| Protective Effects of B Vitamins and Antioxidants on the Risk of Arsenic-Related Skin Lesions in Bangladesh Lydia B. Zablotska,1 Yu Chen,2 Joseph H. Graziano,3 Faruque Parvez,3 Alexander van Geen,4 Geoffrey R. Howe,1 and Habibul Ahsan1,5,6,7,8 1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; 2Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA; 3Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA; 4Lamont-Doherty Earth Observatory of Columbia University, New York, New York, USA; 5Department of Health Studies, 6Department of Medicine, 7Department of Human Genetics, and 8Cancer Research Center, The University of Chicago, Chicago, Illinois, USA Abstract
Background: An estimated 25–40 million of the 127 million people of Bangladesh have been exposed to high levels of naturally occurring arsenic from drinking groundwater. The mitigating effects of diet on arsenic-related premalignant skin lesions are largely unknown. Objectives: The purpose of this study was to clarify the effects of the vitamin B group (thiamin, riboflavin, niacin, pyridoxine, and cobalamin) and antioxidants (vitamins A, C, and E) on arsenic-related skin lesions. Methods: We performed a cross-sectional study using baseline data from the Health Effects of Arsenic Longitudinal Study (HEALS) , 2000–2002, with individual-level, time-weighted measures of arsenic exposure from drinking water. A total of 14,828 individuals meeting a set of eligibility criteria were identified among 65,876 users of all 5,996 tube wells in the 25-km2 area of Araihazar, Bangladesh ; 11,746 were recruited into the study. This analysis is based on 10,628 subjects (90.5%) with nonmissing dietary data. Skin lesions were identified according to a structured clinical protocol during screening and confirmed with further clinical review. Results: Riboflavin, pyridoxine, folic acid, and vitamins A, C, and E significantly modified risk of arsenic-related skin lesions. The deleterious effect of ingested arsenic, at a given exposure level, was significantly reduced (ranging from 46% reduction for pyridoxine to 68% for vitamin C) for persons in the highest quintiles of vitamin intake. Conclusions: Intakes of B-vitamins and antioxidants, at doses greater than the current recommended daily amounts for the country, may reduce the risk of arsenic-related skin lesions in Bangladesh. Key words: antioxidants, arsenic, Bangladesh, B vitamins, skin lesions. Environ Health Perspect 116:1056–1062 (2008) . doi:10.1289/ehp.10707 available via http://dx.doi.org/ [Online 16 April 2008]
Address correspondence to H. Ahsan, The University of Chicago, 5841 South Maryland Ave., Suite N102, Chicago, IL 60637 USA. Telephone: (773) 834-9956. Fax: (773) 702-0139. E-mail: habib@uchicago.edu This work was supported by National Institutes of Health grants 2P42 ES10349-06, P30ES09089, R01CA107431, and RO1CA102484. The authors declare they have no competing financial interests. Received 25 July 2007 ; accepted 13 April 2008. An erratum is posted online at http://www.ehponline.org/docs/2008/10707/errata.html.
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