title: Arsenic exposure and type 2 diabetes: results from the 2007-2009 Canadian Health Measures Survey.
abstract: BACKGROUND
  Inorganic arsenic and its metabolites are considered dangerous to human health. Although several studies have reported associations between low-level arsenic exposure and diabetes mellitus in the United States and Mexico, this association has not been studied in the Canadian population. We evaluated the association between arsenic exposure, as measured by total arsenic concentration in urine, and the prevalence of type 2 diabetes (T2D) in 3151 adult participants in Cycle 1 (2007-2009) of the Canadian Health Measures Survey (CHMS).
  
  
  METHODS
  All participants were tested to determine blood glucose and glycated hemoglobin. Urine analysis was also performed to measure total arsenic. In addition, participants answered a detailed questionnaire about their lifestyle and medical history. We assessed the association between urinary arsenic levels and T2D and prediabetes using multivariate logistic regression while adjusting for potential confounders.
  
  
  RESULTS
  Total urinary arsenic concentration was positively associated with the prevalence of T2D and prediabetes: adjusted odds ratios were 1.81 (95% CI: 1.12-2.95) and 2.04 (95% CI: 1.03-4.05), respectively, when comparing the highest (fourth) urinary arsenic concentration quartile with the lowest (first) quartile. Total urinary arsenic was also associated with glycated hemoglobin levels in people with untreated diabetes.
  
  
  CONCLUSIONS
  We found significant associations between arsenic exposure and the prevalence of T2D and prediabetes in the Canadian population. Causal inference is limited due to the cross-sectional design of the study and the absence of long-term exposure assessment.
authors.affiliation: Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Quebec, Canada.|Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Quebec, Canada.
authors.forename: S K
authors.initials: SK
authors.lastname: Feseke
authors.affiliation: Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: St-Laurent
authors.affiliation: Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Quebec, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Anassour-Sidi
authors.affiliation: Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Quebec, Canada.|Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Quebec, Canada.|Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Ayotte
authors.affiliation: Département de santé environnementale et santé au travail, Chaire d'analyse et de gestion des risques toxicologiques, École de santé publique, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Bouchard
authors.affiliation: Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Quebec, Canada.|Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Quebec, Canada.|Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Levallois
mesh_terms: D000328:Adult; D000368:Aged; D001151:Arsenic / Q000652:urine*; D001786:Blood Glucose / Q000032:analysis; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000652:urine; D060766:Drinking Water / Q000032:analysis / Q000592:standards; D004781:Environmental Exposure; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008019:Life Style; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000652:urine; D015995:Prevalence; D013223:Statistics as Topic
chemical_list: D001151:Arsenic; D001786:Blood Glucose; D060766:Drinking Water; D006442:Glycated Hemoglobin
keywords: Canadian Health Measures Survey; population survey; type 2 diabetes; urinary arsenic