Arsenic contamination of groundwater and its detrimental effects on human health have been well-documented across various Asian nations [1]. The severity of the issue is particularly alarming in Bangladesh [2]. Inorganic arsenic compounds have been classified as a group of carcinogenic agents harmful to human [3]. Numerous studies conducted in regions such as Taiwan, Chile and Argentina have conclusively demonstrated an increased risk of cancer among populations chronically exposed to inorganic arsenic through drinking water [4-6]. Specifically, a significant dose-response relationship has been established between arsenic concentration in well water and the incidence of cancers affecting the bladder, kidney, skin, lungs and liver in both men and women [6,7]. The discovery of arsenic in groundwater within the Padma-Meghna-Brahmaputra plain of Bangladesh was first reported in 1992 [8]. This region is now regarded as one of the most severely impacted areas worldwide with respect to arsenic contamination [9]. Comprehensive surveys investigating arsenic contamination in Bangladesh began in 1996, initially identifying only three affected villages in two districts [8]. Presently, Bangladesh is grappling with an environmental crisis, as groundwater arsenic levels have surpassed the maximum permissible limit of 50 µg/L [9,10]. Apart from arsenicosis, other symptoms frequently reported in affected populations include chronic weakness, persistent cough, lung crepitations and diabetes mellitus [11-13]. The influence of nutritional factors on arsenic metabolism and toxicity remains an area requiring further exploration. Some studies suggest that poor nutritional status may heighten susceptibility to arsenic-related health issues. Research conducted in West Bengal, India, demonstrated that participants with suboptimal nutritional status (weight below 80% of the standard body weight for their age and sex) exhibited a 1.6-fold increase in the prevalence of keratosis, with males showing a 1.5-fold increase and females a 2.1-fold increase, indicating that malnutrition may exacerbate vulnerability to arsenic toxicity [14]. Experimental studies have revealed that animals, such as rabbits, fed diets deficient in methionine, choline, or proteins displayed reduced arsenic methylation and increased arsenic retention in tissues, particularly in the liver [15]. Similarly, another study observed a decrease in the urinary excretion of dimethyl arsenic acid (DMA) in mice subjected to a choline-deficient diet [16]. However, the precise mechanisms by which individual nutritional status influences arsenic metabolism and toxicity are not yet fully understood. Contrarily, research conducted among the Atacameño population in northern Chile found no evidence of malnutrition in individuals with arsenic-induced skin lesions, indicating potential variability in how nutrition interacts with arsenic toxicity across different populations [9]. This study aims to assess the nutritional status of arsenic-exposed and non-exposed individuals in select regions, providing critical data to guide health policy and nutritional interventions aimed at mitigating the impact of arsenic toxicity on public health.

This cross-sectional comparative study was conducted in selected area Village: Krishno Kathi, Union: Jalalpur, Thana: Tala, District: Satkhira, Bangladesh from July 2001 to December 2002 known for varying levels of arsenic contamination in drinking water. The study areas were chosen based on previous records of arsenic exposure and their accessibility. Arsenic-exposed areas were identified using data from local water testing authorities and non-exposed areas were selected from adjacent regions with safe drinking water. The study population comprised both arsenic-exposed and non-exposed individuals aged 18 years and above residing in the selected areas for at least five years. A multistage random sampling technique was employed. In the first stage, two arsenic-exposed and two non-exposed areas were randomly selected. In the second stage, households within these areas were selected using systematic random sampling. A total of 100 participants were enrolled, with 50 from arsenic-exposed areas and 50 from non-exposed areas.

Inclusion Criteria

• Individuals who had been living in the selected areas for at least five years.
• For the arsenic-exposed group, individuals who consumed arsenic-contaminated water (>50 ppb) for at least five years.
• For the non-exposed group, individuals who consumed water with arsenic levels below the permissible limit (<10 ppb).

Exclusion Criteria

• Pregnant or lactating women.
• Individuals with chronic illnesses (such as cancer, renal disease, or heart disease).
• Participants who had changed their residence in the last five years.

A structured questionnaire was used for collecting demographic and socioeconomic data, including age, sexand access to safe drinking water. Nutritional status was assessed using anthropometric measurements and dietary intake data. Height and weight were measured using standardized procedures and Body Mass Index (BMI) was calculated. Dietary intake data were collected using a 24-hour dietary recall method, supplemented with a food frequency questionnaire (FFQ) to capture longer-term eating patterns. The study protocol was reviewed and approved by the Institutional Review Board (IRB). Informed consent was obtained from all participants prior to data collection and confidentiality of personal information was maintained throughout the study.

Arsenic Exposure Assessment

To confirm arsenic exposure, water samples were collected from participants primary drinking water sources, including tube wells and community water supplies. Arsenic levels in water were measured using atomic absorption spectrophotometry (AAS). Participants were categorized as exposed if their drinking water arsenic concentration exceeded 50 μg/L, following the World Health Organization's guideline for arsenic in drinking water.

Nutritional Assessment

Nutritional status was evaluated using two main indicators: Body Mass Index (BMI)and dietary intake. BMI was categorized as underweight (<18.5 kg/m²), normal weight (18.5–24.99 kg/m²) and overweight (˃24.99kg/m). Dietary diversity was assessed based on the consumption of key food groups using the FFQ.

Data Analysis

Data were entered and analyzed using SPSS. Descriptive statistics were used to summarize demographic characteristics, arsenic exposure levels and nutritional outcomes. Independent t-tests and chi-square tests were performed to compare means and proportions between arsenic-exposed and non-exposed groups. A p-value of <0.05 was considered statistically significant.

A total of 100 participants were enrolled, equally divided into arsenic-exposed and non-exposed groups. In terms of socio-economic characteristics (Table 1), the mean age of participants in the exposed group was 32.72±14.89 years, while that of the non-exposed group was 35.39±12.75 years. Although the age distribution across various age groups showed some variation between the exposed and non-exposed groups, the differences were not statistically significant (P > 0.05). Similarly, the gender distribution between males and females did not differ significantly between the two groups, with males accounting for 62% and 60% in the exposed and non-exposed groups, respectively. Furthermore, a significant difference in Body Mass Index (BMI) was observed, where the exposed group had a significantly lower BMI (mean 19.29±0.95) compared to the non-exposed group (mean 20.62±1.32, P = 0.0008). Additionally, the arsenic concentration in the exposed group was substantially higher (653.54±28.78 mg/L) than in the non-exposed group (12.4±4.37 mg/L, P = 0.000).  In terms of daily nutrient intake (Table 2), the total weight of food consumed, energy intake, protein, fat, carbohydrate, calciumand other micronutrients were evaluated. However, no statistically significant differences were found between the exposed and non-exposed groups for most nutrients. For instance, the mean energy intake for the exposed group was 1138.12±662.63 kcal compared to 1100.93±244.42 kcal for the non-exposed group (P = 0.403). Similarly, the protein intake was 35±26 grams for the exposed group and 31±23 grams for the non-exposed group (P = 0.202). The intake of fat, carbohydrate, calcium, ironand other micronutrients such as riboflavin and zinc showed minimal differences between the groups, none of which were statistically significant (P > 0.05). The nutritional status of the study participants (Table 3) revealed a significant difference in BMI categories between the two groups. Specifically, 60% of the exposed group had a low BMI (˂ 18.5 kg/m²) compared to 28% in the non-exposed group (P < 0.01). Conversely, a higher percentage of participants in the non-exposed group (68%) had a normal BMI (18.5–24.99 kg/m²) compared to 36% in the exposed group. Both groups had an identical percentage of overweight individuals (4%) with no significant difference observed.

Table 1: Socio-economic characteristics of the study population (N=100).

Table 2: Amount of principal nutrients taken per day by the study population (N=100).

Table 3: Nutritional status of the study participants (N=100).

Poor nutritional status may heighten an individual's vulnerability to arsenic toxicity, while conversely, arsenicosis may contribute to deteriorating nutritional status. This relationship has been documented in various studies conducted in Chile, West Bengal (India) and Bangladesh [14,17-19]. The present study offers valuable insights into the nutritional and socio-economic characteristics of arsenic-exposed and non-exposed populations in specific regions of Bangladesh. The findings highlight notable distinctions between these groups, particularly concerning body mass index (BMI) and nutrient intake, which could inform public health strategies and interventions. The analysis of socio-economic characteristics revealed no significant differences in age distribution between the arsenic-exposed and non-exposed groups (p >0.05), suggesting that the demographic profile was evenly matched. However, understanding the socio-economic backdrop is essential for interpreting nutritional status. Socio-economic status affects access to quality food and healthcare, both of which are critical for maintaining nutritional well-being. Previous research has demonstrated that individuals from lower socio-economic backgrounds often face restricted access to varied food sources and healthcare services, intensifying the negative nutritional impact of arsenic exposure [20]. The current study also found no significant gender differences between the exposed and non-exposed groups (p >0.05). In contrast, significant disparities were observed in BMI. The mean BMI was notably lower in the arsenic-exposed group (19.29±0.95 kg/m²) compared to the non-exposed group (20.62±1.32 kg/m²), with a p-value of 0.0008, indicating a clear association between arsenic exposure and reduced BMI [20]. This supports previous findings that chronic arsenic exposure correlates with diminished nutritional status and adverse health outcomes [21]. The study’s analysis of daily nutrient intake showed no significant differences in total food weight, energy, protein, fat, carbohydrates, or micronutrient consumption between the two groups (all p >0.05). This observation is particularly striking as it implies that despite similar dietary intake levels, the arsenic-exposed group experiences worse nutritional outcomes. A significant proportion of participants with low BMI (<18.5 kg/m²) was found in the arsenic-exposed group (60%), compared to the non-exposed group (28%), underscoring a strong correlation between arsenic exposure and malnutrition. The statistical significance (p <0.01) reinforces this association, suggesting that chronic arsenic exposure exacerbates nutritional deficiencies. These findings align with prior research indicating that arsenic disrupts metabolic processes and impairs nutrient absorption, contributing to poor nutritional outcomes [20]. Additionally, the study revealed that the prevalence of normal BMI (18.5–24.99 kg/m²) was lower among the arsenic-exposed group (36%) than in the non-exposed group (68%). This discrepancy underscores the broader health impact of arsenic exposure, as individuals exposed to arsenic appear more susceptible to undernutrition. Similar outcomes were reported by Mandal et al. (2002), who observed a significant decline in BMI within arsenic-affected populations, potentially due to arsenic’s interference with nutrient metabolism and immune function [22]. Notably, the proportion of participants with a high BMI (>24.99 kg/m²) was the same in both groups at 4%, highlighting the complex nature of nutritional challenges in arsenic-affected regions. These findings emphasize the dual burden of malnutrition and environmental contamination faced by communities with high arsenic exposure. Nutritional status is a fundamental determinant of overall healthand factors that compromise an individual's ability to maintain an adequate BMI can lead to significant public health implications. Consequently, public health interventions designed to enhance nutrition in arsenic-exposed populations must also address the root issue of arsenic contamination to achieve sustainable health improvements.

Limitations of the study: The cross-sectional design restricts the ability to infer causality between arsenic exposure and nutritional status. The small sample size (100 participants) limits the generalizability of the findings. Self-reported dietary intake data may be subject to recall bias, impacting the accuracy of nutrient intake assessment. The study did not account for potential confounding factors such as other environmental exposures or underlying health conditions. The assessment of arsenic exposure was limited to water sources, neglecting potential dietary arsenic intake.

The study highlights significant nutritional disparities between arsenic-exposed and non-exposed individuals in selected areas of Bangladesh. Arsenic-exposed participants had a substantially lower BMI, with 60% categorized as underweight compared to 28% in the non-exposed group. Despite similar daily nutrient intakes between groups, arsenic exposure was associated with poor nutritional outcomes, particularly low BMI. This indicates that arsenic exposure negatively impacts nutritional status, potentially exacerbating health issues. Public health interventions should focus on improving nutrition and reducing arsenic exposure to mitigate these adverse effects and enhance overall health outcomes in affected populations.

Funding: Asia Arsenic Network (AAN) funded by JICA, supervised by NIPSOM  

Conflict of interest: None declared

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