The Impact of Diet and Betel Nut Use on Skin Lesions Associated with Drinking-Water Arsenic in Pabna, Bangladesh

Abstract

An established exposure–response relationship exists between water arsenic levels and skin lesions. Results of previous studies with limited historical exposure data, and laboratory animal studies suggest that diet may modify arsenic metabolism and toxicity. In this study, we evaluated the effect of diet on the risk of arsenic-related skin lesions in Pabna, Bangladesh. Six hundred cases and 600 controls loosely matched on age and sex were enrolled at Dhaka Community Hospital, Bangladesh, in 2001–2002. Diet, demographic data, and water samples were collected. Water samples were analyzed for arsenic using inductively coupled plasma mass spectroscopy. Betel nut use was associated with a greater risk of skin lesions in a multivariate model [odds ratio (OR) = 1.67; 95% confidence interval (CI), 1.18–2.36]. Modest decreases in risk of skin lesions were associated with fruit intake 1–3 times/month (OR = 0.68; 95%CI, 0.51–0.89) and canned goods at least 1 time/month (OR = 0.41; 95% CI, 0.20–0.86). Bean intake at least 1 time/day (OR = 1.89; 95% CI, 1.11–3.22) was associated with increased odds of skin lesions. Betel nut use appears to be associated with increased risk of developing skin lesions in Bangladesh. Increased intake of fruit and canned goods may be associated with reduced risk of lesions. Increased intake of beans may be associated with an increased risk of skin lesions. The results of this study do not provide clear support for a protective effect of vegetable and overall protein consumption against the development of skin lesions, but a modest benefit cannot be excluded.

Gender-Specific Protective Effect of Hemoglobin on Arsenic-Induced Skin Lesions

“…Within the gender-Hb interaction model, betel nut chewing and arsenic levels in toenails were predictive of skin lesions, associations shown previously in this population (22). Higher education levels were generally protective against the presence of skin lesions, as were smoking biri and chewing tobacco.…”

“…Toenail clippings, urine samples, and water samples were also collected during this visit. To ensure a sufficient range of arsenic exposure and to reflect the background exposure distribution, up to 80% of controls were selected from ''low-exposure'' arsenic (<50 Ag/L) areas and 20% of the subjects were from ''high exposure'' (z50 Ag/L) areas in Pabna based on the Bangladesh drinking water standard of 50 Ag/L (22). Initial measurements of water arsenic levels for the purpose of control selection were made with Merck field test kits (23).…”

A case-control study of GST polymorphisms and arsenic related skin lesions

“…Sensitivity analysis was conducted by varying weights of controls selected having a well concentration less than 50 μg/l in a weighted logistic regression analysis as described previously[33]. Briefly, this method was used to determine whether the percentage of controls selected from suspected high and low arsenic areas impacted the stability of the ORs of all of the covariates in the regression models.…”

Betel quid chewing elevates human exposure to arsenic, cadmium and lead

“…Another study reported that Bangladeshi men in UK have a high prevalence of hyperhomocystinemia, compared to their white counterparts, with betel quid chewing and smoking as strong risk factors [25,26]. The fact that betel quid chewers who consume As contaminated drinking water in Bangladesh have a higher incidence of skin lesions [12] led us to investigate if betel quids contain significant levels of As, which may be a contributory factor in the development of adverse health impacts in humans. Fortunately for UK Bangladeshis, exposure to As intake from drinking water is not a problem; unlike the population in Bangladesh where an average content of up to 0.084 mg L −1 of As in groundwater has been reported [27].…”

“…Zarda is often used in betel quids instead of untreated tobacco leaves. A relationship between betel quid chewing and increased risk of As induced skin lesions has been reported by several workers [12][13][14].…”