Environmental Science and Pollution Research

, Volume 26, Issue 19, pp 19272–19281 | Cite as

Evaluation of the association between urinary cadmium levels below threshold limits and the risk of diabetes mellitus: a dose-response meta-analysis

  • Fei-Fei Guo
  • Zhi-Yong Hu
  • Bing-Yan Li
  • Li-Qiang Qin
  • Chunling Fu
  • Huifang Yu
  • Zeng-Li ZhangEmail author
Research Article


As cadmium levels are increasing in the environment, the adverse effects of cadmium exposure specifically associated with chronic diseases are receiving increasing attention. Several population–based studies have been conducted on the association between cadmium and diabetes mellitus (DM) but have reported controversial results. Here, we aimed to evaluate the association between cadmium exposure and DM. In this meta-analysis, a random effects model was used because there was evidence of heterogeneity among studies. A dose-response relationship was assessed through a restricted cubic spline model with three knots. The results showed a positive association between cadmium levels in the body and DM (OR = 1.27; 95% CI, 1.07–1.52). The cadmium levels in the body were defined on the basis of combined urinary and blood cadmium. Subgroup analysis further indicated a positive association between urinary cadmium levels and DM (OR = 1.31; 95% CI, 1.02–1.69). The dose-response analysis results showed a positive association between levels of urinary cadmium above 2.43 μg/g creatinine and DM, and the risk of DM increased by 16% for each l μg/g creatinine increase in urinary cadmium levels. The results from our meta-analysis indicate that cadmium levels in the body are positively associated with DM, and urinary cadmium levels above 2.43 μg/g creatinine are associated with an increased risk of DM.


Cadmium Diabetes mellitus Pancreatic β cells Meta-analysis Dose-response analysis 


Funding source

This work was financially supported by the National Natural Science Foundation of China [grant numbers: 81773414, 81673151].

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fei-Fei Guo
    • 1
  • Zhi-Yong Hu
    • 2
  • Bing-Yan Li
    • 2
  • Li-Qiang Qin
    • 2
  • Chunling Fu
    • 2
  • Huifang Yu
    • 1
  • Zeng-Li Zhang
    • 3
    Email author
  1. 1.Jiaxing Center for Disease Control and PreventionJiaxingChina
  2. 2.Department of Nutrition and Food Hygiene, School of Public HealthSoochow UniversitySuzhouChina
  3. 3.Department of Labor Hygiene and Environmental Health, School of Public HealthSoochow UniversitySuzhouChina

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