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Meta-Analysis
. 2018 Nov 20;15(11):2593.
doi: 10.3390/ijerph15112593.

Associations of Exposure to Air Pollution with Insulin Resistance: A Systematic Review and Meta-Analysis

Jiajia Dang  1 , Mengtong Yang  2 , Xinge Zhang  3 , Haotian Ruan  4 , Guiyu Qin  5 , Jialin Fu  6 , Ziqiong Shen  7 , Anran Tan  8 , Rui Li  9 , Justin Moore  10   11   12
Affiliations
Meta-Analysis

Associations of Exposure to Air Pollution with Insulin Resistance: A Systematic Review and Meta-Analysis

Jiajia Dang et al. Int J Environ Res Public Health. .

Abstract

In this article, we review the available evidence and explore the association between air pollution and insulin resistance (IR) using meta-analytic techniques. Cohort studies published before January 2018 were selected through English-language literature searches in nine databases. Six cohort studies were included in our sample, which assessed air pollutants including PM2.5 (particulate matter with an aerodynamic diameter less than or equal to 2.5 μm), NO₂(nitrogen dioxide), and PM10 (particulate matter with an aerodynamic diameter less than 10 μm). Percentage change in insulin or insulin resistance associated with air pollutants with corresponding 95% confidence interval (CI) was used to evaluate the risk. A pooled effect (percentage change) was observed, with a 1 μg/m³ increase in NO₂ associated with a significant 1.25% change (95% CI: 0.67, 1.84; I² = 0.00%, p = 0.07) in the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and a 0.60% change (95% CI: 0.17, 1.03; I² = 30.94%, p = 0.27) in insulin. Similar to the analysis of NO₂, a 1 μg/m³ increase in PM10 was associated with a significant 2.77% change (95% CI: 0.67, 4.87; I² = 94.98%, p < 0.0001) in HOMA-IR and a 2.75% change in insulin (95% CI: 0.45, 5.04; I² = 58.66%, p = 0.057). No significant associations were found between PM2.5 and insulin resistance biomarkers. We conclude that increased exposure to air pollution can lead to insulin resistance, further leading to diabetes and cardiometabolic diseases. Clinicians should consider the environmental exposure of patients when making screening and treatment decisions for them.

Keywords: air pollution; insulin resistance; meta-analysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study selection process.
Figure 2
Figure 2
Forest plot showing the association between PM2.5 and insulin resistance.
Figure 3
Figure 3
Forest plot showing the association between NO2 and insulin resistance.
Figure 4
Figure 4
Forest plot showing the association between PM10 and insulin resistance.
Figure 5
Figure 5
Funnel plot to explore publication bias for each pollutant.
See this image and copyright information in PMC

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