title: A cross sectional study of anemia and iron deficiency as risk factors for arsenic-induced skin lesions in Bangladeshi women.
abstract: BACKGROUND
  In the Ganges Delta, chronic arsenic poisoning is a health concern affecting millions of people who rely on groundwater as their potable water source. The prevalence of anemia is also high in this region, particularly among women. Moreover, arsenic is known to affect heme synthesis and erythrocytes and the risk of arsenic-induced skin lesions appears to differ by sex.
  
  
  METHODS
  We conducted a case-control study in 147 arsenic-exposed Bangladeshi women to assess the association between anemia and arsenic-induced skin lesions.
  
  
  RESULTS
  We observed that the odds of arsenic-related skin lesions were approximately three times higher among women who were anemic (hemoglobin < 120 g/L) compared to women with normal hemoglobin levels [Odds Ratio (OR) = 3.32, 95% Confidence Intervals (CI): 1.29, 8.52] after adjusting for arsenic levels in drinking water and other covariates. Furthermore, 75% of the women with anemia had adequate iron stores (serum ferritin ≥ 12 μg/L), suggesting that the majority of anemia detected in this population was unrelated to iron depletion.
  
  
  CONCLUSIONS
  Considering the magnitude of arsenic exposure and prevalence of anemia in Bangladeshi women, additional research is warranted that identifies the causes of anemia so that effective interventions can be implemented while arsenic remediation efforts continue.
authors.affiliation: College of Public Health and Human Sciences, Oregon State University, 15 Milam Hall, Corvallis, OR, 97331, USA. Molly.Kile@oregonstate.edu.
authors.forename: Molly L
authors.initials: ML
authors.lastname: Kile
authors.affiliation: Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, Amherst, 100 Holdsworth Way, Amherst, MA, 01003, USA. joycelyn.faraj@gmail.com.
authors.forename: Joycelyn M
authors.initials: JM
authors.lastname: Faraj
authors.affiliation: Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, Amherst, 100 Holdsworth Way, Amherst, MA, 01003, USA. alayner@nutrition.umass.edu.
authors.forename: Alayne G
authors.initials: AG
authors.lastname: Ronnenberg
authors.affiliation: Dhaka Community Hospital Trust, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, Bangladesh. qzaman07@gmail.com.
authors.forename: Quazi
authors.initials: Q
authors.lastname: Quamruzzaman
authors.affiliation: Dhaka Community Hospital Trust, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, Bangladesh. dcht87@gmail.com.
authors.forename: Mahmudar
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Dhaka Community Hospital Trust, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, Bangladesh. mostofa07@gmail.com.
authors.forename: Golam
authors.initials: G
authors.lastname: Mostofa
authors.affiliation: Dhaka Community Hospital Trust, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, Bangladesh. joya9878@yahoo.com.
authors.forename: Sakila
authors.initials: S
authors.lastname: Afroz
authors.affiliation: Department of Environmental Health, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA. dchris@hsph.harvard.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood / Q000150:complications*; D001151:Arsenic / Q000009:adverse effects*; D020261:Arsenic Poisoning / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D001459:Bangladesh; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000737:chemistry*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005293:Ferritins / Q000097:blood; D060587:Groundwater; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D015995:Prevalence; D012307:Risk Factors; D012871:Skin Diseases / Q000139:chemically induced*; D014874:Water Pollutants, Chemical / Q000009:adverse effects; D014881:Water Supply; D055815:Young Adult
chemical_list: D060766:Drinking Water; D006454:Hemoglobins; D014874:Water Pollutants, Chemical; D005293:Ferritins; D007501:Iron; D001151:Arsenic