Exposition aux pesticides et risque de diabète de type 2 : une étude au nord du Bénin (Afrique de l'Ouest)
Background: The present study examines for the first time in sub-Saharan Africa, the association between exposure to organochlorine pesticides (OCPs) and the risk of type 2 diabetes. The study took place in the Borgou area in the northern part of Benin, where the intensive use of pesticides for cotton production coincides with a high prevalence of diabetes compared to other areas of the country. Objectives: 1) To describe in a sample of subjects with diabetes and in non-diabetic control subjects of Borgou serum levels of some OCPs; 2) To assess the relationship between the risk of type 2 diabetes and serum concentrations of OCPs; 3) To examine the association between overall obesity, the percentage of body fat and abdominal obesity with serum concentrations of OCPs; 4) To explore the contribution of some potential sources of exposure to serum concentrations of OCPs. Methods: This is a case-control study of 258 adults aged 18 to 65 years, identified on the basis of a diabetes prevalence study. Subjects were detected by capillary and venous fasting blood glucose at the threshold of 7mmol /l for diabetic subjects and 5.6mmol / l for the controls. The 129 controls were matched with 129 cases for ethnic group, age ± 5 years, sex and residence location. Personal data and information on potential sources of pesticide exposure were collected by questionnaire. Serum OCPs were determined by gas chromatography coupled with mass spectrometry. Overall obesity was determined by a BMI ≥ 30kg/m2. Abdominal obesity was defined according to waist circumference using the Alberti et al. consensual criteria for metabolic syndrome. The percentage of body fat was measured by bioelectrical impedance and was higher at the threshold of 33% in women and 25% in men. Results: Comparing the third and first tertiles of p,p'-DDE and p,p'-DDT serum concentrations, we observed a two to threefold higher odds ratio for diabetes. The likelihood of abdominal obesity or general obesity was three to five times higher in the upper compared to lower tertile for three of the four detected OCPs, that is: p,p'-DDT, β-HCH and trans-Nonachlor. The socioeconomic factors associated with serum OCPs are high level of education, high income and residence in urban area. The non-food sources of exposure were mixed occupational exposure (primary and secondary) and consumption of local tobacco. The food sources of exposure were purchased foods that are greater source of exposure to pesticide than self-production. The frequency of weekly consumption of fish, vegetables, cheese, dried yam as well as millet, oil palm and some legumes such as soybeans, locust bean, cowpea and Bambara groundnut was significantly associated with serum concentrations of OCPs.  Conclusion: The study highlighted the relationship between the serum level of organochlorine pesticides on the one hand, diabetes or obesity on the other. Levels of OCPs observed in Borgou are high enough and need to be monitored and compared to others areas in the country. Factors associated with high levels of OCP in Borgou are high levels of education, high income, residence in urban area, purchase and consumption frequency of several foods. The contribution of the mixture of pollutants, to the increasing prevalence of diabetes in Borgou need to be examined, especially pesticides used currently for commercial productions in agriculture and other persistent pollutants. These results contribute to increase the knowledge on emerging risk factors for diabetes that are environmental pollutants such as pesticides. The implications for public health are important in terms of chronic diseases prevention and sensitization of national policies makers, for proper agricultural and health policy aimed at reducing exposure to pesticides.
Organochlorines pesticides Type2 diabetes Obesity Benin Africa