Systemic Inflammation (C-Reactive Protein) in Type 2 Diabetic Patients Is Associated With Ambient Air Pollution in Pune City, India

  1. Chittaranjan S. Yajnik, MD, FRCP6
  1. 1Department of Health, Jondi-Shapour University of Medical Sciences, Ahvaz, Iran
  2. 2Chest Research Foundation, Pune, Maharashtra, India
  3. 3Technogreen Environmental Solutions, Pune, Maharashtra, India
  4. 4Department of Statistics, Omidieh Branch, Islamic Azad University, Omidieh, Iran
  5. 5Department of Statistics, University of Pune, Pune, Maharashtra, India
  6. 6King Edward Memorial Hospital Research Center, Pune, Maharashtra, India
  1. Corresponding author: Chittaranjan S. Yajnik, diabetes{at}


OBJECTIVE To study the association between ambient air pollutants and serum C-reactive protein (CRP) concentration in 1,392 type 2 diabetic patients in Pune, India.

RESEARCH DESIGN AND METHODS A cross-sectional study was conducted that linked daily time series of ambient air pollution data (obtained from central monitoring sites) and plasma CRP concentration in type 2 diabetic patients from the Wellcome Trust Genetic (WellGen) Study, recruited between March 2005 and May 2007. Air pollution effects on CRP concentration were investigated with delays (lags) of 0–7 days and multiday averaging spans of 7, 14, and 30 days before blood collection adjusted for age, sex, BMI, hemoglobin, fasting plasma glucose, treatment with agents with anti-inflammatory action, season, air temperature, and relative humidity.

RESULTS Median CRP concentration was 3.49 mg/L. For 1 SD increase in SO2 and oxides of nitrogen (NOx) concentrations in ambient air, a day before blood collection (lag1), we observed a significant increase in CRP (9.34 and 7.77%, respectively). The effect was higher with lag2 (12.42% for SO2 and 11.60% for NOx) and wore off progressively thereafter. We also found a significant association with multiday averaging times of up to 30 and 7 days for SO2 and NOx, respectively. No significant associations were found between particulate matter with an aerodynamic profile ≤10 µm (PM10) and CRP concentration except in summer. The association was significantly higher among patients with a shorter duration of diabetes, and in those not on statin and thiazolidinedione treatment.

CONCLUSIONS We demonstrate, for the first time, a possible contribution of ambient air pollution to systemic inflammation in Indian type 2 diabetic patients. This may have implications for vascular complications of diabetes.


  • Received February 27, 2012.
  • Accepted August 29, 2012.

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  1. Diabetes Care vol. 36 no. 3 625-630
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