A case-cohort study examining lifetime exposure to inorganic arsenic in drinking water and diabetes mellitus
Highlights
► We present complex lifetime exposure assessment for arsenic in drinking water. ► Our exposure assessment was validated with urinary biomarker. ► The risk for diabetes increases with exposure to arsenic in drinking water. ► The risk for diabetes with arsenic exposure is independent of known risk factors.
Section snippets
Background
Human exposure to arsenic can occur from many sources including the occupational setting (smeltering and wood preservation),, ingestion of contaminated food, and smoking; however, the majority of exposure is through drinking contaminated water (US EPA, 1988). Previous research has documented a relationship between exposure to high concentrations of inorganic arsenic in drinking water and the risk of type 2 diabetes mellitus (DM) (Lai et al., 1994, Tseng et al., 2000, Rahman et al., 2003, Wang
Study sample
The relationship between inorganic arsenic exposures over time and the risk of incident DM was studied using a case-cohort design within the San Luis Valley Diabetes Study (SLVDS). The SLVDS is a population-based prospective study of risk factors for diabetes mellitus (DM) and other related chronic diseases among Hispanic and non-Hispanic white residents of Alamosa and Conejos Counties in south-central Colorado who were 20 to 74 years of age at their initial study visit. Participant recruitment
Results
This study included a cohort of 548 participants in which there were 141 cases and 6956 person years of follow-up. The study cohort (n=488) was similar to the original cohort (n=936) in demographic, behavioral, and clinical characteristics. On average, cases were similar to non-cases in age and distribution of gender, income group, smokers, and intake of alcohol (Table 1). Cases had a higher percentage of Hispanics and participants with a family history of DM than non-cases. At baseline,
Discussion
In this case-cohort study we found a modest association between DM risk and lifetime exposure to low levels of inorganic arsenic in drinking water (<100 μg/L). Specifically, we found that for every 15 μg/L increase in arsenic concentration in the drinking water, risk for DM increased by 27 percent (95% CI 1% to 59%) after adjusting for ethnicity, and time varying measures of BMI and physical activity.
The cohort used for this study allowed for a strong study design because of the ongoing
Conclusion
Our study presents an association between chronic low-level inorganic arsenic exposure and DM while adjusting for known risk factors over time: age, BMI, ethnicity, and physical activity. Given the complexity of DM, future research relating arsenic exposure to intermediate endpoints is recommended. Investigating the association between inorganic arsenic and outcomes such as impaired glucose tolerance or insulin resistance can shed light on the mechanistic pathway for disease. Lastly, the
Funding
None.
Disclosure
We (authors) report no potential competing financial or non-financial interests.
Acknowledgments
The authors would like to thank Laurie-Peterson Wright and the chemistry laboratory staff at the Colorado Department of Public Health and Environment for their contribution to this research. We would also like to thank Dr. Richard Hamman for authorization to conduct this research as part of the San Luis Valley Diabetes Studies. We would like to thank all of the participants and residents of the San Luis Valley whose courtesy and interest in the research was the source of its success.
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