Extensive
research has used dimethylarsinic acid (DMA) in urine
as a marker of arsenic methylation. The premise is that humans methylate
inorganic arsenicals to monomethylarsonic acid (MMA) and DMA and excrete
these arsenic species into the urine. However, DMA in urine not only
comes from the methylation of inorganic arsenic but also could be
a result of metabolism of other arsenic species, such as arsenosugars
and arsenolipids. Most environmental health and epidemiological studies
of arsenic methylation might have overlooked confounding factors that
contribute to DMA in urine. Here we critically evaluate reported studies
that used methylation indexes, concentration ratios of methylated
arsenicals, or the percentage of DMA in urine as markers of arsenic
methylation efficiency. Dietary intake of arsenosugars potentially
confounds the calculation and interpretation of the arsenic methylation
efficiencies. Many studies have not considered incidental dietary
intake of arsenosugars, arsenolipids, and other organic arsenic species.
Future studies should consider the dietary intake of diverse arsenic
species and their potential effect on the urinary concentrations of
DMA.