Biomarkers of pesticide exposure and diabetes in the 1999-2004 national health and nutrition examination survey.

The associations of 8 pesticides and pesticide metabolites with total diabetes (diagnosed and undiagnosed) and pre-diabetes (glycohemoglobin 5.7-6.4%) were evaluated using the National Health and Nutrition Examination Survey (NHANES), 1999-2004. Six of the pesticides were found to be associated with total diabetes in separate adjusted logistic regressions. These pesticides and pesticide metabolites were beta-hexachlorocyclohexane, p,p'-DDE, p,p'-DDT, oxychlordane, trans-nonachlor, and heptachlor epoxide. When the number of compounds elevated was tested, 4 or more, of the 6, elevated had an odds ratio of 4.99 (95% CI 1.97-12.61) compared to none elevated. When the 6 compounds were tested together in a single combined adjusted logistic regression only oxychlordane, a metabolite of chlordane, and heptachlor epoxide, a metabolite of heptachlor, were significantly associated with total diabetes. In the combined adjusted logistic regression, oxychlordane >or=14.5ng/g lipid adjusted had an odds ratios of 1.90 (95% CI 1.09-3.32) compared to oxychlordane <14.5ng/g lipid adjusted, and heptachlor epoxide >or=14.6ng/g lipid adjusted had an odds ratio of 1.70 (95% CI 1.16-2.49) compared to heptachlor epoxide <14.6ng/g lipid adjusted. Heptachlor epoxide and p,p'-DDT were significantly associated with pre-diabetes in separate adjusted logistic regressions. When these 2 compounds were tested together only heptachlor epoxide remained significantly associated with pre-diabetes. The evidence supporting the relationship between pesticides and pesticide metabolites, with diabetes, was strongest for heptachlor epoxide and oxychlordane, intermediate for p,p'-DDT, and least for beta-hexachlorocyclohexane, p,p'-DDE, and trans-nonachlor. Mirex and dieldrin were not associated with total diabetes or pre-diabetes.