Mamtani, M; Curran, JE; Blangero, J; Kulkarni, H
Background. An epidemiological association between exposure to phthalates and type 2 diabetes (T2D) is known. However, the potential role of environmental phthalates in the complications of T2D is unknown. Methods. Using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2010, we studied the association of 12 urinary phthalate metabolites with self-reported eye affliction/retinopathy in 1,004 participants with diabetes. Data from retinal imaging was used to validate this outcome. Independence of the phthalates→T2D association was studied by adjusting for age, sex, race, marital status, educational attainment, poverty income ratio, physical activity, glycated hemoglobin levels, total serum cholesterol, serum high-density lipoprotein cholesterol, serum triglycerides, blood pressure, duration of diabetes, total calorie intake, and obesity. Results. Self-reported eye affliction/retinopathy had 82% accuracy with Cohen's kappa of 0.31 (p < 0.001). Urinary mono-n-octyl phthalate (MOP) was independently associated with the likelihood of self-reported eye affliction/retinopathy in subjects with T2D after accounting for all the confounders. This significance of this association was robust to the potential misclassification in cases and controls of retinopathy. Further, a significant dose-response relationship between MOP and self-reported eye affliction/retinopathy was demonstrable. Conclusions. We show a novel epidemiological link between the environment and diabetic complications in NHANES 2001-2010 participants.
butyltin derivative; cholesterol; glycosylated hemoglobin; high density lipoprotein; mono (2 ethyl 5 hydroxyhexyl); mono (2 ethyl 5oxohexyl); mono (2 ethyl) hexyl; mono (3 carboxypropyl); mono benzyl; mono cyclohexyl; mono isobutyl; mono isononyl; mono n methyl; phthalic acid; triacylglycerol; unclassified drug; biological marker; mono-n-octyl phthalate; phthalic acid derivative; academic achievement; age; Article; blood pressure; caloric intake; cholesterol blood level; diabetes mellitus; disease classification; disease duration; dose response; environmental exposure; human; imaging; income; lipoprotein blood level; marriage; metabolite; non insulin dependent diabetes mellitus; obesity; poverty; priority journal; public health; race; retinopathy; self report; sex; triacylglycerol blood level; urine level; validation study; adverse effects; chemically induced; Diabetes Mellitus, Type 2; diabetic retinopathy; environmental exposure; female; male; middle aged; nutrition; risk assessment; risk factor; time factor; United States; urinalysis; urine; Biomarkers; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Dose-Response Relationship, Drug; Environmental Exposure; Female; Humans; Male; Middle Aged; Nutrition Surveys; Phthalic Acids; Risk Assessment; Risk Factors; Self Report; Time Factors; United States; Urinalysis
