title: Serum perfluorinated chemicals, glucose homeostasis and the risk of diabetes in working-aged Taiwanese adults.
abstract: BACKGROUND
  The link among perfluoroalkyl and polyfluoroalkyl substances (PFASs), abnormal glucose homeostasis and the risk of diabetes has been intensively debated with conflicting evidence.
  
  
  OBJECTIVE
  We evaluated the associations among PFASs, oral glucose tolerance testing (OGTT) curves and diabetes prevalence in 571 working-aged Taiwanese participants.
  
  
  METHODS
  Exposure measures included serum perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluoroundecanoic acid (PFUA). Outcomes were OGTT curves and prevalent diabetes defined by fasting blood glucose (FBG) ≥126mg/dL, 2-h glucose ≥200mg/dL, or glycated hemoglobin ≥6.5%. Analyses were performed with multiple logistic regression and functional data analysis.
  
  
  RESULTS
  A total of 39 participants (6.8%) had diabetes in this study. After full adjustment, the increase in the geometric means of FBG, 2-h glucose concentrations, and area under the OGTT curve (AUC120) with a doubling increase in PFOS was 3% (95% CI 1-4), 8% (5-12), and 6% (4-9), respectively. Compared to the lowest-quartile of PFOS concentrations (<2.4ng/ml), the OGTT trajectories were significantly steeper in participants of the highest-quartile PFOS exposure (>4.8ng/ml) and the vertical shifting of the mean curve for each PFOS quartile showed a dose-response pattern. The adjusted odds ratio for diabetes comparing the highest to lowest quartile was 3.37 (95% CI 1.18-9.65). For PFOA, PFNA, and PFUA, the opposite pattern of OGTT trajectory and the opposite risk profile for diabetes were observed.
  
  
  CONCLUSIONS
  Chronic PFOS exposure was associated with impaired glucose homeostasis and the increased prevalence of diabetes. However, PFOA, PFNA, and PFUA showed a potential protective effect against glucose intolerance and the risk of diabetes. Future research focusing on clarifying possible differential effects of different species of PFASs on glucose homeostasis and establishing the prospective associations between PFASs and diabetes is needed.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan. Electronic address: tachensu@ntu.edu.tw.
authors.forename: Ta-Chen
authors.initials: TC
authors.lastname: Su
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan; Clinical Outcome Research and Training Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chin-Chi
authors.initials: CC
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Juey-Jen
authors.initials: JJ
authors.lastname: Hwang
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Guang-Wen
authors.initials: GW
authors.lastname: Lien
authors.affiliation: Clinical Outcome Research and Training Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan; Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Pao-Chung
authors.initials: PC
authors.lastname: Chen
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology; D004785:Environmental Pollutants / Q000097:blood* / Q000633:toxicity; D005260:Female; D005466:Fluorocarbons / Q000097:blood* / Q000633:toxicity; D005947:Glucose / Q000378:metabolism*; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D004785:Environmental Pollutants; D005466:Fluorocarbons; D005947:Glucose
keywords: Diabetes; Glucose homeostasis; Oral glucose tolerance testing; Perfluorinated chemicals