Abul Hasnat Milton

Chronic Arsenic Exposure and Adverse Pregnancy Outcomes in Bangladesh

Background: Chronic exposure to arsenic through drinking water has the potential to cause adverse pregnancy outcomes, although the association has not been demonstrated conclusively. This cross-sectional study assessed the association between arsenic in drinking water and spontaneous abortion, stillbirth, and neonatal death. Methods: In this cross-sectional study, 533 women were interviewed. Information on sociodemographic characteristics, drinking water use, and adverse pregnancy outcomes was obtained through a structured pretested interviewer-administered questionnaire. The respondents reported use of a total of 223 tube wells; for 208 wells, water samples were measured using an ultraviolet/visible spectrophotometry method, whereas 15 were measured by flow-injection hydride generation atomic absorption spectrometry (FIHG-AAS). Results: Excess risks for spontaneous abortion and stillbirth were observed among the participants chronically exposed to higher concentrations of arsenic in drinking water after adjusting for participants height, history of hypertension and diabetes, and (for neonatal death only) age at first pregnancy. Comparing exposure to arsenic concentration of greater than 50 μg/L with 50 μg/L or less, the odds ratios were 2.5 (95% confidence interval = 1.5–4.3) for spontaneous abortion, 2.5 (1.3–4.9) for stillbirth, and 1.8 (0.9–3.6) for neonatal death. Conclusions: These study findings suggest that chronic arsenic exposure may increase the risk of fetal and infant death.

Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka

The global prevalence of chronic kidney disease (CKD) of uncertain etiology may be underreported. Community-level epidemiological studies are few due to the lack of national registries and poor focus on the reporting of non-communicable diseases. Here we describe the prevalence of proteinuric-CKD and disease characteristics of three rural populations in the North Central, Central, and Southern Provinces of Sri Lanka. Patients were selected using the random cluster sampling method and those older than 19 years of age were screened for persistent dipstick proteinuria. The prevalence of proteinuric-CKD in the Medawachchiya region (North Central) was 130 of 2600 patients, 68 of 709 patients in the Yatinuwara region (Central), and 66 of 2844 patients in the Hambantota region (Southern). The mean ages of these patients with CKD ranged from 44 to 52 years. Diabetes and long-standing hypertension were the main risk factors of CKD in the Yatinuwara and Hambantota regions. Age, exceeding 60 years, and farming were strongly associated with proteinuric-CKD in the Medawachchiya region; however, major risk factors were uncertain in 87% of these patients. Of these patients, 26 underwent renal biopsy; histology indicated tubulointerstitial disease. Thus, proteinuric-CKD of uncertain etiology is prevalent in the North Central Province of Sri Lanka. In contrast, known risk factors were associated with CKD in the Central and Southern Provinces.

Respiratory effects and arsenic contaminated well water in Bangladesh

Arsenic in drinking water causes a widespread concern in Bangladesh, where a major proportion of tube wells is contaminated. Arsenic ingestion causes skin lesions, which is considered as definite exposure. A prevalence comparison study of respiratory effects among subjects with and without arsenic exposure through drinking water was conducted in Bangladesh. Exposed participants were recruited through health awareness campaign programs. Unexposed participants were randomly selected, where tubewells were not contaminated with arsenic. A total of 169 individuals participated (44 exposed individuals exhibiting skin lesions; 125 unexposed individuals). The arsenic concentrations ranged from 136 to 1000 w g l−1. The information regarding respiratory system signs and symptoms were also collected and the analyses were confined to nonsmokers. The crude prevalence ratio for chronic bronchitis and chronic cough amounted to 2.1 (95% CI 0.7-6.1). The prevalence ratios for chronic bronchitis increased with increasing exposure, i.e., 1.0, 1.6, 2.7 and 2.6 using unexposed as the reference. The prevalence ratios for chronic cough were 1.0, 1.6, 2.7 and 2.6 for the exposure categories, using the same unexposed as the reference. The dose-response trend was the same (P < 0.1) for both conditions. These results add to evidence that long-term ingestion of arsenic exposure can cause respiratory effects.

Association between nutritional status and arsenicosis due to chronic arsenic exposure in Bangladesh.

The role of nutritional factors in arsenic metabolism and toxicity is not clear. Provision of certain low protein diets resulted in decreased excretion of DMA and increased tissue retention of arsenic in experimental studies. This paper reports a prevalence comparison study conducted in Bangladesh to assess the nutritional status among the chronic arsenic exposed and unexposed population. 138 exposed individuals diagnosed as arsenicosis patients were selected from three known arsenic endemic villages of Bangladesh and age, sex matched 144 unexposed subjects were randomly selected from three arsenic free villages. The mean arsenic concentration in drinking water for the exposed and unexposed population was 641.15 and 13.5 μg L−1 respectively. Body Mass Index was found to be lower than 18.5, the cut off point for malnutrition, in 57 (41.31%) out of 138 exposed arsenicosis cases and 31 (21.53%) out of 144 unexposed individuals. The crude prevalence ratio (or risk) was 1.92 (95% CI = 1.33 – 2.78) for poor nutritional status among the arsenicosis cases compared to the unexposed population. The findings of this study add to the evidence that poor nutritional status may increase an individuals susceptibility to chronic arsenic toxicity, or alternatively that arsenicosis may contribute to poor nutritional status.

Chronic Arsenic Poisoning and Respiratory Effects in Bangladesh

Chronic Arsenic Poisoning and Respiratory Effects in Bangladesh: Abul Hasnat Milton, et al. Arsenic Cell, NGO Forum for Drinking Water Supply & Sanitation, Bangladesh—A large population in Bangladesh have been exposed to naturally occurring inorganic arsenic through their drinking water. A prevalence comparison study of respiratory disorders among subjects with and without arsenic exposure through drinking water was conducted in Bangladesh. Characteristic skin lesions, keratoses and pigmentation alteration, and the water arsenic level confirmed the arsenic exposure. Three villages were selected from health awareness campaign programs. Participants in these courtyard meetings who had suspected skin lesions, i.e., keratosis, hyperpigmentation and hypopigmentation, were examined by a well‐trained medical officer to confirm the diagnosis. Unexposed subjects were randomly selected from another village, where tubewells were not contaminated with arsenic. We interviewed and examined 218 individuals irrespective of age and sex from these villages. The arsenic level in their drinking water was measured and the mean arsenic level was 614μ/l(ranging from 136μg/l to 1,000μg/l). Information regarding respiratory system signs and symptoms was also collected. There were few smokers, and analyses were therefore confined to nonsmokers. The overall crude prevalence (or risk) among the exposed subjects for chronic cough, and chronic bronchitis, was three times the prevalence in the control population. Age was a slightly negative confounding factor. The crude prevalence ratios were noticeably increased for female participants compared to male participants. A possible explanation for this noticeably increased occurrence of respiratory signs and symptoms in women is related to the presence of weakness. These results add to the evidence that long‐term ingestion of arsenic can cause respiratory problems especially among females.

Continuous Glucose Monitoring–Guided Insulin Adjustment in Children and Adolescents on Near-Physiological Insulin Regimens A randomized controlled trial

OBJECTIVE—This randomized controlled trial assesses the effect on glycemic control of continuous glucose monitoring system (CGMS)-guided insulin therapy adjustment in young people with type 1 diabetes on intensive diabetes treatment regimens with continuous subcutaneous insulin infusion (CSII) or glargine. RESEARCH DESIGN AND METHODS—Pediatric subjects were recruited if they had an HbA1c (A1C) <10% and had been on CSII or glargine for at least 3 months. Thirty-six subjects were randomized to insulin adjustment on the basis of 72 h of CGMS every 3 weeks or intermittent self-monitoring of blood glucose (SMBG) for 3 months. A1C and fructosamine were measured at baseline and 6 and 12 weeks. Follow-up A1C was measured at 6 months. Mean baseline A1C was 8.2% (n = 19) in the CGMS group and 7.9% (n = 17) in the control group. RESULTS—There was a significant improvement in A1C from baseline values in both groups, but there was no difference in the degree of improvement in A1C at 12 weeks between the CGMS (−0.4% [95% CI −0.7 to −0.1]) and the control group (−0.4% [−0.8 to 0.2]). In the CGMS group, improved A1C was at the cost of increased duration of hypoglycemia. CONCLUSIONS—CGMS is no more useful than intermittent fingerstick SMBG and frequent review in improving diabetes control in reasonably well-controlled patients on near-physiological insulin regimens when used in an outpatient clinic setting.

Association between type 2 diabetes and chronic arsenic exposure in drinking water: A cross sectional study in Bangladesh

BackgroundChronic exposure to high level of inorganic arsenic in drinking water has been associated with Type 2 Diabetes (T2D). Most research has been ecological in nature and has focused on high levels of arsenic exposure with few studies directly measuring arsenic levels in drinking water as an index of arsenic exposure. The effect of low to moderate levels of arsenic exposure on diabetes risk is largely unknown thus our study is adding further knowledge over previous works.MethodsThis cross sectional study was conducted in 1004 consenting women and men from 1682 eligible participants yielding a participation rate of 60%. These participants are aged > 30 years and were living in Bangladesh and had continuously consumed arsenic-contaminated drinking water for at least 6 months. T2D cases were diagnosed using glucometer following the new diagnostic criteria (Fasting Blood Glucose > 126 mg/dl) from the WHO guideline (WHO 2006), or a self-reported physician diagnosis of type 2 diabetes. Association between T2D and chronic arsenic exposure was estimated by multiple logistic regression with adjustment for age, sex, education, Body Mass Index (BMI) and family history of T2D.ResultsA total of 1004 individuals participated in the study. The prevalence of T2D was 9% (95% CI 7-11%). After adjustment for diabetes risk factors, an increased risk of type 2 diabetes was observed for arsenic exposure over 50 μg/L with those in the highest category having almost double the risk of type 2 diabetes (OR=1.9 ; 95% CI 1.1-3.5). For most levels of arsenic exposure, the risk estimates are higher with longer exposure; a dose–response pattern was also observed.ConclusionsThese findings suggest an association between chronic arsenic exposure through drinking water and T2D. Risks are generally higher with longer duration of arsenic exposure. The risk of T2D is highest among those who were exposed to the highest concentration of arsenic for more than 10 years.

Dietary zinc is associated with a lower incidence of depression: findings from two Australian cohorts.

BACKGROUND Several animal and human studies have shown that zinc plays a role in reducing depression, but there have been no longitudinal studies in both men and women on this topic. The aim of this study was to investigate dietary zinc, and the zinc to iron ratio, as predictors of incident depression in two large longitudinal studies of mid-age and older Australians. METHODS Data were self-reported, as part of the Australian Longitudinal Study on Women׳s Health (women aged 50-61 years) and Hunter Community Study (men and women aged 55-85 years). Validated food frequency questionnaires were used to assess dietary intake. Energy-adjusted zinc was ranked using quintiles and predictors of incident depression were examined using multivariate logistic regression. RESULTS Both studies showed an inverse association between dietary zinc intake and risk of depression, even after adjusting for potential confounders. Compared to those with the lowest zinc intake those with the highest zinc intake had significantly lower odds of developing depression with a reduction of about 30-50%. There was no association between the zinc to iron ratio and developing depression in either study. LIMITATIONS Dietary assessment was carried out only at baseline and although adjustments were made for all known potential confounders, residual confounding cannot be entirely excluded. CONCLUSIONS Low dietary zinc intake is associated with a greater incidence of depression in both men and women, as shown in two prospective cohorts. Further studies into the precise role of zinc compared to other important nutrients from the diet are needed.

Non-cancer Effects of Chronic Arsenicosis in Bangladesh: Preliminary Results

Abstract A total of 136 patients were studied in three Upazillas of Laxmipur, Barisal and Madaripur districts were selected for health awareness campaign program. According to the existing data, these villages were ranked as high exposure. Demographic data of the patients investigated are showing pigmentation was seen in all—136 cases, keratosis was found only in 110 cases, and skin ulcer was detected in 13 cases. The predominant features are indicating respiratory sign and symptoms followed by conjunctival congestion and redness of eyes. Weakness was predominant symptom, and all most all cases reported weakness. There were few smokers (n = 16) and analyses were confined to non-smokers (n = 94). A total of the 94 subjects participated in this study. The sex ratio was 1:1.3 (male vs. female). The relative risk of chronic cough increased with age (RR = 2.12, for 26–50 age group; RR = 2.30 for age group more than 51) reflecting chronic exposure, but the 95% confidence intervals included unity. The relative risk of chronic bronchitis increased with age (RR = 2.68, for 26–50 age group; RR = 2.30 for age group more than 51) reflecting chronic exposure, but the 95% confidence intervals also included unity. The findings presented here provide evidence that ingestion of inorganic arsenic in drinking water may results in increases risk of chronic cough and bronchitis.

Association between hypertension and chronic arsenic exposure in drinking water: a cross-sectional study in Bangladesh.

Chronic arsenic exposure and its association with hypertension in adults are inconclusive and this cross-sectional study investigated the association. The study was conducted between January and July 2009 among 1,004 participants from 1,682 eligible women and men aged ≥30 years living in rural Bangladesh who had continuously consumed arsenic-contaminated drinking water for at least 6 months. Hypertension was defined as systolic blood pressure ≥140 mmHg (systolic hypertension) and diastolic blood pressure ≥90 mmHg (diastolic hypertension). Pulse pressure was calculated by deducting diastolic from systolic pressure and considered to be increased when the difference was ≥55 mmHg. The prevalence of hypertension was 6.6% (95% CI: 5.1–8.3%). After adjustment for other factors, no excess risk of hypertension was observed for arsenic exposure >50μg/L or to that of arsenic exposure as quartiles or as duration. Arsenic concentration as quartiles and >50 μg/L did show a strong relationship with increased pulse pressure (adjusted OR: 3.54, 95% CI: 1.46–8.57), as did arsenic exposure for ≥10 years (adjusted OR: 5.25, 95% CI: 1.41–19.51). Arsenic as quartiles showed a dose response relationship with increased pulse pressure. Our study suggests an association between higher drinking water arsenic or duration and pulse pressure, but not hypertension.