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Cadmium Exposure and Incidence of Diabetes Mellitus - Results from the Malmo Diet and Cancer Study

Journal article
Authors Y. Borne
Björn Fagerberg
M. Persson
Gerd Sällsten
N. Forsgard
B. Hedblad
Lars Barregård
G. Engstrom
Published in Plos One
Volume 9
Issue 11
ISSN 1932-6203
Publication year 2014
Published at Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Institute of Medicine, Department of Molecular and Clinical Medicine
Language en
Subject categories Occupational medicine, Cancer and Oncology


Background: Cadmium is a pollutant with multiple adverse health effects: renal dysfunction, osteoporosis and fractures, cancer, and probably cardiovascular disease. Some studies have reported associations between cadmium and impaired fasting glucose and diabetes. However, this relationship is controversial and there is a lack of longitudinal studies. Objectives: To examine prospectively whether cadmium in blood is associated with incidence of diabetes mellitus. Methods: The study population consists of 4585 subjects without history of diabetes (aged 46 to 67 years, 60% women), who participated in the Malmo Diet and Cancer study during 1991-1994. Blood cadmium levels were estimated from hematocrit and cadmium concentrations in erythrocytes. Incident cases of diabetes were identified from national and local diabetes registers. Results: Cadmium concentrations in blood were not associated with blood glucose and insulin levels at the baseline examination. However, cadmium was positively associated with HbA1c in former smokers and current smokers. During a mean follow-up of 15.2 +/- 4.2 years, 622 (299 men and 323 women) were diagnosed with new-onset of diabetes. The incidence of diabetes was not significantly associated with blood cadmium level at baseline, neither in men or women. The hazard ratio (4th vs 1st quartile) was 1.11 (95% confidence interval 0.82-1.49), when adjusted for potential confounders. Conclusions: Elevated blood cadmium levels are not associated with increased incidence of diabetes. The positive association between HbA1c and blood cadmium levels has a likely explanation in mechanisms related to erythrocyte turnover and smoking.

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