Keywords
Pesticide exposure, obesity, farmer health, insecticide exposure, herbicide exposure, fungicide exposure
Pesticide exposure, obesity, farmer health, insecticide exposure, herbicide exposure, fungicide exposure
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
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.
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 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.
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
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.
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.
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
Not Obese (N = 20217) N (%) | Obese (N = 78) N (%) | P value** |
---|---|---|
Gender | 0.173 | |
Male | 9072 (99.7) | 29 (0.3) |
Female | 11145 (99.6) | 49 (0.4) |
Age, yr | 0.030* | |
20-30 | 722 (99.4) | 4 (0.6) |
31-40 | 1830 (99.4) | 11 (0.6) |
41-50 | 4238 (99.4) | 24 (0.6) |
51-60 | 6518 (99.6) | 23 (0.4) |
61+ | 6909 (99.8) | 16 (0.2) |
Mean ± SD = 55 ± 12 | ||
Min-Max = 20-98 | ||
Cigarette smoke | 0.040* | |
Non- smoke | 17043 (99.6) | 64 (0.4) |
Ex-smoker | 918 (99.1) | 8 (0.9) |
Smoker | 2256 (99.7) | 6 (0.3) |
Alcohol consumption | 0.557 | |
Non-drinker | 15553 (99.6) | 57 (0.4) |
Ex-drinker | 1461 (99.5) | 8 (0.5) |
Regular drinker | 3203 (99.6) | 13 (0.4) |
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.
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.
Not obese (N = 20217) N (%) | Obese (N = 78) N (%) | OR (crude) | OR (adjusted)* | |
---|---|---|---|---|
Any pesticide | ||||
No | 1092 (99.3) | 8 (0.7) | 1.0 | 1.0 |
Yes | 19113 (99.6) | 70 (0.4) | 0.50 (0.24-1.04) | 0.49 (0.23-1.02) |
Insecticide | ||||
No | 4246 (99.8) | 8 (0.2) | 1.0 | 1.0 |
Yes | 15959 (99.6) | 70 (0.4) | 2.33 (1.12-4.84)** | 2.27 (1.09-4.74) |
Herbicide | ||||
No | 2292 (99.9) | 2 (0.1) | 1.0 | 1.0 |
Yes | 17913 (99.6) | 76 (0.4) | 4.86 (1.19-19.81) | 4.72 (1.16-19.29) |
Fungicide | ||||
No | 12071 (99.7) | 31 (0.3) | 1.0 | 1.0 |
Yes | 8124 (99.4) | 47 (0.6) | 2.25 (1.43-3.54) | 2.17 (1.37-3.44) |
Rodenticide | ||||
No | 15800 (99.7) | 46 (0.3) | 1.0 | 1.0 |
Yes | 4405 (99.3) | 32 (0.7) | 2.50 (1.59-3.92) | 2.52 (1.59-3.99) |
Molluscicide | ||||
No | 15357 (99.8) | 38 (0.2) | 1.0 | 1.0 |
Yes | 4848 (99.2) | 40 (0.8) | 3.33 (2.14-5.20) | 3.37 (2.13-5.31) |
Pesticide | Not obese (N = 20217) N (%) | Obese (N = 78) N (%) | OR crude | OR adjusted |
---|---|---|---|---|
Herbicide | ||||
Glyphosate | ||||
No | 5715 (99.7) | 17 (0.3) | 1.0 | 1.0 |
Yes | 14490 (99.6) | 61 (0.4) | 1.42 (0.83-2.43) | 1.41 (0.82-2.42) |
Paraquat | ||||
No | 10617 (99.7) | 37 (0.3) | 1.0 | 1.0 |
Yes | 9588 (99.6) | 41 (0.4) | 1.23 (0.79-1.92) | 1.20 (0.77-1.87) |
D24 | ||||
No | 10527 (99.7) | 35 (0.3) | 1.0 | 1.0 |
Yes | 9678 (99.6) | 43 (0.4) | 1.34 (0.86-2.10) | 1.32 (0.85-2.07) |
Butachlor | ||||
No | 16025 (99.7) | 43 (0.3) | 1.0 | 1.0 |
Yes | 4180 (99.2) | 35 (0.8) | 3.12 (2.00-4.88)** | 3.05 (1.94-4.79) |
Alachlor | ||||
No | 18660 (99.6) | 68 (0.4) | 1.0 | 1.0 |
Yes | 1545 (99.4) | 10 (0.6) | 1.78 (0.91-3.46) | 1.69 (0.87-3.30) |
Diuron | ||||
No | 19798 (99.6) | 74 (0.4) | 1.0 | 1.0 |
Yes | 407 (99.0) | 4 (1.0) | 2.63 (0.96-7.23) | 2.48 (0.90-6.85) |
Organophosphate insecticide | ||||
Abamectin | ||||
No | 9570 (99.7) | 25 (0.3) | 1.0 | 1.0 |
Yes | 10635 (99.5) | 53 (0.5) | 1.91 (1.19-3.07) | 1.87 (1.16-3.02) |
Chlorpyrifos | ||||
No | 15459 (99.7) | 40 (0.3) | 1.0 | 1.0 |
Yes | 4746 (99.2) | 38 (0.8) | 3.09 (1.98-4.83) | 2.98 (1.90-4.68) |
Folidol (parathion) | ||||
No | 17665 (99.7) | 62 (0.3) | 1.0 | 1.0 |
Yes | 2540 (99.4) | 16 (0.6) | 1.80 (1.03-3.11) | 1.75 (1.00-3.06) |
Methamidophos | ||||
No | 19430 (99.6) | 71 (0.4) | 1.0 | 1.0 |
Yes | 775 (99.1) | 7 (0.9) | 2.47 (1.13-5.39) | 2.37 (1.08-5.19) |
Monocrotophos | ||||
No | 19743 (99.6) | 72 (0.4) | 1.0 | 1.0 |
Yes | 462 (98.7) | 6 (1.3) | 3.56 (1.54-8.23) | 3.58 (1.55-8.39) |
Mevinphos | ||||
No | 19965 (99.6) | 74 (0.4) | 1.0 | 1.0 |
Yes | 240 (98.4) | 4 (1.6) | 4.50 (1.63-12.40) | 4.35 (1.57-12.06) |
Dicrotophos | ||||
No | 19747 (99.6) | 72 (0.4) | 1.0 | 1.0 |
Yes | 459 (98.7) | 6 (1.3) | 3.59 (1.55-8.51) | 3.51 (1.51-8.15) |
Dichlorvos | ||||
No | 19987 (99.6) | 75 (0.4) | 1.0 | 1.0 |
Yes | 218 (98.6) | 3 (1.4) | 3.67 (1.15-11.72) | 3.74 (1.17-11.98) |
EPN | ||||
No | 19620 (99.6) | 75 (0.4) | 1.0 | 1.0 |
Yes | 585 (99.5) | 3 (0.5) | 1.34 (0.42-4.27) | 1.32 (0.41-4.22) |
Imidacloprid | ||||
No | 19524 (99.6) | 73 (0.4) | 1.0 | 1.0 |
Yes | 681 (99.3) | 5 (0.7) | 1.96 (0.79-4.88) | 1.90 (0.76-4.72) |
Profenofos | ||||
No | 19719 (99.6) | 72 (0.4) | 1.0 | 1.0 |
Yes | 486 (98.8) | 6 (1.2) | 3.38 (1.46-7.81) | 3.15 (1.35-7.31) |
Carbamate insecticide | ||||
Carbaryl | ||||
No | 18948 (99.7) | 64 (0.3) | 1.0 | 1.0 |
Yes | 1257 (98.9) | 14 (1.1) | 3.30 (1.84-5.90) | 3.32 (1.85-5.96) |
Methomyl | ||||
No | 18879 (99.6) | 68 (0.4) | 1.0 | 1.0 |
Yes | 1326 (99.3) | 10 (0.7) | 2.09 (1.08-4.08) | 1.99 (1.02-3.91) |
Carbosulfan | ||||
No | 17714 (99.7) | 56 (0.3) | 1.0 | 1.0 |
Yes | 2491 (99.1) | 22 (0.9) | 2.79 (1.70-4.58) | 2.67 (1.62-4.40) |
Carbofuran | ||||
No | 18088 (99.6) | 64 (0.4) | 1.0 | 1.0 |
Yes | 2117 (99.3) | 14 (0.7) | 1.87 (1.05-3.34) | 1.75 (0.97-3.17) |
Pyrethroid insecticide | ||||
Permethrin | ||||
No | 17769 (99.6) | 67 (0.4) | 1.0 | 1.0 |
Yes | 2436 (99.6) | 11 (0.4) | 1.20 (0.63-2.27) | 1.14 (0.60-2.17) |
Organochlorine insecticide | ||||
Endosulfan | ||||
No | 17127 (99.7) | 53 (0.3) | 1.0 | 1.0 |
Yes | 3078 (99.2) | 25 (0.8) | 2.63 (1.63-4.23) | 2.56 (1.58-4.18) |
Dieldrin | ||||
No | 20026 (99.6) | 75 (0.4) | 1.0 | 1.0 |
Yes | 179 (98.4) | 3 (1.6) | 8.92 (2.57-26.75) | 8.18 (2.52-26.59) |
Aldrin | ||||
No | 20108 (99.6) | 75 (0.4) | 1.0 | 1.0 |
Yes | 97 (97.0) | 3 (3.0) | 8.29 (2.57-26.75) | 8.18 (2.52-26.59) |
DDT | ||||
No | 19285 (99.6) | 69 (0.4) | 1.0 | 1.0 |
Yes | 920 (99.0) | 9 (1.0) | 2.73 (1.36-5.49) | 2.74 (1.36-5.53) |
Chlordane | ||||
No | 19929 (99.6) | 70 (0.4) | 1.0 | 1.0 |
Yes | 276 (97.2) | 8 (2.8) | 8.25 (3.93-17.31) | 8.37 (3.97-17.64) |
Heptachlor | ||||
No | 17046 (99.6) | 62 (0.4) | 1.0 | 1.0 |
Yes | 3159 (99.5) | 16 (0.5) | 1.39 (0.80-2.42) | 1.36 (0.79-2.37) |
Fungicide | ||||
Metalaxyl | ||||
No | 18638 (99.7) | 63 (0.3) | 1.0 | 1.0 |
Yes | 1567 (99.1) | 15 (0.9) | 2.83 (1.61-4.99) | 2.68 (1.51-4.74) |
Mancozeb | ||||
No | 18843 (99.6) | 70 (0.4) | 1.0 | 1.0 |
Yes | 1362 (99.4) | 8 (0.6) | 1.58 (0.76-3.29) | 1.47 (0.70-3.08) |
Maneb | ||||
No | 19280 (99.6) | 71 (0.4) | 1.0 | 1.0 |
Yes | 92 5(99.2) | 7 (0.8) | 2.06 (0.94-4.48) | 2.02 (0.92-4.41) |
Propineb | ||||
No | 19261 (99.6) | 68 (0.4) | 1.0 | 1.0 |
Yes | 944 (99.0) | 10 (1.0) | 3.00 (1.54-5.85) | 2.89 (1.48-5.64) |
carbendazim | ||||
No | 17904 (99.7) | 57 (0.3) | 1.0 | 1.0 |
Yes | 2301 (99.1) | 21 (0.9) | 2.87 (1.74-4.74) | 2.71 (1.64-4.50) |
<0.001* | ||||
Thiophanate | ||||
No | 19831 (99.6) | 73 (0.4) | 1.0 | 1.0 |
Yes | 374 (98.7) | 5 (1.3) | 3.63 (1.46-9.04) | 3.52 (1.41-8.78) |
Benomyl | ||||
No | 19965 (99.6) | 74 (0.4) | 1.0 | 1.0 |
Yes | 240 (98.4) | 4 (1.6) | 4.50 (1.63-12.40) | 4.58 (1.65-12.68) |
Bordeaux mixture | ||||
No | 20096 (99.6) | 76 (0.4) | 1.0 | 1.0 |
Yes | 109 (98.2) | 2 (1.8) | 4.85 (1.18-20.00) | 5.35 (1.29-22.16) |
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.
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.
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:
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).
The author is grateful to all the study participants who took the time to participate in this study and provided valuable information. Thank you very much to local hospital staff from Nakhon Sawan, and Phitsanulok province, and the village health volunteers for collecting data. Thank you also to Mr. Kevin Mark Roebl of Naresuan University’s Writing Clinic (DIALD) for editing assistance.
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Is the work clearly and accurately presented and does it cite the current literature?
Partly
Is the study design appropriate and is the work technically sound?
No
Are sufficient details of methods and analysis provided to allow replication by others?
Partly
If applicable, is the statistical analysis and its interpretation appropriate?
Partly
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
Partly
References
1. Engin A: The Definition and Prevalence of Obesity and Metabolic Syndrome.Adv Exp Med Biol. 2017; 960: 1-17 PubMed Abstract | Publisher Full TextCompeting Interests: No competing interests were disclosed.
Reviewer Expertise: Exposure assessment of pesticides and their association with health effects.
Is the work clearly and accurately presented and does it cite the current literature?
Partly
Is the study design appropriate and is the work technically sound?
Partly
Are sufficient details of methods and analysis provided to allow replication by others?
Yes
If applicable, is the statistical analysis and its interpretation appropriate?
Yes
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
Yes
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Exposure to pesticides and health effects
Alongside their report, reviewers assign a status to the article:
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Version 3 (revision) 17 May 22 |
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Version 2 (revision) 02 Feb 22 |
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Version 1 04 Jun 21 |
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Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list:
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