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Traffic-Related Air Pollution and Incident Type 2 Diabetes: Results from the SALIA Cohort Study

Institut für Umweltmedizinische Forschung (IUF), Leibniz Center at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Environmental Health Perspectives (Impact Factor: 7.03). 09/2010; 118(9):1273-9. DOI: 10.1289/ehp.0901689
Source: PubMed

ABSTRACT Cross-sectional and ecological studies indicate that air pollution may be a risk factor for type 2 diabetes, but prospective data are lacking.
We examined the association between traffic-related air pollution and incident type 2 diabetes.
Between 1985 and 1994, cross-sectional surveys were performed in the highly industrialized Ruhr district (West Germany); a follow-up investigation was conducted in 2006 using data from the Study on the Influence of Air Pollution on Lung, Inflammation and Aging (SALIA) cohort.
1,775 nondiabetic women who were 54-55 years old at baseline participated in both baseline and follow-up investigations and had complete information available.
Using questionnaires, we assessed 16-year incidence (1990-2006) of type 2 diabetes and information about covariates. Complement factor C3c as marker for subclinical inflammation was measured at baseline. Individual exposure to traffic-related particulate matter (PM) and nitrogen dioxide was determined at different spatial scales.
Between 1990 and 2006, 87 (10.5%) new cases of diabetes were reported among the SALIA cohort members. The hazards for diabetes were increased by 15-42% per interquartile range of PM or traffic-related exposure. The associations persisted when different spatial scales were used to assess exposure and remained robust after adjusting for age, body mass index, socioeconomic status, and exposure to several non-traffic-related sources of air pollution. C3c was associated with PM pollution at baseline and was a strong independent predictor of incident diabetes. Exploratory analyses indicated that women with high C3c blood levels were more susceptible for PM-related excess risk of diabetes than were women with low C3c levels.
Traffic-related air pollution is associated with incident type 2 diabetes among elderly women. Subclinical inflammation may be a mechanism linking air pollution with type 2 diabetes.Relevance to clinical practice: Our study identifies traffic-related air pollution as a novel and potentially modifiable risk factor of type 2 diabetes.

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    • "In recent years, there has been extensive literature suggesting an increased risk in the incidence and mortality of several chronic diseases in association with long-term exposure to air pollutants. The biological plausibility is that air pollutants may promote inflammation, oxidative stress and endothelial dysfunction that may contribute to the development of chronic conditions such as cardiovascular disease, hypertension and diabetes (Brook et al., 2004; Coogan et al., 2012; Johnson and Parker, 2009; Kramer et al., 2010; Pearson et al., 2010; Puett et al., 2011; U.S. EPA, 2008, 2009, 2013). In addition, air pollution has also been linked to the worsening of diseases of the pulmonary system, including asthma and chronic obstructive pulmonary disease (COPD) (To et al., 2013a,b). "
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    • "A small number of studies have investigated traffic-related air pollution exposure at participants' residential address as a novel risk factor for type 2 diabetes mellitus (T2DM). Although not conclusive, results suggest an association between risk of T2DM and exposure to PM (Kramer et al. 2010; Puett et al. 2011a; Coogan et al. 2012); however, evidence is stronger for NO 2 and distance to road (Raaschou-Nielsen et al. 2013). That the deleterious effects of PM air pollution may extend to the brain have only recently been discovered and research in this area is currently limited and results inconclusive (Guxens and Sunyer 2012). "
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    • "Several large cohort studies have examined the role of fine particulate pollution in incident type 2 diabetes (Chen et al., 2013) including traffic-related pollution assessed as nitrogen dioxide (NO 2, likely a marker for locally elevated particulate matter), traffic load in vehicles per day, roadway proximity or some combination thereof (Andersen et al., 2012; Coogan et al., 2012; Puett et al., 2011; Kr€ amer et al., 2010). With one exception (Andersen et al., 2012), most of these studies found an association with incident type 2 diabetes and at least one of the traffic indicators examined. "
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