Association of Clinical Complications with Nutritional Status and the Prevalence of Leukopenia among Arsenic Patients in Bangladesh

Laila N Islam,Ahm Nurun Nabi,M Mahfuzur Rahman,Azizul I Kazi,Monsur A Khan

doi:10.3390/ijerph2004020074

Abstract

This study conducted in Bangladesh reports the relationship of clinical complications with nutritional status and the prevalence of leukopenia among arsenic exposed patients living in the rural villages. A total of 115 exposed individuals diagnosed as arsenicosis patients were randomly selected from four known arsenic endemic villages, and age-matched 120 unexposed subjects were enrolled in the study program. The duration of arsenic exposure in about 37% of the patients was at least 10 yrs, while the population mean and range were 7.6 +/- 5.2 yrs, and 1 - 25 yrs, respectively. The mean arsenic concentrations in the drinking water for the exposed and unexposed (control) population were 218.1 microg/L and 11.3 microg/L, respectively. The spot urine sample of the arsenicosis patients contained an average of 234.6 microg/L arsenic. Although very few patients showed elevated WBC count, 16% had leukopenia (below normal count), and the whole population had significantly low WBC count than the control subjects. Prevalences of neutropenia and lymphocytosis were observed in patients with chronic exposure to high levels of arsenic in water. The body mass index was found to be lower than 18.5, the cut-off point for malnutrition (underweight), in about 28% of the arsenicosis cases compared to 15% of the controls. The monthly income and total calorie consumption per day showed the patients were underprivileged than the controls. Arsenical symptoms and complications were more severe in the nutritionally vulnerable (underweight) patients than the overweight ones. Also, the incidences of leukopenia and anaemia were more common in the female patients who were underweight. The findings of this research demonstrate that the poor nutritional status of patients increases the complications of chronic arsenic toxicity; suggest the possibility of other sources of arsenic contamination different from drinking water in the study area; and establish a higher prevalence of leukopenia and lymphocytosis in arsenicosis patients.

Highlights

Endemic arsenic exposure emerged as a single catastrophe affecting millions of people mostly living in Bangladesh, India, Mexico, Taiwan and South America
The liver rapidly detoxifies inorganic arsenic that is consumed in drinking water by transforming it to organic forms called monomethylarsonic acid (MMA) and dimethylarsenic
The results showed kilocalorie consumed per kilogram body weight (Kcal/Kg) was highly significantly different between the female patients of different nutritional groups (p < 0.0001); but was significantly different only between the underweight and overweight male patients (p < 0.05)

Summary

Introduction

Endemic arsenic exposure emerged as a single catastrophe affecting millions of people mostly living in Bangladesh, India, Mexico, Taiwan and South America. In these regions, the concentrations of arsenic amount to several hundred micrograms per liter that considerably exceed the standard of 50 μg/L for drinking water, recommended by the World Health Organization. In Bangladesh, at least 25 million people are drinking arsenic contaminated water [1]. The liver rapidly detoxifies inorganic arsenic that is consumed in drinking water by transforming it to organic forms called monomethylarsonic acid (MMA) and dimethylarsenic A higher prevalence rate of arsenical skin lesions with clear dose-response relationship has been found among Bangladeshi populations drinking arsenic contaminated well water [3]; and callus-like growths all over the extremities with changes in skin pigmentation have been reported [4].

Methods

Results

Conclusion