Original Contribution Arsenic Exposure and Incidence of Type 2 Diabetes in Southwestern American Indians
Original Contribution Arsenic Exposure and Incidence of Type 2 Diabetes in Southwestern American Indians
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N. Kim;Clinton C. Mason;R. Nelson;Scott E. Afton;A. Essader;James E Medlin;K. Levine;J. Hoppin;Cynthia J Lin;W. Knowler;D. Sandler
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作者：
N. Kim;Clinton C. Mason;R. Nelson;Scott E. Afton;A. Essader;James E Medlin;K. Levine;J. Hoppin;Cynthia J Lin;W. Knowler;D. Sandler
在1982年至2007年期间，对来自亚利桑那州的2型糖尿病高患病率的美国印第安人进行了糖尿病筛查，研究了尿砷浓度与糖尿病发病率之间的关系。居住在饮用水中砷含量超过联邦建议限制的人口。150名年龄≥25岁、随后发展为2型糖尿病的非糖尿病受试者按检查年份和性别与150名未患糖尿病≥10年的对照组进行匹配。根据尿肌酐水平调整后的尿总砷浓度范围为6.6µg/L至123.1µg/L，无机砷浓度范围为0.1µg/L至36.0µg/L。在调整了年龄、性别、体重指数和尿肌酐水平的logistic回归模型中，总砷和无机砷增加2倍时，发生糖尿病的比值比分别为1.11（95%可信区间（CI）： 0.79, 1.57）和1.16 （95% CI: 0.89, 1.53）。分类分析表明，无机砷四分位数与糖尿病发病率呈正相关（P = 0.056）；四分位数2-4与四分位数1的事后比较显示，上四分位数患糖尿病的几率高出2倍（OR = 2.14, 95% CI: 1.19, 3.85）。适度升高的无机砷暴露可以预测美国印第安人的2型糖尿病。需要进行更大规模的研究，包括特定砷的测量才能得到证实。环境暴露于砷与不良健康结果有关，包括生殖异常、心血管疾病和癌症。无机形式的砷（亚砷酸盐和砷酸盐）主要来自于摄入受污染的饮用水或食物，是造成这些影响的原因，而有机形式的砷碱、砷糖和砷脂主要来自于摄入海鲜，被认为是无毒的(1)。据报道，在台湾和孟加拉国，饮用水中高浓度的无机砷通常高于500 μg/L，与2型糖尿病风险增加有关（2 - 4），在墨西哥，即使是中等浓度的无机砷也与风险增加有关(5)。2003-2004年全国健康和营养检查调查（NHANES）的分析表明，接触低浓度或中等浓度的砷可能会大大增加患2型糖尿病的风险(6)。然而，砷暴露与2型糖尿病之间的关系是有争议的。大多数支持高砷暴露人群之间关系的证据来自生态学研究，这些研究没有关于个人暴露的数据。最近一项对孟加拉国11319名参与者的研究表明，每个人的……
Association of urinary arsenic concentration with incident diabetes was examined in American Indians from Arizona who have a high prevalence of type 2 diabetes and were screened for diabetes between 1982 and 2007. The population resides where drinking water contains arsenic at concentrations above federally recommended limits. A total of 150 nondiabetic subjects aged ≥25 years who subsequently developed type 2 diabetes were matched by year of examination and sex to 150 controls who remained nondiabetic for ≥10 years. Total urinary arsenic concentration , adjusted for urinary creatinine level, ranged from 6.6 µg/L to 123.1 µg/L, and inorganic arsenic concentration ranged from 0.1 µg/L to 36.0 µg/L. In logistic regression models adjusted for age, sex, body mass index, and urinary creatinine level, the odds ratios for incident diabetes were 1.11 (95% confidence interval (CI): 0.79, 1.57) and 1.16 (95% CI: 0.89, 1.53) for a 2-fold increase in total arsenic and inorganic arsenic, respectively. Categorical analyses suggested a positive relationship between quartiles of inorganic arsenic and incident diabetes (P = 0.056); post-hoc comparison of quartiles 2–4 with quartile 1 revealed 2-fold higher odds of diabetes in the upper quartiles (OR = 2.14, 95% CI: 1.19, 3.85). Modestly elevated exposure to inorganic arsenic may predict type 2 diabetes in American Indians. Larger studies that include measures of speciated arsenic are required for confirmation. Environmental exposure to arsenic is associated with adverse health outcomes, including reproductive abnormalities , cardiovascular disease, and cancer. Inorganic forms of arsenic (arsenite and arsenate), derived principally from ingestion of contaminated drinking water or food, are responsible for these effects, whereas arsenobetaine, arseno-sugars, and arsenolipids, which are organic forms derived principally from ingestion of seafood, are considered non-toxic (1). Very high levels of inorganic arsenic in drinking water, typically above 500 μg/L, are reportedly associated with an increased risk of type 2 diabetes in Taiwan and Ban-gladesh (2–4), and even moderate concentrations are associated with increased risk in Mexico (5). Analysis of the 2003–2004 National Health and Nutrition Examination Survey (NHANES) suggests that exposure to low or moderate concentrations of arsenic may substantially increase the risk of type 2 diabetes (6). The relationship between arsenic exposure and type 2 diabetes , however, is controversial. Most evidence supporting the relationship in populations with high arsenic exposure comes from ecological studies, which have no data on exposure within individuals. A recent study of 11,319 participants in Bangladesh, in which each individual's …