The Relationship between Persistent Organic Pollutants Exposure and Type 2 Diabetes among First Nations in Ontario and Manitoba, Canada: A Difference in Difference Analysis

Int J Environ Res Public Health. 2018 Mar 17;15(3):539. doi: 10.3390/ijerph15030539.


We previously studied the association between fish consumption and prevalence of type 2 diabetes (T2D) in Manitoba and Ontario First Nations (FNs), Canada and found different results. In this study, we used a difference in difference model to analyze the data. Dietary and health data from the First Nations Food Nutrition and Environment Study, a cross-sectional study of 706 Manitoba and 1429 Ontario FNs were analyzed. The consumption of fish was estimated using a food frequency questionnaire. Fish samples were analyzed for dichloro diphenyldichloro ethylene (DDE) and polychlorinated biphenyls (PCBs) content. Difference in difference model results showed that persistent organic pollutant (POP) exposure was positively associated with T2D in a dose-response manner. Stronger positive associations were found among females (OR = 14.96 (3.72-60.11)) than in males (OR = 2.85 (1.14-8.04)). The breakpoints for DDE and PCB intake were 2.11 ng/kg/day and 1.47 ng/kg/day, respectively. Each further 1 ng/kg/day increase in DDE and PCB intake increased the risk of T2D with ORs 2.29 (1.26-4.17) and 1.44 (1.09-1.89), respectively. Our findings suggest that the balance of risk and benefits associated with fish consumption is highly dependent on the regional POP concentrations in fish.

Keywords: First Nations; difference in difference model; fish consumption; long chain n-3 fatty acids; persistent organic pollutants; type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Dichlorodiphenyl Dichloroethylene / analysis*
  • Environmental Exposure
  • Environmental Pollutants / analysis*
  • Female
  • Fishes*
  • Food Contamination / analysis*
  • Humans
  • Indians, North American
  • Male
  • Manitoba / epidemiology
  • Middle Aged
  • Odds Ratio
  • Ontario / epidemiology
  • Polychlorinated Biphenyls / analysis*
  • Prevalence


  • Environmental Pollutants
  • Dichlorodiphenyl Dichloroethylene
  • Polychlorinated Biphenyls