Scientific Reports volume 13, Número do artigo: 9244 (2023) Citar este artigo
2 Altmétrica
Detalhes das métricas
O hidroarsenicismo regional endêmico crônico (CERHA) é um problema global que afeta mais de 200 milhões de pessoas expostas ao arsênico (As) na água potável. Isso inclui 1,75 milhão de indivíduos residentes em La Comarca Lagunera, uma região no centro-norte do México. Os níveis de arsênico nessa região geralmente excedem a diretriz da OMS de 10 µg L-1. Alterações bioquímicas relacionadas ao metabolismo humano do As podem aumentar o risco de sobrepeso e obesidade (O&O), diabetes tipo 2 (DM2) e hipertensão (AHT). Em nosso estudo, investigamos o papel do As na água potável como fator de risco para essas doenças metabólicas. Nós nos concentramos em populações com níveis de água potável historicamente moderados (San Pedro) e baixos (Lerdo) e pessoas sem evidências históricas de contaminação da água por As. A avaliação da exposição ao As foi baseada em medições das concentrações de As na água potável (medianas 67,2, 21,0, 4,3 µg L−1) e na urina de mulheres (9,4, 5,3, 0,8 µg L−1) e homens (18,1, 4,8, 1,0 µg L-1). Uma correlação significativa entre o As na água de beber e na urina evidenciou a exposição ao As na população (R2 = 0,72). Razões de chances ajustadas com intervalos de confiança de 95% evidenciaram maiores chances de serem diagnosticados com DM2 (1,7, 1,2–2,0) e AHT (1,8, 1,7–1,9) em indivíduos que vivem em San Pedro do que em Lerdo. Ainda assim, não houve associação significativa com a obesidade. Verificou-se que os indivíduos que vivem em cidades CERHA têm um risco maior de obesidade (1,3–1,9), DM2 (1,5 a 3,3) e AHT (1,4 a 2,4) em comparação com aqueles que residem em cidades não CERHA. Finalmente, a obesidade é mais provável em mulheres [inverso de OR e 95% CI 0,4 (0,2–0,7)] em comparação com homens, enquanto os homens têm maior probabilidade de serem diagnosticados com DM2 [OR = 2,0 (1,4–2,3)] e AHT [ OR = 2,0 (1,5–2,3)] do que as mulheres, independentemente do município.
A prevalência de sobrepeso e obesidade (O&O), diabetes tipo 2 (DM2) e hipertensão (HAT) aumentou significativamente desde a década de 19701, tornando-se o principal problema de saúde no México e ainda crescendo. Os Inquéritos Nacionais de Saúde e Nutrição de 2016–2018 (ENSANUT)1 revelaram que as pessoas com O&O representavam 96 milhões (71,3 a 75,2%, ou 3 em 4 adultos). Além disso, 13,5 milhões de pessoas (10,4%) foram diagnosticadas com DM2 e 15,2 milhões de pessoas (12%) vivem com AHT. O DM2 é a segunda principal causa de morte no México, com 106.525 mortes relatadas em 20182. O México tem a sexta maior prevalência global de DM2 e a maior incidência de mortes entre os países com grandes populações3.
Os determinantes multifatoriais de O&O, DM2 e AHT incluem dieta de modificação acelerada resultante do consumo de alimentos com alto teor calórico, alto teor de carboidratos e alto teor de gordura, padrões de estilo de vida sedentário e suscetibilidade genética, particularmente entre populações de origem ameríndia3,4,5 . No entanto, fatores ambientais também podem influenciar as predisposições genéticas e contribuir para o rápido aumento de O&O, DM2 e AHT [por exemplo,6,7,8,9].
O hidroarsenicismo regional endêmico crônico (CERHA) está relacionado à presença natural de arsênio (As) em águas subterrâneas para consumo humano e é prevalente em muitos países do mundo10,11,12,13. Mais de 200 milhões de pessoas estão cronicamente expostas ao As na água potável em níveis que excedem as diretrizes da Organização Mundial da Saúde de 10 µg L-1 para água potável10, 14, 15. A população mais severamente afetada pelo CERHA em todo o mundo consiste em famílias de baixo nível socioeconômico . As regiões CERHA nas Américas incluem Argentina, Bolívia, Chile, El Salvador, Estados Unidos da América, Nicarágua, Peru e México. A região CERHA está localizada no centro-norte do México, especificamente na província de La Comarca Lagunera. Nove municípios nos estados de Coahuila e Durango, com uma população de cerca de 1,75 milhão de pessoas2, foram afetados pelo arsênico nas águas subterrâneas por sete décadas. As concentrações típicas de As nas águas subterrâneas na província de La Comarca Lagunera variam de 0,7 a > 800 µg L−1 [por exemplo,16,17,18,19,20]. Os efeitos adversos à saúde relacionados à exposição ao As foram documentados desde a década de 1960.
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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