Di Ciaula A, Portincasa P. Relationships between emissions of toxic airborne molecules and type 1 diabetes incidence in children: An ecologic study. World J Diabetes 2021; 12(5): 673-684 [PMID: 33995854 DOI: 10.4239/wjd.v12.i5.673]
Corresponding Author of This Article
Agostino Di Ciaula, MD, Academic Fellow, Academic Research, Doctor, Medical Assistant, Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, P.zza Giulio Cesare 11, Bari 70124, Italy. agostinodiciaula@tiscali.it
Research Domain of This Article
Public, Environmental & Occupational Health
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. May 15, 2021; 12(5): 673-684 Published online May 15, 2021. doi: 10.4239/wjd.v12.i5.673
Relationships between emissions of toxic airborne molecules and type 1 diabetes incidence in children: An ecologic study
Agostino Di Ciaula, Piero Portincasa
Agostino Di Ciaula, Piero Portincasa, Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari 70124, Italy
Agostino Di Ciaula, International Society of Doctors for Environment (ISDE), Via XXV Aprile n.34 – 52100 Arezzo, Italy
Author contributions: Di Ciaula A designed the research study and performed the research; Di Ciaula A and Portincasa P wrote and revised the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: No institutional review board authorization is required, since the study uses an ecologic approach exploring previously published data on type 1 diabetes incidence and pollutant emissions at country level.
Informed consent statement: No informed consent is required for this study, since no individual patients were enrolled.
Conflict-of-interest statement: The Authors have no conflict of interest.
Data sharing statement: Data sharing is available on request to the corresponding authors.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Agostino Di Ciaula, MD, Academic Fellow, Academic Research, Doctor, Medical Assistant, Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, P.zza Giulio Cesare 11, Bari 70124, Italy. agostinodiciaula@tiscali.it
Received: December 18, 2020 Peer-review started: December 18, 2020 First decision: March 16, 2021 Revised: March 17, 2021 Accepted: April 12, 2021 Article in press: April 12, 2021 Published online: May 15, 2021 Processing time: 138 Days and 16.1 Hours
Abstract
BACKGROUND
Type 1 diabetes originates from gene-environment interactions, with increasing incidence over time.
AIM
To identify correlates of childhood type 1 diabetes in European countries using an ecological approach. Several environmental variables potentially influencing the onset of type 1 diabetes have been previously evaluated. However, the relationships between epidemiologic data and exposure to toxic airborne molecules are scarcely studied.
METHODS
We employed an ecological model to explore, in a wide time period (1990-2018), associations between type 1 diabetes incidence in 19 European countries (systematic literature review) and the nationwide production of five widely diffused air pollutants: particulate matter < 10 μm (PM10), nitrogen oxides (NO), non-methane volatile organic compounds (VOCs), sulphur oxide (SO2), and ammonia.
RESULTS
Data confirm a raising incidence of type 1 diabetes in 18 out of 19 explored countries. The average difference (last vs first report, all countries) was +6.9 × 100000/year, with values ranging from -1.4 (Germany) to +16.6 (Sweden) per 100000/year. Although the overall production of pollutants decreased progressively from 1990 to 2018, type 1 diabetes incidence was positively associated with the nationwide emissions of PM10, VOCs, and NO but not with those of SO2 and ammonia. Type 1 diabetes incidence was significantly higher in countries with high emissions than in those with low emissions of PM10 (27.5 ± 2.4 vs 14.6 ± 2.4 × 100000 residents, respectively), VOCs (24.5 ± 4.4 vs 13.2 ± 1.7 × 100000 residents, respectively), and NO (26.6 ± 3 vs 13.4 ± 2.4 × 100000 residents, respectively), but not of SO2 or ammonia.
CONCLUSION
Evidence justify further studies to explore better links between long-term air quality and type 1 diabetes onset at the individual level, which should include exposures during pregnancy. In this respect, type 1 diabetes could be, at least in part, a preventable condition. Thus, primary prevention policies acting through a marked abatement of pollutant emissions might attenuate future type 1 diabetes incidence throughout Europe.
Core Tip: The environment has a role in the onset of type 1 diabetes. Possible associations include pollutants that are, however, scarcely explored. We evaluated with an ecologic approach associations between the incidence of type 1 diabetes in children and the global emissions of specific air pollutants in 19 European countries, during three decades. We showed that the incidence of type 1 diabetes is associated with the emissions of particulate matter < 10 μm, non-methane volatile organic compounds, and nitrogen oxides. Results allow us to speculate that type 1 diabetes is, at least in part, a preventable condition, with implications in terms of primary prevention.
