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

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/m<sup>2</sup>), and waist circumference. Annual mean residential exposures included air pollutants, air temperature, day-evening-night road traffic noise (L<sub>den</sub>) 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 PM<sub>2.5</sub> and L<sub>den</sub> was consistently associated with diabetes and obesity-related measures (e.g., PM<sub>2.5</sub>-diabetes for men: odds ratio (OR) [95% confidence interval] = 1.12 [1.02; 1.22]; L<sub>den</sub>-BMI for women: 0.22 kg/m<sup>2</sup> [0.16; 0.27]). Greenness showed non-linear (inverted U-shaped) with all outcomes. An interquartile range increase in multiple exposures simultaneously was associated with higher odds of diabetes, obesity and higher obesity-related measures (e.g., mixture (PM<sub>2.5</sub>,L<sub>den,</sub> lack of NDVI)-diabetes: OR = 1.20 [1.09; 1.33] for men; mixture (PM<sub>2.5</sub>,L<sub>den</sub>, lack of NDVI)-BMI: 0.33 kg/m<sup>2</sup> [0.21; 0.44] 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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Journal
Environmental Research
Published
2026-02-24
DOI
https://doi.org/10.1016/j.envres.2026.124096
Primary Topic
Health, Environment, Cognitive Aging
Type
article
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0.00

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article

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

Fatemeh Mayvaneh, Rajini Nagrani, Carolina Judith Klett-Tammen, Thaddäus Tönnies et al.
Environmental Research
Health, Environment, Cognitive Aging
article

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

Fatemeh Mayvaneh, Rajini Nagrani, Carolina Judith Klett-Tammen, Thaddäus Tönnies, Marco Dallavalle, Fiona Niedermayer, Stefan Rach, Tobia Lakes, Professor Dr. Heiko Becher, Lilian Krist, Claudia Meinke-Franze, Nadia Obi, Volker Harth, Cara Övermöhle, Jie Chen, Michael Leitzmann, Wolfgang Hoffmann, Wolfgang Lieb, Ilais Moreno Velásquez, Gabriele Bolte, Hermann Brenner, Jaime E. Hart, Thomas Keil, Börge Schmidt, Nikolaos Nikolaou, Bernd Holleczek, Barbara Hoffmann, Kathrin Wolf, Jana-Kristin Heise, Karin Halina Greiser, Francine Laden, Annette Peters, Matthias B. Schulze, Rafael Mikolajczyk, Verena Katzke, Jeroen Staab, Tamara Schikowski, Beate Fischer, Anna Köttgen, Alexandra Schneider, Klaus Berger, Boya Zhang
article en

Abstract

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/m<sup>2</sup>), and waist circumference. Annual mean residential exposures included air pollutants, air temperature, day-evening-night road traffic noise (L<sub>den</sub>) 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 PM<sub>2.5</sub> and L<sub>den</sub> was consistently associated with diabetes and obesity-related measures (e.g., PM<sub>2.5</sub>-diabetes for men: odds ratio (OR) [95% confidence interval] = 1.12 [1.02; 1.22]; L<sub>den</sub>-BMI for women: 0.22 kg/m<sup>2</sup> [0.16; 0.27]). Greenness showed non-linear (inverted U-shaped) with all outcomes. An interquartile range increase in multiple exposures simultaneously was associated with higher odds of diabetes, obesity and higher obesity-related measures (e.g., mixture (PM<sub>2.5</sub>,L<sub>den,</sub> lack of NDVI)-diabetes: OR = 1.20 [1.09; 1.33] for men; mixture (PM<sub>2.5</sub>,L<sub>den</sub>, lack of NDVI)-BMI: 0.33 kg/m<sup>2</sup> [0.21; 0.44] 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.

Environmental ResearchVol. 297
Brigham and Women's Hospital (US), Harvard University (US), Universität Hamburg (DE), Hochschule Bremen (DE), German Cancer Research Center (DE), University of Bremen (DE), Max Delbrück Center (DE), Heidelberg University (DE), University of Münster (DE), Universitätsmedizin Greifswald (DE), University Medical Center Freiburg (DE), University Hospital Heidelberg (DE), Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR) (DE), Helmholtz Zentrum München (DE), Christian-Albrechts-Universität zu Kiel (DE), Humboldt-Universität zu Berlin (DE), Düsseldorf University Hospital (DE), Leibniz Institute of Environmental Medicine (DE), University Medical Center Hamburg-Eppendorf (DE), Leibniz Institute for Prevention Research and Epidemiology - BIPS (DE), Helmholtz Centre for Infection Research (DE), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Deutsches Diabetes-Zentrum e.V. (DE), Klinikum Saarbrücken (DE), German Center for Diabetes Research (DE), German Institute of Human Nutrition (DE), Heinrich Heine University Düsseldorf (DE), University of Regensburg (DE), University of Duisburg-Essen (DE), Martin Luther University Halle-Wittenberg (DE), Ludwig-Maximilians-Universität München (DE)
Bundesministerium für Bildung und Forschung, Leibniz-Gemeinschaft
Zero hunger
Openalex Percentile: Top 50%
Health, Environment, Cognitive Aging
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