Chemical pollutant mixtures associated with metabolic health: Results from the European Health Examination Survey in Luxembourg

Metabolic syndrome (MetS) and its components -central obesity, hypertriglyceridemia, reduced levels of serum high-density cholesterol (HDL-c), high blood pressure (BP), and hyperglycemia- are highly prevalent worldwide. Classical modifiable risk factors and environmental ones, such as exposure to pollutants can contribute to these high prevalence rates. We assessed whether exposure to pollutant mixtures was associated with MetS and its components, identifying key contributing pollutants. We analyzed data from 606 adults aged 25-64 from the European Health Examination Survey (2013-2015). Among 152 analyzed chemicals, 40 were present in over 50 % of the samples and classified as flame retardants, industrial wastes, and plastics (4), insecticides (17), herbicides (12), and fungicides (7). Using weighted quantile sum regressions, we estimated associations of groups of pollutants and the total mixture with metabolic outcomes. Exposure to insecticides was associated with high BP, hyperglycemia, and hypertriglyceridemia; herbicides with abdominal obesity; and fungicides with MetS, hyperglycemia, and hypertriglyceridemia. The total mixture increased the odds of all outcomes, except low HDL-c [average OR MetS = 2.06 (5th PCT = 1.23); average OR Abdominal obesity = 1.83 (5th PCT = 1.03); average OR High BP = 2.42 (5th PCT = 1.42); average OR Low HDL-c = 1.19 (5th PCT = 0.77); average OR Hyperglycemia = 2.15 (5th PCT = 1.37); average OR Hypertriglyceridemia = 1.89 (5th PCT = 1.10)]. Prosulfocarb was a probable contributor to the mixture effect on MetS and abdominal obesity, ClCF 3CA on hypertriglyceridemia, and PNP on high BP. In conclusion, chemical pollutants are more present in individuals with metabolic derangements, with potentially stronger effects when combined. Reducing pesticide use, promoting safer alternatives, and creating protocols/regulatory standards for multiple-exposure scenarios are crucial for public health.