Nutritional deficiency and arsenical manifestations: a perspective study in an arsenic-endemic region of West Bengal, India.

OBJECTIVE: To assess whether nutritional deficiency increases susceptibility to arsenic-related health effects. DESIGN: Assessment of nutrition was based on a 24 h recall method of all dietary constituents. SETTING: Epidemiological cross-sectional study was conducted in an arsenic endemic area of West Bengal with groundwater arsenic contamination. SUBJECTS: The study was composed of two groups ­ Group 1 (cases, n 108) exhibiting skin lesions and Group 2 (exposed controls, n 100) not exhibiting skin lesions ­ age- and sex-matched and having similar arsenic exposure through drinking water and arsenic levels in urine and hair. RESULTS: Both groups belonged to low socio-economic strata (Group 1 significantly poorer, P<0·01) and had low BMI (prevalence of BMI<18·5 kg/m2: in 38% in Group 1 and 27% in Group 2). Energy intake was below the Recommended Daily Allowance (set by the Indian Council of Medical Research) in males and females in both groups. Increased risk of arsenical skin lesions was found for those in the lowest quintile of protein intake (v. highest quintile: OR=4·60, 95% CI 1·36, 15·50 in males; OR=5·62, 95% CI 1·19, 34·57 in females). Significantly lower intakes of energy, protein, thiamin, niacin, Mg, Zn and choline were observed in both males and females of Group 1 compared with Group 2. Significantly lower intakes of carbohydrate, riboflavin, niacin and Cu were also observed in female cases with skin lesions compared with non-cases. CONCLUSIONS: Deficiencies of Zn, Mg and Cu, in addition to protein, B vitamins and choline, are found to be associated with arsenical skin lesions in West Bengal.

Hypertension in chronic arsenic exposure: A case control study in West Bengal.

Various systemic manifestations are reported to be caused by chronic arsenic exposure in the population living in the Indo-Bangladesh subcontinent. This study from West Bengal assesses the likelihood of occurrence of hypertension (HTN) in individuals resident in an area of high groundwater contamination with arsenic (Nadia district) compared to those from a non-contaminated area (Hoogly district) in West Bengal, India. Two hundred and eight study participants (Group 1) were recruited from a cross-sectional study in six villages in the Nadia district and 100 controls (Group 2) from a village in the Hoogly district. The two groups were evenly matched in regard to age and sex. History taking and clinical examination including blood pressure measurement were undertaken in each participant. Water samples from current and previous drinking water sources and hair and urine samples from each participant were collected for estimation of arsenic. The present study shows evidence of increased association of HTN in individuals resident in arsenic endemic region compared to those from a non-endemic region in West Bengal. There were increased odds ratios for HTN [Adjusted Odds Ratio, OR, 2.87 (95 %CI = 1.26-4.83)] in Group- 1 participants compared to Group- 2 people. Within Group 1, there was no difference in prevalence of HTN between those with and without skin lesion. There was a dose-effect relationship seen with increasing cumulative arsenic exposure and arsenic level in hair and HTN in participants living in arsenic endemic region.The findings reported here support an association between arsenic exposure and HTN. More work is needed to characterize the link further.

Effect of drinking arsenic-contaminated water in children.

Chronic arsenic toxicity due to drinking of arsenic-contaminated water has been a major environmental health hazard throughout the world including India. Although a lot of information is available on health effects due to chronic arsenic toxicity in adults, knowledge of such effect on children is scanty. A review of the available literature has been made to highlight the problem in children. Scientific publications on health effects of chronic arsenic toxicity in children with special reference to psychological issues are reviewed. The prevalence of skin abnormalities such as pigmentation change and keratosis, the diagnostic signs of chronic arsenic toxicity, vary in various arsenic-exposed children population in different regions of the world. The occurrence of chronic lung disease including pulmonary interstitial fibrosis has been described in arsenic-exposed children in Chile. Affection of intellectual function has also been reported to occur in arsenic-exposed children studied in Thailand, Bangladesh, and India. Methylation patterns of arsenic in children aggregate in families and are correlated in siblings, providing evidence of a genetic basis for the variation in arsenic methylation. Chronic arsenic toxicity due to drinking of arsenic-contaminated water causes significant morbidity in children resulting in skin lesions, lung disease, and defect in intellectual function.

Effect of Safe Water on Arsenicosis: A Follow-up Study.

BACKGROUND: Arsenic pollution in groundwater, used for drinking purposes, has been envisaged as a problem of global concern. Treatment options for the management symptoms of chronic arsenicosis are limited. Mitigation option available for dealing with the health problem of ground water arsenic contamination rests mainly on supply of arsenic safe water in arsenic-endemic region of Indo-Bangladesh subcontinent. Limited information is available regarding the long-term effect of chronic arsenic toxicity after stoppage of consumption of arsenic-containing water. OBJECTIVE: The current study was, therefore, done to assess, objectively, the effect of drinking arsenic safe water (<50 µg/L) on disease manifestation of arsenicosis. RESULTS: Manifestations of various skin lesions and systemic diseases associated with chronic arsenic exposure were ascertained initially by carrying on baseline study on 208 participants in Nadia (Cohort-I, with skin lesion and Cohort-II, without skin lesion) using a scoring system, as developed by us, and compared objectively at the end of each year for 3 year follow-up period. All the participants who had arsenic contaminated drinking water source in their houses were supplied with arsenic removal filters for getting arsenic-free water during the follow-up period. In participants belonging to Cohort-I, the skin score was found to improve significantly at the end of each year, and it was found to be reduced significantly from 2.17 ± 1.09 to 1.23 ± 1.17; P < 0.001 at the end of 3 year's intervention study indicating beneficial effect of safe water on skin lesions. The systemic disease symptom score was also found to improve, but less significantly, at the end of 3 years in both the cohorts. Most important observation during the follow-up study was persistence of severe symptoms of chronic lung disease and severe skin lesion including Bowen's disease in spite of taking arsenic-safe water. Further, death could not be prevented to occur because of lung cancer and severe lung disease. CONCLUSION: It is, therefore, an urgent need to make arrangement for availability of safe water source among the arsenic-affected people in the district. Many of the people in the affected villages are not aware of contamination of their home tube wells with arsenic. Awareness generation and motivation of the people for testing their drinking water sources for arsenic and environmental interventions like rain water harvesting, ground water recharge, and restricting excessive use of ground water for domestic and agricultural purposes are also important to prevent further exposure of arsenic to these people.

Health impact of supplying safe drinking water on patients having various clinical manifestations of fluorosis in an endemic village of west bengal.

BACKGROUND: Excessive fluoride in drinking water causes dental, skeletal and non-skeletal fluorosis which is encountered in endemic proportions in several parts of the world. The World Health Organization (WHO) guideline value and the permissible limit of fluoride as per the Bureau of Indian Standards (BIS) is 1.5 mg/L. Studies showed that withdrawal of sources identified for fluoride, often leads to reduction of fluoride in the body fluids (re-testing urine and serum after a week or ten days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10-15 days. OBJECTIVE: To determine the prevalence of signs and symptoms of suspected dental, skeletal and non-skeletal fluorosis along with food habits, addictions and use of fluoride-containing toothpaste among participants taking water with fluoride concentration above permissible limit and to assess the changes in clinical manifestations of the above participants after consumption of safe drinking water with fluoride concentration below permissible limit. MATERIALS AND METHODS: A longitudinal intervention study was conducted from October 2010 to December 2011 in a village selected randomly in Purulia District of West Bengal which is endemic for fluorosis. Thirty-six families with 104 family members in the above village having history of taking unsafe water containing high level of fluoride were selected for the study. The occurrence of various dental, skeletal and non-skeletal manifestations of fluorosis along with food habits, addictions and use of fluoride-containing toothpaste among the study population was assessed; the impact of taking safe water with fluoride concentration below permissible limit from a supplied community filter on these clinical manifestations was studied by follow-up examination of the above participants for six months. The data obtained is compared with the collected data from the baseline survey. RESULTS: The prevalence of signs and symptoms of dental, skeletal and non-skeletal fluorosis was (18.26%), (18.26-43.26%) and (12.49-38.46%) among the study population. Withdrawal of source(s) identified for fluoride by providing community filters supplying safe water along with nutritional interventions lead to 1.92% decrease of manifestation of dental fluorosis, 2.88-18.26% decrease of manifestations of skeletal fluorosis and 3.8-5.77% decrease in manifestations of non-skeletal fluorosis within six months. Following repeated motivation of participants during visit there was also 2.88% decrease in the usage of fluoride-containing toothpaste, 4.81% decrease in consumption of black lemon tea, supari and tobacco which are known sources of fluoride ingestion in our body. CONCLUSION: Increased prevalence of dental, skeletal and non-skeletal fluorosis was found among the study population. Withdrawal of sources(s) identified for fluoride by supplying community filter, dietary restriction and other nutritional interventions led to decrease of manifestations of the three types of fluorosis within six months. The government should play a vital role in ensuring drinking water safety at the household and community level by supplying domestic filters at affordable costs and community filter along with nutritional intervention to the fluorosis-affected villages on a priority basis to mitigate the problem.