Mitochondrial DNA variations in Austronesian-speaking populations living in the New Georgia Islands, the Western Province of the Solomon Islands.

Modern Austronesian (AN)-speaking Melanesians are considered to be derived from the admixture of indigenous non-Austronesian (NAN)-speaking people and AN-speaking people from Southeast Asia. In this study, we analyzed mitochondrial DNA (mtDNA) variations in the D-loop region for two AN-speaking Melanesian populations (Munda and Kusaghe) and an AN-speaking Micronesian population (Rawaki) in the New Georgia Islands, the Western Province of the Solomon Islands to examine their genetic similarities to AN-speaking Polynesians in Tonga and NAN-speaking Melanesians, Gidra, in Papua New Guinea. The 'Polynesian motif', which is well-characterized mtDNA marker for Polynesians, was frequently observed in Munda and Kusaghe. Of particular interest, haplogroup E1a2 + 16261, which has been rarely observed in the Solomon Islands, accounted for 12.8% in Kusaghe. It has been reported that the haplogroup E1a2 arose in Island Southeast Asia (ISEA) 9400 ± 2850 years ago. Phylogenetic and principle component analyses for 24 Oceanian populations revealed that Munda and Kusaghe populations were genetically close to Tongan population, but not to Gidra. Rawaki population showed no apparent genetic similarities to populations of Tonga and Gidra. Our results suggest that considerable gene flow from AN-speaking populations originated from Southeast Asia to indigenous Melanesians occurred in the New Georgia Islands.

Physical growth and diets of school children: Trends from 2001 to 2015 in rural West Java, Indonesia.

OBJECTIVES: This study aimed to assess changes in physical growth and diets of school children in rural West Java, Indonesia, between 2001 and 2015, a period of rapid socioeconomic change. METHODS: In 2001 and 2015, anthropometric measurements (height, weight, mid-upper arm circumference, skin-fold thickness), food consumption surveys, and questionnaires on socioeconomic status were completed by fourth-grade school children in a rural village in West Java. RESULTS: Height increments of 5.9 cm for boys and 4.7 cm for girls during this 14-year period were calculated as 4.21 cm per decade for boys and 3.36 cm per decade for girls, which is equivalent to height increments observed during rapid economic development periods in other countries. Weights also increased by 3.8 kg for boys and 2.0 kg for girls during this period. Variations in weight status significantly increased in 2015; while 98% of the children were within the 'normal' range in 2001, the prevalence of overweight increased from 2.4% in 2001 to 13.7% in 2015 and that of thinness was 4.3% in 2015. Energy, protein, and fat intakes significantly increased in 2015. In 2015, a significant correlation between nutritional intake and weight status was observed, especially among boys. CONCLUSIONS: Socioeconomic changes between 2001 and 2015 caused increased heights and weights and greater variation in weight status, especially among boys.

Association study of CREBRF missense variant (rs373863828:G > A; p.Arg457Gln) with levels of serum lipid profile in the Pacific populations.

BACKGROUND: A missense variant (rs373863828:G > A; p.Arg457Gln) of the CREBRF gene is strongly associated with a higher body mass index (BMI; kg/m2) in Polynesian populations. This variant has also been reported to be associated with lower total cholesterol in Samoans. AIM: The aim of this study is to examine the association of rs373863828:G > A with levels of serum lipids in four Pacific populations. METHODS: A total of 613 adult subjects were recruited from Tonga (Polynesians) and the Solomon Islands (Melanesians and Micronesians). Multiple regression analyses adjusted for age and sex were performed to examine the association of rs373863828 with levels of serum lipids in each population. RESULTS: A significant association of rs373863828:G > A with lower level of HDL-cholesterol was detected in the Tonga population (ß = -3.32 and p-value = 0.030). The expected change in HDL-cholesterol with respect to a single copy of the rs373863828-A allele was 3.32 mg/dL. However, the association between rs373863828-A and lower levels of HDL-cholesterol was not significant after further adjustment for BMI in the Tonga population (ß = -2.32 and p-value = 0.13). CONCLUSIONS: The rs373863828-A allele may not directly affect the level of serum HDL-cholesterol independent of BMI. To confirm the present findings, association studies with large sample sizes and functional analyses are required.

A missense variant, rs373863828-A (p.Arg457Gln), of CREBRF and body mass index in Oceanic populations.

It has been suggested that a 'thrifty' genotype hypothesis can account for high prevalence of obesity in the island populations of Oceania. A recent genome-wide association study revealed that a missense variant, rs373863828-A (p.Arg457Gln), of the CREBRF gene (encoding CREB3 regulatory factor) was associated with an excessive increase in body mass index (BMI) in Samoans. In the present study, the association of rs373863828-A with an increase in BMI was examined in four Austronesian (AN)-speaking populations in Oceania. We found that rs373863828-A was frequently observed (frequency of 0.15) in Tongans (Polynesians), and was strongly associated with higher BMI (P=6.1 × 10-4). A single copy of the rs373863828-A allele increased BMI by 3.09 kg m-2 after adjustment of age and sex. No significant association was detected in the other three AN-speaking populations (Melanesians and Micronesians) living in Solomon Islands. This was probably due to the low allele frequency (0.02-0.06) of rs373863828-A as well as small sample size. The rs373863828-A allele was not found in both AN-speaking and non-AN-speaking Melanesians living in Papua New Guinea. Our results suggest that rs373863828-A of CREBRF, a promising thrifty variant, arose in recent ancestors of AN-speaking Polynesians.

Developmental stage-dependent influence of environmental factors on growth of rural Sundanese children in West Java, Indonesia.

This study investigated the growth trajectories and the relative relevance levels of nutrition, disease, and hormonal status at various developmental stages among children in adverse environments to provide population-based empirical evidence for the life history theory. Three years of longitudinal anthropometric data in 1-year intervals were obtained from 418 boys and girls aged 0 to 12 years at recruitment. Following the final measurement, the main survey, which included blood and feces sampling, 3-h interval food consumption recall surveys for energy and nutrient intakes and anthropometry, was performed. Blood and feces were used for detecting, respectively, anemia and hormonal (IGF-I and IGFBP-3) levels as well as intestinal helminthiasis (Ascaris, Trichuris, and hookworm). The major findings of this study are summarized as follows: 1) the growth velocity of the subject children lagged behind international standards during childhood and juvenility but caught up during early adolescence; 2) diseases, both intestinal helminths and anemia, had significant effects on growth in childhood but not at older ages; and 3) hormonal status significantly affected growth in the children, with its highest significance in early adolescence. A larger growth than international standards in early adolescence likely follows programmed hormonal mechanisms after the onset of puberty. The onset of puberty might be associated with adequate amounts of nutrient intake and be mediated by hormonal function, because the IGF-IZ score was significantly correlated with energy and protein intakes at the transitional period from juvenility to adolescence, when puberty occurs.

Hypertension-susceptibility gene prevalence in the Pacific Islands and associations with hypertension in Melanesia.

Human essential hypertension is partly caused by genetic factors. Angiotensinogen (AGT), G-protein ß3-subunit (GNB3) and cytochrome P450 3A5 (CYP3A5) are candidate hypertension susceptibility genes and risk alleles at these loci have been thought to arise owing to human adaptation to climatic changes following the migration out-of-Africa. This study aimed to reveal the frequencies of hypertension-susceptibility genotypes in Pacific Island populations and associations of these single-nucleotide polymorphisms (SNPs) to hypertension. Genotyping was conducted for 804 individuals from Melanesian, Micronesian and Polynesian populations at SNPs in the genes encoding AGT (rs699, rs5049 and rs5051), GNB3 (rs5443) and CYP3A5*1/*3 (rs776746). Associations between these SNPs and hypertension were tested for 383 Melanesian Solomon Islanders. We found that the A/A genotype at rs5049 was a risk factor for hypertension (P=0.025) in the Melanesian Solomon Islanders; three SNPs for AGT were in linkage disequilibrium. The ancestral alleles of rs699, rs5051 and rs776746, and the derived allele of rs5443 were as frequent in the populations surveyed here as in other equatorial populations. Although other polymorphisms associated with hypertension and additional populations remain to be studied, these findings suggest that the Pacific Islanders' susceptibility to hypertension arose because of human migration and adaptation.

The serum leptin level and body mass index in Melanesian and Micronesian Solomon Islanders: focus on genetic factors and urbanization.

OBJECTIVES: This study examined the association between the serum leptin level and body mass index (BMI) and the effects of urbanization and polymorphisms of leptin (LEP) or leptin receptor (LEPR) genes on the leptin level in three Solomon Islands populations. METHODS: A Melanesian population living in a remote area (participants: 106 males and 106 females, ages: 18-74 years), a Melanesian population in an urban area (89 and 94, 18-79 years), and a Micronesian population who migrated to a peri-urban area in the 1960s (84 and 69, 18-71 years) were studied. Anthropometric and serum leptin measurements and genotyping for LEP G-2548A and LEPR K109R and Q223R were performed. RESULTS: The prevalence of obesity (BMI ≥ 30 kg/m(2)) was the highest in the Micronesian population (30.1%), followed by the urban (18.6%) and the rural (2.4%) Melanesian population. The serum leptin concentration was the highest in the urban Melanesian, followed by the Micronesian and the rural Melanesian populations (P < 0.05). Interestingly, the parameter coefficients of the leptin concentrations on the BMIs were nearly identical in the urban and rural Melanesians after adjusting for age and gender. The LEPR 223Q/Q genotype was associated with an increased leptin level only in the Micronesian population after adjusting for BMI (P = 0.0008 and 0.0016 referenced to the Q/R and the R/R types, respectively). CONCLUSIONS: These observations suggest that the increase in obesity in the Micronesians had a genetic component while that in Melanesians might have been related with the urbanization.

Energy and nutrient intake of Tongan adults estimated by 24-hour recall: the importance of local food items.

Tongan adults show one of the highest prevalences of obesity in the world. The present study aims to estimate Tongans' energy and nutrient intakes and food sources using a 24-hour recall survey for 14 days targeting 15 men and 19 women. The mean (SD) daily energy intake was 12.2 (2.3) MJ for men and 10.6 (2.2) MJ for women. Imported foods accounted for about half of their energy and macronutrient intakes, but for much less of their micronutrients. Some local food items, specifically pork, kava, and sea hare, contributed significantly to their vitamin, Fe, and Ca intakes, respectively. These findings suggest that heavy reliance on imported foods can lead not only to a high prevalence of obesity, but also to micronutrient deficiencies.

Admixture with indigenous people helps local adaptation: admixture-enabled selection in Polynesians.

BACKGROUND: Homo sapiens have experienced admixture many times in the last few thousand years. To examine how admixture affects local adaptation, we investigated genomes of modern Polynesians, who are shaped through admixture between Austronesian-speaking people from Southeast Asia (Asian-related ancestors) and indigenous people in Near Oceania (Papuan-related ancestors). METHODS: In this study local ancestry was estimated across the genome in Polynesians (23 Tongan subjects) to find the candidate regions of admixture-enabled selection contributed by Papuan-related ancestors. RESULTS: The mean proportion of Papuan-related ancestry across the Polynesian genome was estimated as 24.6% (SD = 8.63%), and two genomic regions, the extended major histocompatibility complex (xMHC) region on chromosome 6 and the ATP-binding cassette transporter sub-family C member 11 (ABCC11) gene on chromosome 16, showed proportions of Papuan-related ancestry more than 5 SD greater than the mean (> 67.8%). The coalescent simulation under the assumption of selective neutrality suggested that such signals of Papuan-related ancestry enrichment were caused by positive selection after admixture (false discovery rate = 0.045). The ABCC11 harbors a nonsynonymous SNP, rs17822931, which affects apocrine secretory cell function. The approximate Bayesian computation indicated that, in Polynesian ancestors, a strong positive selection (s = 0.0217) acted on the ancestral allele of rs17822931 derived from Papuan-related ancestors. CONCLUSIONS: Our results suggest that admixture with Papuan-related ancestors contributed to the rapid local adaptation of Polynesian ancestors. Considering frequent admixture events in human evolution history, the acceleration of local adaptation through admixture should be a common event in humans.

A scan for genetic determinants of human hair morphology: EDAR is associated with Asian hair thickness.

Hair morphology is one of the most differentiated traits among human populations. However, genetic backgrounds of hair morphological differences among populations have not been clarified yet. In addition, little is known about the evolutionary forces that have acted on hair morphology. To identify hair morphology-determining genes, the levels of local genetic differentiation in 170 genes that are related to hair morphogenesis were evaluated by using data from the International HapMap project. Among highly differentiated genes, ectodysplasin A receptor (EDAR) harboring an Asian-specific non-synonymous single nucleotide polymorphism (1540T/C, 370Val/Ala) was identified as a strong candidate. Association studies between genotypes and hair morphology revealed that the Asian-specific 1540C allele is associated with increase in hair thickness. Reporter gene assays suggested that 1540T/C affects the activity of the downstream transcription factor NF-kappaB. It was inferred from geographic distribution of 1540T/C and the long-range haplotype test that 1540C arose after the divergence of Asians from Europeans and its frequency has rapidly increased in East Asian populations. These findings lead us to conclude that EDAR is a major genetic determinant of Asian hair thickness and the 1540C allele spread through Asian populations due to recent positive selection.

The Q223R polymorphism in LEPR is associated with obesity in Pacific Islanders.

Various Pacific Island populations have experienced a marked increase in the prevalence of obesity in past decades. This study examined the association of a promoter polymorphism of the leptin gene (LEP), G-2548A (rs7799039), and two non-synonymous single nucleotide polymorphisms of the leptin receptor gene (LEPR), K109R (rs1137100) and Q223R (rs1137101), with body weight, body mass index (BMI) and obesity (BMI > or = 30) in Pacific Islanders. A total of 745 Austronesian (AN)-speaking participants were analyzed after adjusting for age, gender, and population differences. The results revealed that carriers of the 223Q alleles of LEPR had significantly higher body weight (P = 0.0009) and BMI (P = 0.0022) than non-carriers (i.e., 223R homozygotes); furthermore, the 223Q carriers also had a signiWcantly higher risk of obesity in comparison to non-carriers (P = 0.0222). The other two polymorphisms, G-2548A and K109R, were associated with neither body weight, BMI, nor obesity. The 223Q allele was widely found among the AN-speaking study subjects, thus suggesting that the LEPR Q223R polymorphism is one of the factors contributing to the high prevalence of obesity in the Pacific Island populations.

Admixture and natural selection shaped genomes of an Austronesian-speaking population in the Solomon Islands.

People in the Solomon Islands today are considered to have derived from Asian- and Papuan-related ancestors. Papuan-related ancestors colonized Near Oceania about 47,000 years ago, and Asian-related ancestors were Austronesian (AN)-speaking population, called Lapita, who migrated from Southeast Asia about 3,500 years ago. These two ancestral populations admixed in Near Oceania before the expansion of Lapita people into Remote Oceania. To understand the impact of the admixture on the adaptation of AN-speaking Melanesians in Near Oceania, we performed the genome-wide single nucleotide polymorphism (SNP) analysis of 21 individuals from Munda, the main town of the New Georgia Islands in the western Solomon Islands. Population samples from Munda were genetically similar to other Solomon Island population samples. The analysis of genetic contribution from the two different ancestries to the Munda genome revealed significantly higher proportions of Asian- and Papuan-related ancestries in the region containing the annexin A1 (ANXA1) gene (Asian component > 82.6%) and in the human leukocyte antigen (HLA) class II region (Papuan component > 85.4%), respectively. These regions were suspected to have undergone natural selection since the time of admixture. Our results suggest that admixture had affected adaptation of AN-speaking Melanesians in the Solomon Islands.

Gene flow and natural selection in oceanic human populations inferred from genome-wide SNP typing.

It is suggested that the major prehistoric human colonizations of Oceania occurred twice, namely, about 50,000 and 4,000 years ago. The first settlers are considered as ancestors of indigenous people in New Guinea and Australia. The second settlers are Austronesian-speaking people who dispersed by voyaging in the Pacific Ocean. In this study, we performed genome-wide single-nucleotide polymorphism (SNP) typing on an indigenous Melanesian (Papuan) population, Gidra, and a Polynesian population, Tongans, by using the Affymetrix 500K assay. The SNP data were analyzed together with the data of the HapMap samples provided by Affymetrix. In agreement with previous studies, our phylogenetic analysis indicated that indigenous Melanesians are genetically closer to Asians than to Africans and European Americans. Population structure analyses revealed that the Tongan population is genetically originated from Asians at 70% and indigenous Melanesians at 30%, which thus supports the so-called Slow train model. We also applied the SNP data to genome-wide scans for positive selection by examining haplotypic variation and identified many candidates of locally selected genes. Providing a clue to understand human adaptation to environments, our approach based on evolutionary genetics must contribute to revealing unknown gene functions as well as functional differences between alleles. Conversely, this approach can also shed some light onto the invisible phenotypic differences between populations.

Twenty years' demographic change in sedentes and migrants of an international migrant-sending community in Tonga.

In the Kingdom of Tonga, migration to overseas developed countries has prevailed. To elucidate the effects of migration on population dynamics, an interview survey was conducted in the migrant-sending community of Kolovai, in the outer region of Tongatapu Island. All births, deaths, marriages and in- and out-migrations that took place between 1983 and 2002 were recorded for all members of the 'Kolovai population', consisting of persons who had lived in this community for at least a one-year period during this 20 years. The 'Kolovai population' members, numbering 1184 (564 males and 620 females), were divided into three groups based on residence at the end of each year, i.e. Kolovai (called KK), other places in Tonga (KT) or overseas countries (KO). The KK population decreased from 774 in 1982 to 570 in 2002, owing mostly to an increase of 167 persons as the natural balance and a decrease of 324 persons as the balance of international migration. Comparison of total fertility rate (TFR) between KK and KO women revealed that the mean TFR of the former decreased from 3.460 in the earlier 10-year period (1983-1992) to 2.240 in the later 10-year period (1993-2002), while that of the latter was more than 3.5 in both 10-year periods. This difference was largely due to the decrease in the proportion married among KK women. If the current trends of international migration and fertility continue, the population of Kolovai will be reduced and its age composition will become cylinder-shaped in the near future.

Medicinal plants used by the villagers of a Sundanese community in West Java, Indonesia.

AIM OF THE STUDY: Based on the authors' fieldwork in a Sundanese village, Indonesia, this paper aimed to elucidate the roles of herbal medicine in treatment of illnesses and to report medicinal plants and their uses, comparing with those mentioned in the encyclopedic book series of Plant Resources of South-East Asia (PROSEA). MATERIALS AND METHODS: Interview survey was conducted for all of the 19 herbalist healers about their therapies for the past 1-month period, and the medicinal plants used were botanically identified. For 70 non-healer households, treatments for all members' illness episodes in the past 1-month period were asked. RESULTS: Medicinal plants were used in two-thirds of illness cases, either through the villagers' self-treatment (60.9%) or by the healers (6.5%). The healers made 96 therapies for illnesses (classified into 23 categories), using 117 plant species. There were 257 types of illness-plant pairs, and only 114 of them (44.4%) were judged conformed to those mentioned in the PROSEA. CONCLUSION: Sundanese villagers have depended heavily on herbal medicine, and high proportion of non-conformed illness-plant pairs suggests necessity of further studies about Sundanese medicinal plants, particularly their pharmacological effects.

Mutual interaction between nutritional status and chronic arsenic toxicity due to groundwater contamination in an area of Terai, lowland Nepal.

OBJECTIVE: To reveal the inter-relationship between nutritional status and arsenic toxicity. DESIGN: Cross-sectional study. SETTING: A survey in an area of lowland Nepal, where a high prevalence of both skin manifestation and malnutrition was observed. Daily arsenic intake was estimated by measuring the arsenic concentration and daily consumption of the drinking water. PARTICIPANTS: Adult villagers (248 men and 291 women). About half were classified as "underweight" (body mass index <18.5), indicating poor nutritional status. MAIN RESULTS: Arsenic intake was negatively correlated with body mass index and substantially increased the prevalence of underweight individuals, among whom the prevalence of skin manifestations was 1.65-fold higher than normal weight individuals. When exposure level was considered, the prevalence of skin symptoms was consistently higher in the underweight than in the normal group. Although enhanced susceptibility in men was apparent by the increased prevalence of cutaneous symptoms, no sex difference was observed in the prevalence of underweight individuals related with exposure to arsenic. CONCLUSIONS: The present data suggested that exposure to arsenic is associated with an increased prevalence of underweight, a serious health problem in developing countries, which in turn is associated with increased skin manifestation of arsenic poisoning.

Locally Sustainable School Lunch Intervention Improves Hemoglobin and Hematocrit Levels and Body Mass Index among Elementary Schoolchildren in Rural West Java, Indonesia.

School lunch is not provided in public elementary schools in Indonesia, and students frequently buy and eat snacks at school. We hypothesized that providing a traditional Sundanese meal as school lunch would be beneficial for children in rural West Java. To test this hypothesis, we evaluated the effect of a 1-month school lunch intervention aiming at sustainability and based on children's nutritional intake, hemoglobin and hematocrit levels, and body mass index (BMI). A lunch (including rice, vegetable dish, animal protein dish, plant protein dish, and fruit) containing one-third of the recommended daily allowance of energy was offered every school day for 1 month, targeting 68 fourth-grade elementary schoolchildren. At baseline, the prevalence of anemia was 33.3%. The prevalence of stunting and underweight were 32.4% and 2.9%, respectively, whereas that of overweight and obesity combined was 17.6%, indicating a double burden of malnutrition among the subjects. During the intervention, intakes of protein (p < 0.05), calcium (p < 0.05), and vitamin C (p < 0.001) significantly increased, while that of fat significantly decreased (p < 0.001). After the intervention, hemoglobin (p < 0.05) and hematocrit (p < 0.05) levels were significantly improved, thereby almost halving the rate of anemia. These changes were significantly larger in the baseline anemic group than the non-anemic group (p < 0.01). BMI significantly increased in the baseline underweight/normal group (p < 0.001) but not in the overweight/obese group. The school lunch intervention significantly improved nutritional intakes and health statuses, implying its potential for reducing anemia and resolving the double burden of malnutrition among rural Indonesian schoolchildren.

Polymorphisms associated with a tropical climate and root crop diet induce susceptibility to metabolic and cardiovascular diseases in Solomon Islands.

The people of the Solomon Islands represent an Austronesian (AN)-speaking population's adaptation to a humid tropical environment and subsistence of tuberous crops. Genome-wide association studies (GWASs) of other populations (e.g. the Human Genome Diversity Project [HGDP]) have suggested the existence of genotypes adaptive to ecoregion, diet, and subsistence, and that those genotypes are also associated with metabolic and cardiovascular diseases. Recently, the incidence of non-communicable diseases has been increasing in the Solomon Islands. In the present study, we explored the association of genotypes adaptive to a tropical environment and tuberous crop diet with metabolic and cardiovascular conditions in rural and urban AN-speaking Melanesian and Micronesian populations of the Solomon Islands. A total of 561 participants were genotyped for single nucleotide polymorphisms (SNPs) potentially associated with a tropical environment (rs174570 and rs2237892) and a tuberous crop diet (rs162036, rs185819, and rs2722425). The results showed that the allele frequencies of the Solomon Islands populations adopted patterns similar to those in populations from other hot, tropical areas with a tuberous crop diet in previous studies. Furthermore, rs162036, rs185819, rs2237892, and rs2722425 were all strongly associated with one or more metabolic and cardiovascular conditions. The derived allele of rs2722425 (i.e. rs2722425-G) was significantly associated with an elevated LDL level (P = 0.000264) even after the significance level was adjusted for multiple testing (i.e., α = 0.0005). Our results suggest that the inhabitants of the Solomon Islands exhibit the effects of the tropical environment and tuberous crop diet on their allele frequencies, and that their susceptibility to metabolic and cardiovascular diseases is therefore considered to be associated with their environment and diet.

Prevalence of arsenicosis in terai, Nepal.

This paper summarizes the findings of surveys on arsenicosis cases conducted during 2001-2004 in terai, Nepal, by governmental and non-governmental organizations in their respective project areas and by some national and international institutes. Studies were conducted in six arsenic-contaminated districts of terai, namely Nawalparasi, Bara, Parsa, Rautahat, Rupandehi, and Kapilvastu. In these districts, arsenic contamination in tubewells varied from 2.1% to 25.7%. The prevalence of arsenicosis was, on average, 2.2% and varied from 0.7% in Kapilavastu district to 3.6% in Nawalparasi district. In the community-based study, the highest prevalence (18.6%) of arsenicosis was found in Patkhouli village of Nawalparasi, where 95.8% of tubewells were contaminated with arsenic. The prevalence of arsenicosis was higher in older age-groups (>50 years) of both the sexes. Males suffered more from arsenicosis than females (odds ratio: 2.50, 95% confidence interval 1.80-3.47). Skin manifestations, such as melanosis and keratosis, were the common symptoms of arsenicosis. Most patients were identified in the early or mild stage of the disease. They are expected to recover if further exposure to arsenic could be avoided by providing arsenic-safe drinking-water through intervention measures.

Arsenic contamination in drinking water and skin manifestations in lowland Nepal: the first community-based survey.

A community-based, dose-response study on arsenic contamination was conducted in three communities in Terai in lowland Nepal. The arsenic concentration of all the tube wells in use (n = 146) and the prevalence of arsenic-induced skin manifestation among 1,343 (approximately 80% of the inhabitants) subjects indicated the existence of a highly contaminated area in Terai. It was found that overall prevalence of arsenicosis among the subjects > or = 15 years old was 6.9%, which was comparable to those found by the same examiner in arsenic-contaminated areas in Bangladesh, and that males had prevalence a twice as high as females, which could not be explained by the difference in the exposure level.