Associazione tra obesità, diabete e ipertensione e l'arsenico nell'acqua potabile nella provincia di Comarca Lagunera (nord

Jul 28, 2023

Rapporti scientifici volume 13, numero articolo: 9244 (2023) Citare questo articolo

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L’idroarsenicismo regionale endemico cronico (CERHA) è un problema globale che colpisce oltre 200 milioni di persone esposte all’arsenico (As) nell’acqua potabile. Ciò include 1,75 milioni di persone che risiedono a La Comarca Lagunera, una regione nel Messico centro-settentrionale. I livelli di arsenico in questa regione superano tipicamente le linee guida dell'OMS di 10 µg L−1. Le alterazioni biochimiche legate al metabolismo umano possono aumentare il rischio di sovrappeso e obesità (O&O), diabete di tipo 2 (T2D) e ipertensione (AHT). Nel nostro studio, abbiamo studiato il ruolo dell’As nell’acqua potabile come fattore di rischio per queste malattie metaboliche. Ci siamo concentrati su popolazioni con livelli di As di acqua potabile storicamente moderati (San Pedro) e bassi (Lerdo) e su persone senza prove storiche di contaminazione dell’acqua da As. La valutazione dell'esposizione all'As si è basata sulle misurazioni delle concentrazioni di As nell'acqua potabile (mediane 67,2, 21,0, 4,3 µg L−1) e nelle urine nelle donne (9,4, 5,3, 0,8 µg L−1) e negli uomini (18,1, 4,8, 1,0 µg L−1). Una correlazione significativa tra As nell'acqua potabile e nelle urine ha evidenziato l'esposizione all'As nella popolazione (R2 = 0,72). Gli odds ratio aggiustati con intervalli di confidenza del 95% hanno evidenziato maggiori probabilità di essere diagnosticati con T2D (1,7, 1,2–2,0) e AHT (1,8, 1,7–1,9) negli individui che vivono a San Pedro rispetto a quelli a Lerdo. Tuttavia, non è stata riscontrata alcuna associazione significativa con l’obesità. È stato riscontrato che gli individui che vivono nelle città CERHA hanno un rischio più elevato di obesità (1,3–1,9), T2D (da 1,5 a 3,3) e AHT (da 1,4 a 2,4) rispetto a quelli che risiedono in città non CERHA. Infine, l’obesità è più probabile nelle donne [inverso di OR e IC al 95% 0,4 (0,2-0,7)] rispetto agli uomini, mentre agli uomini è più probabile che venga diagnosticato T2D [OR = 2,0 (1,4-2,3)] e AHT [ OR = 2,0 (1,5–2,3)] rispetto alle donne, indipendentemente dal comune.

La prevalenza di sovrappeso e obesità (O&O), diabete di tipo 2 (T2D) e ipertensione (AHT) è aumentata in modo significativo a partire dagli anni ’701, rendendolo il principale problema sanitario in Messico, e tuttora in crescita. Il National Health and Nutrition Surveys (ENSANUT)1 del 2016-2018 ha rivelato che le persone affette da O&O erano 96 milioni (dal 71,3 al 75,2%, ovvero 3 adulti su 4). Inoltre, a 13,5 milioni di persone (10,4%) è stato diagnosticato il T2D e 15,2 milioni di persone (12%) vivono con AHT. Il T2D è la seconda causa di morte in Messico, con 106.525 decessi segnalati nel 20182. Il Messico ha la sesta più alta prevalenza globale di T2D e la più alta incidenza di decessi tra i paesi con una popolazione numerosa3.

I determinanti multifattoriali di O&O, T2D e AHT includono una dieta modificata accelerata derivante dal consumo di cibi ad alto contenuto calorico, ad alto contenuto di carboidrati e ricchi di grassi, modelli di vita sedentari e suscettibilità genetica, in particolare tra le popolazioni di derivazione amerindia3,4,5 . Tuttavia, i fattori ambientali possono anche influenzare le predisposizioni genetiche e contribuire al rapido aumento di O&O, T2D e AHT [eg,6,7,8,9].

L'idroarsenicismo regionale endemico cronico (CERHA) è correlato alla presenza naturale di arsenico (As) nelle acque sotterranee destinate al consumo umano ed è prevalente in molti paesi del mondo10,11,12,13. Oltre 200 milioni di persone sono cronicamente esposte all'As nell'acqua potabile a livelli che superano le linee guida dell'Organizzazione Mondiale della Sanità di 10 µg L−1 per l'acqua potabile10, 14, 15. La popolazione più gravemente colpita dal CERHA a livello mondiale è costituita da famiglie con status socioeconomico basso . Le regioni CERHA nelle Americhe includono Argentina, Bolivia, Cile, El Salvador, Stati Uniti d'America, Nicaragua, Perù e Messico. Una regione CERHA si trova nel Messico centro-settentrionale, più precisamente nella provincia di La Comarca Lagunera. Nove municipalità negli stati di Coahuila e Durango, con una popolazione di quasi 1,75 milioni di persone2, sono state colpite dalla presenza di arsenico nelle acque sotterranee per settant’anni. Le concentrazioni tipiche di As nelle acque sotterranee nella provincia di La Comarca Lagunera variano da 0,7 a > 800 µg L−1 [ad es.,16,17,18,19,20]. Gli effetti nocivi sulla salute legati all’esposizione all’As sono stati documentati fin dagli anni ’60.

1100 mm y−1), and average summer and winter temperatures of 31 and 16 ºC, respectively. Higher and lower precipitation occurs in July–August (13–52 mm/d, Julian days 190–220) and April (4 mm d−1, Julian 90–120). Before the Nazas and Aguanaval rivers were dammed, their flow discharges formed 13 ephemeral lagoons, including the Mayran lagoon, the largest in Latin America. These lagoons disappeared after the construction of the dams in the 1940s–1960s. In addition, the aquifer recharge in the region lowered rapidly after the 1960s. At the same time, the water demand tripled in the last 70 years due to the growth of agricultural and dairy cattle activities and the human population. Currently, water uses are agricultural-dairy cattle (91%) and urban and industrial activities (9%), with 60.6% of the volume extracted from the aquifers and 39.4% from the dams23./p> 200 mg dL−1 indicates T2D. We defined T2D prevalence as diagnosed T2D when T2D diagnosis was self-reported in the questionnaires and undiagnosed T2D for participants who answered "NO" in the self-reported questionnaire, but had an FSBG result ≥ 126 mg dL−1./p> 95%, and the coefficient of variation was < 10% in both CRMs. The method detection limits were < 10 ng L−1 for As. We normalized As levels in urine by creatinine concentration (units in µg of As per gram of creatinine)./p> 25 to 125 µg L−1), low (> 10–25 µg L−1), and below the WHO guideline value of 10 µg L−1./p> 1 indicates that exposure may be a risk factor for the disease. Conversely, an OR < 1 implies exposure may be a protective factor against the disease. Wald X2 test was employed to assess the significance of each variable. The Wald test is a significance test for individual regression coefficients in LRM. All statistical analyses were performed using JMP version 14 software (SAS Institute, Cary, NC, USA) with p values < 0.05 considered statistically significant./p> 0.05)./p> 0.05)./p> 0.05). However, As levels in San Pedro were three times higher than those in Lerdo municipality (p < 0.05). In Nazas, Cuencame, Simon Bolivar, and Mapimi, the As levels in groundwater (2.0–10.7 µg L−1) were significantly lower than in San Pedro and Lerdo municipalities (p < 0.05). Regarding As levels in drinking water, values in San Pedro (30.0–42.2 µg L−1) were two times higher than those in Lerdo (16.8–19.4 µg L−1). Arsenic levels in tap water in non-CERHA municipalities (1.2–10.0 µg L−1), were significantly lower than in Lerdo and San Pedro (p < 0.05). No significant differences were observed in the median As levels in groundwater collected from CERHA and non-CERHA municipalities in the La Comarca region during our 2005–2007 and 2015–2017 surveys, as well as in the compilated historical dataset (p > 0.05)./p> 10 times (0.8–1.0 µg U-As L−1) than in non-exposed people (Table 2). Non-significant differences were observed between the sexes. Comparatively, the medians of the urine creatinine levels showed not significant differences between localities exposed and non-exposed to As in drinking water and sex (medians 0.6 to 0.8 g L−1), except in non-exposed women with minimum of 0.29(0.12–0.68) g L−1 (Table 2). Levels of As in urine normalized to creatinine (µg U-As g−1 U-creat), also included in Table 2, showed a large variability with medians from 6.8 to 15.9 µg U-As g−1 U-creat. Non-significant differences were observed in the normalized As in urine exposure and non-exposure or between the sexes (p > 0.05)./p> 0.05). Diagnosed T2D adults showed higher urinary As levels than non-diagnosed T2D (p < 0.05). High variability in the urinary As levels were observed between diagnosed and undiagnosed AHT adults without significant differences. In Lerdo, non-significant differences were observed between sex for the same pathology or among pathologies for the same sex (p > 0.05). The urinary As excretion in non-exposed people neither showed significant differences between sex and pathologies. In all groups in San Pedro, the levels of urinary As were significantly higher than in Lerdo people (p < 0.05). Likewise, all the urinary As excretion values in non-exposed people were significantly lower than people with moderate and low exposure to As in drinking water in San Pedro (7–13 times higher) and Lerdo (2–5 times higher) (p < 0.05), respectively./p> 0.05), however, both were higher than people in non-CERHA municipalities in La Comarca (p < 0.05)./p> 126 mg dL−1). In addition, 13–17% of participants showed values that indicate uncontrolled diabetes (FSBG > 200 mg dL−1). The declared AHT prevalence accounted for 34.9% in San Pedro (women 30.8% and men 40.2%), 29.9% in Lerdo city (women 18.2 and men 33.5%), and 21.7% (women 17.2 and 28.3% men) in non-CERHA municipalities. Based on measurements of SBP and DBP, 2–3% of participants declaring "NO" to AHT questions were added to the AHT percentages in both cities. Although probable errors in the diagnostic could occur in this study (non-diagnosed or misdiagnosed), the prevalence of T2D and AHT in adults increased slightly regarding the questionary declarations. A higher prevalence of T2D and AHT was observed in San Pedro concerning Lerdo municipality. Besides, non-exposed people showed significantly lower incidence of T2D and AHT than exposed people to moderate and low As levels in drinking water in San Pedro and Lerdo, respectively./p> 130 villages and communities in the CERHA municipalities [Fig. 1;23]. However, the intensive extraction of groundwater, mainly from the clean water polygon in the metropolitan zone of Torreon-Gómez Palacio-Lerdo and its surroundings, progressively has caused the aquifer deficit (> 120–183 million m3 y−1) and groundwater depletion (> 1 to 3 m y−1) in the past decades25. Large-volume pumping creates unnatural groundwater gradients that mobilize the waters from the "dirty" (e.g., Francisco I Madero and San Pedro municipalities) to "clean" (e.g., Torreón and Lerdo municipalities) zone, promoting the intrusion of water with high contents of solutes, including As. The progressive groundwater depletion hypothetically increases the As levels because the pumped waters have interacted for a longer time with volcanic and intrusive rocks, one of the probable sources of As in the region. Consequently, the continuous movement and mixing of water masses from dirty to clean zones could increases the As levels in the clean water reservoir groundwater polygon. Given the severe health implications associated with exposure to As, it is imperative that a systematic and continuous monitoring program be implemented in the region./p>

In high-level CERHA municipalities, most wells showed As levels above the Mexican health standard for As in drinking water of 25 µg L−130, a non-safeguard human health standard." href="/articles/s41598-023-36166-5#ref-CR31" id="ref-link-section-d684812e4862"31 2.5 times higher than the WHO recommendation. In low-level CERHA municipalities, most wells are below the Mexican health standard; however, > 80% of the analyzed wells had higher levels than the WHO guideline. In addition, practically all groundwater wells in the CERHA region are significantly enriched in As concerning typical values in natural waters of 1–2 μg L−110, 11, 32, 33./p>

Because the toxicological effects associated with prolonged exposure to As is drinking waters are very variable and can lead to severe skin damage (e.g., hyperkeratosis or hyperhidrosis), vascular and hematological lesions (anemia), neurological disorders, decreased sexual activity, malformations congenital and cancer (skin, lung, kidney, gallbladder)8, 11, 15, the WHO recommended a restrictive quality standard of 10 µg L−1 in drinking water15, ." href="/articles/s41598-023-36166-5#ref-CR31" id="ref-link-section-d684812e4909"31, 33. Mexico maintained the previously WHO recommended limit in drinking water of 25 µg L−1 for several decades. Since May 2, 2023, the more stringent WHO quality standard of 10 µg L−1 has been mandatory in Mexico34./p> 2 times as likely to be obese than men, independent of the exposition As level or residence municipality./p> 104 μg L−1, respectively. Our logistic regression model revealed that people in San Pedro (moderate As level in drinking water) showed more chances of being diagnosed with T2D regarding Lerdo municipality (low exposition level). Also, the chances for T2D in exposed people in CERHA municipalities are 1.5–3.3 higher for people in non-CERHA municipalities. Besides, the chances of being T2D diagnosed are double in men than in women. Thus, our prospective findings support an association of As exposure from drinking water with a higher risk of T2D in the range of levels observed./p> > MMA > TMA). The degree of methylation varies with age (adults > children) and sex (women > men, especially during pregnancy)54, 56. Determining the As species in urine provides valuables insights into the transformation and metabolism of As within the body. Studies conducted in the exposed population of CERHA municipalities in La Comarca Lagunera province have reported high concentrations of As in urine, predominantly DMA (75–78%), followed by MMA (10–12%) and inorganic As (10–15%)19, 55./p> women) and residence place (San Pedro > Lerdo > non-CERHA municipalities people)./p>

./p>

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