Elsevier

Environment International

Volume 116, July 2018, Pages 74-82
Environment International

Long-term exposure to airborne particulate matter and NO2 and prevalent and incident metabolic syndrome – Results from the Heinz Nixdorf Recall Study

https://doi.org/10.1016/j.envint.2018.02.035Get rights and content

Highlights

  • •

    Air pollution has been found to be associated with many diseases related to MetS.

  • •

    We found several air pollutants to be associated with MetS.

  • •

    The most consistent associations were found for NO2 and prevalent MetS.

  • •

    Noise did not confound the air pollution effects estimates in a relevant way.

Abstract

Introduction

Recently, epidemiological studies have found a link between air pollution (AP) and individual components of the metabolic syndrome (MetS), a condition predisposing to cardiometabolic diseases. However, very few studies have explored a possible association between air pollution and MetS.

Objective

We analyzed the effects of long-term exposure to airborne particulate matter and NO2 on prevalence and incidence of MetS.

Methods

We used data of the population-based prospective Heinz Nixdorf Recall study (baseline 2000–2003) to investigate the association(s) between AP exposure and MetS prevalence at baseline (n = 4457) and MetS incidence at first follow-up visit (n = 3074; average follow-up: 5.1 years). Mean annual exposure to size-fractioned particulate matter (PM10, PM2.5, PMcoarse, and PM2.5abs) and nitrogen dioxide (NO2) was assessed using a land use regression model. MetS was defined as central obesity plus two out of four additional risk factors (i.e., elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure or elevated plasma glucose). We estimated odds ratios (ORs) of MetS prevalence and incidence per interquartile range (IQR) of exposure, adjusting for demographic and lifestyle variables.

Results

We observed a MetS prevalence of 20.7% (n = 922) and an incidence of 9.7% (n = 299). NO2 was positively associated with MetS prevalence, with an OR increase per IQR of 1.12 (95%-CI 1.02–1.24, IQR = 6.1 μg/m3). PM10 and PM2.5 were both borderline positively associated with MetS incidence, with ORs of 1.14 (95%-CI 0.99–1.32, IQR = 2.1 μg/m3) and 1.19 (95%-CI 0.98–1.44, IQR = 1.5 μg/m3) per IQR, respectively.

Conclusion

In summary, we found a weak positive association between air pollution and MetS. The strongest and most consistent effects were observed between NO2 and prevalent MetS.

Introduction

The metabolic syndrome (MetS) is considered to be a major public health problem, as it increases the risk of atherosclerotic cardiovascular diseases (CVD), type 2 diabetes mellitus (T2D), and all-cause mortality (Alberti et al., 2009; Kaur, 2014). Overall, the International Diabetes Federation (IDF) estimates that around 25% of the world's adult population has MetS (IDF, 2006). MetS is defined as a collection of concurrent abnormal body measurements and laboratory tests that are hypothesized to result from a common underlying pathological mechanism, including elevated fasting plasma glucose, abdominal obesity, high total cholesterol, and high blood pressure (BP) (IDF, 2006; Kaur, 2014). Modifiable risk factors for MetS are insulin resistance, central obesity, a proinflammatory state, physical inactivity, and hormonal changes (IDF, 2006). Environmental exposures, such as air pollution (AP), have rarely been investigated as potential risk factors to develop MetS, although AP has been shown to have a wide range of acute and chronic health impacts related to MetS (Thurston et al., 2017). Most studies have focused on the association between AP and cardiopulmonary morbidity and mortality (Brook et al., 2010; Pope III and Dockery, 2006), while recent studies have also suggested that exposure to major air pollutants (e.g. particulate matter (PM10 and PM2.5) and nitrogen dioxide (NO2)) may increase the risk of T2D (Eze et al., 2014; Rao et al., 2015; Thiering and Heinrich, 2015; Wang et al., 2014; Weinmayr et al., 2015; Yan and Wang, 2014). Furthermore, two studies have observed that persons with MetS may be particularly vulnerable to the effects of AP (Chen and Schwartz, 2008; Park et al., 2010). Epidemiological studies have also observed associations between AP and specific components of MetS, such as obesity and insulin resistance (Li et al., 2016; Wolf et al., 2016; Brook et al., 2015; Thiering et al., 2013). However, to our knowledge only two epidemiological studies have looked at AP exposure and MetS as an outcome itself. (Eze et al., 2015; Wallwork et al., 2016). Both studies looked at long-term AP, one in a cross-sectional and one in a longitudinal design, and observed a positive association between AP and MetS.

The aim of this study was to investigate whether long-term exposure of AP (airborne particulate matter and NO2) at a person's residence increases the chance to have or to develop MetS (prevalence and incidence), using data from the baseline (t0) and first follow-up (t1) examinations of the Heinz Nixdorf Recall (HNR) cohort study in Germany.

Section snippets

Study design

This study was conducted using data from the baseline (t0:2000–2003) and first follow-up (t1:2006–2008) examinations of the Heinz Nixdorf Recall (risk factors, evaluation of coronary calcium and lifestyle) study, an ongoing prospective population-based cohort study located in three adjacent cities (Bochum, Essen, and Mülheim) within the highly urbanized German Ruhr Area. The rationale and design of the cohort study have been described in detail in another paper (Schmermund et al., 2002). In

Study population

In total, 4457 participants were available for cross-sectional analyses with a MetS prevalence of 20.7% (n = 922). Participants were excluded from the cross-sectional analyses if MetS (Yes/No) was not determinable at t0 or if exposure or covariate data were missing (n = 357; Fig. 1).

For the longitudinal analysis, 3074 participants free of MetS (defined as in Table 1) at baseline were included, with a cumulative MetS incidence of 9.7% (n = 299) over a mean follow-up period of 5.1 years.

Discussion

In general, our results suggest that a weak positive association may exist between long-term AP exposure and prevalent and incident MetS, with most consistent associations apparent between NO2 and prevalent MetS and between PM10 and PM2.5 exposure and incident MetS. Overall, the association observed between NO2 and prevalent MetS was strongest and most consistent, independent of the exposure model or MetS definition used.

Conclusion

In summary, we found a weak positive association between air pollution and MetS. The strongest and most consistent effects were observed between NO2 and prevalent MetS. We also found suggestive evidence for a positive association between PM10 and PM2.5 with incident MetS.

In future studies, it would be desirable to investigate the long-term effect of AP on incident MetS with longer follow-up, include potentially susceptible populations and investigate specific components of AP.

Acknowledgment

We thank the Heinz Nixdorf Foundation (chairman: M. Nixdorf; former chairman: †Dr. jur. Schmidt) for the generous support of this study. We are indebted to the investigative group and the study personnel of the Heinz Nixdorf Recall study. We also thank the North Rhine-Westphalia State Agency for Nature, Environment and Consumer Protection for providing emission and land use data for North Rhine-Westphalia. We thank Anna Buschka for her support and data management.

Funding

This study was supported by the German Research Council (DFG; HO3314/4-3).

Competing financial interests

The authors declare they have no actual or potential competing financial interests.

References (71)

  • K.G.M.M. Alberti et al.

    Definition, diagnosis and classification of diabetes mellitus and its complications part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation

    Diabet. Med.

    (1998)
  • K.G.M.M. Alberti et al.

    Harmonizing the metabolic syndrome

    Circulation

    (2009)
  • W. Babisch

    Stress hormones in the research on cardiovascular effects on noise

    Noise Heal.

    (2003)
  • R. Beelen et al.

    Development of NO2 and NOx land use regression models for estimating air pollution exposure in 36 study areas in Europe - the ESCAPE project

    Atmos. Environ.

    (2013)
  • J. Brocato et al.

    Particulate matter from Saudi Arabia induces genes involved in inflammation, metabolic syndrome and atherosclerosis

    J. Toxicol. Environ. Health

    (2015)
  • R.D. Brook et al.

    The relationship between diabetes mellitus and traffic-related air pollution

    Am. Coll. Occup. Environ. Med.

    (2008)
  • R.D. Brook et al.

    Particulate matter air pollution and cardiovascular disease. An update to the scientific statement from the American

    Circulation

    (2010)
  • R.D. Brook et al.

    Extreme air pollution conditions adversely affect blood pressure and insulin resistance. The air pollution and cardiometabolic disease study

    Hypertension

    (2015)
  • J. Chen et al.

    Metabolic syndrome and inflammatory responses to long-term particulate air pollutants

    Environ. Health Perspect.

    (2008)
  • N. Dragano et al.

    Subclinical coronary atherosclerosis and Neighbourhood deprivation in an urban region

    Eur. J. Epidemiol.

    (2009)
  • EEA
  • M. Eeftens et al.

    Development of land use regression models for PM2.5, PM2.5 absorbance, PM10 and PMcoarse in 20 European study areas; results of the ESCAPE project

    Environ. Sci. Technol.

    (2012)
  • C. Eriksson et al.

    Long-term aircraft noise exposure and body mass index, waist circumference, and type 2 diabetes: a prospective study

    Environ. Health Perspect.

    (2014)
  • EU

    EU directive 2008/50/EC of the European parliament and of the council on ambient air quality and cleaner air for Europe

    Off. J. Eur. Communities

    (2008)
  • I.C. Eze et al.

    Long-term exposure to ambient air pollution and metabolic syndrome in adults

    PLoS One

    (2015)
  • K.B. Fuks et al.

    Long-term exposure to ambient air pollution and traffic noise and incident hypertension in seven cohorts of the European study of cohorts for air pollution effects (ESCAPE)

    Eur. Heart J.

    (2016)
  • M.S. Goldberg et al.

    Identification of persons with cardiorespiratory conditions who are at risk of dying from the acute effects of ambient air particles

    Environ. Health Perspect.

    (2001)
  • P. Haberzettl et al.

    Exposure to fine particulate air pollution causes vascular insulin resistance by inducing pulmonary oxidative stress

    Environ. Health Perspect.

    (2016)
  • HEI

    Traffic-Related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and Health Effects

    (2009)
  • F. Hennig et al.

    Association between source-specific particulate matter air pollution and hs-CRP: local traffic and industrial emissions

    Environ. Health Perspect.

    (2014)
  • F. Hennig et al.

    Comparison of land-use regression modeling with dispersion and chemistry transport modeling to assign air pollution concentrations within the Ruhr area

    Atmosphere (Basel).

    (2016)
  • B. Hoffmann et al.

    Residence close to high traffic and prevalence of coronary heart disease

    Eur. Heart J.

    (2006)
  • B. Hoffmann et al.

    Residential exposure to traffic is associated with coronary atherosclerosis

    Circulation

    (2007)
  • B. Hoffmann et al.

    Chronic residential exposure to particulate matter air pollution and systemic inflammatory markers

    Environ. Health Perspect.

    (2009)
  • P.L. Huang

    A comprehensive definition for metabolic syndrome

    Dis. Model. Mech.

    (2009)

    • Cited by (0)

    View full text
    © 2018 Published by Elsevier Ltd.