Том 13 научных докладов, номер статьи: 9244 (2023) Цитировать эту статью
2 Альтметрика
Подробности о метриках
Хронический эндемический региональный гидромышьяк (CERHA) представляет собой глобальную проблему, от которой страдают более 200 миллионов человек, подвергшихся воздействию мышьяка (As) в питьевой воде. Сюда входят 1,75 миллиона человек, проживающих в Ла-Комарка-Лагунера, регионе на северо-центральной части Мексики. Уровни мышьяка в этом регионе обычно превышают норматив ВОЗ в 10 мкг/л. Биохимические изменения, связанные с метаболизмом As у человека, могут увеличить риск избыточного веса и ожирения (O&O), диабета 2 типа (СД2) и гипертонии (АГТ). В нашем исследовании мы изучили роль As в питьевой воде как фактора риска развития этих метаболических заболеваний. Мы сосредоточились на группах населения с исторически умеренным (Сан-Педро) и низким (Лердо) уровнем содержания As в питьевой воде, а также на людях, у которых не было исторических свидетельств загрязнения воды As. Оценка воздействия As была основана на измерениях концентрации As в питьевой воде (медианы 67,2, 21,0, 4,3 мкг л-1) и концентрации As в моче у женщин (9,4, 5,3, 0,8 мкг л-1) и мужчин (18,1, 4,8, 1,0). мкг л-1). Значительная корреляция между As в питьевой воде и моче свидетельствовала об экспозиции As в популяции (R2 = 0,72). Скорректированные отношения шансов с доверительными интервалами 95% свидетельствуют о более высоких шансах постановки диагноза СД2 (1,7, 1,2–2,0) и АГТ (1,8, 1,7–1,9) у людей, живущих в Сан-Педро, чем у жителей Лердо. Тем не менее, значимой связи с ожирением не было. Было обнаружено, что люди, живущие в городах CERHA, имеют более высокий риск ожирения (1,3–1,9), СД 2 (1,5–3,3) и АГТ (1,4–2,4) по сравнению с жителями городов, не входящих в CERHA. Наконец, ожирение более вероятно у женщин (обратное ОШ и 95% ДИ 0,4 (0,2–0,7)] по сравнению с мужчинами, в то время как у мужчин чаще диагностируется СД2 [ОШ = 2,0 (1,4–2,3)] и АГТ [ OR = 2,0 (1,5–2,3)], чем женщины, независимо от муниципалитета.
Распространенность избыточного веса и ожирения (O&O), диабета 2 типа (СД2) и гипертонии (АГ) значительно возросла с 1970-х годов1, что делает их ведущей проблемой здравоохранения в Мексике и продолжает расти. Национальные исследования здоровья и питания (ENSANUT)1 2016–2018 годов показали, что на долю людей с О&О приходится 96 миллионов человек (от 71,3 до 75,2%, или 3 из 4 взрослых). Кроме того, у 13,5 млн человек (10,4%) был диагностирован СД2, а у 15,2 млн человек (12%) проживает АГТ. СД2 является второй по значимости причиной смерти в Мексике: в 2018 году было зарегистрировано 106 525 смертей2. Мексика занимает шестое место в мире по распространенности СД2 и самый высокий уровень смертности среди стран с большой численностью населения3.
Многофакторные детерминанты O&O, СД2 и АГТ включают ускоренную модификацию диеты в результате потребления высококалорийной, высокоуглеводной и жирной пищи, малоподвижный образ жизни и генетическую предрасположенность, особенно среди индейского населения3,4,5 . Однако факторы окружающей среды также могут влиять на генетическую предрасположенность и способствовать быстрому увеличению случаев O&O, СД2 и АГТ [например, 6,7,8,9].
Хронический эндемический региональный гидромышьяк (CERHA) связан с естественным присутствием мышьяка (As) в грунтовых водах, используемых человеком, и распространен во многих странах мира10,11,12,13. Более 200 миллионов человек хронически подвергаются воздействию мышьяка в питьевой воде на уровнях, превышающих рекомендованные Всемирной организацией здравоохранения нормы в 10 мкг л-1 для питьевой воды10, 14, 15. Население, наиболее серьезно пострадавшее от CERHA во всем мире, состоит из домохозяйств с низким социально-экономическим статусом. . Регионы CERHA в Северной и Южной Америке включают Аргентину, Боливию, Чили, Сальвадор, Соединенные Штаты Америки, Никарагуа, Перу и Мексику. Регион CERHA расположен в центральной части северной Мексики, а именно в провинции Ла-Комарка-Лагунера. Девять муниципалитетов в штатах Коауила и Дуранго с населением около 1,75 миллиона человек2 страдают от мышьяка в грунтовых водах на протяжении семи десятилетий. Типичные концентрации мышьяка в грунтовых водах в провинции Ла-Комарка-Лагунера колеблются от 0,7 до > 800 мкг/л [например,16,17,18,19,20]. Неблагоприятные последствия для здоровья, связанные с воздействием мышьяка, документируются с 1960-х годов.
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-d43362325e4862"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-d43362325e4909"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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