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

• Type of Material: Article
• Authors: Shadassa Ourshalimian, Emory University; Abu Mohd Naser, Emory University; Mahbubur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh; Solaiman Doza, International Centre for Diarrhoeal Disease Research, Bangladesh; Jennifer Stowell, Emory University; Kabayam Venkat Narayan, Emory University; Mohammad Shamsudduha, University College London; Matthew Gribble, Emory University
• Language: English
• Date: 2019-05-01
• Publisher: Academic Press Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.envres.2018.12.049
• Title of Journal or Parent Work: Environmental Research
• Volume: 172
• Start Page: 249
• End Page: 257
• Grant/Funding Information: Our analysis was supported by a grant from Unilever Ltd., and supported in part by funding from the National Institute of Environmental Health Sciences (P30 ES019776).
• Keywords: Diabetes mellitus; Prevalence; Exposure; Association; Science & Technology; Epidemiology; Exposome; Variability; Environmental Sciences & Ecology; Cumulative risk assessment; Public, Environmental & Occupational Health; Exposure mixtures; Medical geology; Life Sciences & Biomedicine; Diabetes; Environmental Sciences
• Research Categories: Health Sciences, Epidemiology; Environmental Sciences; Biogeochemistry; Health Sciences, Occupational Health and Safety

Abstract

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.