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Am J Epidemiol. 2018 Aug 1;187(8):1598-1612. doi: 10.1093/aje/kwy048.

The Association of Arsenic Exposure and Arsenic Metabolism With the Metabolic Syndrome and Its Individual Components: Prospective Evidence From the Strong Heart Family Study.

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Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
Area of Cardiometabolic and Renal Risk, Clinical Research Foundation of Valencia, Valencia, Spain.
Department of Statistics and Operational Research, Faculty of Mathematics, University of Valencia, Valencia, Spain.
Missouri Breaks Industries Research, Inc., Eagle Butte, South Dakota.
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Department of Analytical Chemistry, Institute of Chemistry, University of Graz, Graz, Austria.
Texas Biomedical Research Institute, San Antonio, Texas.
MedStar Health Research Institute, Hyattsville, Maryland.
Department of Medicine, School of Medicine, Georgetown University, Washington, DC.


Inorganic arsenic exposure is ubiquitous, and both exposure and interindividual differences in its metabolism have been associated with cardiometabolic risk. However, the associations of arsenic exposure and arsenic metabolism with the metabolic syndrome (MetS) and its individual components are relatively unknown. We used Poisson regression with robust variance to evaluate the associations of baseline arsenic exposure (urinary arsenic levels) and metabolism (relative percentage of arsenic species over their sum) with incident MetS and its individual components (elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, hypertension, and elevated fasting plasma glucose) in 1,047 participants from the Strong Heart Family Study, a prospective family-based cohort study in American Indian communities (baseline visits were held in 1998-1999 and 2001-2003, follow-up visits in 2001-2003 and 2006-2009). Over the course of follow-up, 32% of participants developed MetS. An interquartile-range increase in arsenic exposure was associated with a 1.19-fold (95% confidence interval: 1.01, 1.41) greater risk of elevated fasting plasma glucose concentration but not with other individual components of the MetS or MetS overall. Arsenic metabolism, specifically lower percentage of monomethylarsonic acid and higher percentage of dimethylarsinic acid, was associated with higher risk of overall MetS and elevated waist circumference but not with any other MetS component. These findings support the hypothesis that there are contrasting and independent associations of arsenic exposure and arsenic metabolism with metabolic outcomes which may contribute to overall diabetes risk.

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