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
ARTICLE HIGHLIGHTS
Research background
Type 1 diabetes onset depends on gene-environment interactions, and several reports show, worldwide, an increased incidence of type 1 diabetes over time.
Research motivation
The effect of environmental factors on type 1 diabetes incidence in pediatric age is still incompletely unexplored.
Research objectives
To correlate the incidence of childhood type 1 diabetes in European countries with the global, nationwide production of toxic airborne molecules.
Research methods
We employed a systematic literature review to explore type 1 diabetes incidence in pediatric age in 19 European countries (time period: 1990-2018). We therefore applied an ecological study design to explore possible associations with 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.
Research results
A raising incidence of type 1 diabetes was evident in 18 out of 19 countries. Considering the whole group of countries, type 1 diabetes incidence was associated with the nationwide emissions of PM10, NO, non-methane VOCs, but not with those of SO2 and ammonia.
Research conclusions
The global burden of emission of specific air pollutants is associated with type 1 diabetes incidence. The study design employed in the present study can only indicate the existence of ecological associations and does not necessarily point to specific pathogenic links. However, results suggest the possibility that type 1 diabetes could be, at least in part, a preventable condition.
Research perspectives
Further studies conducted with specific models are needed to explore better the pathogenic links between type 1 diabetes, air pollutants and other known risk factors of disease as genetic factors, viral infection history, individual diet, and lifestyle.
