Adverse associations of different obesity measures and the interactions with long-term exposure to air pollutants with prevalent type 2 diabetes mellitus: The Henan Rural Cohort study

Ning Kang, Gongbo Chen, Runqi Tu, Wei Liao, Xiaotian Liu, Xiaokang Dong, Ruiying Li, Mingming Pan, Shanshan Yin, Kai Hu, Zhenxing Mao, Wenqian Huo, Yuming Guo, Shanshan Li, Jian Hou, Chongjian Wang

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Background: Obesity and ambient air pollution are independent risk factors of type 2 diabetes mellitus (T2DM), however, the evidence regarding their joint associations on T2DM was sparsely studied in low-middle income countries. Methods: A total of 38,841 participants were selected from Henan Rural Cohort study which was carried out during 2015–2017. Obesity was identified by body mass index (BMI), WC (waist circumstance), WHR (waist-to-hip ratio), WHtR (waist-to-height ratio), BFP (body fat percent), and VFI (visceral fat index). Three-year averaged-concentrations of NO2, PM1, PM2.5, and PM10 were assessed by using the method of spatiotemporal model incorporated into the satellites data. The independent associations of obesity indicators and exposure to air pollutants on fasting blood glucose (FBG) and T2DM were assessed by generalized linear and logistic regression model, respectively, and their interaction associations on T2DM were quantified by using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). Results: Positive associations of six obesity measures and four air pollutants with FBG levels and prevalent T2DM were observed. Obese participants measured by BMI plus high exposure to NO2, PM1, PM2.5 and PM10 were related to a 2.96-fold (2.66–3.29), 2.87-fold (2.58–3.20), 2.98-fold (2.67–3.32) and 3.01-fold (2.70–3.35) increased risk for prevalent T2DM, respectively; similarity of joint associations of the other obesity measures and air pollutants on T2DM were observed. The additive associations of different obesity measures and air pollutants with prevalent T2DM were further found. Conclusions: The synergistic associations of obesity and air pollutants on FBG levels and prevalent T2DM were observed, indicating that obese participants were at high risk for prevalent T2DM in highly polluted rural regions.

Original languageEnglish
Article number112640
Number of pages9
JournalEnvironmental Research
Publication statusPublished - 1 May 2022


  • Air pollutants
  • Obesity
  • Rural population
  • Synergistic association
  • Type 2 diabetes mellitus

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