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Environ Int. 2019 Feb;123:390-398. doi: 10.1016/j.envint.2018.12.026. Epub 2018 Dec 19.

Perfluoroalkyl substances and risk of type II diabetes: A prospective nested case-control study.

Author information

1
Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
2
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
3
Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
4
Department for Health Security, Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland.
5
Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
6
Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: Agneta.Akesson@ki.se.

Abstract

BACKGROUND:

Perfluoroalkyl substances (PFAS) have drawn much attention due to bioaccumulation potential and their current omnipresence in human blood. We assessed whether plasma PFAS, suspected to induce endocrine-disrupting effects, were prospectively associated with clinical type 2 diabetes (T2D) risk.

METHODS:

We established a nested case-control study within the Swedish prospective population-based Västerbotten Intervention Programme cohort. Several PFAS were measured in plasma from a subset of 124 case-control pairs at baseline (during 1990-2003) and at 10-year follow-up. T2D cases were matched (1:1) according to gender, age and sample date with participants without T2D (controls). Conditional logistic regressions were used to prospectively assess risk of T2D by baseline PFAS plasma concentrations. Associations between long-term PFAS plasma levels (mean of baseline and follow-up) and insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B%) at follow-up were prospectively explored among 178 and 181 controls, respectively, by multivariable linear regressions.

RESULTS:

After adjusting for gender, age, sample year, diet and body mass index, the odds ratio of T2D for the sum of PFAS (Σ z-score PFAS) was 0.52 (95% confidence interval, CI: 0.20, 1.36), comparing third with first tertile; and 0.92 (95% CI: 0.84, 1.00) per one standard deviation increment of sum of log-transformed PFAS. Among the controls, the adjusted β of HOMA2-IR and HOMA-B% for the sum of PFAS were -0.26 (95% CI: -0.52, -0.01) and -9.61 (95% CI: -22.60, 3.39) respectively comparing third with first tertile.

CONCLUSIONS:

This prospective nested case-control study yielded overall inverse associations between individual PFAS and risk of T2D, although mostly non-significant. Among participants without T2D, long-term PFAS exposure was prospectively associated with lower insulin resistance.

KEYWORDS:

Diabetes; Endocrine disruption; Environmental contaminants; Environmental epidemiology; Environmental risk factors; Insulin resistance; Nested case-control study; Plasma perfluoroalkyl substances; Prospective assessment

PMID:
30622063
DOI:
10.1016/j.envint.2018.12.026
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