Study On The Correlation And Interaction Between Heavy Metals Exposure And Diabetes

Objective To analyze the urine cobalt?Co?,manganese?Mn?,molybdenum?Mo?,cadmium?Cd?levels and diabetes prevalence in the general population using the US National Health and Nutrition Survey?NHANES?database;to reveal the association between heavy metals and diabetes,fasting blood glucose?FPG?,hemoglobin A1c?HbA1c?,homeostasis model assessment for insulin resistance?HOMA-IR?,insulin;further to explore the interaction of mutiple heavy metals,providing a scientific basis for the in-depth study of the mechanism of diabetes affected by heavy metals.Methods A cross-sectional analysis was performed based on the 2011-2016 US NHANES database,and a total of 1423 adults were included.?1?Descriptive study was used to analyze the basic characteristics of the population;?2?The unconditional logistic regression analysis was used to analyze the relationship between urinary heavy metals and diabetes;?3?The generalized linear regression analysis was used to study the association between urinary heavy metals and FPG,HbA1c,HOMA-IR,insulin;?4?The dose-response relationship between heavy metals and FPG,HbA1c,HOMA-IR,insulin was analyzed by categorical analysis and restricted cubic splines functions?RCS?;?5?Bayesian kernel machine regression?BKMR?model was used to explore the interaction of urinary Co,Mn,Mo and Cd.Results 1.This study included a total of 1423 people,including 804 males and619 females.The detection rate of diabetes was 19.3%in the total population,with the highest detection rate among people over 60 years of age?37.9%?.From the analysis of different races,the detection rate was the highest in the black,followed by Hispanic.With the increase of educational level,the detection rate of diabetes gradually decreased.The detection rate of people with a cultural level below high school was 24.8%,and the detection rate was 17.1%among people with college level and above.In addition,the detection rate of diabetes increased with the increase of BMI.Diabetes detection rate was the highest in people who smoked continuously?25.8%?,and 33.9%in people with the history of hypertension.2.After adjusting gender,age,race/ethnicity,education level,poverty income ratio,smoking status,drinking status,BMI,average daily energy intake,physical activity,family history of diabetes and hypertension?Model 2?,among men,compared with the lowest quantile?Q1?of urinary Co,the highest quartile?Q4?increased the risk of diabetes by 91%?OR?95%CI?:1.91?1.02,3.55??.We also found a positive dose-response relationship between the urinary Co and insulin(P_overall<0.001,P_nonlinear=0.513)and HOMA-IR(P_overall=0.001,P_nonlinear=0.736)in man.3.Among women,whether adjusting Model 2 or Model 3,with the concentration of urinary Mn increasing,the risk of diabetes increased(P_trend<0.05).In addition,there were a positive linear dose-response relationship between urinary Mn with FPG(P_overall=0.029,P_nonlinear=0.328)and HbA1c(P_overall=0.029,P_nonlinear=0.328)in women.4.Regardless of adjusting other confounding factors,as the concentration of urinary Mo increasing,the risk of diabetes also increased in the total population(P_trend<0.05).There was a positive linear dose-response relationship between the urinary Mo and FPG?Poverall=0.028,Pnonlinear=0.826?,HbA1c?Poverall=0.034,Pnonlinear=0.376?.5.Diabetes risk,FPG,HbA1c,insulin and HOMA-IR levels increased with concentration of heavy metal mixtures increasing in urine.When the concentrations of the other two metals were fixed at the median,the slope of the dose-response curve between the urinary Mn and FPG increased with the Co concentration rising from 10^thh to 90^th,indicating that there was a positive interaction between the urinary Mn and Co.The slope of the dose-response curve between urinary Mo and FPG or HbA1c increased with the urinary Mn concentration rising from 10^th to 90^th,indicating that the urinary Mo and Mn had a positive interaction.Conclusions 1.There is a gender difference in the effects of urinary Co and Mn on diabetes:among men,there is a positive dose-response relationship between urinary Co and insulin/HOMA-IR;among women,there was a positive dose-response relationship between urinary Mn and diabetes risk,FPG and HbA1c.There was a positive dose-response relationship between urinary Mo and diabetes risk,FPG and HbA1c in the total population,and there was no gender difference.2.The risk of diabetes,FPG,HbA1c,insulin concentration and HOMA-IR levels increase with the concentration of four metal mixtures?Co,Mn,Mo and Cd?in urine increasing.There is a positive interaction between urinary Mn and Mo,Mn and Co on FPG,and there is a positive interaction between urinary Mn and Mo on HbA1c.