title: Refinement of arsenic attributable health risks in rural Pakistan using population specific dietary intake values.
abstract: Previous risk assessment studies have often utilised generic consumption or intake values when evaluating ingestion exposure pathways. If these values do not accurately reflect the country or scenario in question, the resulting risk assessment will not provide a meaningful representation of cancer risks in that particular country/scenario.
  
  
  
  This study sought to determine water and food intake parameters for one region in South Asia, rural Pakistan, and assess the role population specific intake parameters play in cancer risk assessment.
  
  
  
  A questionnaire was developed to collect data on sociodemographic features and 24-h water and food consumption patterns from a rural community. The impact of dietary differences on cancer susceptibility linked to arsenic exposure was evaluated by calculating cancer risks using the data collected in the current study against standard water and food intake levels for the USA, Europe and Asia. A probabilistic cancer risk was performed for each set of intake values of this study.
  
  
  
  Average daily total water intake based on drinking direct plain water and indirect water from food and beverages was found to be 3.5Lday-1(95% CI: 3.38, 3.57) exceeding the US Environmental Protection Agency's default (2.5Lday-1) and World Health Organization's recommended intake value (2Lday-1). Average daily rice intake (469gday-1) was found to be lower than in India and Bangladesh whereas wheat intake (402gday-1) was higher than intake reported for USA, Europe and Asian sub-regions. Consequently, arsenic-associated cumulative cancer risks determined for daily water intake was found to be 17 chances in children of 3-6years (95% CI: 0.0014, 0.0017), 14 in children of age 6-16years (95% CI: 0.001, 0.0011) and 6 in adults of 16-67years (95% CI: 0.0006, 0.0006) in a population size of 10,000. This is higher than the risks estimated using the US Environmental Protection Agency and World Health Organization's default recommended water intake levels. Rice intake data showed early life cumulative cancer risks of 15 chances in 10,000 for children of 3-6years (95% CI: 0.0012, 0.0015), 14 in children of 6-16years (95% CI: 0.0011, 0.0014) and later life risk of 8 adults (95% CI: 0.0008, 0.0008) in a population of 10,000. This is lower than the cancer risks in countries with higher rice intake and elevated arsenic levels (Bangladesh and India). Cumulative cancer risk from arsenic exposure showed the relative risk contribution from total water to be 51%, from rice to be 44% and 5% from wheat intake.
  
  
  
  The study demonstrates the need to use population specific dietary information for risk assessment and risk management studies. Probabilistic risk assessment concluded the importance of dietary intake in estimating cancer risk, along with arsenic concentrations in water or food and age of exposed rural population.
authors.affiliation: Water@leeds, School of Geography, University of Leeds, Leeds LS2 9JT, United Kingdom. Electronic address: gyhj@leeds.ac.uk.
authors.forename: Hifza
authors.initials: H
authors.lastname: Rasheed
authors.affiliation: Water@leeds, School of Geography, University of Leeds, Leeds LS2 9JT, United Kingdom. Electronic address: r.slack@leeds.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Slack
authors.affiliation: Water@leeds, School of Geography, University of Leeds, Leeds LS2 9JT, United Kingdom. Electronic address: p.kay@leeds.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Kay
authors.affiliation: School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, United Kingdom. Electronic address: y.gong@leeds.ac.uk.
authors.forename: Yun Yun
authors.initials: YY
authors.lastname: Gong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001151:Arsenic / Q000032:analysis*; D002648:Child; D000074341:Dietary Exposure; D005260:Female; D005506:Food Contamination / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced; D010154:Pakistan; D018570:Risk Assessment; D012424:Rural Population; D014874:Water Pollutants, Chemical / Q000032:analysis*; D055815:Young Adult
chemical_list: D014874:Water Pollutants, Chemical; D001151:Arsenic
keywords: Cancer risk assessment; Dietary exposure; Rice intake; Risk assessment; Water consumption; Wheat intake