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Signes-Pastor AJ, Gutiérrez-González E, García-Villarino M, Rodríguez-Cabrera FD, López-Moreno JJ, Varea-Jiménez E, Pastor-Barriuso R, Pollán M, Navas-Acien A, Pérez-Gómez B, Karagas MR. Toenails as a biomarker of exposure to arsenic: A review. Environ Res 2021; 195:110286. [PMID: 33075355 PMCID: PMC7987585 DOI: 10.1016/j.envres.2020.110286] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 05/04/2023]
Abstract
This systematic review summarizes the current evidence related to the reliability of toenail total arsenic concentrations (thereafter "arsenic") as a biomarker of long-term exposure. Specifically, we reviewed literature on consistency of repeated measures over time, association with other biomarkers and metal concentrations, factors influencing concentrations, and associations with health effects. We identified 129 papers containing quantitative original data on arsenic in toenail samples covering populations from 29 different countries. We observed geographic differences in toenail arsenic concentrations, with highest median or mean concentrations in Asian countries. Arsenic-contaminated drinking water, occupational exposure or living in specific industrial areas were associated with an increased toenail arsenic content. The effects of other potential determinants and sources of arsenic exposure including diet, gender and age on the concentrations in toenails need further investigations. Toenail arsenic was correlated with the concentrations in hair and fingernails, and with urine arsenic mainly among highly exposed populations with a toenail mean or median ≥1 μg/g. Overall, there is a growing body of evidence suggesting that arsenic content from a single toenail sample may reflect long-term internal dose-exposure. Toenail arsenic can serve as a reliable measure of toxic inorganic arsenic exposure in chronic disease research, particularly promising for cancer and cardiovascular conditions.
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Affiliation(s)
- Antonio J Signes-Pastor
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, 1 Medical Center Dr, Williamson Translational Research Bldg, Lebanon NH, 03756, USA.
| | - Enrique Gutiérrez-González
- Spanish Agency of Food Safety and Nutrition, Ministry of Consumer Affairs, Alcalá, 56, 28014, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Monforte de Lemos 5, 28029, Madrid, Spain
| | - Miguel García-Villarino
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Monforte de Lemos 5, 28029, Madrid, Spain; Unit of Molecular Cancer Epidemiology, University Institute of Oncology of the Principality of Asturias (IUOPA) - Department of Medicine, University of Oviedo, Julian Clavería Street s/n, 33006, Oviedo, Asturias, Spain
| | - Francisco D Rodríguez-Cabrera
- Public Health Teaching Unit, National School of Public Health, Carlos III Institute of Health, Monforte de Lemos 5, 28029. Madrid, Spain
| | - Jorge J López-Moreno
- Public Health Teaching Unit, National School of Public Health, Carlos III Institute of Health, Monforte de Lemos 5, 28029. Madrid, Spain
| | - Elena Varea-Jiménez
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, 28029, Madrid, Spain
| | - Roberto Pastor-Barriuso
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Monforte de Lemos 5, 28029, Madrid, Spain; Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, 28029, Madrid, Spain
| | - Marina Pollán
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Monforte de Lemos 5, 28029, Madrid, Spain; Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, 28029, Madrid, Spain
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Beatriz Pérez-Gómez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Monforte de Lemos 5, 28029, Madrid, Spain; Public Health Teaching Unit, National School of Public Health, Carlos III Institute of Health, Monforte de Lemos 5, 28029. Madrid, Spain; Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, 28029, Madrid, Spain
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, 1 Medical Center Dr, Williamson Translational Research Bldg, Lebanon NH, 03756, USA
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