title: Nickel exposure is associated with the  prevalence of type 2 diabetes in Chinese adults.
abstract: BACKGROUND
  Nickel exposure can induce hyperglycaemia in rodents, but little is known about its association with abnormal glucose metabolism in humans. We aimed to investigate the association of nickel exposure with the prevalence of type 2 diabetes in Chinese adults.
  
  
  METHODS
  A total of 2115 non-institutionalized men and women aged 55 to 76 years from Beijing and Shanghai were included, and urinary nickel concentration was assessed by inductively coupled plasma mass spectroscopy. The prevalence of type 2 diabetes was compared across urinary nickel quartiles. Fasting plasma glucose, insulin, lipids, C-reactive protein and glycated haemoglobin A1c, as well as urinary albumin and creatinine were measured.
  
  
  RESULTS
  The median concentration of urinary nickel was 3.63 mg/l (interquartile range: 2.29–5.89 mg/l), and the prevalence of diabetes was 35.3% (747 cases/2115 persons). Elevated levels of urinary nickel were associated with higher fasting glucose, glycated haemoglobin A1c, insulin and homeostatic model assessment of insulin resistance (all P<0.01). The odds ratios (95% confidence interval) for diabetes across the increasing urinary nickel quartiles were 1.27 (0.97–1.67), 1.78 (1.36–2.32) and 1.68 (1.29–2.20), respectively (referencing to 1.00), after multivariate adjustment including lifestyle factors, body mass index and family history of diabetes (P for trend <0.001). The association remained unchanged after further controlling for urinary creatinine and C-reactive protein (P for trend <0.001).
  
  
  CONCLUSIONS
  Increased urinary nickel concentration is associated with elevated prevalence of type 2 diabetes in humans.
authors.forename: Gang
authors.initials: G
authors.lastname: Liu
authors.forename: Liang
authors.initials: L
authors.lastname: Sun
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.forename: Mingjiang
authors.initials: M
authors.lastname: Zhu
authors.forename: Zi
authors.initials: Z
authors.lastname: Li
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: ZhenzhenWang
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.forename: Xingwang
authors.initials: X
authors.lastname: Ye
authors.forename: Huaixing
authors.initials: H
authors.lastname: Li
authors.forename: He
authors.initials: H
authors.lastname: Zheng
authors.forename: Choon Nam
authors.initials: CN
authors.lastname: Ong
authors.forename: Huiyong
authors.initials: H
authors.lastname: Yin
authors.forename: Xu
authors.initials: X
authors.lastname: Lin
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000368:Aged; D001786:Blood Glucose; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D007333:Insulin Resistance; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009532:Nickel / Q000652:urine*; D015995:Prevalence
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D009532:Nickel