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Occup Environ Med. 2018 Sep;75(9):661-667. doi: 10.1136/oemed-2018-104996. Epub 2018 Apr 19.

Metals in urine in relation to the prevalence of pre-diabetes, diabetes and atherosclerosis in rural India.

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Department of Chemistry, DST Unit of Nanoscience and Thematic Unit of Excellence in Water Research, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India.
KMCH Research Foundation, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India.
Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Contributed equally



Diabetes and cardiovascular diseases are growing burdens in rural communities worldwide. We have observed a high prevalence of diabetes among rural farming communities in India and sought to evaluate the association of non-traditional risk factors, such as metals, with diabetes and other cardiometabolic risk factors in this community.


Anthropometric measurements, chemistries and carotid intima-media thickness were determined in 865 participants of the Kovai Medical Center and Hospital-Nallampatti Non-Communicable Disease Study-I (KMCH-NNCD-I, 2015), a cross-sectional study conducted in a farming village in South India. Urinary metal levels were determined by inductively couped plasma-mass spectrometry analysis and corrected to urinary creatinine level. Statistical analyses were performed to study the association between urinary metal levels and clinical parameters.


82.5% of the study population were involved in farming and high levels of toxic metals were detected in the synthetic fertilisers used in the study village. The prevalence of pre-diabetes, diabetes and atherosclerosis was 43.4%, 16.2% and 10.3%, respectively. On logistic regression analysis, no association of traditional risk factors such as body mass index, blood pressure and total cholesterol with disease conditions was observed, but urinary levels of metals such as arsenic, chromium, aluminium and zinc showed an association with diabetes, while arsenic and zinc showed an association with pre-diabetes and atherosclerosis.


Our data suggest a probable role of metals in the aetiology of diabetes and cardiovascular diseases in rural communities. Identifying and eliminating the causes of increased levels of these environmental chemicals could have a beneficial impact on the burden of non-communicable diseases in rural population.


arsenic; atherosclerosis; cardiometabolic risk factors; diabetes; metals; pre-diabetes; rural health


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