Protective effects of B vitamins and antioxidants on the risk of arsenic-related skin lesions in Bangladesh.
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.


OBJECTIVE
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 arsenic-related 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.
Zablotska
Lydia B
LB
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Chen
Yu
Y
Graziano
Joseph H
JH
Parvez
Faruque
F
van Geen
Alexander
A
Howe
Geoffrey R
GR
Ahsan
Habibul
H
D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage / Q000494:pharmacology*; D001151:Arsenic; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000494:pharmacology; D001459:Bangladesh; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000139:chemically induced / Q000517:prevention & control*; D012307:Risk Factors; D012871:Skin Diseases / Q000139:chemically induced / Q000517:prevention & control*; D014801:Vitamin A / Q000008:administration & dosage / Q000494:pharmacology; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000494:pharmacology*; D014810:Vitamin E / Q000008:administration & dosage / Q000494:pharmacology
D000975:Antioxidants; D014801:Vitamin A; D014803:Vitamin B Complex; D014810:Vitamin E; D001151:Arsenic; D001205:Ascorbic Acid