Background

A large body of evidence has shown a link between arsenic exposure and diabetes, but the underlying mechanisms have not yet been clarified.

Objective

We explored the association between arsenic exposure and the reduction of skeletal muscle mass as a potential mechanism of insulin resistance for developing arsenic-related hyperglycemia.

Methods

A total of 581 subjects were recruited from arsenic-endemic and non-endemic areas in Bangladesh and their fasting blood glucose (FBG), serum insulin, and serum creatinine levels were determined. Subjects’ arsenic exposure levels were assessed by arsenic concentrations in water, hair, and nails. HOMA-IR and HOMA-β were used to calculate insulin resistance and β-cell dysfunction, respectively. Serum creatinine levels and lean body mass (LBM) were used as muscle mass indicators.

Results

Water, hair and nail arsenic concentrations showed significant positive associations with FBG, serum insulin and HOMA-IR and inverse associations with serum creatinine and LBM in a dose-dependent manner both in males and females. Water, hair and nail arsenic showed significant inverse associations with HOMA-β in females but not in males. FBG and HOMA-IR were increased with the decreasing levels of serum creatinine and LBM. Odds ratios (ORs) of hyperglycemia were significantly increased with the increasing concentrations of arsenic in water, hair and nails and with the decreasing levels of serum creatinine and LBM. Females’ HOMA-IR showed greater susceptibility to the reduction of serum creatinine and LBM, possibly causing the greater risk of hyperglycemia in females than males. Path analysis revealed the mediating effect of serum creatinine level on the relationship of arsenic exposure with HOMA-IR and hyperglycemia.

Conclusion

Arsenic exposure elevates FBG levels and the risk of hyperglycemia through increasing insulin resistance with greater susceptibility in females than males. Additionally, arsenic exposure-related reduction of skeletal muscle mass may be a mechanism underlying the development of insulin resistance and hyperglycemia.

中文翻译：

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砷暴露相关的高血糖症与胰岛素抵抗相关，伴随着骨骼肌质量的减少。

背景

大量证据表明砷暴露与糖尿病之间存在联系，但其潜在机制尚未阐明。

目的

我们探讨了砷暴露与骨骼肌质量减少之间的联系，将其作为发展与砷相关的高血糖的胰岛素抵抗的潜在机制。

方法

从孟加拉国的砷病地方病和非地方病地方招募了总共581名受试者，并测定了他们的空腹血糖（FBG），血清胰岛素和血清肌酐水平。通过水，头发和指甲中的砷浓度评估受试者的砷暴露水平。HOMA-IR和HOMA-β分别用于计算胰岛素抵抗和β细胞功能障碍。血清肌酐水平和瘦体重（LBM）用作肌肉质量指标。

结果

在男性和女性中，水，头发和指甲的砷浓度与FBG，血清胰岛素和HOMA-IR呈显着正相关，与血清肌酐和LBM呈负相关，呈剂量依赖性。在女性中，水，头发和指甲中的砷与HOMA-β呈显着负相关，而在男性中则没有。随着血清肌酐和LBM水平的降低，FBG和HOMA-IR升高。随着水中，头发和指甲中砷浓度的增加以及血清肌酐和LBM水平的降低，高血糖的几率（OR）显着增加。女性的HOMA-IR对降低血清肌酐和LBM的敏感性更高，可能导致女性高血糖的风险高于男性。

结论

通过增加胰岛素抵抗，女性比男性更易感染砷，从而增加了FBG水平和高血糖风险。另外，砷暴露相关的骨骼肌质量的减少可能是胰岛素抵抗和高血糖症发展的潜在机制。