Worse pulmonary function in association with cumulative exposure to nanomaterials. Hints of a mediation effect via pulmonary inflammation

Table 2 Levels of pulmonary inflammation in association with 10-year cumulative exposure to nanomaterials

Inflammatory biomarkers (pg/mL)	β (95% CI)	p-value
IL-10^{a, b,c, d}	0.31 (0.16–0.45)	< 0.0001
IL-10^{e, f,g, h}	0.37 (0.23–0.52)	< 0.0001
IL-1β^{a, b,c, d}	0.34 (0.20–0.47)	< 0.0001
IL-1β^{e, f,g, h}	0.46 (0.29–0.62)	< 0.0001
TNF-α^{a, b,c, d}	0.48 (0.31–0.65)	< 0.0001
TNF-α^{e, f,g, h}	0.42 (0.25–0.58)	< 0.0001

^{a, b,c, d} models including cumulative exposure expressed as particle number concentration and lung function parameters, namely FEV₁, FVC, FEV₁/FVC and FEF_{25 − 75%}, one at a time; ^{e f g h} models including cumulative exposure expressed as Lung-Deposited Surface Area (LDSA) and lung function parameters, namely FEV₁, FVC, FEV₁/FVC and FEF_{25 − 75%}, one at a time
All estimates are derived from single-mediator Generalized Multilevel Structural Equation Models with the recruiting center and the IDs as latent variables accounting for between- and within-level variability. The ORs are calculated for an IQR-increase of cumulative exposure to nanomaterials (10 years) and are adjusted by potential confounders including active/inactive lifestyle, lifetime tobacco smoking (pack-years), sex, age, Body Mass Index (BMI) and ethnicity. The parameter-specific Lower Limit of Normal (LLN) are derived from the Global Lung Function Initiative (GLI, 2012) to express each respiratory parameter as below or above the fifth percentile (or a z-score < − 1.64) of the Global Lung Initiative spirometric reference equations distribution (Quanjer, 2012). Interleukins (ILs) and Tumor Necrosis Factor alpha are measured in exhaled breath condensate as pulmonary biomarker of inflammation

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