Association Between Long-term Exposure to Air Pollution and Biomarkers Related to Insulin Resistance, Subclinical Inflammation, and Adipokines

Diabetes. 2016 Nov;65(11):3314-3326. doi: 10.2337/db15-1567. Epub 2016 Sep 7.


Insulin resistance (IR) is present long before the onset of type 2 diabetes and results not only from inherited and lifestyle factors but also likely from environmental conditions. We investigated the association between modeled long-term exposure to air pollution at residence and biomarkers related to IR, subclinical inflammation, and adipokines. Data were based on 2,944 participants of the KORA (Cooperative Health Research in the Region Augsburg) F4 study conducted in southern Germany (2006-2008). We analyzed associations between individual air pollution concentration estimated by land use regression and HOMA-IR, glucose, insulin, HbA1c, leptin, and high-sensitivity C-reactive protein levels from fasting samples using multivariable linear regression models. Effect estimates were calculated for the whole study population and subgroups of individuals who did not have diabetes, had prediabetes, or had diabetes. Among all participants, a 7.9 μg/m3 increment in particulate matter of <10 μm was associated with higher HOMA-IR (15.6% [95% CI 4.0; 28.6]) and insulin (14.5% [3.6; 26.5]). Nitrogen dioxide was associated with HOMA-IR, glucose, insulin, and leptin. Effect estimates for individuals with prediabetes were much larger and highly statistically significant, whereas individuals who did not have diabetes or had diabetes showed rather weak associations. No association was seen for HbA1c level. Our results suggested an association between long-term exposure to air pollution and IR in the general population that was attributable mainly to individuals with prediabetes.

MeSH terms

  • Adipokines / blood
  • Adult
  • Aged
  • Air Pollution / adverse effects*
  • Biomarkers / blood*
  • C-Reactive Protein
  • Cross-Sectional Studies
  • Female
  • Humans
  • Inflammation / blood
  • Inflammation / chemically induced
  • Inflammation / metabolism
  • Insulin Resistance / physiology
  • Male
  • Middle Aged
  • Particulate Matter / adverse effects


  • Adipokines
  • Biomarkers
  • Particulate Matter
  • C-Reactive Protein