Association between long-term air pollution exposure and development of diabetes among community-dwelling adults: Modification of the associations by dietary nutrients

BACKGROUND:Studies on the modifying effects of dietary factors on the association between air pollution and diabetes-related outcomes are limited. We examined whether dietary nutrients could modify the association between long-term air pollution exposure and the development of diabetes. METHODS:We used data from the Cardiovascular Disease Association Study, which enrolled adults aged 40-69 years in Korea between 2005 and 2011 and followed them up until 2016 (n = 14,667). Annual concentrations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) at each participant's residence(s) were estimated using community multiscale air quality models. Intake of 22 dietary nutrients was assessed using a validated food frequency questionnaire during the baseline survey. We examined the product terms between air pollution levels (continuous) and each dietary nutrient (quartile) using Cox regression models, adjusted for potential confounders. RESULTS:PM2.5 [hazard ratio (HR) = 1.49, 95 % confidence interval (CI): 1.11, 2.00] and NO2 (HR = 1.29, 95 % CI: 1.12, 1.49) concentrations were found to be associated with incident diabetes. NO2 levels interacted with dietary intake of retinol, vitamin A, and cholesterol (p-values for interaction < 0.05). Stronger associations were observed between NO2 levels and the occurrence of diabetes among individuals with a lower intake of these nutrients compared to those with a higher intake. No interaction was found between PM2.5 and the 22 investigated dietary nutrients. CONCLUSIONS:Adequate intake of dietary nutrients, such as retinol, vitamin A, and cholesterol, from various food items in a balanced diet may prevent the occurrence of diabetes in a setting wherein reduction of air pollution levels cannot be achieved in a short time frame.