title: Arsenic exposure and incidence of type 2 diabetes in Southwestern American Indians.
abstract: Association of urinary arsenic concentration with incident diabetes was examined in American Indians from Arizona who have a high prevalence of type 2 diabetes and were screened for diabetes between 1982 and 2007. The population resides where drinking water contains arsenic at concentrations above federally recommended limits. A total of 150 nondiabetic subjects aged ≥25 years who subsequently developed type 2 diabetes were matched by year of examination and sex to 150 controls who remained nondiabetic for ≥10 years. Total urinary arsenic concentration, adjusted for urinary creatinine level, ranged from 6.6 µg/L to 123.1 µg/L, and inorganic arsenic concentration ranged from 0.1 µg/L to 36.0 µg/L. In logistic regression models adjusted for age, sex, body mass index, and urinary creatinine level, the odds ratios for incident diabetes were 1.11 (95% confidence interval (CI): 0.79, 1.57) and 1.16 (95% CI: 0.89, 1.53) for a 2-fold increase in total arsenic and inorganic arsenic, respectively. Categorical analyses suggested a positive relationship between quartiles of inorganic arsenic and incident diabetes (P = 0.056); post-hoc comparison of quartiles 2-4 with quartile 1 revealed 2-fold higher odds of diabetes in the upper quartiles (OR = 2.14, 95% CI: 1.19, 3.85). Modestly elevated exposure to inorganic arsenic may predict type 2 diabetes in American Indians. Larger studies that include measures of speciated arsenic are required for confirmation.
authors.forename: Nan Hee
authors.initials: NH
authors.lastname: Kim
authors.forename: Clinton C
authors.initials: CC
authors.lastname: Mason
authors.forename: Robert G
authors.initials: RG
authors.lastname: Nelson
authors.forename: Scott E
authors.initials: SE
authors.lastname: Afton
authors.forename: Amal S
authors.initials: AS
authors.lastname: Essader
authors.forename: James E
authors.initials: JE
authors.lastname: Medlin
authors.forename: Keith E
authors.initials: KE
authors.lastname: Levine
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hoppin
authors.forename: Cynthia
authors.initials: C
authors.lastname: Lin
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000652:urine; D001130:Arizona / Q000453:epidemiology; D001151:Arsenic / Q000009:adverse effects / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000209:etiology / Q000652:urine; D060766:Drinking Water / Q000737:chemistry; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D014874:Water Pollutants, Chemical / Q000009:adverse effects / Q000032:analysis*
chemical_list: D015415:Biomarkers; D060766:Drinking Water; D014874:Water Pollutants, Chemical; D003404:Creatinine; D001151:Arsenic
keywords: Indians, North American; arsenic; diabetes mellitus, type 2; incidence; nested case-control studies