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Niedermayer, F. ; Hoffmann, B.* ; Zhang, B.* ; Chen, J.* ; Hart, J.E.* ; Laden, F.* ; Bolte, G.* ; Lakes, T.* ; Schikowski, T.* ; Greiser, K.H.* ; Staab, J.* ; Nikolaou, N. ; Dallavalle, M. ; Schulze, M.B.* ; Lieb, W.* ; Övermöhle, C.* ; Tönnies, T.* ; Katzke, V.* ; Becher, H.* ; Fischer, B.* ; Leitzmann, M.* ; Berger, K.* ; Mayvaneh, F.* ; Keil, T.* ; Krist, L.* ; Klett-Tammen, C.J.* ; Heise, J.K.* ; Pischon, T.* ; Velásquez, I.M.* ; Schmidt, B.* ; Nagrani, R.* ; Rach, S.* ; Brenner, H.* ; Holleczek, B.* ; Harth, V.* ; Obi, N.* ; Köttgen, A.* ; Mikolajczyk, R.* ; Meinke-Franze, C.* ; Hoffmann, W.* ; Schneider, A.E. ; Wolf, K. ; Peters, A.

Sex-specific individual and joint associations of multiple environmental exposures with diabetes and obesity in the population-based German National Cohort (NAKO).

Environ. Res. 297:124096 (2026)
Publ. Version/Full Text Research data DOI PMC
Open Access Hybrid
Creative Commons Lizenzvertrag
Recent studies have suggested a potential association of particulate matter (PM) and noise with diabetes and obesity, but studies examining other environmental exposures and their sex-specific and joint associations remain limited. Therefore, we investigated sex-specific individual and joint associations of annual exposure to multiple environmental factors with diabetes and obesity-related measures using cross-sectional data from the population-based multi-center German National Cohort (NAKO). Outcomes included self-reported diabetes mellitus, body mass index (BMI), obesity (BMI ≥ 30 kg/m2), and waist circumference. Annual mean residential exposures included air pollutants, air temperature, day-evening-night road traffic noise (Lden) and surrounding greenness (normalized difference vegetation index (NDVI)). We used sex-stratified linear and logistic regression models to assess individual associations and quantile g-computation to assess joint associations. Among 174,955 adult participants (50.4% women), 5.6% reported a diabetes diagnosis and 20.9% were obese. An interquartile range increase in PM2.5 and Lden was consistently associated with diabetes and obesity-related measures (e.g., PM2.5-diabetes for men: odds ratio (OR) [95% confidence interval] = 1.12 [1.02; 1.22]; Lden-BMI for women: 0.22 kg/m2 [0.16; 0.27]). Greenness showed non-linear (inverted U-shaped) with all outcomes. A one-quartile increase in multiple exposures simultaneously was associated with higher odds of diabetes, obesity and higher obesity-related measures (e.g., mixture (PM2.5,Lden, lack of NDVI)-diabetes: OR =1.14 [1.07; 1.21] for men; mixture (PM2.5,Lden, lack of NDVI)-BMI: 0.28 kg/m2 [0.21; 0.36] for women). While longitudinal studies need to confirm these findings, the study highlights that reducing multiple adverse environmental exposures could be potential targets for the prevention of diabetes and obesity.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Environmental Epidemiology ; Exposure Mixture ; Metabolic Disease ; Urbanization
ISSN (print) / ISBN 0013-9351
e-ISSN 1096-0953
Journal Environmental Research
Quellenangaben Volume: 297, Issue: , Pages: , Article Number: 124096 Supplement: ,
Publisher Elsevier
Publishing Place San Diego, Calif.
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology (EPI)