title: Metals in Urine and Diabetes in U.S. Adults.
abstract: Our objective was to evaluate the relationship of urine metals including barium, cadmium, cobalt, cesium, molybdenum, lead, antimony, thallium, tungsten, and uranium with diabetes prevalence. Data were from a cross-sectional study of 9,447 participants of the 1999-2010 National Health and Nutrition Examination Survey, a representative sample of the U.S. civilian noninstitutionalized population. Metals were measured in a spot urine sample, and diabetes status was determined based on a previous diagnosis or an A1C ≥6.5% (48 mmol/mol). After multivariable adjustment, the odds ratios of diabetes associated with the highest quartile of metal, compared with the lowest quartile, were 0.86 (95% CI 0.66-1.12) for barium (Ptrend = 0.13), 0.74 (0.51-1.09) for cadmium (Ptrend = 0.35), 1.21 (0.85-1.72) for cobalt (Ptrend = 0.59), 1.31 (0.90-1.91) for cesium (Ptrend = 0.29), 1.76 (1.24-2.50) for molybdenum (Ptrend = 0.01), 0.79 (0.56-1.13) for lead (Ptrend = 0.10), 1.72 (1.27-2.33) for antimony (Ptrend < 0.01), 0.76 (0.51-1.13) for thallium (Ptrend = 0.13), 2.18 (1.51-3.15) for tungsten (Ptrend < 0.01), and 1.46 (1.09-1.96) for uranium (Ptrend = 0.02). Higher quartiles of barium, molybdenum, and antimony were associated with greater HOMA of insulin resistance after adjustment. Molybdenum, antimony, tungsten, and uranium were positively associated with diabetes, even at the relatively low levels seen in the U.S.
  
  
  METHODS
  Prospective studies should further evaluate metals as risk factors for diabetes.
authors.affiliation: Social & Scientific Systems, Inc., Silver Spring, MD amenke@s-3.com.
authors.forename: Andy
authors.initials: A
authors.lastname: Menke
authors.affiliation: Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Cowie
mesh_terms: D000328:Adult; D000965:Antimony / Q000652:urine; D001464:Barium / Q000652:urine; D002104:Cadmium / Q000652:urine; D002586:Cesium / Q000652:urine; D003035:Cobalt / Q000652:urine; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000652:urine; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007854:Lead / Q000652:urine; D008297:Male; D008670:Metals / Q000652:urine*; D008875:Middle Aged; D008982:Molybdenum / Q000652:urine; D009749:Nutrition Surveys; D016017:Odds Ratio; D015995:Prevalence; D013793:Thallium / Q000652:urine; D014414:Tungsten / Q000652:urine; D014481:United States / Q000453:epidemiology; D014501:Uranium / Q000652:urine
chemical_list: D008670:Metals; D002104:Cadmium; D002586:Cesium; D001464:Barium; D007854:Lead; D003035:Cobalt; D014501:Uranium; D008982:Molybdenum; D000965:Antimony; D013793:Thallium; D014414:Tungsten