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Research Article

Association between pesticide exposure and obesity: A cross-sectional study of 20,295 farmers in Thailand

[version 1; peer review: 1 approved with reservations, 1 not approved]
PUBLISHED 04 Jun 2021
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Abstract

Background: Obesity is a serious condition because it is associated with other chronic diseases which affect the quality of life. In addition to diet and exercise, recent research has found that pesticide exposure might be another important risk factor.  
Methods: The objective of this large cross-sectional study was to determine the association between pesticide exposure and obesity among farmers in Nakhon Sawan and Phitsanulok province, Thailand. Data on pesticide use and obesity prevalence from 20,295 farmers aged 20 years and older was collected using an in-person interview questionnaire. The association was analysed using multivariable logistic regression, adjusted for its potential confounding factors. 
Results: Obesity was found to be associated with pesticide use in the past. The risk of obesity was significantly predicted by types of pesticides, including insecticides (OR = 2.27, 95% CI 1.09-4.74), herbicides (OR = 4.72, 95% CI 1.16-19.29), fungicides (OR = 2.17, 95% CI 1.37-3.44), rodenticides (OR = 2.52, 95% CI 1.59-3.99), and molluscicides (OR = 3.37, 95% CI 2.13-5.31). Among 35 surveyed individual pesticides, 24 were significantly associated with higher obesity prevalence (OR = 1.75, 95% CI 1.00-3.06 to OR = 8.37, 95% CI 3.97-17.64), including herbicide butachlor, 17 insecticides (three carbamate insecticides, five organochlorine insecticides, and nine organophosphate insecticides), and six fungicides. 
Conclusion: This study found obesity in farmers in Nakhon Sawan and Phitsanulok province, Thailand, to be associated with the long-term use of several types of pesticides. The issue should receive more public attention, and pesticide use should be strictly controlled.

Keywords

Pesticide exposure, obesity, farmer health, insecticide exposure, herbicide exposure, fungicide exposure

Abbreviations

BMI: body mass index

CM: carbamate pesticide

CVD: cardiovascular diseases

2,5-DCP: 2,5-dichlorophenol

DDT: dichlorodiphenyltrichloroethane

EDC: endocrine-disrupting chemicals

ICD-10: International Classification of Diseases 10th

OC: organochlorine pesticide

OPs: organophosphate pesticide

PCBs: polychlorinated biphenyl

p,p'-DDE: dichlorodiphenyldichloroethylene

VHV: village health volunteers

Background

Obesity is a global public health problem. In 2016, the World Health Organization (WHO) reported that there were approximately two billion people aged 18 years and older who were overweight, of which 650 million were obese, with this number expected to rise.1 In Thailand, the latest national survey reported obesity prevalence among adults aged 18 years and older, to be 4.0% class I obesity (body mass index (BMI) 30.0-34.9 kg/m2), 0.8% class II obesity (BMI 35.0-39.9 kg/m2), and 0.1% class III obesity (BMI ≥40.0 kg/m2).2 Obesity is not just an image problem, it can also affect health and well-being. Obesity has been linked with various health problems, including cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), cancer, and other health problems including liver and kidney disease, sleep apnea, and depression, which can eventually lead to mortality.3 Many factors can affect obesity, including age, genes, diet, a sedentary lifestyle, certain diseases, and medications, as well as other health conditions including sleeping habits, stress, and depression.4

Recent studies have found that pesticide exposure may be associated with metabolic disorders such as obesity.5 Mice studies have reported that chlorpyrifos, an organophosphate pesticide, has interfered with mucus-bacterial interactions in the gut, leading to increased lipopolysaccharide entry into the body resulting in excess fat storage.6 A study in Korea found women with Methanobacteriales, a bacteria in the gut that is linked to obesity, have higher body weight and waist circumference.7 This finding was consistent with a study in the United States of America (U.S.A) that with the use of the National Health and Nutrition Examination Survey (NHANES), found that obesity in adults was associated with the fumigant insecticide paradichlorobenzene,8 and 2,5-dichlorophenol (2,5-DCP) exposure.9 In a cohort study, dichlorodiphenyldichloroethylene (p,p'-DDE), and polychlorinated biphenyl (PCBs) were associated with higher BMI, high triglyceride levels, and insulin resistance.10 A recent study also linked a simultaneous exposure to bisphenol A (BPA), bisphenol S (BPS), and mono (carboxyoctyl) phthalate (MCOP), to an elevated risk of obesity.11

As far as we know, to date, this issue has not been investigated in Thailand. This cross-sectional study aimed to determine the association between pesticide exposure and obesity among farmers in Nakhon Sawan and Phitsanulok province, Thailand. Identification of individual pesticides to predict the risk of obesity was the main interest. The results will be useful for verification of previous results and prevention of obesity.

Methods

Study design and setting

Data in this cross-sectional study was collected from farmers in Nakhon Sawan and Phitsanulok province, Thailand. Nakhon Sawan province is located about 250 km north of Bangkok, Thailand, with a population of 1,066,455 people and 401,432 households, from 15 districts (data for the year 2016). The majority of people are farmers, and the main crops are rice, sugarcane, and cassava. In 2017, the province had a gross domestic product (GDP) of 21,852 THB (716 USD).12 In 2019, Phitsanulok province, located 377 km north of Bangkok, had a population of 865,368 people from nine districts and 342,787 households. Agriculture is the biggest sector of the economy, generating about 28% of GDP with an employment rate of 41.9%. The major crops in the province are rice, sugar cane, cassava, and vegetables13 (Thailand Information Centre, n.d.).

Study participants and sampling procedure

Study participants were farmers aged 20 years and older, who had worked as farmers for at least five years. Participants were selected using multistage sampling. Firstly, three districts from each province were randomly selected. In each district, three sub-districts were further randomly selected. In each sub-district, we selected 2,100-4,500 farmer families, accounting for about 30-100% of all farmer families in each sub-district. Using data from the local authority and personal contact, village health volunteers (VHV) identified farmer families, who were contacted for data collection. In each family, one adult who met the inclusion criteria was interviewed.

All local hospitals inside the selected subdistrict were contacted and public health staff and its membership VHV were invited to participate in the study. VHV who had mobile phone and internet access to the online questionnaires were recruited. These volunteers also had to attend a one-day training session to be informed about the project and to be trained on interviewing the participants, along with the correct use of online questionnaires. Most of the interviews took place in the participant’s home, however sometimes in other places, e.g. local temple or hospital. Data was collected between October 2020 and February 2021. Data from all 20,295 participants were included in the data analysis.

The minimum sample size was calculated to be 18,772, based on the following assumptions: significance level = 95%; power of detection = 80%; ratio of unexposed/exposed = 1; percent of unexposed with outcome = 5%; odds ratio = 1.2.

Study questionnaire and data collection

Data was collected using an in-person interview questionnaire and an online version. The questionnaire had three major parts (provided as Extended data15). Part I, contained demographic information, including gender, age, marital status and education. Information on cigarette smoking and alcohol consumption were also collected.

In part II, there were questions regarding the long-term use of pesticides. This question was modified from the questionnaire used in our previous study.16 Data on both types and individual pesticides were collected. Pesticides were categorized into insecticides, herbicides, fungicides, rodenticides, and molluscicides. Insecticides were further subdivided into four classes: organochlorine, organophosphate, carbamate, and pyrethroid. For individual pesticides, we collected data on 35 pesticides that were commonly used in Thailand and have been reported in previous literatures to affect obesity.16 Study participants were asked whether they have ever used the pesticides, using a ‘yes’ or ‘no’ question. Pesticide use was defined as a mixture or spray pesticides for agriculture purposes. Household pest control was excluded in this study.

In part III, participants were asked whether they had been medically diagnosed with obesity by using a “yes” or “no” question. This information was later confirmed by the disease record ICD-10 of the local hospitals. The confirmed cases were included in the data analysis, while the missing data was excluded. In Thailand, the Ministry of Public Health follows the International Diabetes Federation’s definition (2005), which defines obesity as a waist circumference of no more than 90 cm for men and 80 cm for women, plus two out of the following four criteria:17

  • 1. Triglyceride level ≥150 mg/dL

  • 2. HDL less than 40 mg/dL for men, or 50 mg/dL for women

  • 3. Blood pressure ≥130/85 mmHg, or taking medication for hypertension

  • 4. Fasting blood glucose ≥100 mg/dL, or taking medication for hyperglycemia

Statistical analysis

Demographic data were analysed using descriptive statistics (frequency, percentage, mean, and standard deviation). An association between pesticides and obesity was determined using multivariable logistic regression, adjusted for gender (male, female), age (20-30, 31-40, 41-50, 51-60, 60>), smoking (non-smoker, ex-smoker, smoker) and alcohol consumption (non-drinker (or abstainer), ex-drinker, regular drinker), presented in odds ratio (OR), 95% confidence intervals.

P-values <0.05 were statistically significant. All data analysis was performed using IBM SPSS Statistics (version 26) and OpenEpi online version 3.5.1.

Ethical considerations

The study was approved by the Ethical Committee of Naresuan University (COA No. 657/2019). Before the interviews, all the study participants gave informed consent to participate in the study, and they had the right to stop the interview at any time.

Results

Out of the 20,295 participants, most were women (45%), aged 40 years and older, with an average age of 55 (± 12 years). Current smokers were 11%, while 15% drank alcohol. Demographic data of the participants is shown in Table 1 and the Underlying Data.18

Table 1. Characteristics of not obese, and obese participants.

Not Obese
(N = 20217)
N (%)
Obese
(N = 78)
N (%)
P value**
Gender0.173
Male9072 (99.7)29 (0.3)
Female11145 (99.6)49 (0.4)
Age, yr0.030*
20-30722 (99.4)4 (0.6)
31-401830 (99.4)11 (0.6)
41-504238 (99.4)24 (0.6)
51-606518 (99.6)23 (0.4)
61+6909 (99.8)16 (0.2)
Mean ± SD = 55 ± 12
Min-Max = 20-98
Cigarette smoke0.040*
Non- smoke17043 (99.6)64 (0.4)
Ex-smoker918 (99.1)8 (0.9)
Smoker2256 (99.7)6 (0.3)
Alcohol consumption0.557
Non-drinker15553 (99.6)57 (0.4)
Ex-drinker1461 (99.5)8 (0.5)
Regular drinker3203 (99.6)13 (0.4)

* Statistically significant difference with p-value <0.05.

** Chi-square test

A total of 90 participants were diagnosed with obesity. Among these individuals, 12 were not confirmed by the ICD-10 record, thus only 78 were included in the data analysis. The prevalence of obesity among participants was 0.4% (Table 2). Besides obesity, many of the patients also had other diseases, e.g., hypertension, T2DM, dyslipidemia.

Table 2. Prevalence of obesity and the characteristics of obese patients.

Number (%)
Total numbers of obese90
Obese confirmed with ICD-1078
Not confirmed12
Prevalence of obesity
(78*100/20,295)0.4%
Gender
Male29 (37.2)
Female49 (62.8)
Age, years
20-304 (5.1)
31-4011 (14.1)
41-5024 (30.8)
51-6023 (29.5)
60+16 (20.5)
Mean ± SD = 51 ± 12
Min-Max = 27-72
Having other related diseases
Hypertension43 (55.1)
Diabetes mellitus23 (29.5)
Dyslipidemia11 (14.1)
Heart disease2 (2.6)
Sleep disorder2 (2.6)
Stroke1 (1.3)

It was found that all types of pesticides, including insecticides, herbicides, fungicides, rodenticides, and molluscicides, were significantly associated with obesity prevalence (Table 3). The associations were also found in many of the surveyed individual pesticides (Table 4). Those pesticides were from various types of pesticide, including herbicides butachlor, 18 insecticides (three carbamate (CM) insecticide, five organochlorine pesticides (OC) insecticide, and nine organophosphate pesticides (OP) insecticide), and six fungicides.

Table 3. Association (OR) between different types of pesticide and obesity.

Not obese (N = 20217)
N (%)
Obese (N = 78)
N (%)
OR (crude)OR (adjusted)*
Any pesticide
No1092 (99.3)8 (0.7)1.01.0
Yes19113 (99.6)70 (0.4)0.50 (0.24-1.04)0.49 (0.23-1.02)
Insecticide
No4246 (99.8)8 (0.2)1.01.0
Yes15959 (99.6)70 (0.4)2.33 (1.12-4.84)**2.27 (1.09-4.74)
Herbicide
No2292 (99.9)2 (0.1)1.01.0
Yes17913 (99.6)76 (0.4)4.86 (1.19-19.81)4.72 (1.16-19.29)
Fungicide
No12071 (99.7)31 (0.3)1.01.0
Yes8124 (99.4)47 (0.6)2.25 (1.43-3.54)2.17 (1.37-3.44)
Rodenticide
No15800 (99.7)46 (0.3)1.01.0
Yes4405 (99.3)32 (0.7)2.50 (1.59-3.92)2.52 (1.59-3.99)
Molluscicide
No15357 (99.8)38 (0.2)1.01.0
Yes4848 (99.2)40 (0.8)3.33 (2.14-5.20)3.37 (2.13-5.31)

* Adjusted variables: Gender (male, female), age (20-30, 31-40, 41-50, 51-60, 60+), smoking (never, ex-smoker, current smoker), alcohol consumption (never, used to drink, currently drink).

** Significant OR were indicated in bold numbers.

Table 4. Association (OR) between individual pesticide and obesity.

PesticideNot obese
(N = 20217)
N (%)
Obese
(N = 78)
N (%)
OR crudeOR adjusted
Herbicide
Glyphosate
No5715 (99.7)17 (0.3)1.01.0
Yes14490 (99.6)61 (0.4)1.42 (0.83-2.43)1.41 (0.82-2.42)
Paraquat
No10617 (99.7)37 (0.3)1.01.0
Yes9588 (99.6)41 (0.4)1.23 (0.79-1.92)1.20 (0.77-1.87)
D24
No10527 (99.7)35 (0.3)1.01.0
Yes9678 (99.6)43 (0.4)1.34 (0.86-2.10)1.32 (0.85-2.07)
Butachlor
No16025 (99.7)43 (0.3)1.01.0
Yes4180 (99.2)35 (0.8)3.12 (2.00-4.88)**3.05 (1.94-4.79)
Alachlor
No18660 (99.6)68 (0.4)1.01.0
Yes1545 (99.4)10 (0.6)1.78 (0.91-3.46)1.69 (0.87-3.30)
Diuron
No19798 (99.6)74 (0.4)1.01.0
Yes407 (99.0)4 (1.0)2.63 (0.96-7.23)2.48 (0.90-6.85)
Organophosphate insecticide
Abamectin
No9570 (99.7)25 (0.3)1.01.0
Yes10635 (99.5)53 (0.5)1.91 (1.19-3.07)1.87 (1.16-3.02)
Chlorpyrifos
No15459 (99.7)40 (0.3)1.01.0
Yes4746 (99.2)38 (0.8)3.09 (1.98-4.83)2.98 (1.90-4.68)
Folidol (parathion)
No17665 (99.7)62 (0.3)1.01.0
Yes2540 (99.4)16 (0.6)1.80 (1.03-3.11)1.75 (1.00-3.06)
Methamidophos
No19430 (99.6)71 (0.4)1.01.0
Yes775 (99.1)7 (0.9)2.47 (1.13-5.39)2.37 (1.08-5.19)
Monocrotophos
No19743 (99.6)72 (0.4)1.01.0
Yes462 (98.7)6 (1.3)3.56 (1.54-8.23)3.58 (1.55-8.39)
Mevinphos
No19965 (99.6)74 (0.4)1.01.0
Yes240 (98.4)4 (1.6)4.50 (1.63-12.40)4.35 (1.57-12.06)
Dicrotophos
No19747 (99.6)72 (0.4)1.01.0
Yes459 (98.7)6 (1.3)3.59 (1.55-8.51)3.51 (1.51-8.15)
Dichlorvos
No19987 (99.6)75 (0.4)1.01.0
Yes218 (98.6)3 (1.4)3.67 (1.15-11.72)3.74 (1.17-11.98)
EPN
No19620 (99.6)75 (0.4)1.01.0
Yes585 (99.5)3 (0.5)1.34 (0.42-4.27)1.32 (0.41-4.22)
Imidacloprid
No19524 (99.6)73 (0.4)1.01.0
Yes681 (99.3)5 (0.7)1.96 (0.79-4.88)1.90 (0.76-4.72)
Profenofos
No19719 (99.6)72 (0.4)1.01.0
Yes486 (98.8)6 (1.2)3.38 (1.46-7.81)3.15 (1.35-7.31)
Carbamate insecticide
Carbaryl
No18948 (99.7)64 (0.3)1.01.0
Yes1257 (98.9)14 (1.1)3.30 (1.84-5.90)3.32 (1.85-5.96)
Methomyl
No18879 (99.6)68 (0.4)1.01.0
Yes1326 (99.3)10 (0.7)2.09 (1.08-4.08)1.99 (1.02-3.91)
Carbosulfan
No17714 (99.7)56 (0.3)1.01.0
Yes2491 (99.1)22 (0.9)2.79 (1.70-4.58)2.67 (1.62-4.40)
Carbofuran
No18088 (99.6)64 (0.4)1.01.0
Yes2117 (99.3)14 (0.7)1.87 (1.05-3.34)1.75 (0.97-3.17)
Pyrethroid insecticide
Permethrin
No17769 (99.6)67 (0.4)1.01.0
Yes2436 (99.6)11 (0.4)1.20 (0.63-2.27)1.14 (0.60-2.17)
Organochlorine insecticide
Endosulfan
No17127 (99.7)53 (0.3)1.01.0
Yes3078 (99.2)25 (0.8)2.63 (1.63-4.23)2.56 (1.58-4.18)
Dieldrin
No20026 (99.6)75 (0.4)1.01.0
Yes179 (98.4)3 (1.6)8.92 (2.57-26.75)8.18 (2.52-26.59)
Aldrin
No20108 (99.6)75 (0.4)1.01.0
Yes97 (97.0)3 (3.0)8.29 (2.57-26.75)8.18 (2.52-26.59)
DDT
No19285 (99.6)69 (0.4)1.01.0
Yes920 (99.0)9 (1.0)2.73 (1.36-5.49)2.74 (1.36-5.53)
Chlordane
No19929 (99.6)70 (0.4)1.01.0
Yes276 (97.2)8 (2.8)8.25 (3.93-17.31)8.37 (3.97-17.64)
Heptachlor
No17046 (99.6)62 (0.4)1.01.0
Yes3159 (99.5)16 (0.5)1.39 (0.80-2.42)1.36 (0.79-2.37)
Fungicide
Metalaxyl
No18638 (99.7)63 (0.3)1.01.0
Yes1567 (99.1)15 (0.9)2.83 (1.61-4.99)2.68 (1.51-4.74)
Mancozeb
No18843 (99.6)70 (0.4)1.01.0
Yes1362 (99.4)8 (0.6)1.58 (0.76-3.29)1.47 (0.70-3.08)
Maneb
No19280 (99.6)71 (0.4)1.01.0
Yes92 5(99.2)7 (0.8)2.06 (0.94-4.48)2.02 (0.92-4.41)
Propineb
No19261 (99.6)68 (0.4)1.01.0
Yes944 (99.0)10 (1.0)3.00 (1.54-5.85)2.89 (1.48-5.64)
carbendazim
No17904 (99.7)57 (0.3)1.01.0
Yes2301 (99.1)21 (0.9)2.87 (1.74-4.74)2.71 (1.64-4.50)
<0.001*
Thiophanate
No19831 (99.6)73 (0.4)1.01.0
Yes374 (98.7)5 (1.3)3.63 (1.46-9.04)3.52 (1.41-8.78)
Benomyl
No19965 (99.6)74 (0.4)1.01.0
Yes240 (98.4)4 (1.6)4.50 (1.63-12.40)4.58 (1.65-12.68)
Bordeaux mixture
No20096 (99.6)76 (0.4)1.01.0
Yes109 (98.2)2 (1.8)4.85 (1.18-20.00)5.35 (1.29-22.16)

* Adjusted variables: Gender (male, female), age (20-30, 31-40, 41-50, 51-60, 60+), smoking (never, ex-smoker, current smoker), alcohol consumption (never, used to drink, currently drink).

** Significant OR were indicated in bold numbers.

Discussion

In this study, the prevalence of obesity was very low (0.4%). This might be due to the fact that the patients had underlying medical conditions, as stated in the ICD-10 records. This group of patients represent those with severe obesity or other health problems that needed medical attention. This was consistent with the data from a national survey in Thailand which found that the prevalence of obesity among adults aged 18 years and older to be 4.0% class I obesity (BMI 30.0-34.9 kg/m2), 0.8% class II obesity (BMI 35.0-39.9 kg/m2), and 0.1% class III obesity (BMI ≥40.0 kg/m2).2 In further analysis, this study also found that many of the obesity cases have other health problems (hypertension (55%), T2DM (30%)) (Table 2).

This results of this study also found that many pesticides are strongly associated with the prevalence of obesity. The risk of obesity was significantly predicted by various types of pesticides, including insecticides (OR = 2.27, 95% CI 1.09-4.74), herbicides (OR = 4.72, 95% CI 1.16-19.29), fungicides (OR = 2.17, 95% CI 1.37-3.44), rodenticides (OR = 2.52, 95% CI 1.59-3.99), and molluscicides (OR = 3.37, 95% CI 2.13-5.31) (Table 3). Among 35 surveyed individual pesticides 24 were significantly associated with obesity (OR = 1.75, 95% CI 1.00-3.06 to OR = 8.37, 95% CI 3.97-17.64), including herbicide butachlor, 17 insecticides (three CMs- carbaryl, methomyl, carbosulfan, five organochlorine insecticides- endosulfan, dieldrin, aldrin, DDT, chlordane, and nine organophosphate insecticides- abamectin, chlorpyrifos, folidol (parathion), methamidophos, monocrotophos, mevinphos, dicrotophos, dichlorvos, profenofos), and six fungicides- metalaxyl, propineb, carbendazim, thiophanate, benomyl, bordeaux mixture (Table 4). Turnbaugh et al,19 found pesticides affect the gut microbiome that controls the energy harvest, which may lead to obesity. This finding was supported by a recent study that found long-term exposure to chlorpyrifos affects gut microbiota homeostasis and induces inflammation, resulting in excess fat accumulation in the body.6 Additionally, a Korean study reported on the Methanobacteriales in the gut being associated with increased waist circumference, and bodyweight.7

Some pesticides are endocrine-disrupting chemicals (EDC). These are exogenous chemicals that interfere with the action of hormones, and/or obesogens, that inappropriately regulate lipid metabolism and adipogenesis to promote obesity.20 At present, there are 105 pesticides listed as EDC, insecticides (46%) e.g. OCs DDT, 2,4-D, aldrin, endosulfan, chlorpyrifos, herbicide (21%) e.g. alachlor, diuron, glyphosate, and fungicides (31%) e.g., benomyl, carbendazim. A study found EDCs affect weight gain by altering lipid metabolism, fat cell size and number, and hormones involved in appetite, food preference, and energy metabolism.21

Epidemiological studies on the association between pesticide exposure and obesity are rare. U.S.A National Health and Nutrition Examination Survey (NHANES) from 2005-2008, indicated that obesity of the general population was associated with environmental exposure to some pesticides, e.g. 2,4-dichlorophenol (2,4-DCP), and 2,5-dichlorophenol (2,5-DCP).8 Among non-diabetic individuals, a study found that exposure to OC pesticides, especially p,p'-DDE, increased the risk of higher BMI, triglycerides, and decreased HDL cholesterol.10 Another study using NHANES survey from 2003-2006, also found exposure to environmental pesticides increased obesity in children aged 6-19 years.22 In this study, a dose-dependency was observed between the quartile of exposure to 2,5-DCP and the prevalence of obesity. These results were supported by a follow-up study which found 2,5-DCP exposure to be significantly associated with obesity (OR = 1.09, 95% CI 1.1-1.19) among children and adolescents aged 6-18 years.9 A follow-up cohort study has found that middle-aged obese women were associated with mothers that used DDT, while pregnant with these women. (OR = 1.26, 95% CI 6-49 to OR = 1.31, 95% CI 6-62).23

Though a large sample size was used, the number of obese participants was still small. This limited the power of detection and control of confounding factors. Data on other risk factors, such as diet, exercise, or genetics were not collected. These confounding factors might have a different impact on the results. Another concern was that the obesity cases from ICD-10 records may not have been valid or represent the prevalence of the disease in the study. Currently, data on the validity of ICD-10 diagnosis coding for overweight/obesity in Thailand is not available. However, studies in Europe e.g., Sweden and Denmark, reported that the data is accurate and suitable to be used in epidemiological research.24

The strength of this study was in its large sample size, and the ability to identify several groups and individual pesticides that were associated with obesity. This finding supported the literature and the hypothesis that pesticide exposure can increase obesity risk.

Conclusion

In Nakhon Sawan and Phitsanulok province of Thailand, obesity in farmers was associated with the long-term use of several types of pesticides, including insecticides, herbicides, fungicides, rodenticides, and molluscicides. The study additionally found 24 individual pesticides that increased the risk of obesity. This finding was consistent with the literature and studies done in other countries. The information should be publicized, and pesticide use should be controlled. Further studies should be done to confirm the results, and to determine a safe limit of pesticide exposure for obesity risk.

Data availability

Underlying data

Figshare: Dataset for study on pesticide exposure and obesity, among farmers in Nakhon Sawan and Phitsanulok province, Thailand.

https://doi.org/10.6084/m9.figshare.14524983.v1.18

This project contains the following underlying data:

  • Dataset Pesticide and obesity (SAV and CSV). (All underlying data gathered in this study)

  • Data Dictionary (DOCX).

Extended data

Figshare: Dataset for study on pesticide exposure and obesity, among farmers in Nakhon Sawan and Phitsanulok province, Thailand.

https://doi.org/10.6084/m9.figshare.14524980.v1.15

This project contains the following extended data:

  • Questionnaire-pesticide and obesity-English (DOCX). (Study questionnaire in English)

  • Questionnaire-pesticide and obesity-Thai (DOCX). (Study questionnaire in Thai)

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

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Noppakun K and Juntarawijit C. Association between pesticide exposure and obesity: A cross-sectional study of 20,295 farmers in Thailand [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2021, 10:445 (https://doi.org/10.12688/f1000research.53261.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 04 Jun 2021
Views
38
Cite
Reviewer Report 15 Oct 2021
Yuki Ito, Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan 
Not Approved
VIEWS 38
The authors have investigated the relationships of pesticides used by farmers and obesity following the Thailand Ministry of Public Health definitions. They found a positive association between pesticide use and obesity. However, there are major points to be concerned as ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Ito Y. Reviewer Report For: Association between pesticide exposure and obesity: A cross-sectional study of 20,295 farmers in Thailand [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2021, 10:445 (https://doi.org/10.5256/f1000research.56626.r95935)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 02 Feb 2022
    Chudchawal Juntarawijit, Faculty of Agriculture, Natural Resources and Environment, Naresuan University, Phitsanulok, 65000, Thailand
    02 Feb 2022
    Author Response
    Comment
    The authors have investigated the relationships of pesticides used by farmers and obesity following the Thailand Ministry of Public Health definitions. They found a positive association between pesticide use ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 02 Feb 2022
    Chudchawal Juntarawijit, Faculty of Agriculture, Natural Resources and Environment, Naresuan University, Phitsanulok, 65000, Thailand
    02 Feb 2022
    Author Response
    Comment
    The authors have investigated the relationships of pesticides used by farmers and obesity following the Thailand Ministry of Public Health definitions. They found a positive association between pesticide use ... Continue reading
Views
19
Cite
Reviewer Report 01 Oct 2021
Yankai Xia, State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China 
Approved with Reservations
VIEWS 19
This study used questionnaire-based pesticide exposure data of 20,295 farmers to determine the association between pesticide use and obesity in Thailand. With the large-scale cross-sectional epidemiological data, the study determined that regional obesity in farmers could be associated with pesticide ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Xia Y. Reviewer Report For: Association between pesticide exposure and obesity: A cross-sectional study of 20,295 farmers in Thailand [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2021, 10:445 (https://doi.org/10.5256/f1000research.56626.r94404)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 02 Feb 2022
    Chudchawal Juntarawijit, Faculty of Agriculture, Natural Resources and Environment, Naresuan University, Phitsanulok, 65000, Thailand
    02 Feb 2022
    Author Response
    Comment
    This study used questionnaire-based pesticide exposure data of 20,295 farmers to determine the association between pesticide use and obesity in Thailand. With the large-scale cross-sectional epidemiological data, the study ... Continue reading
  • Author Response 02 Feb 2022
    Chudchawal Juntarawijit, Faculty of Agriculture, Natural Resources and Environment, Naresuan University, Phitsanulok, 65000, Thailand
    02 Feb 2022
    Author Response
    Table 2-2  OR after adding more variables to the model.

    Pesticide: Molluscicide
    OR (as shown in Table2)   3.36 (2.13-5.31)
    OR (after add baseline diseases)   3.30 (2.08-5.22)
    OR (add district ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 02 Feb 2022
    Chudchawal Juntarawijit, Faculty of Agriculture, Natural Resources and Environment, Naresuan University, Phitsanulok, 65000, Thailand
    02 Feb 2022
    Author Response
    Comment
    This study used questionnaire-based pesticide exposure data of 20,295 farmers to determine the association between pesticide use and obesity in Thailand. With the large-scale cross-sectional epidemiological data, the study ... Continue reading
  • Author Response 02 Feb 2022
    Chudchawal Juntarawijit, Faculty of Agriculture, Natural Resources and Environment, Naresuan University, Phitsanulok, 65000, Thailand
    02 Feb 2022
    Author Response
    Table 2-2  OR after adding more variables to the model.

    Pesticide: Molluscicide
    OR (as shown in Table2)   3.36 (2.13-5.31)
    OR (after add baseline diseases)   3.30 (2.08-5.22)
    OR (add district ... Continue reading

Comments on this article Comments (0)

Version 3
VERSION 3 PUBLISHED 04 Jun 2021
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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