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Veterans and Agent Orange: Herbicide/Dioxin Exposure and Type 2 Diabetes
cause versus 1.05 (0.80–1.36) for multiple cause—which remained not statistically significant.
Using information from interviews, including lifetime occupational histories, and medical examinations, Calvert and NIOSH colleagues (1996, 1999) compared serum lipid concentrations, serum glucose, and diabetes in a group of TCP production workers to neighborhood controls, matched on age, race, and gender. The workers were drawn from two U.S. plants and were exposed at least 15 years prior to the study.
In their 1996 paper, 4 the authors examined data regarding 281 workers and 260 referents; data from 273 workers and 259 referents were used in the analyses. Mean total cholesterol, mean high-density lipoprotein (HDL) cholesterol, and the ratio of mean total cholesterol to HDL were determined for the workers, divided into roughly equal-sized quartiles by whole-weight serum TCDD concentration (<158 fg/g serum, 5 158–520, 521–1,515, and 1,516–19,717 fg/g serum), and controls. Measures were based on blood drawn after a 12-hour or longer fast. The authors used reference values described in the National Cholesterol Education Program to set thresholds for categorizing a value as abnormal. Cut points chosen were
cholesterol ≥ 6.21 mmol/l (240 mg/dl),
HDL cholesterol ≤ 0.91 mmol/1 (35 mg/dl),
triglyceride > 2.82 mmol/1 (250 mg/dl), and
total cholesterol/HDL ratio ≥ 5.
The highest serum TCDD concentration group had the highest rate of abnormal HDL cholesterol concentration (odds ratio [OR] = 2.2, 1.1 –4.7), controlling for body weight index, use of beta blocker, and current diabetes. The trend for mean triglyceride concentration quartiles was borderline significant (p = .05), controlling for gender, plant location, body weight index, cumulative cigarette consumption, use of beta-blocker medication, race, and diabetes. None of the other relationships tested yielded statistically significant results. To explore whether the observed associations were influenced by total serum lipid variations, the authors added a total serum lipid term to the model—it did not, however, change the findings.
The authors concluded that the association of serum TCDD concentration with their lipid measures was small compared to the influence of other factors. They also observed that because TCDD is lipophilic and partitions into serum lipids, individuals with higher serum lipid concentrations would be expected to have higher serum TCDD concentrations, all else being equal.
4
This paper is also reviewed in Update 1998 under the discussion of lipid and lipoprotein disorders.
5
The unit femtograms per gram of serum is not directly comparable to the lipid-adjusted measures (picograms per gram of lipid and, equivalently, nanograms per kilogram of lipid) used in the other papers reviewed here.
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