Published online May 15, 2021. doi: 10.4239/wjd.v12.i5.673
Peer-review started: December 18, 2020
First decision: March 16, 2021
Revised: March 17, 2021
Accepted: April 12, 2021
Article in press: April 12, 2021
Published online: May 15, 2021
Type 1 diabetes onset depends on gene-environment interactions, and several reports show, worldwide, an increased incidence of type 1 diabetes over time.
The effect of environmental factors on type 1 diabetes incidence in pediatric age is still incompletely unexplored.
To correlate the incidence of childhood type 1 diabetes in European countries with the global, nationwide production of toxic airborne molecules.
We employed a systematic literature review to explore type 1 diabetes incidence in pediatric age in 19 European countries (time period: 1990-2018). We therefore applied an ecological study design to explore possible associations with the nationwide production of five widely diffused air pollutants: Particulate matter < 10 μm (PM10), nitrogen oxides (NO), non-methane volatile organic compounds (VOCs), sulphur oxide (SO2), and ammonia.
A raising incidence of type 1 diabetes was evident in 18 out of 19 countries. Considering the whole group of countries, type 1 diabetes incidence was associated with the nationwide emissions of PM10, NO, non-methane VOCs, but not with those of SO2 and ammonia.
The global burden of emission of specific air pollutants is associated with type 1 diabetes incidence. The study design employed in the present study can only indicate the existence of ecological associations and does not necessarily point to specific pathogenic links. However, results suggest the possibility that type 1 diabetes could be, at least in part, a preventable condition.
Further studies conducted with specific models are needed to explore better the pathogenic links between type 1 diabetes, air pollutants and other known risk factors of disease as genetic factors, viral infection history, individual diet, and lifestyle.