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Environmental exposure to heavy metals is associated with increased risk of type 2 diabetes (T2D). Although T2D in adolescents and young adults is increasingly prevalent, the association between toxic and essential metals and glucose homeostasis in adolescents has not been reported. We examined the associations of individual and mixture of urinary concentrations of four toxic metals (arsenic As, cadmium Cd, mercury Hg, and lead Pb), and seven essential metals (chromium Cr, cobalt Co, copper Cu, manganese Mn, nickel Ni, selenium Se, and zinc Zn) with glucose homeostasis traits in 1939 Chinese adolescents (mean age 15.6 ± 2.1, 49.1 % boys) in Hong Kong. We used linear regression, advanced machine learning-based quantile-g-computation (qgcomp), Bayesian kernel machine regression (BKMR), and restricted cubic splines to examine the associations, dose-response relationships, and interactions between creatinine-adjusted urinary concentrations of 11 metals and fasting plasma glucose (FPG), insulin resistance (HOMA-IR), and beta-cell function (HOMA-beta). After adjusting for confounders, the urinary As-FPG, Cr-FPG, Zn-HOMA-IR, Cu-HOMA-beta, Cr-HOMA-beta associations were linear while that of Mn-HOMA-beta was non-linear. We observed an interaction between toxic (Cr) and essential (As) metals for HOMA-beta. We further observed sex-specific associations of toxic (As) and essential metals (Cr, Zn, Mn, and Cu) with glucose homeostasis traits as well as the associations of metal mixture of 11 metals with increased FPG and HOMA-IR. These complex associations between urinary metal concentrations and glucose homeostasis traits in adolescents call for prospective studies to evaluate their long-term significance on metabolic health.
Yu et al. (Wed,) studied this question.