When the total ambient PM₂.₅ levels are several-fold higher than the recommended limit, it may be important to study the distributions of different sizes of particulate matter (PM). Here, we assess the distributions of various sizes of total PM₂.₅ for 12 months (on a monthly basis) in New Delhi, India. Importantly, we found that ultrafine particles (i.e., particles <0.5 μm) contribute significantly to total PM₂.₅. PM<₀.₂₅ were the most cytotoxic particles to human lung epithelial cells in all the 12 months. In addition, PM<₀.₂₅ were associated with significantly higher cytotoxicity per unit mass compared to other size fractions constituting PM₂.₅. For any given size of PM, the amount of reactive oxygen species (ROS) generated per unit mass is higher for the month of March as compared to that for the rest of the months in the year. The higher ROS generations for all sizes of PM collected in the month of March was not explained by differences in their metal content values. Our data suggests the lack of correlation between total PM₂.₅ levels and the highly cytotoxic PM<₀.₂₅. In summary, this work establishes the need for policy changes to routinely monitor PM<₀.₂₅ and the necessity to establish exposure limits for PM<₀.₂₅, especially when the total PM₂.₅ levels are breached.

Studies have found that ambient particulate matter (PM) affects fasting blood glucose. However, the results are not consistent. We conducted a systematic review and meta-analysis to determine the relationship between PM with an aerodynamic diameter of 10 μm or less (PM₁₀) and PM with an aerodynamic diameter of 2.5 μm or less (PM₂.₅) and fasting blood glucose. We searched PubMed, Web of Science, the Wanfang Database and the China National Knowledge Infrastructure up to April 1, 2019. A total of 24 papers were included in the review, and 17 studies with complete or convertible quantitative information were included in the meta-analysis. The studies were divided into groups by PM size fractions (PM₁₀ and PM₂.₅) and length of exposure. Long-term exposures were based on annual average concentrations, and short-term exposures were those lasting less than 28 days. In the long-term exposure group, fasting blood glucose increased 0.10 mmol/L (95% CI: 0.02, 0.17) per 10 μg/m³ of increased PM₁₀ and 0.23 mmol/L (95% CI: 0.01, 0.45) per 10 μg/m³ of increased PM₂.₅. In the short-term exposure group, fasting blood glucose increased 0.02 mmol/L (95% CI: −0.01, 0.04) per 10 μg/m³ of increased PM₁₀ and 0.08 mmol/L (95% CI: 0.04, 0.11) per 10 μg/m³ of increased PM₂.₅. Further prospective studies are needed to explore the relationship between ambient PM exposure and fasting blood glucose.

Epidemiological studies have investigated the associations of bisphenol A (BPA) exposure with hypertension risk or blood pressure levels, but findings are inconsistent. Furthermore, the association between its alternatives bisphenol S and F (BPS and BPF) and hypertension risk are not yet known. We conducted a cross-sectional study in 1437 eligible participants without hypertension-related diseases, with complete data about blood pressure levels, hypertension diagnosis, and urinary bisphenols concentrations. Multivariable logistic and linear models were respectively applied to examine the associations of urinary bisphenols concentrations with hypertension risk and blood pressure levels. The dose-response relationship was explored by the restricted cubic spline model. Compared with the reference group of BPA, individuals in the middle and high exposure group had an adjusted odds ratio (OR) of 1.30 and 1.40 for hypertension, had a 3.08 and 2.82 mm Hg higher systolic blood pressure (SBP) levels, respectively, with an inverted “U” shaped dose-response relationship. Compared with the reference group of BPS, individuals in the second and third tertile had an adjusted OR of 1.49 and 1.48 for hypertension, had a 2.61 and 3.89 mm Hg increased levels of SBP, respectively, with a monotonic curve. No significant associations of BPF exposure with hypertension risk or blood pressure levels were found. BPA and BPS exposure were suggested to be associated with increased hypertension risk and blood pressure levels, with different dose-response relationships. Our findings have important implications for public health but require confirmation in prospective studies.

Telomere length (TL) has been suggested to be a surrogate for cellular ageing, and a record of cumulative inflammation and oxidative stress over life. An emerging body of evidence has associated exposure to air pollution to changes in TL. To date there is no available systematic review of literature on this association. We aimed to systematically review and conduct meta-analysis of published studies on the relationship between air pollution and TL in adults. Electronic databases were systematically searched for available English language studies on the association between air pollution and TL published up to 1 July 2018. Meta-analyses were conducted following MOOSE guidelines. The heterogeneity in the reported associations was assessed using Cochran's Q test and quantified as I² index. Publication bias was assessed using Egger's regression. Our search identified 19 eligible studies including 11 retrospective and eight prospective studies of which, four had excellent quality, ten had good quality and five had fair quality. Meta-analysis result of two studies on long-term exposure to PM₂.₅ showed an inverse association between these exposures and TL (for 5 μg/m³ PM₂.₅–0.03 95% CI; −0.05, −0.01). Meta-analysis of short-term exposure to PM₂.₅ with three studies and Polychlorinated Biphenyls (PCBs) with two studies revealed a direct association between these exposures and TL (0.03 95% CI; 0.02, 0.04 and 0.10 95% CI; 0.06, 0.15 respectively). No statistically significant relationship between exposure to PM₁₀ and polycyclic aromatic hydrocarbons (PAHs) exposure and TL were observed. We observed suggestive evidence for associations between air pollution and TL with potentially different direction of associations for short- and long-term exposures.

Metal pollution is a severe environmental issue in China, which has been recently linked with the risk of hypertension. However, relevant epidemiological studies are limited. The present exploratory study was conducted to assess the associations of environmental exposure to metals with the odds of hypertension as well as blood pressure (BP) levels using urine samples in a Chinese general population. From May 2016 to April 2017, a total of 823 eligible participants were consecutively enrolled in our study in Wuhan, China. Hypertension was defined as systolic BP (SBP) of ≥140 mmHg or diastolic BP (DBP) of ≥90 mmHg, a self-reported physician diagnosis, or current use of antihypertensive medication. We used urine samples as biomarkers to reflect the levels of environmental exposure to 20 metals. Multivariable regression models were applied to assess the potential association. Multi-metal models were conducted to investigate the impacts of co-exposure to various metals. Based on the results from various models, positive trends for increased odds of hypertension with increasing quartiles of vanadium (V), iron (Fe), zinc (Zn) and selenium (Se) were suggested. Compared with those in the lowest quartiles, participants in the highest quartiles of V, Fe, Zn and Se had a 4.4-fold, 4.9-fold, 4.2-fold and 2.5-fold increased odds of having hypertension, respectively. High urinary Hg level was found to increase the levels of DBP. Individuals in the highest group of Hg were found to have a 4.3 mmHg higher level of DBP. Our findings suggest that environmental exposure to V, Fe, Zn, Se and Hg might increase the risk of hypertension or elevate the levels of BP. These findings warrant further prospective studies in a larger population.

The long-term associations between multiple metals and incident diabetes are uncertain. We aimed to examine the relationship between plasma concentrations of 23 metals and the incidence of type 2 diabetes among Chinese senior adults. We quantified fasting plasma concentrations of 23 metals by inductively coupled plasma mass spectrometry among 1039 incident diabetes cases and 1039 controls (age and sex matched) nested in a prospective study, the Dongfeng-Tongji cohort. Both cases and controls were free of diabetes at baseline (2008–2010), incident diabetes were identified using the following criteria: fasting glucose ≥ 7.0 mmoL/l; or hemoglobin A1c (HbA1c) ≥ 6.5%; or self-reported physician diagnosis of diabetes or use of anti-diabetic medication during the follow-up visits in 2013. In the conditional logistic regression models, the multivariable adjusted ORs (95% CIs) of diabetes across quartiles (Q1–Q4) of metal concentrations were as follows: titanium, 1.00, 0.92, 1.31, 1.38 (1.00–1.91, Ptrend = 0.011); selenium, 1.00, 1.08, 1.45, 1.27 (0.93–1.74, Ptrend = 0.05); and antimony, 1.00, 0.79, 0.77, 0.60 (0.44–0.83, Ptrend = 0.002). Arsenic was significantly associated with diabetes in the crude model (ORs comparing extreme quartiles 1.30; 1.02–1.65; Ptrend = 0.006), but was not significant after adjustment for socio-demographic factors. No significant associations were found for other metals. In conclusion, titanium and selenium were positively while antimony was negatively associated with incident diabetes.

Parabens, known as ubiquitous preservatives, have been linked to adverse health outcomes in humans. This study aimed to examine urinary paraben concentrations of children at 3 years of age and evaluate their associations with anthropometric parameters. Urinary parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), butylparaben (BuP) and benzylparaben (BeP) were measured among 436 children in a birth cohort using gas chromatography with tandem mass spectrometry. Generalized linear models were performed to evaluate associations of paraben exposures with age- and sex-specific z scores, including weight, height, weight for height and body mass index. MeP, EtP and PrP were the dominant parabens in urinary samples, with the median concentrations of 6.03 μg/L, 3.17 μg/L, 2.40 μg/L, respectively. The median values of estimated daily intake (EDIurine) of five urinary paraben concentrations were 12.10, 5.68, 4.50, 0.06 and 0.17 μg/kg-body weight/day, respectively. Urinary EtP concentrations were positively associated with weight z scores [regression coefficient β = 0.16, 95% confidence interval (CI): 0.04, 0.29; p = 0.01] and height z scores (β = 0.15, 95% CI: 0.03, 0.27; p = 0.01). Positive associations were found between the sum of molar concentrations of five parabens and height z scores among all children (β = 0.24, 95% CI: 0.04, 0.45; p = 0.02). These significant associations were only observed in boys. Our findings suggest that exposure to parabens may be adversely associated with physical growth in 3-year-old boy children. Further prospective studies are warranted to understand the toxicological mechanisms of paraben exposures and potential risk of children.

Knowledge of environmental risk factors for stroke and their role are limited. We performed a case-cohort study to evaluate the association between serum persistent organic pollutants (POPs) level and stroke risk.526 subcohort members and 111 stroke incidence cases were identified from the Korean Cancer Prevention Study-II. Serum levels of POPs were measured using gas chromatography/high-resolution mass spectrometry. The hazard ratios (HRs) for stroke (ischemic, hemorrhagic, and all stroke types) were estimated using the weighted Cox regression model. Age, sex, body mass index, smoking status, physical activity, family history of cardiovascular disease, and hypertension were adjusted in the weighted Cox regression model.After adjusting for potential confounding factors, increased risk for stroke was observed among participants with serum concentration of p,p'-DDE in the highest tertile compared to those in the lowest tertile (HR = 4.10, 95% CI: 1.58, 10.59). A similar association was estimated for PCB118 (HR = 2.33, 95% CI: 1.04, 5.22), PCB156 (HR = 3.42, 95% CI: 1.42, 8.23), and PCB138 (HR = 3.80, 95% CI: 1.48, 9.76). For TEQ, stroke was three times as likely to occur among subjects with TEQ in the highest tertile compared to those in the lowest tertile (HR = 3.12, 95% CI: 1.27, 7.65). PCBs were positively associated with ischemic stroke, but not with hemorrhagic stroke.Elevated serum POPs levels were associated with an increased risk of stroke, especially ischemic stroke.

Although several studies have estimated the effects of temperature on mortality and morbidity, little is known regarding the burden of out-of-hospital cardiac arrest (OHCA) attributable to solar radiation.We obtained data for all cases of OHCA and meteorological data reported between 2011 and 2014 in 3 Japanese prefectures: Hokkaido, Ibaraki, and Fukuoka. We first examined the relationship between daily solar radiation and OHCA risk for each prefecture using time-varying distributed lag non-linear models and then pooled the results in a multivariate random-effects meta-analysis. The attributable fractions of OHCA were calculated for low and high solar radiation, defined as solar radiation below and above the minimum morbidity solar radiation, respectively. The minimum morbidity solar radiation was defined as the specific solar radiation associated with the lowest morbidity risk.A total of 49,892 cases of OHCA occurred during the study period. The minimum morbidity solar radiation for each prefecture was the 100th percentile (72.5 MJ/m2) in Hokkaido, the 83rd percentile (59.7 MJ/m2) in Ibaraki, and the 70th percentile (53.8 MJ/m2) in Fukuoka. Overall, 20.00% (95% empirical confidence interval [eCI]: 10.97–27.04) of the OHCA cases were attributable to daily solar radiation. The attributable fraction for low solar radiation was 19.50% (95% eCI: 10.00–26.92), whereas that for high solar radiation was 0.50% (95% eCI: −0.07–1.01).Low solar radiation was associated with a substantial attributable risk for OHCA. Our findings suggest that public health efforts to reduce OHCA burden should consider the solar radiation level. Large prospective studies with longitudinal collection of individual data is required to more conclusively assess the impact of solar radiation on OHCA.

We used real-world exposure scenarios to evaluate the effect of six ambient air pollutant (PM₂.₅, PM₁₀, NO₂, SO₂, CO, and O₃) exposure on renal function among older adults without chronic kidney disease (CKD). We recruited 169 older adults without CKD in Beijing, China, for a longitudinal study from 2016 to 2018. The Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (EPI) equations were employed to derive the estimated glomerular filtration rate (eGFR). A linear mixed-effects model with random intercepts for participants was employed to determine the effects of air pollutants on renal function evaluated on the basis of eGFR and urinary albumin/creatinine ratio at different exposure windows (1-, 2-, 3-, 5-, 7-, 14-, 28-, 45-, and 60-days moving averages). An interquartile range (IQR) increase in NO₂ for was associated with significant decreases of in eGFR (MDRD equation) [percentage changes: −4.49 (95% confidence interval: −8.44, −0.37), −5.51 (−10.43, −0.33), −2.26 (−4.38, −0.08), −3.71 (−6.67, −0.65), −5.44 (−9.58, −1.11), −5.50 (−10.24, −0.51), −6.15 (−10.73, −1.33), and −6.34 (−11.17, −1.25) for 1-, 2-, 5-, 7-, 14-, 28-, 45-, and 60-days moving averages, respectively] and in eGFR (EPI equation) [percentage changes: −5.04 (−7.09, −2.94), −6.25 (−8.81, −3.62), −5.16 (−7.34, −2.92), −5.10 (−7.85, −2.28), −5.83 (−8.23, −3.36), −6.04 (−8.55, −3.47) for 1-, 2-, 14-, 28-, 45-, and 60-days moving averages, respectively]. In two-pollutant model, only the association of NO₂ exposure with eGFR remained robust after adjustment for any other pollutant. This association was stronger for individuals with hypertension for the EPI equation or BMI <25 kg/m² for the MDRD equation at lags 1 and 1–2. Our findings suggest that NO₂ exposure is associated with eGFR reduction among older adults without CKD for short (1-, 2-days) and medium (14-, 28-, 45-, 60-days) term exposure periods; thus, NO₂ exposure may contribute to renal impairment.