Nutritional Factors and Susceptibility to Arsenic-Caused Skin Lesions in West Bengal, India

Abstract

There has been widespread speculation about whether nutritional deficiencies increase the susceptibility to arsenic health effects. This is the first study to investigate whether dietary micronutrient and macronutrient intake modulates the well-established human risk of arsenic-induced skin lesions, including alterations in skin pigmentation and keratoses. The study was conducted in West Bengal, India, which along with Bangladesh constitutes the largest population in the world exposed to arsenic from drinking water. In this case-control study design, cases were patients with arsenicinduced skin lesions and had < 500 µg/L arsenic in their drinking water. For each case, an age-and sex-matched control was selected from participants of a 1995-1996 cross-sectional survey, whose drinking water at that time also contained < 500 µg/L arsenic. Nutritional assessment was based on a 24-hr recall for major dietary constituents and a 1-week recall for less common constituents. Modest increases in risk were related to being in the lowest quintiles of intake of animal protein [odds ratio (OR) = 1.94; 95% confidence interval (CI), 1.05-3.59], calcium (OR = 1.89; 95% CI, 1.04-3.43), fiber (OR = 2.20; 95% CI, 1.15-4.21), and folate (OR = 1.67; 95% CI, 0.87-3.2). Conditional logistic regression suggested that the strongest associations were with low calcium, low animal protein, low folate, and low fiber intake. Nutrient intake was not related to arsenic exposure. We conclude that low intake of calcium, animal protein, folate, and fiber may increase susceptibility to arsenic-caused skin lesions. However, in light of the small magnitude of increased risks related to these dietary deficiencies, prevention should focus on reducing exposure to arsenic.

Association of Clinical Complications with Nutritional Status and the Prevalence of Leukopenia among Arsenic Patients in Bangladesh

“…Patients with protein-energy malnutrition have inadequate supply of methionine from dietary sources, and studies in rabbits have shown low amount of methionine or protein in the diet decreased methylation of inorganic arsenic [30]; and deficiency of other dietary trace elements including zinc and selenium [31] may lead to arsenic accumulation and contribute to the toxic effects in the body. A recent study has shown that low intake of calcium, animal protein, folate and dietary fiber may increase susceptibility to arseniccaused skin lesions [32]. Moreover, apart from the poor nutritional status, peoples in Bangladesh have greater daily intake of water (and thus consume more arsenic) than those living in other parts of the world that are not tropical, and thereby suffer from the adverse effects of arsenic toxicity.…”

Protective Role of Spirulina and Vitamin E against Arsenic Toxicity in Rats

“…Low intake of calcium, animal protein, folate and fiber may increase susceptibility to arsenic-caused skin lesions (Mitra et al, 2004). The potential of dietary antioxidants (vitamin C, E and β-carotene) may reduce the arsenic burden in human by increasing its metabolism (Dey, 2002).…”

Groundwater Arsenic Contamination in West Bengal: Current Scenario, Effects and Probable Ways of Mitigation

“…Several studies have suggested a strong association between poor nutritional status with clinical manifestations of chronic arsenicosis, resulted less detoxification in the liver and impaired urinary elimination of arsenic ; Haque et al, 2003;Mitra et al, 2004).…”