甲基汞對神經系統之危害已於人類流行病學研究中陸續被證實，其主要影響包括:辨色力異常、運動失調、認知功能異常、步態不穩、不自主震顫等症狀，同時亦會對人體肝腎功能及內分泌系統造成危害。至於戴奧辛，國內外研究亦發現會對神經系統、肝腎功能及內分泌系統造成危害，且一般人主要之甲基汞及戴奧辛暴露來源皆以魚類及海鮮類的食用為主，因此若不愼食用污染地區魚類及海鮮時，是否因交互作用而產生嚴重之健康危害為科學家及社會大眾普遍存在的疑慮。中石化安順廠（前身為台灣鹼業公司安順廠）位於顯宮、鹿耳兩里的交界處，距鹿耳門溪南側約一公里，於民國31年設立鹼氯工廠，以汞極法電解食鹽水製造氫氧化鈉及氯氣，而後於民國58年正式量產五氯酚鈉（戴奧辛為副產品），其廢水、廢棄物之排放因而造成廠區及周邊環境之戴奧辛及汞污染。該廠於民國68年停止運作、71年關廠，台南市政府於民國93年將其公告為污染管制廠址。該廠關廠後約5000公斤五氯酚鈉遺留在該廠，在未妥善管理下直接排放進入海水儲水池內，依據過去研究顯示該海水儲水池無論是底泥或捕獲的魚體之總汞、甲基汞及戴奧辛濃度皆高，顯示海水儲水池以及棲息於該池中之魚類已經受到戴奧辛及汞的污染，而附近溪流，如鹿耳門溪、竹筏港溪之底泥及水生物亦檢出高濃度之戴奧辛及總汞。暴露評估研究亦指出當地有部分居民曾經捕撈海水儲存池及鹿耳門溪之水生物如魚、蝦及蟹類食用，亦或將所捕撈的魚類及海鮮類販售至當地市集，表示當地居民可能經由食用上述污染源捕撈之水生物，導致甲基汞及戴奧辛之高暴露風險。因此本研究針對此戴奧辛與甲基汞污染區附近居民，同時暴露兩污染物之神經及慢性健康影響進行調查及解析。
本研究共完成2359位居民血液採樣，經血液甲基汞高低濃度（19.2 μg/L）分組後，在認知能力篩選工具(CASI問卷)各項目分數表現上如長期記憶、短期記憶及心智操作力之分數在高濃度組顯著低於低濃度組(p< 0.05)。而長期記憶、心智操作力及定向感異常率在高濃度組顯著高於低濃度組(p< 0.05)。這些發現顯示血液甲基汞濃度與居民之長期記憶、心智操作力及定向感的損傷風險具顯著相關性。在手指鍵入速度部份，女性高濃度組無論是在慣用手或是非慣用手皆有顯著變慢的情形。至於血液總汞與神經傳導速度各項檢查結果皆未發現相關性。至於血液戴奧辛則與左側運動-腓神經之神經傳導速度有顯著負相關(β= -0.86, p=0.037)。
本研究發現胰島素抗性指標(HOMA-IR)隨者血液戴奧辛濃度上升而逐漸增加，且有統計上顯著意義(原始模式: β= 0.39, p< 0.001; 校正後模式: β= 0.31; p< 0.001，校正因子:年齡、性別、BMI、抽菸運動、體重控制、糖尿病家族史)，此一結果支持戴奧辛長期暴露可能與胰島素抗性風險的增加有關的假說；亦呼應戴奧辛長期暴露可能與第二型糖尿病的罹患風險增加具顯著相關性之流行病學研究結果。本研究亦發現居民在胰島素抗性與血液戴奧辛濃度呈現單調地(monotonic)上升關係，且當居民血液濃度超過20.5 pg WHO98-TEQDF/g lipid時，觀察到胰島素抗性的風險有顯著上升的現象(百分之50分位至75分位組：校正後OR = 2.7，95% CI = 1.0– 7.8；百分之75分位至90分位組：校正後OR = 3.5，95% CI = 1.1– 11.8；>百分之90分位組:校正後OR = 5.0，95% CI = 1.5– 18.3)。此外，亦觀察到血液戴奧辛中位數濃度隨者代謝症候群危險因子增加而增加的趨勢(Ptrend< 0.05)，這些發現也說明了血液戴奧辛和代謝症候群具相關性。本研究使用因素分析定義出四個代謝症候群因子包括血脂異常、血壓、體型和血糖異常，結果顯示血液戴奧辛與血壓被分類至同一因子，因此戴奧辛和代謝症候群的相關性可能是透過影響高血壓造成的，然而仍需更多後續研究加以證實。而在非糖尿病居民身上若同時具有高血液戴奧辛濃度及具胰島素抗性者，會較單一血液戴奧辛較高者，或單一具胰島素抗性的風險者，有更高的代謝症候群風險，這些資料亦顯示血液戴奧辛或具胰島素抗性可能皆會影響代謝症候群且有交互作用(交互作用項的OR = 1.80, 95% CI = 1.32– 2.48)。同樣地，在非糖尿病居民身上若同時具有高血液戴奧辛及總汞濃度者會較單一血液戴奧辛較高或總汞較高者，具更高的胰島素抗性風險，這些資料亦顯示血液戴奧辛或總汞皆可能會影響胰島素抗性，因此，本研究亦觀察到同時暴露到高濃度血液戴奧辛及總汞者呈現交互作用(交互作用項的OR = 2.1, 95% CI = 1.1– 4.1 )。本研究發現在非糖尿病居民之十年一般心血管疾病發生率危險指數及風險亦有隨者戴奧辛及總汞濃度上升而逐漸上升的趨勢(兩者Ptrend< 0.05)。且經校正干擾因子，如性別、體脂肪百分比、運動、體重控制、糖尿病、高血壓、中風等疾病之家族史後，血液戴奧辛濃度亦與十年一般心血管疾病發生率危險指數及風險兩者皆有統計上顯著正相關(p< 0.001)，然總汞與此危險指數及風險則未發現相關性。
本研究已經引起社會大眾對當地環境污染的重視，尤其是戴奧辛與甲基汞易經由附近污染水體中魚及海鮮類，進而經食物鏈的累積而對人體造成健康危害，然目前針對戴奧辛所訂定的每日容許攝取量與總汞建議上限皆未考慮此協同作用，值得相關單位重視。而此篇研究的結果亦提供社會大眾所關切的議題一個重要的結果，即使戴奧辛與總汞兩污染物造成胰島素抗性的病理生理機制仍值得進一步探討，而後續更值得我們所關心及深入了解的是戴奧辛與總汞兩污染物對胰島素抗性所產生的協同作用是否會提高當地居民糖尿病、心血管疾病及其他慢性疾病的罹患率。

The neurotoxic effects caused by methylmercury （MeHg） have been well documented in several epidemiologic studies. The most frequent clinical signs and symptoms were color discrimination, incoordination, impaired cognitive performance, cerebellar ataxia and tremor. However, it will also cause adverse health effects, which targets on the liver, kidney function and endocrine system. Besides, several epidemiologic and animal studies have also suggested that polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) would pose the simliar health effects as the methylmercury. Fish consumption was the main and crucial exposure pathway for general population to dioxins and methylmercury. If people consume the polluted fishes and seafood by accident, it might cause higher health risk, which was also the keystone of this study. An-Shun chlor-alkali plant had operated for forty years and manufactured sodium hydroxide, chlorine gas and pentachlophenol (PCP). During the manufactural processes, lots of sludge contained mercury was released into the nearby environment around the factory. The measured data provided evidence that the PCP and untreated wastewater from the factory might had spread via the wastewater and soil into the sea reservoir. Local residents used to catch aquatics such as fish, shrimp and crabs from the reservoir for consumption or vendor. Fish and aquatic organisms consumption from the sea reservoir was the main and crucial pathway for their exposure to dioxins and methylmercury. And the measured data also revealed that the residents had high health effects risk of dioxins and mercury. This study provided a good opportunity to examine the hypothesis that residents co-exposed dioxins and methylmercury might be associated with an increased risk of neurologic and endocrine toxic effects, and even a potential interaction. In Cognitive Abilities Screening Instrument (CASI C-2.0), higher abnormality rates for remote memory (p= 0.036), mental manipulation (p= 0.013), and orientation (p= 0.005) were found in the High-MeHg group than in the Low-MeHg group. The left peroneal motor nerve conduction velocity (NCV) was significantly decreased with serum dioxins (β= -0.86, p= 0.037). We found a slight monotonic increase in the risk for insulin resistance across the serum PCDD/F categories (P for the trend: < 0.001). Groups with serum dioxins higher than 20.5 pg WHO98-TEQDF/g lipid had a higher risk of insulin resistance (adjusted odds ratios of 2.7, 3.5 and 5.0 for 50th to < 75th, 75th to < 90th and  90th percentile, respectively) compared with the reference group (< 9.6 pg WHO98-TEQDF/g lipid [< 10th percentile]). Serum dioxins were significantly increased with the number of MetS components (serum PCDD/F levels: 16.9, 20.7, 26.7, 29.5, 28.2, and 24.0 pg WHO98-TEQDF/g lipid, respectively). In factor analysis, four risk factors—lipidemia, blood pressure, body size, and glycemia—accounted for 72.8% of the variance in the 10 core factors in participants and revealed that dioxins were linked to MetS through shared correlations with high blood pressure. After adjusting for confounding factors, participants with higher serum dioxin levels or insulin resistance were at significant risk for having MetS (adjusted odds ratio [AOR] 1.40 [95% CI 1.03-1.90] for dioxins; AOR 6.69 [95% CI 5.03-8.99] for insulin resistance). Participants exposed to higher levels of dioxins and possessed insulin resistance had a much greater risk (AOR 1.80 [95% CI 1.32- 2.48]) of having MetS. High-dose exposure to dioxins is suggested to be a blood pressure-related factor which raised MetS risk by modifying the effect of insulin resistance on metabolic syndrome. After adjusting for confounding factors, residents with higher serum dioxin levels or blood mercury levels (reference: < 25th percentile; higher: > 75th percentile) were at a significant risk for insulin resistance (adjusted odds ratio [AOR] 4.0 [95% CI 2.3-7.3] for dioxins; AOR 2.3 [95% CI 1.5-3.5] for mercury) and HOMA β-cell dysfunction (AOR 2.3 [95% CI 1.3-3.9] only for dioxins). We found a striking multiplicative interaction between dioxins and mercury, even in non-diabetic residents(AOR 2.1 [95% CI 1.1- 4.1]). Accumulated dioxins and mercury may synergistically increase the risk of developing insulin resistance. The Framingham General Cardiovascular Disease score and risk were both significantly increased with serum dioxins (p< 0.001), which shows dioxin might also cause cardiovascular toxic effects.
In our large-scale study with a great deal of variation in PCDD/F and mercury co-exposure, we found that participants—even those without diabetes—co-exposed to higher levels of PCDD/Fs and mercury had a much greater risk of having insulin resistance, which persisted even after we had adjusted for the effect of the other explanatory variables. Our results have important ramifications for public concern, whatever pathophysiologic mechanism underlies the interaction between serum PCDD/Fs and mercury and its association with insulin resistance.
Whether the synergistically increasing risk of insulin resistance leads to a higher prevalence of diabetes deserves more attention and follow-up. In humans, PCDD/Fs and mercury are easily accumulated by eating fish and other seafood. It should concern us that the current Tolerable Daily Intake (TDI) for PCDD/Fs and recommended limits for methylmercury may underestimate the synergistic risk.
In conclusion, we found a significant association between serum PCDD/Fs, blood mercury, and insulin resistance after adjusting for confounding factors: interaction between dioxins, mercury, and insulin resistance exists even in persons without diabetes. Accumulated dioxins and mercury may synergistically increase the risk of developing insulin resistance. Further study is needed to confirm these findings in other persons co-exposed to high levels of PCDD/Fs and mercury. Information about the long-term health implications of insulin resistance should be promptly delivered to those with a history of co-exposure to PCDD/Fs and mercury because of the extra risk of type 2 diabetes, cardiovascular disease, and chronic disease they may incur.

Abbasi AH, Jalili MA. 1961. Poisoning by ethyl mercury toluene sulphonanilide Brit J industr Med 18: 303-308.
Akagi H, Mortimer DC, Miller DR. 1979. Mercury methylation and partition in aquatic systems. Bull Environ Contam Toxicol 23: 372-376.
Akagi H, Malm O, Branches FJP, Kinjo Y, Kashima Y, Guimaraes JRD, et al. 1995. Human exposure to mercury due to goldmining in the Tapajos River Basin, Amazon, Brazil: speciation of mercury in human hair, blood and urine. Water Air Soil Pollut 80:85-94.
Al-Saleem T, and the Clinical Committee on Mercury Poisoning. 1976. Levels of mercury and pathologic changes in patients with organomercury poisoning. Bulletin of the World Health Organization 53: 99-104.
Alatas F, Özdenmnir N, Alatas Ö, Erginel S, Mentintas M, Isik R. 1999. The Effects of Smoking on Glutathione Levels inBronchoalveolar Lavage Fluid. Tr. J. of Medical Sciences 29:643-647.
Alberg A. 2002. The influence of cigarette smoking on circulating concentrations of antioxidant micronutrients. Toxicology 180:121.
Alderfer R, Sweeney M, Fingerhut M, Hornung R, Wille K, Fidler A. 1992. Measures of depressed mood in workers exposed to 2,3,7,8-
tetrachlorodibenzo-p-dioxin. Chemosphere 25: 247-250.
Alonso-Magdalena P, Morimoto S, Ripoll C, Fuentes E, Nadal A. 2006. The estrogenic effect of bisphenol A disrupts pancreatic beta-cell function in vivo and induces insulin resistance. Environ Health Perspect 114: 106-112.
Alsharif NZ, Hassoun EA. 2004. Protective effects of vitamin A and vitamin E succinate against 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-induced body wasting, hepatomegaly, thymic atrophy, production of reactive oxygen species and DNA damage in C57BL/6J mice. Basic & Clinical Pharmacology & Toxicology 95:131-138.
Andreasen EA, Mathew LK, Tanguay RL. 2006. Regenerative growth is impacted by TCDD: Gene expression analysis reveals extracellular matrix modulation. Toxicological Sciences 92:254-269.
Andreyev AY, Kushnareva YE, Starkov AA. 2005. Mitochondrial metabolism of reactive oxygen species. Biochemistry. Biokhimiia 70:200-214.
Annas A, Brittebo EB. 1998. Localization of cytochrome P4501A1 and covalent binding of a mutagenic heterocyclic amine in blood vessel endothelia of rodents. Toxicology 129:145-156.
Arzuaga X, Reiterer G, Majkova Z, Kilgore MW, Toborek M, Hennig B. 2007. PPARalpha ligands reduce PCB-induced endothelial activation: possible interactions in inflammation and atherosclerosis. Cardiovasc Toxicol 7:264-272.
Ashe WF, Suskind RR. 1950. Reports on chloracne cases, Monsanto Chemical Co., Nitro, West Virginia, October 1949 and April 1950. Cincinnati, OH, Department of Environmental Health, College of Medicine, University of Cincinnati (unpublished).
Assennato G, Cervino D, Emmet E, Longo G, Mer loF. 1989. Followup on subjects who developed chloracne following TCDD exposure of Seveso. American Journal of Industrial Medicine 16:119-125.
Baader EW, Bauer HJ. 1951. Industrial intoxication due to pentachlorophenol. Industrial Medicine and Surgery 20: 286-290.
Bagchi D, Balmoori J, Bagchi M, Ye X, Williams CB, Stohs SJ. 2002. Comparative effects of TCDD, endrin, naphthalene and chromium (VI) on oxidative stress and tissue damage in the liver and brain tissues of mice. Toxicology 175:73-82.
Bakir F, Damluji SF, Amin-Zaki L, Murtadha M, Khalidi A, Al-Rawi NY, Tikriti S, et al. 1973. Methylmercury poisoning in Iraq, Science 181:230-241.
Barrios M, Guardia J. 2001. Relation of the cerebellum with cognitive function: Neuroanatomical, clinical and neuroimaging evidence. Rev Neurol 33: 582-591.
Balkau B, Charles MA. 1999. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 16:442-443.
Barbieri S, Pirovano C, Scarlato G, Tarchini P, Zappa A, Maranzana M. 1988. Long-term effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin on the peripheral nervous system. Clinical and neurophysiological controlled study on subjects with chloracne form the Seveso area. Neuroepidemiology 7:29-37.
Bauer H, Schulz K, Spiegelburg W. 1961. Industrial poisoning in the manufacture of chlorophenol compounds. Arch Gewerbepath Gewerbehyg 18:538-555.
Bemis JC, Seegal RF. 2000. Polychlorinated biphenyls and methylmercury alter intracellular calcium concentrations in rat cerebellar granule cells. Neurotoxicology 21:1123-1134.
Bemis JC, Seegal RF. 1999. Polychlorinated biphenyls and methylmercury act synergistically to reduce rat brain dopamine content in vitro. Environ Health Perspect 107:879-885.
Bertazzi PA. 1991. Long-term effects of chemical disasters. Lessons and results from Seveso. Sci Total Environ 106:5-20.
Bertazzi PA, Bernucci I, Brambilla G, Consonni D, Pesatori AC. 1998. The Seveso studies on early and long-term effects of dioxin exposure: a review. Environ Health Perspect 106 Suppl 2:625-633.
Biswas G, Srinivasan S, Anandatheerthavarada HK, Avadhani NG. 2008. Dioxin-mediated tumor progression through activation of mitochondria-to-nucleus stress signaling. Proc Natl Acad Sci USA 105:186-191.
Boden G. 1996. Fatty acids and insulin resistance. Diabetes Care 19:394-395.
Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB, Monauni T, Muggeo M. 2000. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 23:57-63.
Boersma ER, Lanting CI. 2000. Environmental exposure to polychlorinated biphenyls (PCBs) and dioxins. Consequences for longterm neurological and cognitive development of the child lactation. Adv Exp Med Biol 478:271.
Branches FJ, Erickson TB, Aks SE, Hryhorczuk DO. 1993. The price of gold: mercury exposure in the Amazon rainforest. Clin Toxicol 31:295-306.
Brouwer A, Morse DC, Lans MC, Schuur AG, Murk AJ, Klasson-Wehler E, et al. 1998. Interactions of persistent environmental organohalogens with the thyroid hormone system: mechanisms and possible consequences for animal and human health. Toxicol Ind Health 14:59-84.
Brunnberg S, Andersson P, Lindstam M, Paulson I, Poellinger L, Hanberg A. 2006. The constitutively active Ah receptor (CA-Ahr) mouse as a potential model for dioxin exposure effects in vital organs. Toxicology 224:191-201.
Calvert GM, Sweeney MH, Deddens J, Wall DK. 1999. Evaluation of diabetes mellitus, serum glucose, and thyroid function among United States workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Occup Environ Med 56:270-276.
Calvert GM, Wille KK, Sweeney MH, Fingerhut MA, Halperin WE. 1996. Evaluation of serum lipid concentrations among U.S. workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Arch Environ Health 51:100-107.
Canga L, Rifkind R. Heart as a target organ in 2,3,7,8-tetra-chlorodibenzo-p-dioxin toxicity: decreased beta-adrenergic responsiveness and evidence of increased intracellular calcium. 1988. Proc Natl Acad Sci USA 85:905-909.
Carney SA, Chen J, Burns CG, Xiong KM, Peterson RE, Heideman W. 2006. Aryl hydrocarbon receptor activation produces heart-specific transcriptional and toxic responses in developing zebrafish. Molecular Pharmacology 70:549-561.
Carta P, Flore C, Alinovi R, Ibba A, Tocco MG, Aru G, et al. 2003. Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through fish consumption. Neurotoxicology 24:617-623.
Carroll S, Cooke CB, Butterly RJ. 2000. Metabolic clustering, physical activity and fitness in nonsmoking, middle-aged men. Med Sci Sports Exerc 32:2079-86.
Centers For Disease Control Vietnam Experience Study. 1988b. Health status of Vietnam veterans. I. Psychosocial characteristics. Journal of the American Medical Association 259:2701-2707.
Chafetz MD, Friedman AL, Kevorkian CG, Levy JK. 1996. The cerebellum and cognitive function: implications for rehabilitation. Arch Phys Med Rehabil 77:1303-1308.
Chang K, Hsieh K, Lee T, Tang S, Tung T. 1981. Immunologic evaluation of patients with polych;orinated biphenyl poisoning determination of lymphocyte subpopulations. Toxicol Appl Pharmacol 61:58-63.
Chang AM, Smith MJ, Bloem CJ, Galecki AT, Halter JB, Supiano MA. 2006. Limitation of the homeostasis model assessment to predict insulin resistance and beta-cell dysfunction in older people. J Clin Endocrinol Metab 91:629-634.
Chang JW, Pai MC, Chen HL, Guo HR, Su HJ, Lee CC. 2008. Cognitive function and blood methylmercury in adults living near a deserted chloralkali factory. Environ Res 108: 334-339.
Chang JW, Chen HL, Su HJ, PC Liao, Guo HR, Lee CC. 2009. Association between insulin resistance and exposure to dioxins in Taiwanese living near a highly contaminated area. Epidemiology. (already accepted)
Cheal KL, Abbasi F, Lamendola C, McLaughlin T, Reaven GM, Ford ES. 2004. Relationship to insulin resistance of the adult treatment panel III diagnostic criteria for identification of the metabolic syndrome. Diabetes 53:1195-1200.
Chen HL, Liao PC, Su HJ, Guo YL, Chen CH, Lee CC. 2005. Profile of PCDD/F levels in serum of general Taiwanese between different gender, age and smoking status. The Science of the Total Environment 337:31-43.
Chen HL, Su HJ, Lee CC. 2006. Patterns of serum PCDD/Fs affected by vegetarian regime and consumption of local food for residents living near municipal waste incinerators from Taiwan. Environ Int 32:650-655.
Chen HL, Hsu CY, Hung DZ, Hu ML. 2006. Lipid peroxidation and antioxidant status in workers exposed to PCDD/Fs of metal recovery plants. The Science of the Total Environment 372:12-19.
Chen YW, Huang CF, Tsai KS, Yang RS, Yen CC, Yang CY, Lin-Shiau SY, Liu SH. 2006. Methylmercury induces pancreatic beta-cell apoptosis and dysfunction. Chem Res Toxicol 19:1080-1085.
Chen YW, Huang CF, Tsai KS, Yang RS, Yen CC, Yang CY, Lin-Shiau SY, Liu SH. 2006. The role of phosphoinositide 3-kinase/Akt signaling in low-dose mercury-induced mouse pancreatic beta-cell dysfunction in vitro and in vivo. Diabetes 55:1614-1624.
Chuang SY, Chen CH, Tsai ST, Chou P. 2002. Clinical Identification of the Metabolic Syndrome in Kinmen, Taiwan. Acta Cardiol Sin 18:16-23.
Cinca I, Dumitrescu I, Onaca P, Serbanescu A, Nestorescu B. 1979. Accidental ethyl mercury poisoning with nervous system, skeletal muscle, and myocardium injury. Journal of Neurology, Neurosurgery and Psychiatry 43: 143-149.
Clarke WR, Schrott HG, Burns TL, Sing CF, Lauer RM. 1986. Aggregation of blood pressure in the families of children with labile high systolic blood pressure. The Muscatine Study. Am J Epidemiol 123:67-80.
Clarkson TW, Magos L, Myers GJ. 2003. Current Concepts: The Toxicology of Mercury-Current Exposures and Clinical Manifestations. New England Journal of Medicine 349:1731-1737.
Costa A, Rios M, Casamitjana R, Gomis R, Conget I. 1998. High prevalence of abnormal glucose tolerance and metabolic disturbances in first degree relatives of NIDDM patients. A study in Catalonia, a Mediterranean community. Diabetes Res Clin Pract 41:191-196.
Committee on Environmental Health, AAP. PCBs in breast milk. 1994. Pediatrics 94:122-123.
Covaci A, Koppen G, Van Cleuvenbergen R, Schepens P, Winneke G, van Larebeke N, et al. 2002. Persistent organochlorine pollutants in human serum of 50–65 years old women in the Flanders Environmental and Health Study (FLEHS). Part 1: concentrations and regional differences. Chemosphere 48:811-825.
Cranmer M, Louie S, Kennedy RH, Kern PA, Fonseca VA. 2000. Exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is associated with hyperinsulinemia and insulin resistance. Toxicol Sci 56:431-436.
Creso E, De Marino V, Donatelli L, Pagnini G.. 1978. Neuropsychopharmacological effects of TCDD. Boll Soc Ital Biol Sper 54:1592-1596.
Crusio WE, Schwegler H. 2005. Learning spatial orientation tasks in the radial-maze and structural variation in the hippocampus in inbred mice. Behav Brain Funct 1:3-13.
Cuvin-Aralar ML, and Furness RW, 1991. Mercury and selenium interaction: a review. Ecotoxicology and Environmental Safety 21: 348-364.
D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. 2008. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117:743-753.
Dalton TP, Kerzee JK, Wang B, Miller M, Dieter MZ, Lorenz JN, et al. 2001. Dioxin exposure is an environmental risk factor for ischemic heart disease. Cardiovascular Toxicology 1:285-298.
Davis RL, Milham S. 1990. Altered immune status in aluminum reduction plant workers. Am J Ind Med 18:79-85.
Davy KP, Hall JE. 2004. Obesity and hypertension: two epidemics or one? Am J Physiol Regul Integr Comp Physiol 286:R803-13.
Darvill T, Lonky E, Reihman J, Stewart P, Pagano J. 2000. Prenatal exposure to PCBs and infant performance on the Fagan Test of Infant Intelligence. Neurotoxicology 21:1029-1038.
DeFronzo RA, Tobin JD, Andres R. 1979. The glucose clamp technique: a method for the quantification of beta cell sensitivity to glucose and of tissue sensitivity to insulin. Am J Physiol 237:E214-E223.
DeVito MJ, Birnbaum LS, Farland WH, and Gasiewicz TA. 1995. Comparisons of estimated human body burdens of dioxinlike chemicals and TCDD body burdens in experimentally exposed animals. Environmental Health Perspectives 103: 820-831.
Diliberto JJ, Burgin D, Birnbaum LS. 1999. Effects of CYP1A2 on disposition of 2,3,7,8-tetrachlorodibenzo-p-dioxin, 2,3,4,7,8-pentachlorodibenzofuran, and 2,2’,4,4’,5,5’-hexachlorobiphenyl in CYP1A2 knockout and parental (C57BL6N and 129/Sv) strains of mice. Toxicology and Applied Pharmacology 159:52-64.
Diliberto JJ, DeVito MJ, Ross DG, Birnbaum LS. 2001. Subchronic exposure of [3H]-2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in female B6C3F1 mice: Relationship of steady-state levels to disposition and metabolism. Toxicological Sciences 61:241-255.
Dohr O, Vogel C, Abel J. 1994. Modulation of growth factor expression by 2,3,7,8-tetrachlorodibenzo-p-dioxin. Exp Clin Immunogenet 11:142-148.
Dolbec J, Mergler D, Sousa Passos CJ, Sousa de Morais S, Lebel J. 2000. Methylmercury exposure affects motor performance of a riverine population of the Tapajos river, Brazilian Amazon. Int Arch Occup Environ Health 73:195-203.
Dong W, Teraoka H, Yamazaki K, Tsukiyama S, Imani S, Imagawa T, et al. 2002. 2,3,7,8-Tetrachlorodibenzo-p-dioxin toxicity in the zebrafish embryo: Local circulation failure in the dorsal midbrain is associated with increased apoptosis. Toxicological Sciences 69:191-201.
Duffard R, Garcia G, Rosso S, Bortolozzi A, Madariaga M, Di Paolo O, et al. 1996. Central Nervous System Myelin Deficit in Rats Exposed to 2,4-Dichlorophenoxyacetic Acid Throughout Lactation. Neurotoxicology and Teratology 18:691-696.
Ebrahimi FA, Bobba N, Lee E, Kulkarni M, See J, Hrris J, Giorani B. 1995. The relationship between Alzheimer’s disease and education by Positron Emission Tomography and Neuropsychological Measures. Archives of Clinical Neuropsychology 10:324.
Eduljee G. 1999. Secondary exposure to dioxins through exposure to PCP and its derivatives. Sci Total Environ 232:193-214.
Ellingsen DG, Bast-Pettersen R, Efskind J, Thomassen Y. 2001. Neuropsychological effects of low mercury vapor exposure in chloralkali workers, Neurotoxicology 22 :249-258.
Emoto M, Nishizawa Y, Maekawa K, Hiura Y, Kanda H, Kawagishi T, et al. 1999. Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulphonylureas. Diabetes Care 22:818-822.
Enan E, Liu PC, and Matsumura F. 1992. TCDD 2,3,7,8-tetrachlorodibenzo-p-
dioxin) causes reduction in glucose uptake through glucose transporters on the plasma membrane of the guinea pig adipocyte. Journal of Environmental Science & Health Part B: Pesticides, Food Contaminants, & Agricultural Wastes; 27:495-510.
Engeli S, Schling P, Gorzelniak K, et al. 2003. The adipose-tissue renin-angiotensin-aldosterone system: role in the metabolic syndrome? Int J Biochem Cell Biol 35:807-25.
Engleson G, Herner T. 1952. Alkyl mercury poisoning. Acta Paediatrica Scandavica 41: 289-294.
Eto K. 1977. Pathology of Minamata disease. Toxicol Pathol 25:614-623. Feldman RG. 1982. Neurologic manifestation of mercury intoxication. Acta Neurol Scand 66:201-209.
Everett CJ, Frithsen IL, Diaz VA, Koopman RJ, Simpson WM Jr, Mainous AG 3rd. 2007. Association of a polychlorinated dibenzo-p-dioxin, a polychlorinated biphenyl, and DDT with diabetes in the 1999-2002 National Health and Nutrition Examination Survey. Environ Res 103:413-418.
Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). 2001. JAMA 285:2486-2497.
Enan E, Matsumura F. 2004. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD)-induced changes in glucose transporting activity in guinea pigs, mice, and rats in vivo and in vitro. J Biochem Toxicol 9:97-106.
Fabsitz RR, Sholinsky P, Carmelli D. 1994. Genetic influences on adult weight gain and maximum body mass index in male twins. Am J Epidemiol 140:711-720.
Filippini G, Bordo B, Crenna P, Massetto N, Musicco M, Boeri R. 1981. Relationship between clinical and electrophysiological findings and indicators of heavy exposure to 2,3,7,8- tetrachlorodibenzodioxin. Scandinavian Journal of Work Environment & Health 7:257-262.
Ferrannini E. 1998. Insulin resistance versus insulin deficiency in non-insulin-dependent diabetes mellitus: problems and prospects. Endocr Rev 19:477-490.
Flesch-Janys D, Becher H, Gurn P, Jung D, Konietzko J, Manz A, and Papke O. 1996. Elimination of polychlorinated dibenzo-p-dioxins and dibenzofurans in occupationally exposed persons. Journal of Toxicology & Environmental Health 47: 363-378.
Ford ES, Giles WH, Dietz WH. 2002. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 287: 356-359.
Ganther HE. 1980. Interactions of vitamin E and selenium with mercury and silver. Annals of the New York Academy of Sciences 355: 212-226.
Genter MB, Clay CD, Dalton TP, Dong H, Nebert DW, Shertzer HG. 2006. Comparison of mouse hepatic mitochondrial versus microsomal cytochromes P450 following TCDD treatment. Biochemical and Biophysical Research Communications 342:1375-1381.
Goff DC Jr, Zaccaro DJ, Haffner SM, Saad MF. 2003. Insulin sensitivity and the risk of incident hypertension: insights from the Insulin Resistance Atherosclerosis Study. Diabetes Care 26:805-809.
Golden CJ, Hammeke TA, Purish AD. Manual for the Luria Nebraska Neuropsychological Battery. Los Angeles: Western Psychological Services; 1980.
Goldey ES, Crofton KM. 1998. Thyroxine replacement attenuates hypothyroxinemia, hearing loss, and motor deficits following developmental exposure to Aroclor 1254 in rats. Toxicol Sci 45:94-105.
Goldey ES, Kehn LS, Rehnberg GL, Crofton KM. 1995b. Effects of developmental hypothyroidism on auditory and motor function in the rat. Toxicol Appl Pharmacol 135:67-76.
Goldey ES, Kehn LS, Lau C, Rehnberg GL, Crofton KM. 1995a. Developmental exposure to polychlorinated biphenyls (Aroclor 1254) reduced circulating thyroid hormone concentrations and causes hearing deficits in rats. Toxicol Appl Pharmacol 135:77-88.
Goldstein BJ. 2002. Insulin resistance as the core defect in type 2 diabetes mellitus. Am J Cardiol 90:3G-10G.
Grahmann F, Claus D, Grehl H, Neundörfer B. 1993. Electrophysiologic evidence for a toxic polyneuropathy in rats after exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). J Neurol Sci 115:71-75.
Grandjean P, Weihe P. 1993. Neurobehavioral effects of intrauterine methylmercury exposure: bias problems in epidemiological studies. In: Proceeding of the International Symposium on Assessment of Environmental Pollution and Health Effects from Methylmercury. 152-162.
Grandjean P, Weihe P, White RF. 1995. Milestone development in infants exposed to methylmercury from human milk. Neurotoxicology 16:27-33.
Grandjean P, Weihe P, White RF, Debes F, Araki S, Yokoyama K, Murata K, Sorensen N, Dahl R, Jorgensen PJ. 1997. Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury. Neurotoxicol Teratol 19: 417-428.
Grandjean P, White RF, Nielsen A, Cleary D, de Oliveira Santos EC. 1999. Methylmercury neurotoxicity in Amazonian children downstream from gold mining, Environ Health Perspect 107:587-591.
Grandjean P, Weihe P, Burse VW, Needham LL, Storr-Hansen E, Heinzow B, et al. 2001. Neurobehavioral deficits associated with PCB in 7-year-old children prenatally exposed to seafood neurotoxicants. Neurotoxicol Teratol 23: 305-317.
Greene ME, Pitts J, McCarville MA, Wang XS, Newport JA, Edelstein C. 2000. PPARgamma: observations in the hematopoietic system. Prostaglandins Other Lipid Mediat 62:45-73.
Grubbs WD, Lustik MB, Brockman AS, Henderson AC, Burnett FR, Land RG, et al. 1995. Air Force Health Study. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Vol III: 1992 Followup Examination Results, May 2, 1995. Springfield, VA:National Technical Information Service.
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. 1999. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 341:549-555.
Haire-Joshu D, Glasgow RE, Tibbs TL. 1999. Smoking and diabetes. Diabetes Care 22:1887-98.
Hallgren CG, Hallmans G, Jansson JH, Marklund SL, Huhtasaari F, Schutz A, et al., 2001. Markers of high fish intake are associated with decreased risk of a first myocardial infarction. The British Journal of Nutrition 86: 397-404.
Halperin W, Vogt R, Sweeney MH, Shopp G, Fingerhut M, Petersen M. 1998. Immunological markers among workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Occupational and Environmental Medicine 55:742-749.
Hankinson O. 1995. The aryl hydrocarbon receptor complex. Annu Rev Pharmacol Toxicol 35:307-340.
Hanley AJ, Karter AJ, Festa A, D’Agostino R Jr, Wagenknecht LE, Savage P, et al. 2002. Insulin Resistance Atherosclerosis S: Factor analysis of metabolic syndrome using directly measured insulin sensitivity: The Insulin Resistance Atherosclerosis Study. Diabetes 51:2642-2647.
Harada M. 1995. Minamata disease: methylmercury poisoning in Japan caused by environmental pollution. Crit Rev Toxicol 25:1-24.
Hassoun EA, Wilt SC, DeVito MJ, Van BA, Alsharif NZ, Birnbaum LS, et al. 1998. Induction of oxidative stress in brain tissues of mice after subchronic exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Toxicological Sciences 42:23-27.
Hassoun EA, Li F, Abushaban A, Stohs SJ. 2000. The relative abilities of TCDD and its congeners to induce oxidative stress in the hepatic and brain tissues of rats after subchronic exposure. Toxicology 145:103-113.
Hassoun EA, Al-Ghafri M, Abushaban A. 2003. The role of antioxidant enzymes in TCDD-induced oxidative stress in various brain regions of rats after subchronic exposure. Free Radical Biology and Medicine 35:1028-1036.
Hauner H, Petruschke T, Russ M, Röhrig K, Eckel J. 1995. Effects of tumour necrosis factor alpha (TNF alpha) on glucose transport and lipid metabolism of newly-differentiated human fat cells in cell culture. Diabetologia 38:764-771.
Hermans MP, Levy JC, Morris RJ, Turner RC. 1999. Comparison of tests of beta-cell function across a range of glucose tolerance from normal to diabetes. Diabetes 48:1779-1786.
Henriksen GL, Ketchum NS, Michalek JE, Swaby JA. 1997. Serum dioxin and diabetes mellitus in veterans of Operation Ranch Hand. Epidemiology 8:252-258.
Hermansky SJ, Holcslaw TL, Murray WJ, Markin RS, Stohs SJ. 1988. Biochemical and functional effect of 2,3,7,8-tetra-chlorodibenzo-p-dioxin on the heart of female rats. Toxicol Appl Pharmacol 95:175-184.
Hirayama C, Irisa T, Yamamoto T. 1969. Fine structural changes of the liver in a patient with chlorobiphenyls intoxication. Fukuoka Acta Med 60: 455-461.
Hirose H, Saito I, Kawabe H, Saruta T. 2003. Insulin resistance and hypertension: seven-year follow-up study in middle-aged Japanese men (the KEIO study). Hypertens Res 26:795-800.
Howdeshell KL. 2002. A model of the development of the brain as a construct of the thyroid system. Environ Health Perspect 110(suppl 3):337-348.
Hock C, Drasch G, Golombowski S, Müller-Spahn F, Willershausen-Zönnchen B, Schwarz P, et al. 1998. Increased blood mercury levels in patients with Alzheimer's disease. J Neural Transm 105:59-68.
Huang PL, Huang Z, Mashimo H, Bloch KD, Moskowitz MA, Bevan JA, et al. 1995. Hypertension in mice lacking the gene for endothelial nitric oxide synthase. Nature 377:239-242.
Huisman M, Koopman-Esseboom C, Lanting CI, van der Paauw CG, Tuinstra LG, Fidler V, et al. 1995. Neurological condition in 18-month-old children perinatally exposed to polychlorinated biphenyls and dioxins. Early Hum dev 43:165-76.
Hwang LC, Bai CH, Chen CJ. 2006. Prevalence of obesity and metabolic syndrome in Taiwan. J Formos Med Assoc 105:626-635.
IARC. Polychlorinated dibenzo-p-dioxins. 1997. In: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol 69: Polychlorinated Dibenzo-para-dioxins and Polychlorinated Dibenzofurans. Lyon:International Agency for Research on Cancer:33-343.
Imazu M, Yamamoto H, Toyofuku M, Sumii K, Okubo M, Egusa G, et al. 2001. Hyperinsulinemia for the development of hypertension: data from the Hawaii-Los Angeles-Hiroshima Study. Hypertens Res - Clin E 24:531-536.
Imura N, Sukegawa E, Pan SK, Nagao K, KIM JY, Kwan T, Ukita T. 1971. Chemical methylation of inorganic mercury with methylcobalamin, a vitamin B12 analog. Science 172:1248-1249.
Iregren A, Gamberale F, Kjellberg A. 1996. A psychological test system to diagnose environmental hazards. Neurotoxicol Teratol 18:485-491.
Iwasaki T, Miyazaki W, Takeshita A, Kuroda Y, Koibuchi N. 2002. Polychlorinated biphenyls suppress thyroid hormone-induced transactivation. Biochem Biophys Res Commun 299:384-388.
Jacobson JL, Jacobson SW. 1993. A 4 year followup study of children born to consumers of Lake Michigan fish. J. Great Lakes Res 19:776-783.
Jacobson JL, Jacobson SW. 1996. Intellectual impairment in children exposed to polychlorinated biphenyls in utero. New Engl J Med 335:783-789.
Jacobson JL, Jacobson SW, Humphrey HE. 1990. Effects of in utero exposure to polychlorinated biphenyls and related contaminants on cognitive functioning in young children. J Pediatr 116:38-45.
Jacobson JL, Jacobson SW, Schwartz PM, Fein GG, Dowler JK. 1984. Prenatal exposure to an environmental toxin: A test of the multiple effects model. Dev Psychol 20:523-532.
Johansson N, Basun H, Winblad B, Nordberg M. 2002. Relationship between mercury concentration in blood, cognitive performance, and blood pressure in an elderly urban population. Biometals 15:189-195.
Jokinen MP, Walker NJ, Brix AE, Sells DM, Haseman JK, Nyska A. 2003. Increase in cardiovascular pathology in female Sprague-Dawley rats following chronic treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin and 3,3’,4,4’,5-pentachlorobiphenyl. Cardiovascular Toxicology 3:299-310.
Jokinen MP, Walker NJ, Brix AE, Sells DM, Haseman JK, Nyska A. 2003. Increase in cardiovascular pathology in female Sprague-Dawley rats following chronic treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin and 3,3’,4,4’,5-pentachlorobiphenyl. Cardiovasc Toxicol 3:299-310.
Joy T, Lahiry P, Pollex RL, Hegele RA. 2008. Genetics of metabolic syndrome. Curr Diab Rep 8:141-148.
Kaplan NM. 2002. In N. M. Kaplan (Ed.), Kaplan’s clinical hypertension (pp. 56-135). Philadelphia: Lippincott Williams & Wilkins.
Kario K, Matsuo T, Kobayashi H, Imiya M, Matsuo M, Shimada K. 1996. Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers. Hypertension 27:130-135.
Kashimoto T, Miyata H, Kunita S, Tung TC, Hsu ST, Chang KJ, et al. 1981. Role of polychlorinated dibenzofuran in yusho (PCB poisoning). Archives of environmental health 36:321-326.
Kaura P, Aschner M, Syversen T. 2006. Glutathione modulation influences methyl mercury induced neurotoxicity in primary cell cultures of neurons and astrocytes. NeuroToxicology 27: 492-500.
Kelling CK, Menahan LA, Peterson RE. 1987. Effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin treatment on chemical function of the rat heart. Toxicol Appl Pharmacol 91:497-501.
Kern PA, Dicker-Brown A, Said ST, Kennedy R, Fonseca VA. 2002. The stimulation of tumor necrosis factor and inhibition of glucose transport and lipoprotein lipase in adipose cells by 2,3,7,8-tetrachlorodibenzo-p-dioxin. Metabolism 51:65-68.
Kimmig J, Schulz KH. 1957a. Chlorinated aromatic cyclic ethers as the cause of socalled chloracne. Naturwissenschaften 44:337-338.
Kimmig J, Schulz KH. 1957b. Occupational acne due to chlorinatedaromatic cyclic esters. Dermatologica 115:540.
Kilburn KH. 1998. Neurobehavioral impairment and symptoms associated with aluminum remelting. Archives of Environmental Health 53:325-335.
Klawans HL. 1987. Dystonia and tremor following exposure to 2,3, 7,8-tetrachlorodibenzo-p-dioxin. Mov Disord 2:255-261.
Kociba RJ, Keyes DG, Beyer JE, Carreon RM, Wade CE, Dittenber DA, et al. 1978. Results of a two-year chronic toxicity and oncogenicity study of 2,3,7,8-tetrachlorodibenzo-p-dioxin in rats. Toxicol Appl Pharmacol 46:279-303.
Kociba RJ, Keyes DG, Beyer JE, Carreon RM, Gehring PJ. 1979. Long-term toxicology studies of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in laboratory animals. Ann NY Acad Sci 320:397-404.
Koopman-Esseboom C, Weisglas-Kuperus N, de Ridder MA, Van der Paauw CG, Tuinstra LG, Sauer PJ. 1996. Effects of Polychlorinated biphenyl/dioxin exposure and feeding type on infants' mental and psychomotor development. Pediatrics 97:700-706.
Kopf PG, Huwe JK, Walker MK. 2008. Hypertension, cardiac hypertrophy, and impaired vascular relaxation induced by 2,3,7,8-tetrachlorodibenzo-p-dioxin are associated with increased superoxide. Cardiovasc Toxicol. 8:181-193.
Kuusisto J, Lempiainen P, Mykkanen L, Laakso M. 2001. Insulin resistance syndrome predicts coronary heart disease events in elderly type 2 diabetic men. Diabetes Care 24:1629-1633.
Kuratsune M, Yoshimura H, Hori Y, Okumura M, Masuda Y. 1996. YUSHO: A human disaster caused by PCBs and related compounds. In: Survival of patients (Ikeda M, Yoshimura T, eds) Kyushu University Press. 317-323. Kyushu University press.
Kuwabara K, Murakami K, Todo M, Aoki T, Asaki T, Murai M, et al. 2004. A novel selective peroxisome proliferator-activated receptor alpha agonist, 2-methyl-c-5-[4-[5-methyl-2-(4-methylphenyl)-4-oxazolyl]butyl]-1,3-dioxane-r-2-carboxylic acid (NS-220), potently decreases plasma triglyceride and glucose levels and modifies lipoprotein profiles in KK-Ay mice. J Pharmacol Exp Ther 309:970-977.
Landmesser U, Dikalov S, Price SR, McCann L, Fukai T, Holland SM, et al. 2003. Oxidation of tetrahydrobiopterin leads to uncoupling of endothelial cell nitric oxide synthase in hypertension. The Journal of Clinical Investigation 111: 1201-1209.
Laaksonen DE, Lakka HM, Salonen JT, Niskanen LK, Rauramaa R, Lakka TA. 2002. Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care 25:1612-1618.
Lavado-Autric R, Auso E, Garcia-Velasco JV, Arufe MdC, Escobar del Ray F, Berbel P, et al. 2003. Early maternal hypothyroxemia alters histogenesis and cerebral cortex cytoarchitecture of the progeny. J Clin Invest 111:1073-1082.
Lazarus JH. 1999. Thyroid hormone and intellectual development: a clinician's view. Thyroid 9:659-660.
Lebel J, Mergler D, Branches F, Lucotte M, Amorim M, Larribe F, Dolbec J. 1998 Neurotoxic effects of low-level methylmercury contamination in the Amazonian Basin. Environ Res 79:20-32.
Lebovitz HE. 2003. The relationship of obesity to the metabolic syndrome. Int J Clin Pract Suppl 15:18-27.
Lee CC, Lin WT, Liao PC, Su HJ, Chen HL. 2006. High average daily intake of PCDD/Fs and serum levels in residents living near a deserted factory producing pentachlorophenol (PCP) in Taiwan: influence of contaminated fish consumption. Environ Pollut 141:381-386.
Lee DH, Lee IK, Porta M, Steffes M, Jacobs DR Jr. 2007. Relationship between serum concentrations of persistent organic pollutants and the prevalence of metabolic syndrome among non-diabetic adults: results from the National Health and Nutrition Examination Survey 1999-2002. Diabetologia 50:1841-1851.
Lee DH, Lee IK, Jin SH, Steffes M, Jacobs DR Jr. 2007. Association between serum concentrations of persistent organic pollutants and insulin resistance among nondiabetic adults: results from the National Health and Nutrition Examination Survey 1999-2002. Diabetes Care 30:622-628.
Lee DH, Lee IK, Song K, Steffes M, Toscano W, Baker BA, et al. 2006.A strong dose-response relation between serum concentrations of persistent organic pollutants and diabetes: results from the National Health and Examination Survey 1999-2002. Diabetes Care 29:1638-1644.
Levick JR. 2003. Introduction to cardiovascular physiology. London: Hodder Arnold.
Lidfeldt J, Nyberg P, Nerbrand C, Samsioe G, Schersten B, Agardh CD. 2003. Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The Women's Health in the Lund Area (WHILA) study. Diabetes Obes Metab 5:106-112.
Liese AD, Mayer-Davis EJ, Tyroler HA, Davis CE, Keil U, Schmidt MI, et al. 1997. Familial components of the multiple metabolic syndrome: the ARIC study. Diabetologia 40:963-970.
Lim J, DeWitt JC, Sanders RA, Watkins JB, III, Henshel DS. 2007. Suppression of endogenous antioxidant enzymes by 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced oxidative stress in chicken liver during development. Archives of Environmental Contamination and Toxicology 52:590-595.
Lin RT, Lai CL, Tai CT, Liu CK, Yen YY, Howng SL. 1998. Prevalence and subtypes of dementia in southern Taiwan: Impact of age, sex, education, and urbanization. Journal of the Neurological Sciences 160:67-75.
Lind PM, Orberg J, Edlund UB, Sjoblom L, Lind L. 2004. The dioxin-like pollutant PCB 126 (3,3’,4,4’,5-pentachlorobiphenyl) affects risk factors for cardiovascular disease in female rats. Toxicol Lett 150:293-299.
Lind PM, Orberg J, Edlund UB, Sjöblom L, Lind L. 2004. The dioxin-like pollutant PCB 126 (3,3',4,4',5-pentachlorobiphenyl) affects risk factors for cardiovascular disease in female rats. Toxicol Lett 150:293-299.
Liu HC, Chou P, Lin KN, Wang SJ, Fuh JL, Lin HC, et al. 1994. Assessing cognitive abilities and dementia in a predominantly illiterate population of older individuals in Kinmen. Psychol Med 24:763-770.
Liu CK, Lin RT, Lai CL, Tai CT. 1998. A normative study of Chinese version of the cognitive ability screening instrument [abstract], Acta Neurol Taiwan 7:142.
Liu HC, Teng EL, Lin KN, Chuang YY, Wang PN, Fuh JL, Liu CY. 2002. Performance on the cognitive abilities screening instrument at different stages of Alzheimer's disease. Dement Geriatr Cogn Disord 13:244-248.
Lofroth G, and Zebuhr Y. 1992. Polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) in mainstream and sidestream cigarette smoke. Bulletin of Environmental Contamination & Toxicology 48: 789-94.
Longnecker MP, Michalek JE. 2000. Serum dioxin level in relation to diabetes mellitus among Air Force veterans with background levels of exposure. Epidemiology 11:44-48.
Lund BO, Miller DM, and Woods JS, 1993. Studies on Hg(II)-induced H2O2 formation and oxidative stress in vivo and in vitro in rat kidney mitochondria. Biochemical Pharmacology 45: 2017-2024.
Lund AK, Peterson SL, Timmins GS, Walker MK. 2005. Endothelin-1-mediated increase in reactive oxygen species and NADPH oxidase activity in hearts of aryl hydrocarbon receptor (AhR) null mice. Toxicol Sci 88:265-273.
Mahaffey KR, Mergler D. 1998. Blood levels of total and organic mercury in residents of the upper St. Lawrence River basin, Quebec: association with age, gender, and fish consumption. Environ Res 77:104-114.
Marchand A, Tomkiewicz C, Marchandeau JP, Boitier E, Barouki R, Garlatti M. .2005. 2,3,7,8-tetrachlorodibenzo-p-dioxin induces insulin-like growth factor binding protein-1 gene expression and counteracts the negative effect of insulin. Mol Pharmacol 67:444-452.
Marshal F. Folstein, Susan E. Folstein and Paul R. McHugh. 1975. “Mini-Mental State”: a practical method for grading the cognitive impairment of patients for the clinician. J Psychiatry Res 12:189-198.
Matsuo N, Suzuki T, Akagi H. 1989. Mercury concentration in organs of contemporary Japanese. Arch Environ Health 44:298-303.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. 1985. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412-419.
Masunaga S, Takasuga T, Nakanishi J. 2001. Dioxin and dioxin-like PCB impurities in some Japanese agrochemical formulations. Chemosphere 44:873-885.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. 1985. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412-419.
Martin JV. 1984. Lipid abnormalities in workers exposed to dioxin. BrJ Ind Med 41:254-256.
Meigs JB. 2000. Invited commentary: insulin resistance syndrome? Syndrome X? Multiple metabolic syndrome? A syndrome at all? Factor analysis reveals patterns in the fabric of correlated metabolic risk factors. Am J Epidemiol 152:908-911.
Michalek JE, Ketchum NS, and Longnecker MP. 2001. Serum dioxin and hepatic abnormalities in veterans of Operation Ranch Hand. Annals of Epidemiology 11: 304-311.
Miner JC. 1991. Air Force Health Study, an epidemiologic investigation of health effects in Air Force personnel following exposure to herbicides. Serum dioxin analysis of 1987 examination results. National Technical Information Service # AD A-237-516 through AD A237-A524.
Mitchell BM, Dorrance AM, Webb RC. 2003. GTP cyclohydrolase 1 inhibition attenuates vasodilation and increases blood pressure in rats. American Journal of Physiology. Heart and Circulatory Physiology 285:H2165-H2170.
Mitchell BM, Dorrance AM, Webb RC. 2003. GTP cyclohydrolase 1 downregulation contributes to glucocorticoid hypertension in rats. Hypertension 41:669-674.
Moens AL, Kass DA. 2006. Tetrahydrobiopterin and cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology 26:2439-2444.
Moro P, Gallina P, Paris M, Cazzolato G, Alessandrini P, Bittolo-Bon G. 2003. Hypertriglyceridemia is associated with increased insulin resistance in subjects with normal glucose tolerance: Evaluation in a large cohort of subjects assessed with the 1999 World Health Organization criteria for the classification of diabetes. Metabolism 52:616-619.
Moses M, Lilis R, Crow KD, Thornton J, Fischbein A, Anderson HA, et al. 1984. Health status of workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin in the manufacture of 2,4,5-trichlorophenoxyacetic acid. Comparison of findings with and without chloracne. American Journal of Industrial Medicine 5:161-182.
Moses M, Lilis R, Crow KD, Thornton J, Fischbein A, Anderson HA, et al. 1984. Health status of workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin in the manufacture of 2,4,5-trichlorophenoxyacetic acid: comparison of findings with and without chloracne. Am J Ind Med 5:161-182.
Mutter J, Naumann J, Sadaghiani C, Schneider R, Walach H. 2004. Alzheimer disease: mercury as pathogenetic factor and apolipoprotein E as a moderator. Neuroendocrinol Lett 25:331-339.
Myers GJ, Davidson PW, Shamlaye CF, Axtell CD, Cernichiari E, Choisy O, et al. 1997. Effects of prenatal methylmercury exposure from a high fish diet on developmental milestones in the Seychelles Child Development Study. Neurotoxicology 18:819-829.
Myers GJ, Davidson PW, Cox C, Shamlaye CF, Tanner MA, Marsh DO, et al. 1995. Summary of the Seychelles child development study on the relationship of fetal methylmercury exposure to neurodevelopment. Neurotoxicology 16:711-716.
Myersa GJ, Davidsonb PW, Coxc C, Shamlayed C, Cernichiarie E, Clarksone TW. 2000.Twenty-seven years studying the human neurotoxicity of methylmercury exposure. Environ Res 83:275-285.
Nagayama J, Tsuji H, Iida T, Hirakawa H, Matsueda T, Ohki M. 2001. Effects of contamination level of dioxins and related chemicals on thyroid hormone and immune response systems in patients with “Yusho”. Chemosphere 43: 1005-1010.
Nagayama J, Tsuji H, Iida T, Hirakawa H, Matsueda T, Okamira K, et al. 1998. Postnatal exposure to chlorinated dioxins and related chemicals on lymphocyte subsets in Japanese breast-fed infants. Chemosphere 37: 1781-1787
Neuberger M, Rappe C, Bergek S, Cai H, Hansson M, Jäger R, et al. 1999. Persistent health effects of dioxin contamination in herbicide production. Environ Res 81:206-214.
Ninomiya T, Ohmori H, Hashimoto K, Tsuruta K, Ekino S. 1995. Expansion of methylmercury poisoning outside of Minamata: an epidemiological study on chronic methylmercury poisoning outside of Minamata. Environ Res 70:47-50.
Nutrition section. UNICEF New York. Breastfeeding and environmental contamination. A discussion paper. May 1997.
Okumura M, Katsuki S. 1969. Clinical observation on Yusho (chlorobiphenyls poisoning). Fukuoka Acta Med 60: 440-446.
Okumura M. 1972. Course of serum enzyme change in PCB poisoning. Fukuoka Acta Med 63: 396-400.
Oskarsson A, Schültz A, Skerfving S, Hallén IP, Ohlin B, Lagerkvist BJ. 1996. Total and inorganic mercury in breast milk and blood in relation to fish consumption and amalgam fillings in lactating women. Arch Environ Health 51:234-241.
Pai MC, Chan SH. 2001. Education and cognitive decline in Parkinson's disease: a study of 102 patients. Acta Neurol Scand 103:243-247.
Palha JA, Nissanov J, Fernandes R, Sousa JC, Bertrand L, Dratman MB, et al. 2002. Thyroid hormone distribution in the mouse brain: the role of transthyretin. Neuroscience 113:837-847.
Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas J, Tousoulis D, Toutouza M, et al. 2004. Impact of lifestyle habits on the prevalence of the metabolic syndrome among Greek adults from the ATTICA study. Am Heart J 147:106-112.
Papke O. 1998. PCDD/PCDF:human backround data for Germany, a 10-year experience. Environmental Health Perspectives 106: 723-731.
Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. 2003. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 163: 427-436.
Patterson DG, Jr., Todd GD, Turner WE, Maggio V, Alexander LR, and Needham LL. 1994. Levels of non-ortho-substituted (coplanar), mono- and di-ortho-substituted polychlorinated biphenyls, dibenzo-p-dioxins, and dibenzofurans in human serum and adipose tissue. Environ Health Perspect 102: 195-204.
Pelclova D, Prazny M, Skrha J, Fenclova Z, Kalousova M, Urban P, et al. 2007. 2,3,7,8-TCDD exposure, endothelial dysfunction and impaired microvascular reactivity. Human and Experimental Toxicology 26:705-713.
Peper M, Klett M, Frentzel-Beyme R, Heller WD. 1993. Neuropsychological effects of chronic exposure to environmental dioxins and furans. Environ Res 60:124-135.
Persistent Organic Pollutants: A Global Issue, A Global Response. U.S EPA. Available at: http://www.epa.gov/oia/toxics/pop.htm#pops. Accessed September 1, 2008.
Pesatori AC, Zocchetti C, Guercilena S, Consonni D, Turrini D, Bertazzi PA. 1998. Dioxin exposure and non-malignant health effects: a mortality study. Occup Environ Med 55:126-131.
Phillips C, Lopez-Miranda J, Perez-Jimenez F, McManus R, Roche HM. 2006. Genetic and nutrient determinants of the metabolic syndrome. Curr Opin Cardiol 21:185-193.
Pietsch M, Portier C, Patterson D, Prellwitz W, Rose DM, Thews A, et al. 1998. Immunologic findings in workers formerly exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin and its congeners. Environ Health Perspect 106:689-695.
Plinio C, Costantino F, Rossella A, Antonio I, Maria GT, Gabriella A, et al. 2003. Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through fish consumption. NeuroToxicology 24: 617-623.
Pocchiari F, Silvano V, Zamp ieri A. 1979. Human health effects from accidental release of tetrachlorodibenzo-p-dioxin (TCDD) at Seveso, Italy. Annals of the New York Academy of Sciences 77:311-320.
Pollock DM. 2005. Endothelin, angiotensin, and oxidative stress in hypertension. Hypertension 45:477-480.
Porterfield SP. 1994. Vulnerability of the developing brain to thyroid abnormalities: environmental insults to the thyroid system. Environ Health Perspect 102:125-130.
Porta M. 2006. Persistent organic pollutants and the burden of diabetes. Lancet 368:558-559.
Puddu P, Puddu GM, Cravero E, De PS, Muscari A. 2007. The putative role of mitochondrial dysfunction in hypertension. Clinical and Experimental Hypertension 29:427-434.
Puntarulo S, Cederbaum AI. 1998. Production of reactive oxygen species by microsomes enriched in specific human cytochrome P450 enzymes. Free Radical Biology and Medicine 24:1324-1330.
Remillard RB, Bunce NJ. 2002. Linking dioxins to diabetes: epidemiology and biologic plausibility. Environ Health Perspect 110:853-858.
Rennie KL, McCarthy N, Yazdgerdi S, Marmot M, Brunner E. 2003. Association of the metabolic syndrome with both vigorous and moderate physical activity. Int J Epidemiol 32:600-606.
Rice D, Barone S Jr. 2000. Critical periods of vulnerability for the developing nervous system: evidence from humans and animal models. Environ Health Perspect 108:511-533.
Rice DC. 1989. Delayed neurotoxicity in monkeys exposed developmentally to methylmercury. Neurotoxicology 10:645-650.
Rice DC. 1998. Age-related increase in auditory impairment in monkeys exposed in utero plus postnatally to methylmercury. Toxicol Sci 44:191-196.
Rice DC, Hayward S. 1999. Comparison of visual function at adulthood and during aging in monkeys exposed to lead or methylmercury, Neurotoxicology 20:767-784.
Rice DC. 1996. Evidence for delayed neurotoxicity produced by methylmercury, Neurotoxicology 17:583-596.
Rice DC, Hayward S. 1999. Comparison of visual function at adulthood and during aging in monkeys exposed to lead or methylmercury. Neurotoxicology 20:767-784.
Rice DC, Schoeny R, Mahaffey K. 2003. Methods and rationale for derivation of a reference dose for methylmercury by the US EPA. Risk Anal 23:107-115.
Roegner RH, Grubbs WD, Lustik MB, Brockman AS, Henderson SC, Williams DE, et al. 1991. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Serum Dioxin Analysis of 1987 Follow-up Examination Results. NTIS AD A-237-516 through AD A-237-524: San Antonio: Armstrong Laboratory, Brooks Air Force Base.
Roegner RH, Grubbs WD, Lustik MB, Brockman AS, Henderson AC, Williams DE, et al. 1996. Air Force Health Study: An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides: Serum Dioxin Analysis of 1987 Examination Results. Rpts NTIS AD-A-237-5 1 6-AD-A-237-524. Springfield, VA:National Technical Information Service, 1991.
Russell DH, Buckley AR. 1988. Hypothalamic site of action of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Toxicology & Applied Pharmacology 94:496-502.
Safe S. 1984. Polychlorinated biphenyls (PCBs) and polybrominatedbiphenyls(PBBs):Biochemistry toxicology and mechanism ofaction. CRC Crit Rev in Toxicol 13:319-395.
Salonen JT. 1993. The role of iron as a cardiovascular risk factor. Curr Opin Lipid. 4: 277-282.
Salonen JT, Seppänen K, Nyyssönen K, Korpela H, Kauhanen J, Kantola M, et al. 1995. Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men. Circulation 91: 645-655.
Salonen JT, Seppänen K, Lakka TA, Salonen R, and Kaplan GA. 2000. Mercury accumulation and accelerated progression of carotid atherosclerosis: a population-based prospective 4-year follow-up study in men in eastern Finland. Atherosclerosis 148: 265-273.
Sastry BV, Janson VE, Clark CP, Owens LK. 1997. Cellular toxicity of 2,4,5-trichlorophenoxyacetic acid: formation of 2,4,5-trichlorophenoxyacetylcholine. Cell Mol Biol 43:549-57.
Sattar N, Gaw A, Scherbakova O, Ford I, O'Reilly DS, Haffner SM, et al. 2003. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. (See comment). Circulation 108:414-419.
Schell JD Jr, Budinsky RA, Wernke MJ. 2001. PCBs and neurodevelopmental effects in Michigan children: An evaluation of exposure and dose characterization. Regul Toxicol Pharmacol 33:300-312.
Schiffrin EL. 2005. Vascular endothelin in hypertension. Vascular Pharmacology 43:19-29.
Schiller CM, Adcock CM, Moore RA, Walden R. 1985. Effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin and fasting on body weight and lipid parameters in rats. Toxicol Appl Pharmacol 81:356-361.
Schuur AG, Brouwer A, Bergman A, Coughtrie MWH, Visser TJ. 1998. Inhibition of thyroid hormone sulfation by hydroxylated metabolites of polychlorinated biphenyls. Chem Biol Interact 109:293-297.
Schuhmacher M, Domingo JL, Llobet JM, Lindstrom G, and Wingfors H. 1999. Dioxin and dibenzofuran concentrations in blood of a general population from Tarragona, Spain. Chemosphere 38: 1123-1133.
Schwartz PM, Jacobson SW, Fein GG, Jacobson JL. 1983. Lake Michigan fish consumption as a source of polychlorinated biphenyls in human cord serum, maternal serum, and milk. Am J Public Health 73:293-296.
Senft AP, Dalton TP, Nebert DW, Genter MB, Hutchinson RJ, Shertzer HG. 2002. Dioxin increases reactive oxygen production in mouse liver mitochondria. Toxicology and Applied Pharmacology 178:15-21.
Shertzer HG, Clay CD, Genter MB, Chames MC, Schneider SN, Oakley GG, et al. 2004. Uncoupling-mediated generation of reactive oxygen by halogenated aromatic hydrocarbons in mouse liver microsomes. Free Radical Biology and Medicine 36:618-631.
Shimada K, Kawamoto A, Matsubayashi K, Nishinaga M, Kimura S, Ozawa T. 1992. Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension. Journal of Hypertension 10: 875-878.
Shimaya A, Kurosaki E, Shioduka K, Nakano R, Shibasaki M, and Shikama H. 1998. YM268 increases the glucose uptake, cell differentiation, and mRNA expression of glucose transporter in 3T3-L1 adipocytes. Hormone & Metabolic Research 30: 543-548.
Shigenaga K. 1976. Pancreatic islet injury induced by methyl mercuric chloride light and electron microscopic studies. Kumamoto Med J 29:67-81.
Shenker BJ, Guo TL, O I, Shapiro IM. 1999. Induction of apoptosis in human T-cells by methylmercury: temporal relationship between mitochondrial dysfunction and loss of reductive reserve. Toxicol Appl Pharmacol 157:23-35.
Shepard TH. 1967. Onset of function in the human fetal thyroid: biochemical and radioautographic studies from organ culture. J Clin Endocrinol 27:945-958.
Singh Ahuja H, Liu S, Crombie DL, Boehm M, Leibowitz MD, Heyman RA, et al. 2001Differential effects of rexinoids and thiazolidinediones on metabolic gene expression in diabetic rodents. Molecular Pharmacology; 59: 765-773.
Skott P, Hother-Nielsen O, Bruun NE, Giese J, Nielsen MD, Beck-Nielsen H, et al. 1989. Effects of insulin on kidney function and sodium excretion in healthy subjects. Diabetologia 32:694-699.
Slim R, Toborek M, Robertson LW, Lehmler HJ, Hennig B. 2000. Cellular glutathione status modulates polychlorinated biphenyl-induced stress response and apoptosis in vascular endothelial cells. Toxicology and Applied Pharmacology 166:36-42.
Slezak BP, Hatch GE, DeVito MJ, Diliberto JJ, Slade R, Crissman K, et al. 2000. Oxidative stress in female B6C3F1 mice following acute and subchronic exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Toxicological Sciences 54: 390-398.
Sowers JR, Frohlich ED. 2004. Insulin and insulin resistance: impact on blood pressure and cardiovascular disease. Med Clin North Am 88:63-82.
Steenland K, Piacitelli L, Deddens J, Fingerhut M, Chang LI. 1999. Cancer, heart disease, and diabetes in workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. J Natl Cancer Inst 91:779-786.
Suskind RR, Hertzberg VS. 1984. Human health effects of 2,4,5-T and its toxic contaminants. JAMA 251:2372-2380.
Standley PR, Rose KA, Sowers JR. 1995. Increased basal arterial smooth muscle glucose transport in the Zucker rat. Am J Hypertens 8:48-52.
Stephanie M, Curt AS, Katie M. 2001. Memory training improves cognitive ability in patients with dementia. Neuropsychological rehabilitation 11:245-261.
Stewart P, Reihman J, Lonky E, Darvill T, Pagano J. 2000. Prenatal PCB exposure and neonatal behavioral assessment scale (NBAS) performance. Neurotoxicol Teratol 22:21-29.
Sweeney MH, Fingerhut MA, Arezzo JC, Hornung RW, Connally LB .1993. Peripheral neuropathy after occupational exposure to 2,3,7,8-tetrac hlorodibenzo-p-dioxin (TCDD). American Journal of Industrial Medicine 23: 845-858.
Sweeney MH, Hornung RW, Wall DK, Fingerhut MA, Halperin WE. 1992. Prevalence of diabetes and elevated serum glucose levels in workers exposed 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Organohalogen Compounds 10:225-226.
Talbert JS, Brewer KK, Weiner MF, Honig LS, Rosenberg RN, Cullum CM. 1997. Education effects on verbal fluency performance in Alzheimer's Disease. Archives of Clinical Neuropsychology 12:413.
Takizawa Y. 1993. Overview on the Minamata disease—epidemiological aspects. In: Proceeding of the International Symposium on Assessment of Environmental Pollution and Health Effects from Methylmercury. 3-26.
Tarter RE, Edwards KL. 1986. Multifactorial etiology of neuropsychological impairment in alcoholics. Alcohol Clin Exp Res 10:128-135.
Takeuchi T, Eto K. 1997. Pathology and pathogenesis of Minamata disease. In Minamata Diseases—Methyl Mercury Poisoning in Minamata and Niigata, Japan (Tsubaki, T., and Irukayama, K., Eds.):103-141.
Taylor MJ, Lucier GW, Mahler JF, Thompson M, Lockhart AC, Clark GC. 1992. Inhibition of acute TCDD toxicity by treatment with anti-tumor necrosis factor antibody or dexamethasone. Toxicol Appl Pharm 117:126-132.
Teng EL, Hasegawa K, Homma A, Imai Y, Larson E, Graves A, et al. 1994. The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 6:45-58.
Teraoka H, Dong W, Tsujimoto Y, Iwasa H, Endoh D, Ueno N, et al. 2003. Induction of cytochrome P450 1A is required for circulation failure and edema by 2,3,7,8-tetrachlorodibenzo-p-dioxin in zebrafish. Biochemical and Biophysical Research Communications 304:223-228.
Thackaberry EA, Nunez BA, Ivnitski-Steele ID, Friggins M, Walker MK. 2005. Effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin on murine heart development: alteration in fetal and postnatal cardiac growth, and postnatal cardiac chronotropy. Toxicol Sci 88:242-249.
The Criteria of Metabolic Syndrome (in Chinese) [article online]. Bureau of Health Promotion Database. Available at:http://www.bhp.doh.gov.tw/BHPnet/Portal/Them_Show.aspx?Subject = 200712250023&Class = 2&No = 200712250123. Accessed December 25, 2007.
Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). 2002. Final report. Circulation 106:3143-3421.
Touyz RM. 2004. Reactive oxygen species, vascular oxidative stress, and redox signaling in hypertension: What is the clinical significance? Hypertension 44: 248-252.
Troisi RJ, Weiss ST, Parker DR, Sparrow D, Young JB, Landsberg L. 1991. Relation of obesity and diet to sympathetic nervous system activity. Hypertension 17:669-677.
Tsubaki T, Irukayama K. 1977. Minamata Disease, Elsevier Press, Amsterdam, The Netherlands.
Tuomisto J, Pohjanvirta R, MacDonald E, Tuomisto L. 1990. Changes in rat brain monoamines, monoamine metabolites and histamine after a single administration of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Pharmacology & Toxicology 67:260-265.
UNEP. 2003. Global mercury assessment—current mercury exposures and risk evaluations for humans. http://www.chem.unep.ch/mercury/Report
/Final%20report/chapter4.doc.
United Nations Environmental Programme (UNEP) Global Mercury Assessment report Current mercury exposures and risk evaluations for humans. http://www.chem.unep.ch/MERCURY/Report/Final%20report/chapter4.doc, 2003.
U.S. Environmental Protection Agency. 1994. Health Assessment Document for 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) and Related Compounds, Vols I-III. Rpt No EPA/600/BP-92/001. Washington:U.S. Government Printing Office.
Va´zquez MJ, Abuin M, Carro AM, Lorenzo RA, Cela R. 1999. Experimental design approach for the extraction of methylmercury from certified reference materials using microwave energy. Chemosphere 39:1211-1224.
Velloso LA, Folli F, Sun XJ, White MF, Saad MJ, Kahn CR. Cross-talk between the insulin and angiotensin signaling systems. Proc Natl Acad Sci USA 1996; 93:12490-5.
Verhaar MC, Westerweel PE, van Zonneveld AJ, Rabelink TJ. 2004. Free radical production by dysfunctional eNOS. Heart (British Cardiac Society) 90:494-495.
Virtanen JK, Voutilainen S, Rissanen TH, Mursu J, Tuomainen TP, Korhonen MJ, et al. 2005. Mercury, fish oils, and risk of acute coronary events and cardiovascular disease, coronary heart disease, and allcause mortality in men in eastern Finland. Arteriosclerosis, Thrombosis, and Vascular Biology 25: 228-233.
Vogel C, Abel J. 1995. Effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin on growth factor expression in the human breast cancer cell line MCF-7. Arch Toxicol 69:259-265.
Wang SL, Tsai PC, Yang CY, Leon Guo Y. 2008. Increased risk of diabetes and polychlorinated biphenyls and dioxins: a 24-year follow-up study of the Yucheng cohort. Diabetes Care 31:1574-1579.
Weil M, Bressler J, Parsons P, Bolla K, Glass T, Schwartz B. 2005. Blood mercury levels and neurobehavioral function [see comment]. JAMA 293:1875-1882.
Weiss B. 1990. Risk assessment: the insidious nature of neurotoxicity and the aging brain. Neurotoxicology 11:305-313.
Weiss B, Simon W. 1975. Quantitative perspectives on the long-term toxicity of methylmercury and similar poisons. In: B. Weiss and W. Simon, Editors, Behavioural Toxicology. Plenum Press, New York. 429-438.
Webb KB, Ayres SM, Mikes J, Evans RG. 1986. The diagnosis of dioxin-associated illness. Am J Prev Med 2:103-108.
Wong KC, and Hwang MY. 1981. Children born to PCB poisoning mothers. Clin Med (Taipei) 7: 83.
WHO/IPCS. 1989. Mercury: Environmental Aspects. Environmental Health Criteria 86. IPCS. World Health Organisation. Geneva.
WHO/IPCS. 1990a. Methylmercury: Environmental Aspect. Environmental Health Criteria 101. IPCS. World Health Organisation. Geneva.
WHO/IPCS. 1990b. Methylmercury: Environmental Aspects. Environmental Health Criteria 101. IPCS. World Health Organisation. Geneva.
Wirfalt E, Hedblad B, Gullberg B, Mattisson I, Andren C, Rosander U, et al. 2001. Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmo Diet and Cancer cohort. Am J Epidemiol 154:1150-1159.
Wolfe WH, Michalek JE, Miner JC, Needham L, Patterson, D. 1992. Diabetes versus dioxin body burden in veterans of Operation Ranch Hand. Organohalogen Compounds 10:279-282.
World Health Organization Consultation. 1999. Definition, diagnosis and classification of diabetes mellitus and its complications. Part I. Diagnosis and classification of diabetes mellitus. Report of a WHO consultation. Geneva.
Wu CH, Chen HL, Su HJ, Lee CC, Shen KT, Ho WL, et al. 2004. Topical application of 2,3,7,8-tetrachlorodibenzo-p-dioxin lack of skin tumor-promoting potency but induce hepatic injury and tumor necrosis factor-a expression in ICR male mice. Food & Chemical Toxicology 42:1217-1225.
Wu Y, Hsieh R, Lu Y. 1984. Altered distribution of lymphocyte subpopulations and augmentation of lymphocyte proliferation in chronic PCB poisoned patients. Chinese J Microbiol Immunol 17:177-187.Xie A, Walker NJ, Wang D. 2006. Dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin) enhances triggered afterdepolarizations in rat ventricular myocytes. Cardiovasc Toxicol 6:99-110.
Yokoo EM, Valente JG, Grattan L, Schmidt SL, Platt I, Silbergeld EK. 2003. Low level methylmercury exposure affects neuropsychological function in adults. Environ Health 2:8-18.
Yu ML, Guo YL, Hsu CC, Rogan WJ. 1997. Increased mortality from chronic liver disease and cirrhosis 13 years after the Taiwan "yucheng" ("oil disease" incident). Am J Ind Med 31: 172-175.
Zober A, Ott MG, Messerer P. 1994. Morbidity followup study of BASF employees exposed to 2,3,7,8-tetrachlorodbenzo-p-dioxin (TCDD) after a 1953 chemical reactor incident. Occup Environ Med 51:479-486.
中央研究院近代史研究所檔案館，台灣鹼業公司民國四十五年度工作報告。
中石化/台全公司，1999，台南市安順廠區汞及五氯酚污染調查。
呂世宗，1980，鹼氯工廠環境汞污染之調查研究，工業污染防治報告。
李錦地，1980，毒性污染物使用量及殘餘量調查，台灣省水污染防治所報告。
林志森，1985，鹼氯工廠水銀污染防治，工業污染防治報告。
黃煥彰，2002，失落的記憶-台鹼安順廠的污染，看守台灣。
國民健康局，2003，成功大學環境微量毒物研究中心，台南市中石化安順廠附近居民流行病學及健康照護研究(期末報告)。
國家衛生研究院，1997 - 2003，全民健康保險研究資料庫。
行政院衛生署國民健康局，2002，台灣地區國民健康促進知識、態度與行為調查。
行政院衛生署國民健康局，2002，台灣地區高血壓、高血糖、高血脂盛行率調查。
行政院衛生署國民健康局，2005，國民健康訪問暨藥物濫用調查（簡稱：國民健康訪問調查）。
林霧霆，2004，PCDD/F污染水域水生物及鳥類之生物濃縮及生物放大研究，成功大學環境醫學研究所碩士論文。
陳秀玲，2004，臺灣居民血液中戴奧辛來源調查及健康風險評估，成功大學
基礎醫學研究所博士論文。
教育部，2003，實驗廢棄物處理廠附近居民毒性物質暴露風險評估研究第一年(期末報告) 。
教育部，2004，實驗廢棄物處理廠附近居民毒性物質暴露風險評估研究第二年(期末報告)。
行政院環保署，2000，木柵、桃南、新店、樹林等四座垃圾焚化爐附近居民血液中戴奧辛濃度資料之建立專案工作計畫。
行政院環保署，2003，台北縣八里、彰化縣溪洲、嘉義縣鹿草、高雄縣岡山、屏東縣崁頂、台南市城西、台北市內湖及北投等八座垃圾焚化爐附近居民血液中戴奧辛濃度資料之建立專案工作計畫。
行政院環保署，2003，大型垃圾焚化廠附近居民血液中戴奧辛濃度資料之建立計畫。
林文元，2002，利用指標個案病例對照研究來探討代謝症候群的家庭群集現象，台灣大學預防醫學研究所碩士論文。
張珮嘉，2005，台中市四十歲以上民眾代謝症候群盛行率及相關因子之探討。
李龍騰、張玉坤、黃國晉、潘文涵、陳慶餘，2005，台灣地區老年人代謝症候群之盛行率調查，台灣老年醫學雜誌。
李眉、林克能、周碧瑟、傅中玲、王署君、劉秀枝，1994，智能篩檢測驗中文版C-2.0 的初測結果，華文社會的心理測驗。