Protective Effects of B Vitamins and Antioxidants on the Risk of Arsenic-Related Skin Lesions in Bangladesh
Zablotska, Lydia B., Chen, Yu, Graziano, Joseph H., Parvez, Faruque, Geen, Alexander van, Howe, Geoffrey R., Ahsan, Habibul, Environmental Health Perspectives
BACKGROUND: An estimated 25-40 million of the 127 million people of Bangladesh have been exposed to high levels of naturally occurring arsenic from drinking groundwater. The mitigating effects of diet on arsenic-related premalignant skin lesions are largely unknown.
OBJECTIVES: The purpose of this study was to clarify the effects of the vitamin B group (thiamin, riboflavin, niacin, pyridoxine, and cobalamin) and antioxidants (vitamins A, C, and E) on arsenicrelated skin lesions.
METHODS: We performed a cross-sectional study using baseline data from the Health Effects of Arsenic Longitudinal Study (HEALS), 2000-2002, with individual-level, time-weighted measures of arsenic exposure from drinking water. A total of 14,828 individuals meeting a set of eligibility criteria were identified among 65,876 users of all 5,996 tube wells in the 25-km (2) area of Araihazar, Bangladesh; 11,746 were recruited into the study. This analysis is based on 10,628 subjects (90.5%) with nonmissing dietary data. Skin lesions were identified according to a structured clinical protocol during screening and confirmed with further clinical review.
RESULTS: Riboflavin, pyridoxine, folic acid, and vitamins A, C, and E significantly modified risk of arsenic-related skin lesions. The deleterious effect of ingested arsenic, at a given exposure level, was significantly reduced (ranging from 46% reduction for pyridoxine to 68% for vitamin C) for persons in the highest quintiles of vitamin intake.
CONCLUSIONS: Intakes of B-vitamins and antioxidants, at doses greater than the current recommended daily amounts for the country, may reduce the risk of arsenic-related skin lesions in Bangladesh.
KEY WORDS: antioxidants, arsenic, Bangladesh, B vitamins, skin lesions. Environ Health Perspect 116:1056-1062 (2008). doi: 10.1289/ehp. 10707 available via http://dx.doi.org/ [Online 16 April 2008]
Inorganic arsenic occurring in various forms in the environment has been classified as a definite human carcinogen (group 1) since 1979 (International Agency for Research on Cancer 1980). Numerous studies conducted in Taiwan and South America found that exposure to inorganic arsenic from drinking water is associated with cancers of the bladder, kidneys, skin, and other organs and tissues (Cantor 1997; Ferreccio et al. 2000).
Similar to Taiwan, several countries in South Asia have high levels of naturally occurring arsenic in groundwater. In the early 1970s, the government of Bangladesh, with the support and financing of the United Nations Children's Fund, promoted the digging of the tube wells to provide clean drinking water. In the late 1990s, evidence indicated that the groundwater, the main source of drinking water in Bangladesh, is contaminated by naturally occurring arsenic in 59 of the 64 districts of the country. An estimated 25-40 million of Bangladesh's 127 million people have been exposed to levels frequently above the national limit of 50 ppb and often reaching levels as high as 800 ppb (British Geological Survey 2006).
Several studies have shown convincing evidence of the association between drinking arsenic-rich water and skin lesions, which are recognized as precursors of nonmelanoma skin cancer (Ahsan et al. 2006b; Guha Mazumder et al. 1998; Tondel et al. 1999). Recent studies conducted in South Asia have raised the possibility that antioxidants may modify the effects of water arsenic on the risk of skin lesions (Hsueh et al. 1995; Vahter 2000). Folate and cobalamin (vitamin [B.sub.12]) have been suggested to play an important role in the detoxification of ingested arsenic (Gamble et al. 2005b; Mitra et al. 2004; National Research Council 1999). Specifically, methylation of arsenic is a folic acid-dependent reaction catalyzed by a cobalamin-dependent enzyme (Gamble et al. 2005b; Zakharyan and Aposhian 1999). Steinmaus et al. (2005) showed that consumption of high levels of niacin (vitamin [B. …