Abstract
Chronic lead exposure continues to be a global environmental concern. Previous studies reported high levels of lead exposure in people with diabetes. Frailty is one of the vital comorbidities of type 2 diabetes mellitus (T2DM); however, researchers have not determined whether lead exposure is a risk factor for frailty in people with T2DM. This cross-sectional study explored the association between blood lead levels and frailty in a Shanghai diabetic population cohort. Individuals who met ≥3 of 5 predefined criteria (weight loss, exhaustion, low physical activity, slow walking speed and low grip strength) were defined as frailty. A total of 884 participants with T2DM (50.6% men, mean age 70.6 ± 7.4 years) were included. Among them, 147 (16.6%) patients were frail, and the median (interquartile range) concentration of blood lead was 16.0 µg/L (12.0-23.0). Compared with the participants within the lowest quartile of serum lead, positive associations of the 2nd and 4th lead quartiles with frailty were observed (OR, 95% CI; 1.70 1.01-2.84 and 1.72 1.03-2.88, respectively) after adjusting for age, sex and body mass index (BMI). After further adjustment for drinking status, smoking status, diet, education, blood pressure, triglycerides and glycosylated hemoglobin, the associations of serum lead with frailty were still significant for the 4th and 2nd-4th quartiles of lead (1.71, 1.01-2.91 and 1.57, 1.02-2.41, respectively). In the subgroup analyses, we found positive associations of serum lead with frailty in elderly individuals (1.77, 1.13-2.79), those with obesity (2.14, 1.02-4.51), those with unhealthy diets (2.52, 1.26-5.04), and those without hyperlipidemia (2.09, 1.12-3.88), although the interactions were not statistically significant (P for interaction all >0.05). This work provides evidence of an association between chronic lead exposure and physical frailty in a diabetic population in a Chinese cohort. Future prospective and mechanistic studies are warranted to confirm our findings.
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