Circulating levels of perfluoroalkyl substances and prevalent diabetes in the elderly
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Several environmental contaminants, such as polychlorinated biphenyls, dioxins, bisphenol A and phthalates, have been linked to diabetes. We therefore investigated whether other kinds of contaminants, perfluoroalkyl substances (PFAS), also called perfluorinated compounds (PFCs), are also associated with diabetes.
The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study investigated 1,016 men and women aged 70 years. Seven PFAS were detected in almost all participant sera by ultra-high performance liquid chromatograph/tandem mass spectrometry. Diabetes was defined as use of hypoglycaemic agents or fasting glucose >7.0 mmol/l.
114 people had diabetes. In the linear analysis, no significant relationships were seen between the seven PFAS and prevalent diabetes. However, inclusion of the quadratic terms of the PFAS revealed a significant non-linear relationship between perfluorononanoic acid (PFNA) and diabetes, even after adjusting for multiple confounders (OR 1.96, 95% CI 1.19, 3.22, p = 0.008 for the linear term and OR 1.25, 95% CI 1.08, 1.44, p = 0.002 for the quadratic term). Perfluorooctanoic acid (PFOA) also showed such a relationship (p = 0.01). PFOA was related to the proinsulin/insulin ratio (a marker of insulin secretion), but none of the PFAS was related to the HOMA-IR (a marker of insulin resistance) following adjustment for multiple confounders.
PFNA was related to prevalent diabetes in a non-monotonic fashion in this cross-sectional study, supporting the view that this perfluoroalkyl substance might influence glucose metabolism in humans at the level of exposure seen in the general elderly population.
KeywordsDiabetes Elderly Environmental contaminants Epidemiology Insulin Perfluoroalkyl substances
Linear isomer of perfluorooctane sulfonic acid
Perfluorobutane sulfonic acid
Perfluorodecane sulfonic acid
Perfluorohexane sulfonic acid
Perfluorooctane sulfonic acid
Prospective Investigation of the Vasculature in Uppsala Seniors
Peroxisome proliferator-activated receptor
This study was supported by the Swedish Research Council (VR) and the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (FORMAS).
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript. No potential conflicts of interest relevant to this article were reported. BZ is employed by the Medical Products Agency (MPA), Uppsala, Sweden, and the views of the present study are not necessarily official views of the MPA.
PML conceived the project and contributed to critical revision of the manuscript for important intellectual content. BZ was responsible for laboratory analyses of insulin and proinsulin measurements. LL performed data analysis. Also, LL is principal investigator of PIVUS and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SS and BvB performed the analysis of the PFAS. LL wrote the first draft of the manuscript. All authors contributed to critical revision of the manuscript and approved the final version of the manuscript.
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