were measured using Inductively Coupled Plasma-Mass Spectrometry. Birth weight and small-for-gestational-age were confirmed by medical records. Small-for-gestational-age was defined as birth weight below the 10th percentile according to standard percentile for gender, parity, and gestational age. Multiple linear and logistic regression analyses were used to examine the association between maternal mercury exposure and birth weight or small-for-gestational-age adjusted for confounders (including maternal age and body mass index pregnancy).

RESULTS

Overall, 15,444 pregnant women were included in this study. Median (inter-quartile range) of blood mercury and selenium levels were 3.66 (2.59-5.18) ng/g and 170.0 (158.0-183.0) ng/g, respectively. Compared to infants of mothers with the highest blood selenium level, those of mothers with the lowest blood selenium level had neither a significant birth weight increase (9 g, 95% confidence interval: -6, 25) nor a significant odds ratio for small-for-gestational-age (0.903, 95% confidence interval: 0.748, 1.089). Compared to infants of mothers with the lowest blood mercury level, those of mothers with the highest blood mercury level had neither a significant birth weight reduction (-12 g, 95% confidence interval: -27, 4) nor a significant odds ratio for small-for-gestational-age (0.951, 95% confidence interval: 0.786, 1.150). Compared to infants of mothers with the lowest quartile of maternal blood mercury level, all infants of mothers with the highest quartile of maternal blood mercury level had a reduced birth head circumference of 0.073 cm (95% confidence interval: -0.134, -0.011).

CONCLUSIONS

There was no association between maternal blood mercury levels and small-for-gestational-age and birth weight among 15,444 pregnant women. In a Japanese population, which has a relatively higher blood mercury level than reported in Western population, reduced birth size was not found to be associated with blood mercury levels, with the exception of birth head circumference.

Heavy Metal Exposure and Metabolic Syndrome: Evidence from Human and Model System Studies

PURPOSE OF REVIEW

Metabolic syndrome (MS) describes the co-occurrence of conditions that increase one's risk for heart disease and other disorders such as diabetes and stroke. The worldwide increase in the prevalence of MS cannot be fully explained by lifestyle factors such as sedentary behavior and caloric intake alone. Environmental exposures, such as heavy metals, have been implicated, but results are conflicting and possible mechanisms remain unclear. To assess recent progress in determining a possible role between heavy metal exposure and MS, we reviewed epidemiological and model system data for cadmium (Cd), lead (Pb), and mercury (Hg) from the last decade.

RECENT FINDINGS

Data from 36 epidemiological studies involving 17 unique countries/regions and 13 studies leveraging model systems are included in this review. Epidemiological and model system studies support a possible association between heavy metal exposure and MS or comorbid conditions; however, results remain conflicting. Epidemiological studies were predominantly cross-sectional and collectively, they highlight a global interest in this question and reveal evidence of differential susceptibility by sex and age to heavy metal exposures. In vivo studies in rats and mice and in vitro cell-based assays provide insights into potential mechanisms of action relevant to MS including altered regulation of lipid and glucose homeostasis, adipogenesis, and oxidative stress. Heavy metal exposure may contribute to MS or comorbid conditions; however, available data are conflicting. Causal inference remains challenging as epidemiological data are largely cross-sectional; and variation in study design, including samples used for heavy metal measurements, age of subjects at which MS outcomes are measured; the scope and treatment of confounding factors; and the population demographics vary widely. Prospective studies, standardization or increased consistency across study designs and reporting, and consideration of molecular mechanisms informed by model system studies are needed to better assess potential causal links between heavy metal exposure and MS.

Chronic mercury at low doses impairs white adipose tissue plasticity

INTRODUCTION

The toxic effects of mercury (Hg) are involved in homeostasis of energy systems such as lipid and glucose metabolism, and white adipose tissue dysfunction is considered as a central mechanism leading to metabolic disorders.

OBJECTIVE

The aim of this study was to determine the effects of chronic inorganic Hg exposure at low doses on the lipid and glycemic metabolism.

METHODS

Male Wistar rats were divided into two groups and treated for 60 days with: saline solution, i.m. (Untreated) and mercury chloride, i.m. - 1^st dose 4.6 μg/kg, subsequent doses 0.07 μg/kg/day - (Mercury). Histological analyses, Hg levels measurement and GRP78, CHOP, PPARα, PPARγ, leptin, adiponectin and CD11 mRNA expressions were performed in epididymal white adipose tissue (eWAT). Glucose, triglycerides, total cholesterol and insulin plasma levels were also measured.

RESULTS

Hg exposure reduced the absolute and relative eWAT weights, adipocyte size, plasma insulin levels, glucose tolerance, antioxidant defenses and increased plasma glucose and triglyceride levels. In addition, CHOP, GRP78, PPARα, PPARγ, leptin and adiponectin mRNA expressions were increased in Hg-treated animals. No differences in Hg concentration were found in eWAT between the untreated and Hg groups. These results suggest that the reduction in adipocyte size is related to the impaired antioxidant defenses, endoplasmic reticulum (ER) stress, the disrupted PPARs and adipokines mRNA expression induced by the metal in eWAT. These disturbances possibly induced a decrease in circulating insulin levels, an imbalance between lipolysis and lipogenesis mechanisms in eWAT, with an increase in fatty acids mobilization, a reduction in glucose uptake and an activation of pro-apoptotic pathways, leading to hyperglycemia and hyperlipidemia.

CONCLUSIONS

Hg is a powerful environmental WAT disruptor that influences signaling events and impairs metabolic activity and hormonal balance of adipocytes.

Multiple metal exposures and metabolic syndrome: A cross-sectional analysis of the National Health and Nutrition Examination Survey 2011-2014

BACKGROUND

Epidemiologic studies suggest toxic metals are linked with diabetes and cardiovascular disease, while experimental studies indicate nutritionally essential metals are involved in the metabolism of macronutrients and defense against oxidative stress.

OBJECTIVES

We sought to evaluate how essential and toxic metals are cross-sectionally related to metabolic syndrome, a clustering of cardiometabolic conditions.

METHODS

Using data from the 2011-2014 National Health and Nutrition Examination Survey (n = 1088), we characterized metal concentrations as measured in spot urine (arsenic, cadmium, and inorganic/elemental mercury), whole blood (manganese, lead, methylmercury, and selenium), and serum (copper and zinc) samples. Principal component analysis was performed to derive patterns of exposures. Metabolic syndrome was defined according to the 2009 Joint Scientific Statement as the presence of ≥ 3 of the following conditions: high blood pressure, high triglycerides, low HDL cholesterol, high fasting glucose, and abdominal obesity.

RESULTS

After adjustment for potential confounders, prevalence ratios for metabolic syndrome comparing the highest to the lowest quartiles were 1.41 (95% CI: 1.18-1.67) for the arsenic-inorganic/elemental mercury pattern, 0.95 (0.78-1.16) for the methylmercury-manganese pattern, 0.73 (0.57-0.94) for the cadmium-lead pattern, 0.91 (0.76-1.10) for the copper pattern, and 1.36 (1.13-1.63) for the selenium-zinc pattern. The positive associations observed for the arsenic-inorganic/elemental mercury pattern were due to an elevated prevalence of high blood pressure, low HDL cholesterol, and high triglycerides among those with greater exposures. Associations for the selenium-zinc pattern were driven by a positive relationship with high triglycerides. Greater lead-cadmium co-exposures were related to a lower prevalence of dyslipidemia and abdominal obesity.

CONCLUSIONS

These cross-sectional findings suggest both toxic and essential metal exposures may contribute to cardiometabolic health, but need to be confirmed with prospective data.

ICP-DRC-MS analysis of serum essential and toxic element levels in postmenopausal prediabetic women in relation to glycemic control markers

PURPOSE

Assessment of the influence of prediabetes on serum trace element and electrolyte levels in postmenopausal women.

METHODS

A total of 80 prediabetic and 80 healthy postmenopausal women took part in the present study. Serum was analyzed for glucose, insulin, insulin resistance index (HOMA-IR), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). Glycated haemoglobin (HbA1c) levels were also assessed. Serum levels of 28 elements were estimated using inductively-coupled plasma mass spectrometry with dynamic reaction cell technology (ICP-DRC-MS).

RESULTS

Prediabetic women were characterized by significantly higher HbA1c, glucose, insulin, HOMA-IR, ALT, and GGT values. Of trace elements, only serum zinc (Zn) levels were significantly lower in prediabetics by 10% (p=0.001) when compared to the controls. Serum Zn levels were characterized by a significant inverse correlation with HbA1c (r=- 0.205; p=0.009), insulin (r=- 0.246; p=0.002), and HOMA-IR (r=- 0.227; p=0.004). Multiple regression analysis demonstrated a significant inverse association between serum Zn (β=-0.169; p=0.031) and Sr (β=-0.192; p=0.012) and HOMA-IR values after adjustment for anthropometric and biochemical parameters (p for a model <0.001). Although serum Zn was significantly associated with HbA1c both in crude and adjusted models, no significant relationship was detected after adjustment for age and anthropometric parameters.

CONCLUSIONS

Prediabetic postmenopausal women are characterized by significantly lower levels of serum Zn concentration, whereas serum Zn and Sr levels were inversely associated with insulin resistance.

PFOA is associated with diabetes and metabolic alteration in US men: National Health and Nutrition Examination Survey 2003-2012

Exposure to perfluoroalkyl substances (PFAS) is associated with a range of adverse health effects. However, it remains unclear whether PFAS at environmentally relevant exposure levels are related to diabetes and metabolite concentrations in adults. Using cross-sectional data from 7904 adults (age≥20years) in the 2003-2012 National Health and Nutrition Examination Survey (NHANES), we examined the association of PFAS with the prevalence of diabetes and metabolite concentrations. A multivariate logistic regression was applied to investigate the associations of diabetes prevalence with serum perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS) and perfluorononanoate (PFNA) levels. A multivariate generalised linear regression was further performed to investigate the associations between PFAS exposure and some metabolites. We identified a strong positive association between serum PFOA and diabetes prevalence in men with an adjusted model (OR: 2.66, 95% CI: 1.63-4.35; P for trend=0.001). No significant association between serum PFOA and diabetes prevalence was observed in women (OR: 1.47, 95% CI: 0.88-2.46; P for trend=0.737). Furthermore, diabetes was not related to PFOS, PFHxS and PFNA, regardless of gender. In the gender-stratified generalised linear models, men and women with the highest PFOA levels demonstrated a 1.43% (95% CI: 0.62%-2.34%) and a 1.07% (95% CI: 0.27%-1.97%) greater increase in serum total cholesterol (P for trend=0.006 and 0.001) compared to those with the lowest PFOA levels. There were no significant associations between serum PFOA and other metabolites. These results provide epidemiological evidence that environment-related levels of serum PFOA may be positively associated with the prevalence of diabetes in men and with total cholesterol in adults. Further clinical and animal studies are urgently needed to elucidate putative causal relationships and shed light on the potential mode of action involved.

Intake of niacin, folate, vitamin B-6, and vitamin B-12 through young adulthood and cognitive function in midlife: the Coronary Artery Risk Development in Young Adults (CARDIA) study

Background: Epidemiologic evidence regarding niacin, folate, vitamin B-6, and vitamin B-12 intake in relation to cognitive function is limited, especially in midlife.Objective: We hypothesize that higher intake of these B vitamins in young adulthood is associated with better cognition later in life.Design: This study comprised a community-based multicenter cohort of black and white men and women aged 18-30 y in 1985-1986 (year 0, i.e., baseline) from the Coronary Artery Risk Development in Young Adults (CARDIA) study (n = 3136). We examined participants' CARDIA diet history at years 0, 7, and 20 to assess nutrient intake, including dietary and supplemental B vitamins. We measured cognitive function at year 25 (mean ± SD age: 50 ± 4 y) through the use of the Rey Auditory Verbal Learning Test (RAVLT) for verbal memory, the Digit Symbol Substitution Test (DSST) for psychomotor speed, and a modified Stroop interference test for executive function. Higher RAVLT and DSST scores and a lower Stroop score indicated better cognitive function. We used multivariable-adjusted linear regressions to estimate mean differences in cognitive scores and 95% CIs.Results: Comparing the highest quintile with the lowest (quintile 5 compared with quintile 1), cumulative total intake of niacin was significantly associated with 3.92 more digits on the DSST (95% CI: 2.28, 5.55; P-trend < 0.01) and 1.89 points lower interference score on the Stroop test (95% CI: -3.10, -0.68; P-trend = 0.05). Total folate was associated with 2.56 more digits on the DSST (95% CI: 0.82, 4.31; P-trend = 0.01). We also found that higher intakes of vitamin B-6 (quartile 5 compared with quartile 1: 2.62; 95% CI: 0.97, 4.28; P-trend = 0.02) and vitamin B-12 (quartile 5 compared with quartile 1: 2.08; 95% CI: 0.52, 3.65; P-trend = 0.02) resulted in better psychomotor speed measured by DSST scores.Conclusion: Higher intake of B vitamins throughout young adulthood was associated with better cognitive function in midlife.