Abstract
Objective
Epidemiological studies suggest exposure to pesticides to be related to risk of diabetes mellitus. The objective of the present study was to assess the association between pesticide use and diabetes mellitus in a semi-urban population in Nepal.
Methods
We conducted a nested cross-sectional study on pesticides and diabetes mellitus in a population-based cohort from the former Lekhnath Municipality, Nepal. 2643 persons were invited, and 2310 persons participated (response rate 87.4%). All participants were tested for fasting plasma glucose. Diabetes mellitus was defined as either fasting plasma glucose (FPG) ≥ 7.0 mmol/L (126 mg/dL) or self-reported diagnosis of diabetes mellitus. Exposure to pesticides was determined by questionnaire. For the exposed persons, three exposure metrics (years of exposure, weeks of exposure per year and hours of exposure per week) were categorized and used to model exposure–response relationships.
Results
Although 62% of participants reported to be exposed to pesticides, the frequency and intensity of pesticide usage was low. Contrary to our hypothesis, we found lower odds of diabetes mellitus among persons reporting any pesticide use compared to those reporting no use of pesticides—adjusted odds ratio with 95% CI = 0.68 [0.52; 0.90]. However, we found no clear exposure–response relationships between pesticide exposure and neither diabetes mellitus nor FPG, and few and inconsistent associations were seen between pesticide exposure and symptoms of acute pesticide intoxication.
Conclusions
The apparently lower odds of diabetes mellitus among pesticide-exposed persons in this population are probably due to residual confounding. Our results do not seem to support an association between pesticide exposure and diabetes mellitus in this low-exposed population dominated by subsistence farmers, although results should be interpreted with caution in light of the study limitations.
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Availability of data and materials
The dataset analyzed during the current study is not publicly available, as the small size of the study area may make data pseudonymization insufficient to avoid participant re-identification. Data are available from the corresponding author on reasonable request.
Abbreviations
- aOR:
-
Adjusted odds ratio
- ADA:
-
American Diabetes Association
- DDT:
-
Dichloro-diphenyl-trichloroethane
- DM:
-
Diabetes mellitus
- FPG:
-
Fasting plasma glucose
- FCHV:
-
Female Community Health Volunteer
- IFG:
-
Impaired fasting glucose
- MET:
-
Metabolic equivalent task
- rOR:
-
Raw odds ratio
- WHO:
-
World Health Organization
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Acknowledgements
The authors wish to thank the members of staff of the Nepal Development Society for their assistance with the field work.
Funding
MRHH is a Ph.D. student at Aarhus University, supported by grants from the National Research Center for the Working Environment (project number 10322) and Aarhus University Research Foundation (project number 81231). At the time of the project, BG was also a Ph.D. student at Aarhus University, supported by grants from Aarhus University Research Foundation (project number 19439) and the Aarhus University Graduate School of Health (project number 12561). Data collection was supported by the International Centre for Occupational and Environmental Medicine and Public Health, Odense University Hospital (project number N/A). The funding bodies played no role in the design of the study, the collection, analysis and interpretation of the data, or in the writing of the manuscript.
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Conception or design of the work: BG, DN, PK, MRHH, VS, EJ, AS. Data collection: BG, DN. Data analysis and interpretation: MRHH, VS, AS. Drafting of the article: MRHH. Critical revision of the article: MRHH, VS, BG, DN, PK, EJ, AS. Final approval of the version to be published: MRHH, BG, DN, EJ, AS, PK, VS.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee (Nepal Health Research Council, Kathmandu, Nepal, reg. no. 263/2016) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Hansen, M.R.H., Gyawali, B., Neupane, D. et al. Pesticide exposure and diabetes mellitus in a semi-urban Nepali population: a cross-sectional study. Int Arch Occup Environ Health 93, 513–524 (2020). https://doi.org/10.1007/s00420-019-01508-2
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DOI: https://doi.org/10.1007/s00420-019-01508-2