Lifestyle approaches for the prevention and treatment of insulin resistance, metabolic syndrome and T2DM are typically focused on diet and exercise. The goal being to reduce the number of calories going in and increase the number of calories being burned. Yet, a number of environmental pollutants have been clearly linked to increased risk for T2DM including persistent organic pollutants and arsenic.
Over the last decade articles have begun to associate vehicular exhaust – ambient air pollution commonly elevated in all urban areas across the globe. In the last seven years several studies have demonstrated that adults and youth who are exposed to higher levels of nitric oxides, NO2
had higher rates of T2DM. Three studies have demonstrated that children
with increased exposure to vehicular exhaust had higher calculated insulin resistance (using the homeostatic model assessment of insulin-resistance – HOMA IR). Since HOMA-IR results are not always confirmed with glucose tolerance testing, this longitudinal study was done. A new study
provides more proof that urban air pollution plays a role in the development of T2DM and weight gain.
This study followed 314 obese or overweight Latino youth, between 8 and 15 years of age, in the Los Angeles area who participated in the Childhood Obesity Research Center Air Study. These children were recruited between 2001 and 2012 and were followed for an average of 3.4 years. None of those included in the study were diabetic (assessed by an oral glucose tolerance test) or were on any medication that would affect insulin or glucose tolerance.
Levels of ambient vehicular exhaust air pollutants, including nitric oxide, nitrogen dioxide and particulate matter less than 2.5 microns (PM2.5), were estimated by utilizing data collected from monitoring stations in the Los Angeles area. Monthly average exposure levels were calculated from daily values and based on the distance from the measuring stations (using a distance-squared weighting algorithm).
Insulin sensitivity was assessed with a 13-sample insulin-modified frequently sampled intravenous glucose tolerance test. Data from this test provided a rating for whole body insulin sensitivity (Si), acute insulin response to glucose (AIRg), and a assessment of beta-cell function (disposition index [DI]). BMI was also measured throughout the study.
When the exposure data and the BMI status, insulin and glucose response were correlated clear associations were found. Both PM2.5 and NO2 were independently associated with statistically significant reduction in insulin sensitivity. NO2 was associated with a statistically significant decline in beta-cell function. Both PM2.5 and NO2 were associated with a statistically significant increase in BMI.
This new study demonstrates the causal link between urban air pollution, insulin resistance, beta-cell function and adiposity. Clinicians need to start paying attention to the myriad adverse health effects from simply breathing air in any metropolitan area. Air purification units for the home that force air through a series of filters to remove particles down to 1 micron should be on the list of “must haves” for all patients, right next to water filters, organic varieties of “the dirty dozen” (most toxic) fruits and vegetables, and exercise.
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