The objective of this study was to assess whether arsenic exposure is a risk factor for diabetes mellitus as indicated in a few earlier studies. Arsenic in drinking water is known to occur in western Bangladesh, and in 1996, two of the authors conducted a survey of the prevalence of diabetes mellitus among 163 subjects with keratosis taken as exposed to arsenic and 854 unexposed individuals. Diabetes mellitus was determined by history of symptoms, previously diagnosed diabetes, glucosuria, and blood sugar level after glucose intake. The crude prevalence ratio for diabetes mellitus among keratotic subjects exposed to arsenic was 4.4 (95% confidence interval 2.5-7.7) and increased to 5.2 (95% confidence interval 2.5-10.5) after adjustment for age, sex, and body mass index. On the basis of a few earlier measurements of arsenic concentrations in drinking water by the authorities in Bangladesh and another 20 new ad hoc analyses, approximate time-weighted exposure levels to arsenic in drinking water could be estimated for each subject. Three time-weighted average exposure categories were created, i.e., less than 0.5, 0.5-1.0, and more than 1.0 mg/liter. For the unexposed subjects, the corresponding prevalence ratios were 1.0, 2.6, 3.9, and 8.8, representing a significant trend in risk (p < 0.001). The result corroborates earlier studies and suggests that arsenic exposure is a risk factor for diabetes mellitus.
Abstract-A prevalence comparison of hypertension among subjects with and those without arsenic exposure through drinking water was conducted in Bangladesh to confirm or refute an earlier observation of a relation in this respect. Wells with and without present arsenic contamination were identified, and we interviewed and examined 1595 subjects who were depending on drinking water from these wells for living, all Ն30 years of age. The interview was based on a questionnaire, and arsenic exposure was estimated from the history of well-water consumption and current arsenic levels. Of the 1595 subjects studied, 1481 had a history of arsenic-contaminated drinking water, whereas 114 had not. Time-weighted mean arsenic levels (in milligrams per liter) and milligram-years per liter of arsenic exposure were estimated for each subject. Exposure categories were assessed as Ͻ0.5 mg/L, 0.5 to 1.0 mg/L, and Ͼ1.0 mg/L and alternatively as Ͻ1.0 mg-y/L, 1.0 to 5.0 mg-y/L, Ͼ5.0 but Յ10.0 mg-y/L, and Ͼ10.0 mg-y/L, respectively. Hypertension was defined as a systolic blood pressure of Ն140 mm Hg in combination with a diastolic blood pressure of Ն90 mm Hg. Corresponding to the exposure categories, and using "unexposed" as the reference, the prevalence ratios for hypertension adjusted for age, sex, and body mass index were 1.2, 2.2, 2.5 and 0.8, 1.
To determine the relationship of arsenic-associated skdn lesions and degree of arsenic xposure, a cross-sectional study was conducted in Bangladesh, where a large part of the population is eposed through drinking water. Four vges in Bangladesh were identified as mainly dependent on wells contaminated with arsenic. We interviewed and examined 1,481 subjects 30 years of age in these villa. A total of 430 subject had skin lesions (keratosis, hyperpientaion, or hypopigmentaton). Individual exposure assessment could only be estimated by present levels and in terms of a dose index, i.e., arsenic lecvls divided by individual body weight. Arsenic water concentraions ranged from 10 to 2,0 pgL, and the crude overall prelence rate for sin lesions was 29/100. After age adjustment to the world population the prevalence rate was 30.1/100 and 26.5/100 for males and females, respectively. There was a sigificant trend for the prevalence rate both in relation to exposure levels and to dose index (p c 0.05), dless of sex. This study shows a higher prevalence rate of arsenic skin lesions in males than females, with clear dose-rponse relationship. The overall high prevaence rate in the studied villages is an alarming sign of arsenic exposure and requires an urgent remedy. Key wuord cross-sectional study, ecology, environment, epidemiology, exposure, keratosis, public health.
Objectives-Exposure to arsenic causes keratosis, hyperpigmentation, and hypopigmentation and seemingly also diabetes mellitus, at least in subjects with skin lesions. Here we evaluate the relations of arsenical skin lesions and glucosuria as a proxy for diabetes mellitus. Methods-Through existing measurements of arsenic in drinking water in Bangladesh, wells with and without arsenic contamination were identified. Based on a questionnaire, 1595 subjects >30 years of age were interviewed; 1481 had a history of drinking water contaminated with arsenic whereas 114 had not. Time weighted mean arsenic concentrations and mg-years/l of exposure to arsenic were estimated based on the history of consumption of well water and current arsenic concentrations. Urine samples from the study subjects were tested by means of a glucometric strip. People with positive tests were considered to be cases of glucosuria. Results-A total of 430 (29%) of the exposed people were found to have skin lesions. Corresponding to drinking water with <0.5, 0.5-1.0, and >1.0 mg/l of arsenic, and with the 114 unexposed subjects as the reference, the prevalence ratios for glucosuria, as adjusted for age and sex, were 0.8, 1.4, and 1.4 for those without skin lesions, and 1.1, 2.2, and 2.6 for those with skin lesions. Taking exposure as <1.0, 1.0-5.0, >5.0-10.0 and >10.0 mg-years/l of exposure to arsenic the prevalence ratios, similarly adjusted, were 0.4, 0.9, 1.2, and 1.7 for those without and 0.8, 1.7, 2.1, and 2.9 for those with skin lesions. All series of risk estimates were significant for trend, (p<0.01). Conclusions-The results suggest that skin lesions and diabetes mellitus, as here indicated by glucosuria, are largely independent eVects of exposure to arsenic although glucosuria had some tendency to be associated with skin lesions. Importantly, however, glucosuria (diabetes mellitus) may occur independently of skin lesions. (Occup Environ Med 1999;56:277-281)
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