Association between Urinary 3-Phenoxybenzoic Acid Concentrations and Self-Reported Diabetes in Korean Adults: Korean National Environmental Health Survey (KoNEHS) Cycle 2~3 (2012~2017)

Background: Pyrethroid insecticides account for more than 30% of the global insecticide market and are frequently used in agricultural settings and residential and public pest control among the general population. While several animal studies have suggested that exposure to pyrethroids can alter glucose homeostasis, there is only limited evidence of the association between environmental pyrethroid exposure and diabetes in humans. Objectives: This study aimed to report environmental 3-phenoxybenzoic acid (3-PBA) concentrations in urine and evaluate its association with the risk of diabetes in Korean adults. Methods: We analyzed data from the Korean National Environmental Health Survey (KoNEHS) Cycle 2 (2012~2014) and Cycle 3 (2015~2017). A total of 10,123 participants aged ≥19 years were included. Multiple logistic regressions were used to calculate the odds ratios (ORs) for diabetes according to log-transformed urinary 3-PBA levels. We also evaluated age, sex, education, monthly income, marital status, alcohol drinking, physical activity, urinary cotinine, body mass index, and sampling season as potential effect modifiers of these associations. Results: After adjusting for all the covariates, we found significant dose-response relationships between urinary 3-PBA as quartile and the prevalence of diabetes in pooled data of KoNEHS Cycles 2 and 3. In subgroup analyses, the adverse effects of pyrethroid exposure on diabetes were significantly stronger among those aged 19~39 years (p-interaction<0.001) and those who consumed high levels of cotinine (p-interaction= 0.020). Conclusions: Our findings highlight the potential diabetes risk of environmental exposure to pyrethroids and should be confirmed in large prospective studies in different populations in the future.