Arsenic exposure and type 2 diabetes: results from the 2007-2009 Canadian Health Measures Survey

Research progress on arsenic, arsenic-containing medicinal materials, and arsenic-containing preparations: clinical application, pharmacological effects, and toxicity

Introduction: The toxicity of arsenic is widely recognized globally, mainly harming human health by polluting water, soil, and food. However, its formulations can also be used for the clinical treatment of diseases such as leukemia and tumors. Arsenic has been used as a drug in China for over 2,400 years, with examples such as the arsenic-containing drug realgar mentioned in Shennong's Herbal Classic. We have reviewed references on arsenic over the past thirty years and found that research has mainly focused on clinical, pharmacological, and toxicological aspects. Results and Discussion: The finding showed that in clinical practice, arsenic trioxide is mainly used in combination with all-trans retinoic acid (ATRA) at a dose of 10 mg/d for the treatment of acute promyelocytic leukemia (APL); realgar can be used to treat acute promyelocytic leukemia, myelodysplastic syndrome, and lymphoma. In terms of pharmacology, arsenic mainly exerts anti-tumor effects. The dosage range of the action is 0.01-80 μmol/L, and the concentration of arsenic in most studies does not exceed 20 μmol/L. The pharmacological effects of realgar include antiviral activity, inhibition of overactivated lactate dehydrogenase, and resistance to malaria parasites. In terms of toxicity, arsenic is toxic to multiple systems in a dose-dependent manner. For example, 5 μmol/L sodium arsenite can induce liver oxidative damage and promote the expression of pro-inflammatory factors, and 15 μmol/L sodium arsenite induces myocardial injury; when the concentration is higher, it is more likely to cause toxic damage.

Glycemic Changes Related to Arsenic Exposure: An Overview of Animal and Human Studies

BACKGROUND

Arsenic (As) is a risk factor associated with glycemic alterations. However, the mechanisms of action and metabolic aspects associated with changes in glycemic profiles have not yet been completely elucidated. Therefore, in this review, we aimed to investigate the metabolic aspects of As and its mechanism of action associated with glycemic changes.

METHODS

We searched the PubMed (MEDLINE) and Google Scholar databases for relevant articles published in English. A combination of free text and medical subject heading keywords and search terms was used to construct search equations. The search yielded 466 articles; however, only 50 were included in the review.

RESULTS

We observed that the relationship between As exposure and glycemic alterations in humans may be associated with sex, smoking status, body mass index, age, occupation, and genetic factors. The main mechanisms of action associated with changes induced by exposure to As in the glycemic profile identified in animals are increased oxidative stress, reduced expression of glucose transporter type 4, induction of inflammatory factor expression and dysfunction of pancreatic β cells.

CONCLUSIONS

Therefore, As exposure may be associated with glycemic alterations according to inter-individual differences.

Mediating Role of Liver Dysfunction in the Association between Arsenic Exposure and Diabetes in Chinese Adults: A Nationwide Cross-Sectional Study of China National Human Biomonitoring (CNHBM) 2017-2018

Inconsistent results have been reported regarding the association between low-to-moderate arsenic (As) exposure and diabetes. The effect of liver dysfunction on As-induced diabetes remains unclear. The cross-sectional study included 10,574 adults from 2017-2018 China National Human Biomonitoring. Urinary total As (TAs) levels were analyzed as markers of As exposure. Generalized linear mixed models and restricted cubic splines models were used to examine the relationships among TAs levels, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations, and diabetes prevalence. Mediating analysis was performed to assess whether liver dysfunction mediated the association between TAs and diabetes. Overall, the OR (95% CI) of diabetes in participants in the second, third, and fourth quartiles of TAs were 1.08 (0.88, 1.33), 1.17 (0.94, 1.45), and 1.52 (1.22, 1.90), respectively, in the fully adjusted models compared with those in the lowest quartile. Serum ALT was positively associated with TAs and diabetes. Additionally, mediation analyses showed that ALT mediated 4.32% of the association between TAs and diabetes in the overall population and 8.86% in the population without alcohol consumption in the past year. This study suggested that alleviating the hepatotoxicity of As could have implications for both diabetes and liver disease.

Update of the risk assessment of inorganic arsenic in food

The European Commission asked EFSA to update its 2009 risk assessment on arsenic in food carrying out a hazard assessment of inorganic arsenic (iAs) and using the revised exposure assessment issued by EFSA in 2021. Epidemiological studies show that the chronic intake of iAs via diet and/or drinking water is associated with increased risk of several adverse outcomes including cancers of the skin, bladder and lung. The CONTAM Panel used the benchmark dose lower confidence limit based on a benchmark response (BMR) of 5% (relative increase of the background incidence after adjustment for confounders, BMDL05) of 0.06 μg iAs/kg bw per day obtained from a study on skin cancer as a Reference Point (RP). Inorganic As is a genotoxic carcinogen with additional epigenetic effects and the CONTAM Panel applied a margin of exposure (MOE) approach for the risk characterisation. In adults, the MOEs are low (range between 2 and 0.4 for mean consumers and between 0.9 and 0.2 at the 95th percentile exposure, respectively) and as such raise a health concern despite the uncertainties.

Mechanisms Associated with Cognitive and Behavioral Impairment Induced by Arsenic Exposure

Arsenic (As) is a metalloid naturally present in the environment, in food, water, soil, and air; however, its chronic exposure, even with low doses, represents a public health concern. For a long time, As was used as a pigment, pesticide, wood preservative, and for medical applications; its industrial use has recently decreased or has been discontinued due to its toxicity. Due to its versatile applications and distribution, there is a wide spectrum of human As exposure sources, mainly contaminated drinking water. The fact that As is present in drinking water implies chronic human exposure to this metalloid; it has become a worldwide health problem, since over 200 million people live where As levels exceed safe ranges. Many health problems have been associated with As chronic exposure including cancer, cardiovascular diseases, gastrointestinal disturbances, and brain dysfunctions. Because As can cross the blood-brain barrier (BBB), the brain represents a target organ where this metalloid can exert its long-term toxic effects. Many mechanisms of As neurotoxicity have been described: oxidative stress, inflammation, DNA damage, and mitochondrial dysfunction; all of them can converge, thus leading to impaired cellular functions, cell death, and in consequence, long-term detrimental effects. Here, we provide a current overview of As toxicity and integrated the global mechanisms involved in cognitive and behavioral impairment induced by As exposure show experimental strategies against its neurotoxicity.

An updated systematic review and dose-response meta-analysis on the relation between exposure to arsenic and risk of type 2 diabetes

Arsenic is among the most critical environmental toxicants associated with many human disorders. However, its effect on type 2 diabetes mellitus (T2DM) is contradictory. This systematic review and dose-response meta-analysis aim to update information on the association between arsenic exposure and the risk of T2DM. The sample type (drinking water, urine, blood, and nails) conducted the subgroup analysis. Evaluation of the high vs. low arsenic concentrations showed a significant association between drinking water arsenic (OR: 1.58, 95% CI: 1.20-2.08) and urinary arsenic (OR: 1.37, 95% CI: 1.24-1.51) with the risk of T2DM. The linear dose-response meta-analysis showed that each 1 μg/L increase in levels of drinking water arsenic (OR: 1.01, 95% CI: 1.00-1.01) and urinary arsenic (OR: 1.01, 95% CI: 1.00-1.02) was associated with a 1% increased risk of T2DM. The non-linear dose-response analysis indicated that arsenic in urine was associated with the risk of T2DM (Pnon-linearity<0.001). However, this effect was not statistically significant for arsenic in drinking water (Pnon-linearity=0.941). Our findings suggest that blood arsenic was not significantly linked to the increased risk of T2DM in high vs. low (OR: 1.21, 95% CI: 0.85-1.71), linear (OR: 1.04, 95% CI: 0.99-1.09), and non-linear (Pnon-linearity=0.365) analysis. Also, nail arsenic was not associated with the risk of T2DM in this meta-analysis (OR: 1.33, 95% CI: 0.69-2.59). This updated dose-response meta-analysis indicated that arsenic exposure was significantly correlated with the risk of T2DM.

Association of obesity, diabetes, and hypertension with arsenic in drinking water in the Comarca Lagunera province (north-central Mexico)

Chronic endemic regional hydroarsenicism (CERHA) is a global issue that affects over 200 million people exposed to arsenic (As) in drinking water. This includes 1.75 million individuals residing in La Comarca Lagunera, a region in north-central Mexico. Arsenic levels in this region typically exceeds the WHO guideline of 10 µg L^-1. Biochemical alterations related to the human As metabolism may increase the risk of overweight and obesity (O&O), type 2 diabetes (T2D), and hypertension (AHT). In our study, we investigated the role of As in drinking water as a risk factor for these metabolic diseases. We focused on populations with historically moderate (San Pedro) and low (Lerdo) drinking water As levels and people with no historical evidence of As water contamination. The exposure assessment to As was based on measurements of the drinking water (medians 67.2, 21.0, 4.3 µg L^-1) and urinary As concentrations in women (9.4, 5.3, 0.8 µg L^-1) and men (18.1, 4.8, 1.0 µg L^-1). A significant correlation between As in drinking water and urine evidenced the As exposure in the population (R² = 0.72). Adjusted odds ratios with 95% confidence intervals evidenced higher chances of being diagnosed with T2D (1.7, 1.2-2.0) and AHT (1.8, 1.7-1.9) in individuals living in San Pedro than those in Lerdo. Still, there was no significant association with obesity. Individuals living in CERHA towns were found to have a higher risk of obesity (1.3-1.9), T2D (1.5 to 3.3), and AHT (1.4 to 2.4) compared to those residing in non-CERHA towns. Finally, obesity is more probable in women [inverse of OR and 95%CI 0.4 (0.2-0.7)] compared to men, while men is more likely to be diagnosed with T2D [OR = 2.0 (1.4-2.3)] and AHT [OR = 2.0 (1.5-2.3)] than women, independently of the municipality.

Arsenic exposure incurs hyperglycemia mediated by oxidative damage in urban adult population: A prospective cohort study with three repeated measures

The associations and potential mechanisms of low to moderate arsenic exposure with fasting plasma glucose (FPG) and type 2 diabetes mellitus (T2DM) are still unclear. To assess the effects of short-term and long-term arsenic exposure on hyperglycemia and the mediating effect of oxidative damage on such association, three repeated-measures studies with 9938 observations were conducted in the Wuhan-Zhuhai cohort. The levels of urinary total arsenic, FPG, urinary 8-iso-prostaglandin F2alpha (8-iso-PGF2α), urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), and plasma protein carbonyls (PCO) were measured. Generalized linear mixed models were used to evaluate the exposure-response relationships of urinary total arsenic with FPG and the prevalent risks of impaired fasting glucose (IFG), T2DM, and abnormal glucose regulation (AGR). Cox regression models were applied to assess the associations of arsenic exposure with incident risks of IFG, T2DM, and AGR. Mediation analyses were performed to assess the mediating effects of 8-iso-PGF2α, 8-OHdG, and PCO. In cross-sectional analyses, each one-unit increase in natural log-transformed urinary total arsenic was associated with a 0.082 (95% CI: 0.047 to 0.118) mmol/L increase in FPG, as well as a 10.3% (95% CI: 1.4%-20.0%), 4.4% (95% CI: 5.3%-15.2%), and 8.7% (95% CI: 1.2%-16.6%) increase in prevalent risks of IFG, T2DM, and AGR, respectively. In longitudinal analyses, arsenic exposure was further associated with the annual increased rate of FPG with a β (95% CI) of 0.021 (95% CI: 0.010 to 0.033). The incident risks of IFG, T2DM, and AGR were increased without statistical significance when arsenic levels increased. Mediation analyses showed that 8-iso-PGF2α and PCO mediated 30.04% and 10.02% of the urinary total arsenic-associated FPG elevation, respectively. Our study indicated that arsenic exposure was associated with elevated level and progression rate of FPG among general Chinese adults, where lipid peroxidation and oxidative protein damage might be the potential mechanisms.

Comparative Biomonitoring of Arsenic Exposure in Mothers and Their Neonates in Comarca Lagunera, Mexico

Multiple comorbidities related to arsenic exposure through drinking water continue to be public problems worldwide, principally in chronically exposed populations, such as those in the Comarca Lagunera (CL), Mexico. In addition, this relationship could be exacerbated by an early life exposure through the placenta and later through breast milk. This study conducted a comparative analysis of arsenic levels in multiple biological samples from pregnant women and their neonates in the CL and the comparison region, Saltillo. Total arsenic levels in placenta, breast milk, blood, and urine were measured in pregnant women and their neonates from rural areas of seven municipalities of the CL using atomic absorption spectrophotometry with hydride generation methodology. The average concentrations of tAs in drinking water were 47.7 µg/L and 0.05 µg/L in the exposed and non-exposed areas, respectively. Mean levels of tAs were 7.80 µg/kg, 77.04 µg/g-Cr, and 4.30 µg/L in placenta, blood, urine, and breast milk, respectively, in mothers, and 107.92 µg/g-Cr in neonates in the exposed group, which were significantly higher than those in the non-exposed area. High levels of urinary arsenic in neonates were maintained 4 days after birth, demonstrating an early arsenic exposure route through the placenta and breast milk. In addition, our study suggested that breastfeeding may reduce arsenic exposure in infants in arsenic-contaminated areas. Further studies are necessary to follow up on comorbidities later in life in neonates and to provide interventions in this region.

Prevalence of type 2 diabetes mellitus in relation to arsenic exposure and metabolism in Mexican women

BACKGROUND

Experimental studies have shown the diabetogenic potential of inorganic arsenic (iAs); however, the epidemiological evidence is still inconclusive. This could be explained by differences in exposure, metabolism efficiency, nutritional and genetic factors.

OBJECTIVE

To evaluate the association between type 2 diabetes mellitus (T2DM) prevalence with arsenic exposure and metabolism, considering one-carbon metabolism nutrient intake and arsenite methyltransferase (AS3MT) polymorphisms.

METHODS

From healthy controls of a case control study for female breast cancer in northern Mexico, 227 self-reported diabetic women were age-matched with 454 non-diabetics. Participants were interviewed about dietary, sociodemographic and clinical characteristics. Urinary iAs metabolites were determined by HPLC-ICP-MS, methylation efficiency parameters were calculated, and AS3MT c.860 T > C and c.529-56G > C genotypes were determined. Unconditional logistic regression models were used to evaluate associations.

RESULTS

Total arsenic in urine (TAs) ranged from 0.73 to 248.12 μg/L with a median of 10.48 μg/L. In unadjusted analysis, TAs (μg/g) was significantly higher in cases than controls, but not when expressed as TAs (μg/L). Cases had significantly lower urinary monomethylarsonic acid percentage (%MMA), first methylation ratio (FMR), creatinine, and choline and selenium intakes. In multi-adjusted models and in women without HTA history T2DM showed significant positive associations with %iAs and FMR, respectively, and a significant negative association with %DMA. In participants with HTA history there was a marginal positive association (p = 0.08) between T2DM and TAs concentrations (μg/g) without other significant associations.

CONCLUSIONS

Our results support an association between T2DM prevalence and iAs metabolism but not with urinary arsenic levels. However, elucidation of the interplay among iAs metabolism, T2DM and HTA merit further studies.

Research for type 2 diabetes mellitus in endemic arsenism areas in central China: role of low level of arsenic exposure and KEAP1 rs11545829 polymorphism

Type 2 diabetes mellitus (T2DM) is one of the major public health problems worldwide; both genetic and environmental factors are its risk factors. Arsenic, an environmental pollutant, might be a risk factor for T2DM, but the association of low-to-moderate level arsenic exposure with the risk of T2DM is still inconsistent. Single nucleotide polymorphisms (SNPs) can affect the development of T2DM, but the study on KEAP1 rs11545829 (G>A) SNP is few. In this paper, we explored the effect of KEAP1 rs11545829 (G>A) SNP and low-to-moderate level arsenic exposure on risk of T2DM in a cross-sectional case-control study conducted in Shanxi, China. Total of 938 participants, including 318 T2DM cases and 618 controls, were enrolled. Blood glycosylated haemoglobin (HbA1c) was detected by Automatic Biochemical Analyzer, and participants with HbA1c≧6.5% were diagnosed as T2DM. Urinary total arsenic (tAs, mg/L), as the indicator of arsenic exposure, was detected by liquid chromatography-atomic fluorescence spectrometry (LC-AFS). Genomic DNA was extracted and the genotypes of KEAP1 rs11545829 SNP were examined by multiplex polymerase chain reaction (PCR). The urinary tAs concentration in recruited participants was 0.075 (0.03-0.15) mg/L, and was associated with an increased risk of T2DM (OR = 8.45, 95% CI 2.63-27.17); rs11545829 mutation homozygote AA genotype had a protective effect on risk of T2DM (OR = 0.42, 95 % CI 0.25-0.73). Although this protective effect of AA genotype was found in participants with higher urinary tAs level (>0.032 mg/L) (OR = 0.48, 95% CI 0.26-0.86), there was no interaction effect for arsenic exposure and rs11545829 SNP on risk of T2DM. In addition, BMI modified the association between rs11545829 SNP and the risk of T2DM (RERI = -1.11, 95% CI -2.18-0.04). The present study suggest that low-to-moderate level arsenic exposure may be a risk factor, while KEAP1 rs11545829 SNP mutation homozygote AA genotype may be a protective factor for risk of T2DM, especially for T2DM patients with urinary tAs level>0.032 mg/L.

The Global Burden of Type 2 Diabetes Attributable to Tobacco: A Secondary Analysis From the Global Burden of Disease Study 2019

OBJECTIVES

Growing epidemiological studies have reported the relationship between tobacco and health loss among patients with type 2 diabetes (T2D). This study aimed to explore the secular trend and spatial distribution of the T2D burden attributable to tobacco on a global scale to better understand regional disparities and judge the gap between current conditions and expectations.

METHODS

As a secondary analysis, we extracted data of tobacco-attributable T2D burden from the 2019 Global Burden of Disease Study (GBD). Joinpoint regression was adopted to determine the secular trend of age-standardized rates (ASR), with average annual percentage change (AAPC). Gaussian process regression (GPR) was used to explore the average expected relationship between ASRs and the socio-demographic index (SDI). Spatial autocorrelation was used to indicate if there is clustering of age-standardized DALY rate (ASDR) with Moran's I value. Multi-scale geographically weighted regression (MGWR) was to investigate the spatial distribution and scales of influencing factors in ASDR attributable to tobacco, with the regression coefficients for each influencing factor among 204 countries.

RESULTS

Tobacco posed a challenge to global T2D health, particularly for the elderly and men from lower SDI regions. For women, mortality attributable to secondhand smoke was higher than smoking. A downward trend in age-standardized mortality rate (ASMR) of T2D attributable to tobacco was observed (AAPCs= -0.24; 95% CI -0.30 to -0.18), while the ASDR increased globally since 1990 (AAPCs= 0.19; 0.11 to 0.27). Oceania, Southern Sub-Saharan Africa, and Southeast Asia had the highest ASMRs and ASDRs, exceeding expectations based on the SDI. Also, "high-high" clusters were mainly observed in South Africa and Southeast Asian countries, which means a high-ASDR country is surrounded by high-ASDR neighborhoods in the above areas. According to MGWR model, smoking prevalence was the most sensitive influencing factor, with regression coefficients from 0.15 to 1.80.

CONCLUSION

The tobacco-attributable burden of T2D should be considered as an important health issue, especially in low-middle and middle-SDI regions. Meanwhile, secondhand smoke posed a greater risk to women. Regional disparities existed, with hot spots mainly concentrated in South Africa and Southeast Asian countries.

Arsenic exposure and non-carcinogenic health effects

Inorganic arsenic (iAs) exposure is a serious health problem that affects more than 140 million individuals worldwide, mainly, through contaminated drinking water. Acute iAs poisoning produces several symptoms such as nausea, vomiting, abdominal pain, and severe diarrhea, whereas prolonged iAs exposure increased the risk of several malignant disorders such as lung, urinary tract, and skin tumors. Another sensitive endpoint less described of chronic iAs exposure are the non-malignant health effects in hepatic, endocrine, renal, neurological, hematological, immune, and cardiovascular systems. The present review outlines epidemiology evidence and possible molecular mechanisms associated with iAs-toxicity in several non-carcinogenic disorders.

Arsenic Exposure, Arsenic Metabolism, and Glycemia: Results from a Clinical Population in New York City

Little information is available regarding the glycemic effects of inorganic arsenic (iAs) exposure in urban populations. We evaluated the association of total arsenic and the relative proportions of arsenic metabolites in urine with glycemia as measured by glycated blood hemoglobin (HbA1c) among 45 participants with prediabetes (HbA1c ≥ 5.7-6.4%), 65 with diabetes (HbA1c ≥ 6.5%), and 36 controls (HbA1c < 5.7%) recruited from an academic medical center in New York City. Each 10% increase in the proportion of urinary dimethylarsinic acid (DMA%) was associated with an odds ratio (OR) of 0.59 (95% confidence interval (CI): 0.28-1.26) for prediabetes, 0.46 (0.22-0.94) for diabetes, and 0.51 (0.26-0.99) for prediabetes and diabetes combined. Each 10% increase in the proportion of urinary monomethylarsonic acid (MMA%) was associated with a 1.13% (0.39, 1.88) increase in HbA1c. In contrast, each 10% increase in DMA% was associated with a 0.76% (0.24, 1.29) decrease in HbA1c. There was no evidence of an association of total urinary arsenic with prediabetes, diabetes, or HbA1c. These data suggest that a lower arsenic methylation capacity indicated by higher MMA% and lower DMA% in urine is associated with worse glycemic control and diabetes. Prospective, longitudinal studies are needed to evaluate the glycemic effects of low-level iAs exposure in urban populations.

Maternal Arsenic Exposure and Gestational Diabetes: A Systematic Review and Meta-Analysis

Gestational diabetes mellitus (GDM) is a metabolic complication associated with adverse outcomes for mother and fetus. Arsenic (As) exposure has been suggested as a possible risk factor for its development. The aim of this meta-analysis was to provide a comprehensive overview of published evidence on the association between As and GDM. The systematic search from PubMed, MEDLINE, and Scopus was limited to full-length manuscripts published in peer-reviewed journals up to April 2020, identifying fifty articles. Ten studies met the inclusion criteria, nine for quantitative synthesis with a total of n = 1984 GDM cases. The overall pooled risk was 1.56 (95% Confidence Interval - CI = 1.23, 1.99) with moderate heterogeneity (χ² = 21.95; I²% = 64). Several differences among the included studies that may account for heterogeneity were investigated. Stratification for exposure indicator confirmed a positive association for studies assessing urine As. A slightly higher risk was detected pooling studies based in Asia rather than in North America. Stratification for GDM diagnostic criteria showed higher risks when diagnosis was made according to the Canadian Diabetes Association (CDA-SOGC) or World Health Organization (WHO) criteria, whereas a lower risk was observed when adopting the American Diabetes Association (ADA) criteria. These results provide additional evidence for a possible association between As exposure and GDM, although the data need to be interpreted with caution due to heterogeneity.

Interactions of arsenic metabolism with arsenic exposure and individual factors on diabetes occurrence: Baseline findings from Arsenic and Non-Communicable disease cohort (AsNCD) in China

The interaction between arsenic metabolism and potential modifiers on the risk of diabetes is unclear. This research aimed to investigate arsenic metabolism and diabetes prevalence and to identify the interactive effects of arsenic metabolism with some risk factors on diabetes in a Chinese population. A baseline cross-sectional survey was performed in two areas with groundwater arsenic contamination in China. Arsenic levels in water and arsenic metabolites in urine were analyzed. The proportions of each arsenic metabolite (inorganic arsenic [iAs%], monomethylarsonic acid [MMA%], and dimethylarsinic acid [DMA%]) were computed to evaluate arsenic metabolism. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the association between arsenic and diabetes. Interaction on the additive scale between arsenic methylation index and effect modifier was evaluated by calculating the relative excess risk due to interaction (RERI). Compared with participants in the lower tertile of MMA%, participants in the middle and upper tertiles of MMA% were less prone to diabetes (OR: 0.47 and 0.31, respectively). However, participants in the upper tertiles of urinary DMA% (OR: 3.18) were more likely to have diabetes than those participants in the lower tertiles. The stratified analyses revealed that a one-unit increase in DMA% was associated with higher odds of diabetes in females (OR: 1.06, 95% CI: 1.01, 1.11), older people (OR: 1.05, 95% CI: 1.00, 1.10), and subjects with body mass index (BMI) under 25 kg/m² (OR: 1.07, 95% CI: 1.01, 1.14). The additive interactions between DMA% and female gender (RERI: 0.40, 95% CI: 0.01, 11.88), DMA% and age (RERI: 0.02, 95% CI: 0.01, 8.85), as well as DMA% and BMI (RERI: 0.49, 95% CI: 0.01, 9.62), were statistically significant. In conclusion, efficient arsenic metabolism is associated with higher odds of diabetes. Urinary DMA% and individual factors interact to synergistically influence diabetes occurrence in the Chinese population.

A case-control study of arsenic exposure with the risk of primary ovarian insufficiency in women

Arsenic, a well-known toxic metalloid, is ubiquitously existed in environment. Arsenic exposure has been associated with female reproductive health. However, a potential association between arsenic exposure and primary ovarian insufficiency (POI) in women has not been recognized yet. In this case-control study, a total of 169 POI cases and 209 healthy controls were recruited to determine urinary concentrations of arsenic and serum levels of reproductive hormones (follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH) and estradiol). The median concentration of urinary arsenic in cases (21.5 μg/L, 28.0 μg/g for creatinine adjustment) was significantly higher than that of controls (13.8 μg/L, 19.3 μg/g for creatinine adjustment). Urinary arsenic concentrations were significantly positively associated with the risk of POI (adjusted odds ratio (OR) = 2.66, 95% CI: 1.43-4.95 for the highest vs lowest tertile of arsenic, p = 0.002; p for trend = 0.004). We also assessed the associations between arsenic exposure and reproductive hormones that are important for ovarian functions. FSH and LH levels were positively associated with urinary arsenic, whereas AMH and estradiol levels were negatively correlated with this element. This study provided evidence that arsenic exposure could be the potential risk factor for POI in women.

Association between arsenic exposure and biomarkers of type 2 diabetes mellitus in a Croatian population: A comparative observational pilot study

Chronic exposure to high inorganic As levels in drinking water has been related to many diseases, including type 2 diabetes mellitus (T2D). The association with low and moderate As levels, however, remains controversial and has yet not been studied in European populations. This study aimed to investigate possible association between As exposure and biomarkers of T2D in Croatian population. Observation recruited 86 adults from Eastern Croatia, where groundwater is contaminated with inorganic As, and 116 adults from Western Croatia, where As levels in drinking water are low. Both populations were divided in patient groups (T2D or prediabetes) and healthy controls. Exposure was assessed by determining total As in blood and urine and As metabolites in urine. Eastern Croatian population had a significantly higher content of As in urine than Western, whereas the opposite was true for arsenobetain. Total As and As metabolites in urine positively correlated with hemoglobin A1c (HbA1c) and negatively with albuminuria. This study provides important preliminary data on the levels of As in urine and blood and their association with biomarkers of T2D in Croatian population exposed to low or moderate levels of As through drinking water as a solid basis for further research of the pathophysiological effects of such As exposure on the status and complications of diabetes.

Environmental risk assessment of chronic arsenic in drinking water and prevalence of type-2 diabetes mellitus in Pakistan

Chronic arsenic (As) unprotection in drinking water can lead to Type 2 Diabetes Mellitus (T2DM). The purpose of this study was to investigate the association between chronic As in drinking water and the prevalence of T2DM. A study was conducted in targeted urban areas of Peshawar city of KPK, Pakistan, where drinking water is heavily contaminated with chronic arsenic. Participants protected to arsenic were selected from Kohat city of KPK, Pakistan (where people consumed water that is free from As contamination) and treated as the control group. People with arsenic-related skin lesions were defined as participants unprotected to arsenic. T2DM was diagnosed using a glucometer following the fasting blood glucose ≥6.0 mmol L^-1 from the WHO guideline. The common odds ratio for T2DM among participants unprotected to arsenic was <4. The Mantel-Haenszel weighted prevalence ratio with 95% of confidence interval for confounding factors were (age <4 m femininity <4 and body mass index >4). The results revealed that designated association were important. The findings suggested that unprotected chronic arsenic in drinking water may be a risk factor of T2DM.

Arsenic and fasting blood glucose in the context of other drinking water chemicals: a cross-sectional study in Bangladesh

GOAL

The goal of this study was to evaluate the association between groundwater arsenic and fasting blood glucose in the context of other groundwater chemicals, in Bangladesh.

METHODS

Fasting blood glucose, gender, body mass index, sociodemographic variables, and diabetes medication use were measured among adults ≥ 35 years of age (n = 6587) participating in the Bangladesh Demographic and Health Survey (BDHS) 2011. Groundwater chemicals in 3534 well water samples were measured in the British Geological Survey (BGS) and Department of Public Health Engineering (DPHE) 1998-99 survey. We assigned the nearest BGS-DPHE well's chemical exposure to each BDHS participant. We used survey-estimation linear regression methods to model natural log-transformed fasting blood glucose, among those using groundwater as their primary drinking-water source, as a function of groundwater arsenic. We considered possible interactions between categorical arsenic exposure and each of 14 other groundwater chemicals dichotomized at their medians. The chemicals considered as possible effect modifiers included: aluminum, barium, calcium, iron, potassium, lithium, magnesium, manganese, sodium, phosphorous, silicon, sulfate, strontium, and zinc.

RESULTS

Compared to persons exposed to groundwater arsenic ≤ 10 μg/L, the adjusted geometric mean ratio (GMR) of fasting blood glucose was 1.01 (95% confidence interval: 0.98, 1.04) for individuals exposed to groundwater arsenic concentrations > 10 μg/L and ≤ 50 μg/L, and was 1.01 (0.97, 1.03) for those with > 50 μg/L arsenic. There were no Bonferroni-significant interactions with other chemicals, after accounting for the large number of chemicals tested as modifiers.

CONCLUSIONS

In our analysis of groundwater chemistry data from 1998/99 and fasting blood glucose outcomes measured in nearby populations approximately a decade later, there was no overall association of fasting blood glucose with nearby historical groundwater arsenic. This null association was not significantly modified by the historical levels of other groundwater chemicals. These null results are inconclusive regarding shorter-term potential toxicity of arsenic for glucose regulation, if there are differences between the historical concentrations measured in nearby groundwater and the actual drinking water chemical exposures in the population during the etiologically relevant period for more acute phenotypes like fasting blood glucose. Drinking water supply-relevant, longitudinal exposure assessment with less measurement error is needed to more precisely evaluate the joint impacts of drinking water chemicals and establish if there is a sensitive time window for glycemic outcomes.

Low to moderate toenail arsenic levels in young adulthood and incidence of diabetes later in life: findings from the CARDIA Trace Element study

Some studies suggest a positive association between arsenic exposure and risk of diabetes. However, the findings are inconsistent and inconclusive, particularly at a low to moderate arsenic exposure level, and longitudinal data are lacking. We examined toenail arsenic at low to moderate level in young adulthood in relation to incidence of diabetes later in life. This study included 4102 black and white participants aged 20-32 at baseline (1987-88) who completed up to 7 follow-up exams through 2015-16. Toenail arsenic was measured by collision-cell inductively-coupled-plasma mass-spectrometry. Incident diabetes was defined as fasting glucose ≥ 126 mg/dL, non-fasting glucose ≥ 200 mg/dL, 2-h postchallenge glucose ≥ 200 mg/dL, hemoglobin A1c ≥ 6.5%, or use of glucose-lowering medications. Cox proportional hazards model and generalized estimating equations (GEEs) were used to determine the associations of quintiles of toenail arsenic with incident diabetes and other metabolic parameters. The median (inter-quartile range) toenail arsenic level was 0.097 (0.065-0.150) ppm in this study. During the follow-up period, 599 incident cases of diabetes were identified. After adjustment for potential confounders, the hazards ratio (95% confidence interval) was 0.96 (0.73, 1.27) (P for linear trend= 0.85) comparing the highest to the lowest quintile of toenail arsenic levels. No significant association was observed between toenail arsenic and levels of fasting glucose, insulin, homeostatic model assessment of insulin resistance, homeostatic model assessment of beta cell function, or C-reactive protein. The null associations persisted across subgroups of age, sex, race, and body mass index. Findings from this longitudinal study do not support the hypothesis that low to moderate toenail arsenic levels in young adulthood is associated with diabetes risk later in life.

Targeted metabolomics to understand the association between arsenic metabolism and diabetes-related outcomes: Preliminary evidence from the Strong Heart Family Study

BACKGROUND

Inorganic arsenic exposure is ubiquitous and both exposure and inter-individual differences in its metabolism have been associated with cardiometabolic risk. A more efficient arsenic metabolism profile (lower MMA%, higher DMA%) has been associated with reduced risk for arsenic-related health outcomes. This profile, however, has also been associated with increased risk for diabetes-related outcomes.

OBJECTIVES

The mechanism behind these conflicting associations is unclear; we hypothesized the one-carbon metabolism (OCM) pathway may play a role.

METHODS

We evaluated the influence of OCM on the relationship between arsenic metabolism and diabetes-related outcomes (HOMA2-IR, waist circumference, fasting plasma glucose) using metabolomic data from an OCM-specific and P180 metabolite panel measured in plasma, arsenic metabolism measured in urine, and HOMA2-IR and FPG measured in fasting plasma. Samples were drawn from baseline visits (2001-2003) in 59 participants from the Strong Heart Family Study, a family-based cohort study of American Indians aged ≥14 years from Arizona, Oklahoma, and North/South Dakota.

RESULTS

In unadjusted analyses, a 5% increase in DMA% was associated with higher HOMA2-IR (geometric mean ratio (GMR)= 1.13 (95% CI: 1.03, 1.25)) and waist circumference (mean difference=3.66 (0.95, 6.38). MMA% was significantly associated with lower HOMA2-IR and waist circumference. After adjustment for OCM-related metabolites (SAM, SAH, cysteine, glutamate, lysophosphatidylcholine 18.2, and three phosphatidlycholines), associations were attenuated and no longer significant.

CONCLUSIONS

These preliminary results indicate that the association of lower MMA% and higher DMA% with diabetes-related outcomes may be influenced by OCM status, either through confounding, reverse causality, or mediation.

The Association of Arsenic Exposure and Arsenic Metabolism With the Metabolic Syndrome and Its Individual Components: Prospective Evidence From the Strong Heart Family Study

Inorganic arsenic exposure is ubiquitous, and both exposure and interindividual differences in its metabolism have been associated with cardiometabolic risk. However, the associations of arsenic exposure and arsenic metabolism with the metabolic syndrome (MetS) and its individual components are relatively unknown. We used Poisson regression with robust variance to evaluate the associations of baseline arsenic exposure (urinary arsenic levels) and metabolism (relative percentage of arsenic species over their sum) with incident MetS and its individual components (elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, hypertension, and elevated fasting plasma glucose) in 1,047 participants from the Strong Heart Family Study, a prospective family-based cohort study in American Indian communities (baseline visits were held in 1998-1999 and 2001-2003, follow-up visits in 2001-2003 and 2006-2009). Over the course of follow-up, 32% of participants developed MetS. An interquartile-range increase in arsenic exposure was associated with a 1.19-fold (95% confidence interval: 1.01, 1.41) greater risk of elevated fasting plasma glucose concentration but not with other individual components of the MetS or MetS overall. Arsenic metabolism, specifically lower percentage of monomethylarsonic acid and higher percentage of dimethylarsinic acid, was associated with higher risk of overall MetS and elevated waist circumference but not with any other MetS component. These findings support the hypothesis that there are contrasting and independent associations of arsenic exposure and arsenic metabolism with metabolic outcomes which may contribute to overall diabetes risk.

Serum folate and cobalamin levels and urinary dimethylarsinic acid in US children and adults

Nutritional status could affect arsenic metabolism and toxicity in the general population chronically exposed to low levels of inorganic arsenic. In this study, we examined the association of serum folate and cobalamin with urinary concentrations of dimethylarsinic acid (DMA), the most abundant metabolite of inorganic arsenic measured in urine, in children and adults who participated in the 2003-2006 US National Health and Nutrition Examination Surveys. A total of 1161 children (aged 6-19 years) and 1938 adults (aged 20-85 years) were analyzed for the association using multivariate general linear models, adjusting for potential confounders. We observed a positive association between serum levels of folate and cobalamin and creatinine-corrected urinary concentrations of DMA in both children and adults. Furthermore, serum levels of folate and cobalamin were inversely associated with homocysteine (Hcy). These results suggest that dietary intake of folate and cobalamin may exhibit protective functions against arsenic toxicity by increasing arsenic metabolism to the less toxic metabolite DMA and decreasing serum levels of Hcy.

Association between serum arsenic levels and gestational diabetes mellitus: A population-based birth cohort study

Gestational diabetes mellitus (GDM) is a common obstetric complication with adverse effects on both mothers and their children. Previous studies revealed the link between Arsenic (As) exposure and incidence of diabetes mellitus (DM), but the data on the association between maternal As exposure and GDM is scarce. We examined this association among a population-based birth cohort. As concentrations were determined at multiple time points during pregnancy by ICP-MS. The association between As levels and GDM prevalence was examined using logistic regression model after adjustment for confounders. A total of 419 (12.85%) women were diagnosed with GDM. The incidences of GDM gradually increased with increasing quartiles of As levels with significant trend. As levels were associated with the GDM (95%CI: 1.29-2.43) at only the 4th quartile in the first trimester. After adjustment for maternal age, prepregnancy body mass index (BMI), monthly income, gestational age and parity, the association remains significant (95%CI: 1.22-2.38). Stratified analyses showed the associations were largely limited to normal maternal age (95%CI: 1.19-3.04) and normal weight women (95%CI: 1.18-2.66). Our study showed an association between As and GDM in a birth cohort and explored first trimester may be the critical period for As associated GDM. This association was universal in the general pregnant population of normal age and of normal weight.

Association of Low-Moderate Arsenic Exposure and Arsenic Metabolism with Incident Diabetes and Insulin Resistance in the Strong Heart Family Study

BACKGROUND

High arsenic exposure has been related to diabetes, but at low-moderate levels the evidence is mixed. Arsenic metabolism, which is partly genetically controlled and may rely on certain B vitamins, plays a role in arsenic toxicity.

OBJECTIVE

We evaluated the prospective association of arsenic exposure and metabolism with type 2 diabetes and insulin resistance.

METHODS

We included 1,838 American Indian men and women free of diabetes (median age, 36 y). Arsenic exposure was assessed as the sum of inorganic arsenic (iAs), monomethylarsonate (MMA), and dimethylarsinate (DMA) urine concentrations (ΣAs). Arsenic metabolism was evaluated by the proportions of iAs, MMA, and DMA over their sum (iAs%, MMA%, and DMA%). Homeostasis model assessment for insulin resistance (HOMA2-IR) was measured at baseline and follow-up visits. Incident diabetes was evaluated at follow-up.

RESULTS

Median ΣAs, iAs%, MMA%, and DMA% was 4.4 μg/g creatinine, 9.5%, 14.4%, and 75.6%, respectively. Over 10,327 person-years of follow-up, 252 participants developed diabetes. Median HOMA2-IR at baseline was 1.5. The fully adjusted hazard ratio [95% confidence interval (CI)] for incident diabetes per an interquartile range increase in ΣAs was 1.57 (95% CI: 1.18, 2.08) in participants without prediabetes at baseline. Arsenic metabolism was not associated with incident diabetes. ΣAs was positively associated with HOMA2-IR at baseline but negatively with HOMA2-IR at follow-up. Increased MMA% was associated with lower HOMA2-IR when either iAs% or DMA% decreased. The association of arsenic metabolism with HOMA2-IR differed by B-vitamin intake and AS3MT genetics variants.

CONCLUSIONS

Among participants without baseline prediabetes, arsenic exposure was associated with incident diabetes. Low MMA% was cross-sectional and prospectively associated with higher HOMA2-IR. Research is needed to confirm possible interactions of arsenic metabolism with B vitamins and AS3MT variants on diabetes risk. https://doi.org/10.1289/EHP2566.

Association between consumption of private well water contaminated by low levels of arsenic and dysglycemia in a rural region of Quebec, Canada

The association between arsenic (As) exposure and diabetes is not clearly defined for populations exposed to low or moderate levels of inorganic As (iAs) in drinking water (< 150µg/L). In the present study, the relationship between iAs concentration in drinking water (contaminated at a median level of 10.5µg/L) or As biomarkers (ie, urine and nails) and diabetes or prediabetes (defined as level of glycosylated hemoglobin - HbA1c - higher than 6%, self-reported diagnosis of diabetes by a physician, or the use of insulin or oral hypoglycemic drugs) was evaluated in 257 adults from Canada. For that we used logistic regression models and reported the odds ratio (OR) comparing participants in the 80th vs 20th percentile of iAs exposure indicators. The association between iAs exposure indicators and HbA1c was also explored for 234 adults and 35 children not taking insulin or oral hypoglycemic drugs using a linear regression analysis. All models were controlled for confounding variables (age, gender, first-degree family history of diabetes, obesity or overweight in adults' model). We attempted to exclude adults with organic arsenic of marine origin in their urine by removing participants with detectable arsenobetaine or arsenocholine in urinary models. iAs biomarkers (toenail and urine) were not associated with diabetes or prediabetes in adults. iAs in well water was associated with a borderline significantly increased odds of diabetes or prediabetes (OR = 2.39; 95% CI: 0.99-5.72). Higher well water iAs concentrations were significantly associated with increased HbA1c in both adults and children (β: 0.002; p = 0.041 and β: 0.003; p < 0.0001 respectively). In children, HbA1c was also associated with toenail As concentration (β: 0.18; p = 0.016). These results suggest low-level iAs exposure is associated with a continuum of dysglycemia.

Association between cadmium exposure and diabetes mellitus risk: a prisma-compliant systematic review and meta-analysis

Cadmium (Cd) is a pollutant with multiple adverse health effects: cancer, renal dysfunction, osteoporosis and fracture, and cardiovascular disease. Several population-based studies found an association between Cd and diabetes mellitus (DM), but this association is inconsistent with other research. We conducted meta-analysis to examine relationship between urinary/blood Cd exposure and DM risk. Pertinent studies were identified by searching PubMed and Embase databases, and combined odds ratio (OR) and corresponding 95% confidence interval (CI) were applied to evaluate said association. Meta-analysis showed that high U-Cd exposure is not correlated with DM risk (OR = 1.19; 95% CI = 0.83–1.71), and high B-Cd exposure is also not associated with increased risk of DM (OR = 1.16; 95% CI = 0.84-1.62) in the general population. Subgroup and sensitivity analysis proved similar results, with little evidence of publication bias. This meta-analysis suggests that high U-Cd/B-Cd exposure may not be risk factor for DM in general populations. However, large prospective studies are needed to confirm this finding.

Smoking and the risk of type 2 diabetes

Despite accumulating evidence demonstrating strong epidemiologic and mechanistic associations between cigarette smoking, hyperglycemia, and the development of type 2 diabetes, tobacco abuse has not been uniformly recognized as a modifiable risk factor in diabetes prevention or screening strategies. In this review, we highlight population-based studies that have linked cigarette smoking with an increased risk of type 2 diabetes and summarize clinical and preclinical studies offering insight into mechanisms through which cigarette smoking and nicotine exposure impact body composition, insulin sensitivity, and pancreatic β cell function. Key questions for future studies are identified and strategies for smoking cessation as a means to decrease diabetes risk are discussed.

Body burdens, sources and interrelations of selected toxic and essential elements among the nine Cree First Nations of Eeyou Istchee, James Bay region of northern Quebec, Canada

BACKGROUND

this article constitutes a report on the comprehensive Nituuchischaayihtitaau Aschii multi-community environment-and-health study conducted among the Cree peoples (Eeyouch) of northern Quebec, Canada.

OBJECTIVES

to interpret observed concentrations of a suite of chemical elements in a multi-media biological monitoring study in terms of sources and predictors.

METHODS

the concentrations of 5 essential and 6 toxic chemical elements were measured in whole blood, and/or in urine or hair by ICP-MS. Concentrations of essential elements are compared to those considered normal (i.e., required for good health) and, when toxic, deemed acceptable at specified concentrations in public health guidelines. Their dependence on age, sex, the specific community lived-in and diet were explored employing multivariate analysis of variance (MANOVA) involving new variables generated by principle component analysis (PCA) and correspondence analysis (CA).

RESULTS

the 5 most prominent PCA axes explained 67.7% of the variation, compared to 93.0% by 6 main CA factors. Concentrations of the essential elements in whole blood (WB) and iodine(i) and arsenic (As) in urine were comparable to those reported in the recent Canadian Health Measures survey and are assigned to dietary sources. By contrast, WB cadmium (Cd) was elevated even when smoking was considered. Mercury (Hg) concentrations in WB and hair were also higher in adults, although comparable to those observed for other indigenous populations living at northern latitudes. Fish consumption was identified as the prominent source. Of the 5 coastal communities, all but one had lower Hg exposures than the four inland communities, presumably reflecting the type of fish consumed. Use of firearms and smoking were correlated with WB-lead (Pb). The concentrations of both Hg and Pb increased with age and were higher in men, while WB-Cd and smoking prevalence were higher in women when considering all communities. Hg and Pb were low in children and women of reproductive age, with few exceedances of health guidelines. Although individuals with T2D had somewhat lower WB-Cd, there is some indication that Cd may potentiate renal dysfunction in this subgroup. Plots of selected CA axes grouped those elements expected to be in a normal diet and distinguished them from those with well-known unique sources (especially Hg and As in hair; and Hg, Pb and Cd in WB).

CONCLUSIONS

the use of multiple biological media in conjunction with the complementary PCA and CA approaches for constructing composite variables allowed a more detailed understanding of both the sources of the essential and toxic elements in body fluids and the dependencies of their observed concentrations on age, sex, community and diet.

Arsenic: The Underrecognized Common Disease-inducing Toxin

Arsenic toxicity is far more of a clinical problem than commonly recognized. At least 10% of the public water supplies contain levels of arsenic known to increase risk of many chronic diseases, such as cardiovascular disease, many cancers, peripheral neuropathy, and diabetes. Some parts of the country have very high arsenic levels, but because fewer than half of all private and public water supplies have been tested for this common toxin, those drinking or consuming food grown with such water will likely not be aware of their exposure. Several key single nucleotide polymorphisms (SNPs) and methylation deficits can significantly increase a patient's susceptibility to arsenic toxicity. Reduction of arsenic toxicity starts, of course, with avoidance. This means evaluation of water contamination, avoidance of rice and chicken unless tested, cleaning up any old pressure treated wood in the environment, and other precautions. Excretion, neutralization, and protection from damage are facilitated through optimizing methylation processes and the use of natural health products such as turmeric and green tea, and liberally consuming cabbage family foods.

An overview of human biomonitoring of environmental chemicals in the Canadian Health Measures Survey: 2007-2019

Human biomonitoring (HBM) is used to indicate and quantify exposure by measuring environmental chemicals, their metabolites or reaction products in biological specimens. The biomonitoring component of the Canadian Health Measures Survey (CHMS) is the most comprehensive initiative providing general population HBM data in Canada. The CHMS is an ongoing cross-sectional direct measures survey implemented in 2-year cycles. It provides nationally-representative data on health, nutritional status, environmental exposures, and related risks and protective characteristics. The survey follows a robust planning, design and sampling protocol as well as a comprehensive quality assurance and quality control regime implemented for all aspect of the survey to ensure the validity of the HBM results. HBM blood and urine data are available for CHMS cycles 1 (2007-2009), 2 (2009-2011) and 3 (2012-2013). Field collection has been completed for cycle 4 (2014-2015), with cycle 5 (2016-2017) in progress and cycle 6 planning (2018-2019) being finalized. Biomonitoring results for 279 chemicals are expected over the six cycles of the CHMS (220 in individual blood, urine or hair samples, and 59 in pooled serum samples). The chemicals include metals and trace elements, polychlorinated biphenyls (PCBs), organochlorines, flame retardants, perfluoroalkyl substances, volatile organic compounds (VOCs) and metabolites, environmental phenols, triclocarban, acrylamide, pesticides (e.g., triazines, carbamates, organophosphates, phenoxy, pyrethroids) and/or their metabolites, chlorophenols, polycyclic aromatic hydrocarbon (PAH) metabolites, phthalates and alternate plasticizer metabolites, and tobacco biomarkers. Approximately one half of the chemicals measured in individual blood and urine samples over the first three cycles were detected in more than 60% of samples. CHMS biomonitoring data have been used to establish baseline HBM concentrations in Canadians; inform public health, regulatory risk assessment and management decisions; and fulfil national and international reporting requirements. Concurrent efforts are underway in Canada to develop statistically- and risk-based concepts and tools to interpret biomonitoring data.