The Association Between Air Pollution Exposure and Glucose and Lipids Levels
Maayan Yitshak Sade1, Itai Kloog1, Idit F Liberty1
1Department of Medicine (M.Y.S., I.F.L., V.N.), Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel 84105; Clinical Research Center (M.Y.S., V.N.), Soroka University Medical Center, Beer Sheva, Israel 84101; Department of Geography and Environmental Development (I.K.), Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer Sheva, Israel 84105; Asuta Medical Center (I.F.L.), Beer Sheva, Israel 8489507; and Environmental Epidemiology Program (J.S.), Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02115.
Context:
Evidence from recent decades supports a causal association between air pollution (particulate matter <10 μm in diameter [PM10] and PM <2.5 μm in diameter [PM2.5]) and oxidative stress, possibly involving impaired metabolism of glucose and lipids.
Objective:
Using a satellite based model to assess PM exposure at 1-km spatial resolution, we examined the associations between PM and glucose, hemoglobin A1c (HbA1c), and lipids.
Design:
Population-based retrospective cohort study of a 10-year period.
Setting:
Members of the largest health care provider in Southern Israel.
Participants:
We included all serum glucose, HbA1c, and lipids tests of subjects with known cardiovascular diseases and risk factors. Subjects' glycemic status was defined as normal or diabetes.
Main Outcome:
Log-transformed glucose, HbA1c, and lipid values were explored by mixed models, with adjustment for personal and seasonal confounders.
Results:
We assessed 73 117 subjects with over 600 000 samples. Three-month average concentration of PM10, but not 1- to 7-d exposure, was associated with increases of serum glucose, HbA1c, low-density lipoprotein and triglycerides, and decrease of high-density lipoprotein. The strongest associations were observed among subjects with diabetes (percent increase [95% confidence interval], for interquartile range increase of PM10 and PM2.5): 3.58% (1.03%; 6.20%) and 2.93% (0.35%; 5.59%) increase in HbA1c and 2.37% (2.11%; 2.63%) and 1.54% (1.26%; 1.83%) increase in low-density lipoprotein. Antidiabetic medications (other than insulin) attenuated the air pollution effect on serum glucose.
Conclusions:
Intermediate-term, but not short term, exposure to PM is associated with alterations in glucose, HbA1c, and lipids, especially among people with diabetes.
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