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Mutual interaction between nutritional status and chronic arsenic toxicity due to groundwater contamination in an area of Terai, lowland Nepal
  1. Makhan Maharjan1,
  2. Chiho Watanabe1,
  3. Sk Akhtar Ahmad2,
  4. Masahiro Umezaki1,
  5. Ryutaro Ohtsuka1
  1. 1Department of Human Ecology, School of International Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
  2. 2Department of Occupational and Environmental Health, National Institute of Preventive and Social Medicine, Mahakali, Dhaka, Bangladesh
  3. 3National Institute for Environmental Studies, Onogawa, Tsukuba, Ibaraki, Japan
  1. Correspondence to:
 Dr C Watanabe
 Department of Human Ecology, School of International Health, Graduate School of Medicine, Hongo 7-3-1, Tokyo 113-0033, Japan; chiho{at}


Objective: To reveal the inter-relationship between nutritional status and arsenic toxicity.

Design: Cross-sectional study.

Setting: A survey in an area of lowland Nepal, where a high prevalence of both skin manifestation and malnutrition was observed. Daily arsenic intake was estimated by measuring the arsenic concentration and daily consumption of the drinking water.

Participants: Adult villagers (248 men and 291 women). About half were classified as “underweight” (body mass index <18.5), indicating poor nutritional status.

Main results: Arsenic intake was negatively correlated with body mass index and substantially increased the prevalence of underweight individuals, among whom the prevalence of skin manifestations was 1.65-fold higher than normal weight individuals. When exposure level was considered, the prevalence of skin symptoms was consistently higher in the underweight than in the normal group. Although enhanced susceptibility in men was apparent by the increased prevalence of cutaneous symptoms, no sex difference was observed in the prevalence of underweight individuals related with exposure to arsenic.

Conclusions: The present data suggested that exposure to arsenic is associated with an increased prevalence of underweight, a serious health problem in developing countries, which in turn is associated with increased skin manifestation of arsenic poisoning.

  • Astw, arsenic concentrations of the tubewells
  • Asu, arsenic concentrations of the urines
  • BMI, body mass index
  • DAI, daily arsenic intake
  • DWI, daily water intake
  • WHO, World Health Organization

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  • Competing interests: None.

  • Funding: This study was financially supported by the Alliance for Global Sustainability Program and the Ministry of Education, Culture, Sports, Science and Technology in Japan.

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