Arsenic exposure and type 2 diabetes: a systematic review of the experimental and epidemiological evidence.
Arsenic exposure and type 2 diabetes: a systematic review of the experimental and epidemiological evidence.
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DOI：
10.1289/ehp.8551
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发表时间：
2006-05
影响因子：
10.4
通讯作者：
中科院分区：
文献类型：
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慢性砷暴露被认为有助于糖尿病的发展。我们对砷与2型糖尿病相关性的实验和流行病学证据进行了系统回顾。我们确定了19项砷和葡萄糖代谢的体外研究。5项研究报告砷干扰了参与胰岛素相关基因表达的转录因子：胰腺β细胞中的上游因子1和前脂肪细胞中的过氧化物酶体增殖激活受体γ。其他体外研究评估了砷对葡萄糖摄取的影响，通常使用非常高浓度的亚砷酸盐或砷酸盐。这些研究对潜在机制的了解有限。我们确定了10项动物体内研究。这些研究表明砷对葡萄糖代谢的影响不一致。最后，我们确定了19项流行病学研究（6项在台湾和孟加拉国的高砷地区，9项在职业人群，4项在其他人群）。在来自台湾和孟加拉国的研究中，比较极端砷暴露类别的糖尿病合并相对风险估计值为2.52（95%置信区间，1.69-3.75），尽管方法学问题限制了对相关性的解释。来自职业研究和来自台湾或孟加拉国以外的一般人群的证据不一致。总之，现有证据不足以确定砷在糖尿病中的因果作用。由于砷暴露是广泛的，糖尿病患病率达到流行病的比例，实验研究使用砷浓度相关的人类暴露和前瞻性流行病学研究测量砷生物标志物和适当评估糖尿病应该是一个研究的优先事项。
Chronic arsenic exposure has been suggested to contribute to diabetes development. We performed a systematic review of the experimental and epidemiologic evidence on the association of arsenic and type 2 diabetes. We identified 19 in vitro studies of arsenic and glucose metabolism. Five studies reported that arsenic interfered with transcription factors involved in insulin-related gene expression: upstream factor 1 in pancreatic β-cells and peroxisome proliferative-activated receptor γ in preadipocytes. Other in vitro studies assessed the effect of arsenic on glucose uptake, typically using very high concentrations of arsenite or arsenate. These studies provide limited insight on potential mechanisms. We identified 10 in vivo studies in animals. These studies showed inconsistent effects of arsenic on glucose metabolism. Finally, we identified 19 epidemiologic studies (6 in high-arsenic areas in Taiwan and Bangladesh, 9 in occupational populations, and 4 in other populations). In studies from Taiwan and Bangladesh, the pooled relative risk estimate for diabetes comparing extreme arsenic exposure categories was 2.52 (95% confidence interval, 1.69–3.75), although methodologic problems limit the interpretation of the association. The evidence from occupational studies and from general populations other than Taiwan or Bangladesh was inconsistent. In summary, the current available evidence is inadequate to establish a causal role of arsenic in diabetes. Because arsenic exposure is widespread and diabetes prevalence is reaching epidemic proportions, experimental studies using arsenic concentrations relevant to human exposure and prospective epidemiologic studies measuring arsenic biomarkers and appropriately assessing diabetes should be a research priority.