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    Does ozone inhalation cause adverse metabolic effects in humans? A systematic review

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    Author
    LaKind, Judy S
    Burns, Carol J
    Pottenger, Lynn H
    Naiman, Daniel Q
    Goodman, Julie E
    Marchitti, Satori A
    Date
    2021-09-27
    Journal
    Critical Reviews in Toxicology
    Publisher
    Taylor and Francis Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1080/10408444.2021.1965086
    Abstract
    We utilized a practical, transparent approach for systematically reviewing a chemical-specific evidence base. This approach was used for a case study of ozone inhalation exposure and adverse metabolic effects (overweight/obesity, Type 1 diabetes [T1D], Type 2 diabetes [T2D], and metabolic syndrome). We followed the basic principles of systematic review. Studies were defined as “Suitable” or “Supplemental.” The evidence for Suitable studies was characterized as strong or weak. An overall causality judgment for each outcome was then determined as either causal, suggestive, insufficient, or not likely. Fifteen epidemiologic and 33 toxicologic studies were Suitable for evidence synthesis. The strength of the human evidence was weak for all outcomes. The toxicologic evidence was weak for all outcomes except two: body weight, and impaired glucose tolerance/homeostasis and fasting/baseline hyperglycemia. The combined epidemiologic and toxicologic evidence was categorized as weak for overweight/obesity, T1D, and metabolic syndrome,. The association between ozone exposure and T2D was determined to be insufficient or suggestive. The streamlined approach described in this paper is transparent and focuses on key elements. As systematic review guidelines are becoming increasingly complex, it is worth exploring the extent to which related health outcomes should be combined or kept distinct, and the merits of focusing on critical elements to select studies suitable for causal inference. We recommend that systematic review results be used to target discussions around specific research needs for advancing causal determinations. © 2021 The Author(s).
    Keyword
    Systematic review
    diabetes
    metabolic syndrome
    obesity
    overweight
    ozone
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/16781
    ae974a485f413a2113503eed53cd6c53
    10.1080/10408444.2021.1965086
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