title: Urinary arsenic and insulin resistance in US adolescents.
abstract: Chronic arsenic exposure has been associated with increased diabetes risk in adults. Insulin resistance (IR) has been proposed as a mechanism of arsenic-related diabetes. Although limited evidence in adults found no association between arsenic and IR, the association in adolescents is largely unknown. We examined the association between urinary arsenic and insulin resistance in US adolescents. Eight hundred thirty five adolescents aged 12-19 years, with complete data on urinary arsenic (total arsenic, inorganic arsenic and dimethylarsenic acid (DMA)), fasting glucose, insulin and key covariates were identified from the National Health and Nutrition Examination Survey (NHANES) cycles 2003/2004 through 2009/2010. Generalized additive mixed models accounting for intra-cluster correlation arising from the complex survey design were used to estimate the association between the updated Homeostasis Model Assessment (HOMA2)-IR and each type of arsenic. After adjusting for potential confounders, including urinary creatinine, sociodemographic factors, BMI, waist circumference, and arsenobetaine, arsenic exposure was not associated with HOMA2-IR. Interquartile range increases in total arsenic, inorganic arsenic and DMA were associated with 1.5% (95% CI: -2.0, 5.2), 1.1% (95% CI: -1.5, 3.8) and 0.25% (95% CI: -2.3, 2.9) increases in HOMA2-IR, respectively. In conclusion, despite arsenic's association with diabetes in adults and potential role in insulin resistance, our findings do not support the hypothesis that arsenic exposure at levels common in the US contributes to insulin resistance in adolescents. Whether higher doses and longer exposure duration are required for appreciable influence on insulin resistance, or that arsenic does not act through insulin resistance to induce diabetes needs further investigation.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States. Electronic address: pengq@umich.edu.
authors.forename: Qing
authors.initials: Q
authors.lastname: Peng
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States. Electronic address: harlow@umich.edu.
authors.forename: Siobán D
authors.initials: SD
authors.lastname: Harlow
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States; Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States. Electronic address: sungkyun@umich.edu.
authors.forename: Sung Kyun
authors.initials: SK
authors.lastname: Park
mesh_terms: D000293:Adolescent; D001151:Arsenic / Q000652:urine*; D001152:Arsenicals / Q000652:urine*; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003920:Diabetes Mellitus / Q000139:chemically induced; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis; D005215:Fasting / Q000097:blood; D005260:Female; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
chemical_list: D001152:Arsenicals; D001786:Blood Glucose; D007328:Insulin; D001151:Arsenic
keywords: Adolescents; Arsenic; Insulin resistance; NHANES
references.citation: Circulation. 2003 Mar 18;107(10):1448-53
references.pmid: 12642369
references.citation: Epidemiology. 2009 Nov;20(6):816-20; discussion e1-2
references.pmid: 19713856
references.citation: J Clin Endocrinol Metab. 2011 Sep;96(9):2898-903
references.pmid: 21778224
references.citation: Am J Epidemiol. 2006 Feb 15;163(4):374-83
references.pmid: 16394206
references.citation: Med Sci Sports Exerc. 2005 Feb;37(2):316-22
references.pmid: 15692329
references.citation: J Pediatr. 2004 Jan;144(1):47-55
references.pmid: 14722518
references.citation: Environ Health. 2011 Aug 24;10:73
references.pmid: 21864395
references.citation: Diabetes Care. 2004 Feb;27(2):314-9
references.pmid: 14747206
references.citation: Environ Health Perspect. 2000 Jun;108 Suppl 3:545-53
references.pmid: 10852853
references.citation: Environ Health Perspect. 2007 May;115(5):734-42
references.pmid: 17520061
references.citation: Pediatr Nephrol. 2008 Mar;23(3):355-62
references.pmid: 17929061
references.citation: Pediatrics. 2013 Sep;132(3):e646-55
references.pmid: 23958772
references.citation: Environ Health Perspect. 2010 Jun;118(6):864-70
references.pmid: 20100676
references.citation: Diabetes Care. 2004 Jun;27(6):1487-95
references.pmid: 15161807
references.citation: Toxicol Appl Pharmacol. 2004 Jun 1;197(2):67-83
references.pmid: 15163543
references.citation: Environ Health Perspect. 2012 Oct;120(10):1418-24
references.pmid: 23008276
references.citation: Epidemiology. 2009 Nov;20(6):807-15
references.pmid: 19652600
references.citation: Environ Health Perspect. 2009 Mar;117(3):455-60
references.pmid: 19337522
references.citation: Int J Epidemiol. 2011 Dec;40(6):1593-604
references.pmid: 22158669
references.citation: Diabetologia. 2013 Aug;56(8):1696-704
references.pmid: 23666166
references.citation: Epidemiology. 2009 Nov;20(6):821-3; discussion e1-2
references.pmid: 19730267
references.citation: Diabetes Care. 2006 Nov;29(11):2427-32
references.pmid: 17065679
references.citation: Am J Epidemiol. 2012 Nov 15;176(10):865-74
references.pmid: 23097256
references.citation: Environ Res. 2007 Jul;104(3):383-9
references.pmid: 17475235
references.citation: JAMA. 1996 Apr 24;275(16):1233-40
references.pmid: 8601954
references.citation: J Korean Med Sci. 2013 Jun;28(6):861-8
references.pmid: 23772150
references.citation: JAMA. 2008 Aug 20;300(7):814-22
references.pmid: 18714061
references.citation: Environ Health Perspect. 2012 Dec;120(12):1658-70
references.pmid: 22889723