Arsenic and Fasting Blood Glucose in the Context of Other Drinking Water Chemicals: A Cross-Sectional Study in Bangladesh Open Access
Ourshalimian, Shadassa (Spring 2018)
Abstract
Goal: To evaluate the association between groundwater arsenic and fasting blood glucose (FBG), in the context of other groundwater chemicals, in Bangladesh.
Methods: Fasting blood glucose, body mass index, sociodemographic variables, and diabetes medication use were measured among adults ≥ 35 years of age (n=6,587) participating in the Bangladesh Demographic and Health Survey (BDHS) 2011. Groundwater chemicals in 3,534 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. Survey-estimation linear regression methods were used to model FBG, among those using groundwater as primary drinking-water source, as a function of groundwater arsenic. We considered possibly context-dependent arsenic effects within strata of the 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, and used 2 df F-tests to evaluate any arsenic-FBG association.
Results: Compared to persons exposed to groundwater arsenic ≤10 mg/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 mg/L and ≤50 mg/L, and was 1.01 (0.97, 1.03) for those with >50 mg/L arsenic. In adjusted models, arsenic was nominally associated (p<0.05) with fasting blood glucose within strata of other chemicals: high zinc, as well as low calcium, iron, magnesium, and potassium. No chemical-stratified, confounder-adjusted models had Bonferroni-significant arsenic associations, but among persons with low-iron water, arsenic’s unadjusted association with fasting blood glucose was Bonferroni-significant (p<0.0018).
Conclusions: In our exploratory analysis, no overall association between arsenic and fasting blood glucose was detected. This may be due to exposure misclassification. We did detect associations of arsenic with fasting blood glucose conditional on other groundwater chemicals, but these associations may be false positives from multiple testing. Future research might consider these drinking water chemicals as potential effect modifiers of arsenic’s associations with glycemia.
Table of Contents
Table of Contents
Introduction……………………...1
Methods…….……………………...2
Results……………………………...6
Discussion………………………….8
Conclusions……………………...11
Tables………………………….…..12
References……………………....21
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