Abstract
Through multiple different pathways, the environmental multiple metals make their ways to the human bodies, where they induce different levels of the oxidative stress response. This study further investigated the impact of multiple-metal exposure on the risk of developing proliferative diabetic retinopathy (PDR). We designed a case–control study with type 2 diabetic patients (T2D), in which the case group was the proliferative diabetic retinopathy group (PDR group), while the control group was the non-diabetic retinopathy group (NDR group). Graphite furnace atomic absorption spectrometry (GFAAS) and inductively coupled plasma optical emission spectrometry (ICP-OES) were used to detect the metal levels in our participants’ urine samples. The least absolute shrinkage and selection operator (LASSO) regression approach was used to include these representative trace elements in a multiple exposure model. Following that, logistic regression models and Bayesian kernel machine regression (BKMR) models were used to describe the effect of different elements and also analyze their combined effect. In the single-element model, we discovered that lithium (Li), cadmium (Cd), and strontium (Sr) were all positively related to PDR. The multiple-exposure model revealed a positive relationship between Li and PDR risk, with a maximum quartile OR of 2.80 (95% CI: 1.10–7.16). The BKMR model also revealed that selenium (Se) might act as a protective agent, whereas magnesium (Mg), Li, and Cd may raise the risk of PDR. In conclusion, our study not only revealed an association between exposure to multiple metals and PDR risk but it also implied that urine samples might be a useful tool to assess PDR risk.
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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
Thanks to all the subjects participated in this research. This work was supported by The Project for Top Disciplinary Talents of Majors in Universities of Anhui Province [grant numbers gxbjZD09].
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This work was supported by The Project for Top Disciplinary Talents of Majors in Universities of Anhui Province [grant number gxbjZD09].
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Yan-Qing Li, Si-Tian Zhang, Nai-Yu Ke, Fen Huang, and Yan-Feng Zhou contributed to the study conception and design. Material preparation and data collection were performed by Yan-Qing Li, Si-Tian Zhang, Nai-Yu Ke, and Wen-Lei Hu. Yan-Feng Zhou, Fen Huang, Wen-Lei Hu, and Guo-Ao Li analyzed and interpreted the data. Yan-Qing Li, Si-Tian Zhang, and Nai-Yu Ke wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Yan-Qing Li, Si-Tian Zhang, Nai-Yu Ke, and Yan-Cheng Fang contributed equally to this work and should be considered co-first authors.
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Li, YQ., Zhang, ST., Ke, NY. et al. The impact of multiple metals exposure on the risk of developing proliferative diabetic retinopathy in Anhui, China: a case–control study. Environ Sci Pollut Res 30, 112132–112143 (2023). https://doi.org/10.1007/s11356-023-30294-1
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DOI: https://doi.org/10.1007/s11356-023-30294-1