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1025317 
Journal Article 
Mutual interaction between nutritional status and chronic arsenic toxicity due to groundwater contamination in an area of Terai, lowland Nepal 
Maharjan, M; Watanabe, C; Ahmad, SA; Umezaki, M; Ohtsuka, R 
2007 
Yes 
Journal of Epidemiology and Community Health
ISSN: 0143-005X
EISSN: 1470-2738 
61 
389-394 
English 
OBJECTIVE: To reveal the inter-relationship between nutritional status and arsenic toxicity.

DESIGN: Cross-sectional study.

SETTING: A survey in an area of lowland Nepal, where a high prevalence of both skin manifestation and malnutrition was observed. Daily arsenic intake was estimated by measuring the arsenic concentration and daily consumption of the drinking water.

PARTICIPANTS: Adult villagers (248 men and 291 women). About half were classified as "underweight" (body mass index <18.5), indicating poor nutritional status.

MAIN RESULTS: Arsenic intake was negatively correlated with body mass index and substantially increased the prevalence of underweight individuals, among whom the prevalence of skin manifestations was 1.65-fold higher than normal weight individuals. When exposure level was considered, the prevalence of skin symptoms was consistently higher in the underweight than in the normal group. Although enhanced susceptibility in men was apparent by the increased prevalence of cutaneous symptoms, no sex difference was observed in the prevalence of underweight individuals related with exposure to arsenic.

CONCLUSIONS: The present data suggested that exposure to arsenic is associated with an increased prevalence of underweight, a serious health problem in developing countries, which in turn is associated with increased skin manifestation of arsenic poisoning. 
• Arsenic Hazard ID
     1. Initial Lit Search
          PubMed
          WOS
          ToxNet
     4. Considered through Oct 2015
     8. Hazard through Oct 2015
          Epi Hazard ID
          Not Relevant
          Susceptibility Category
               Nutritional Deficiencies (includes socioeconomic status & BMI)
• Arsenic (Inorganic)
     1. Literature
          PubMed
          Toxline, TSCATS, & DART
          Web of Science
     3. Hazard ID Screening
          Potentially relevant epidemiology studies
     5. Susceptibility Screening
          Relevant
               Human
     Cited in Volume 2a
     Cited in Volume 2b
• Arsenic Susceptibility
     4. Susceptibility and Lifestages
          Nutritional deficiencies (includes socioeconomic status and BMI)
     5. Health Effect
          Skin Diseases
     1. Susceptibility Literature Screening
          Keyword Search
     Life Stages Citation Mapping
          5%-10%