Risk factors for increased urinary inorganic arsenic concentrations from low arsenic concentrations in drinking water

A large number of drinking water supplies worldwide have greater than 50 microg l(- 1) inorganic arsenic in drinking water, and there is increasing pressure to reduce concentrations. Few studies have specifically considered low concentrations of arsenic in water supplies and the significance of other factors which may contribute to increased exposure. This study aimed to investigate risk factors for increased urinary inorganic arsenic concentrations, in a population exposed to 10 - 100 microg l(- 1) of arsenic in drinking water, as well as a control population with lower arsenic concentrations in their drinking water. Inorganic arsenic in urine was used as the measure of exposure. The median drinking water arsenic concentration in the exposed population was 43.8 microg l(- 1) (16.0 - 73 microg l(- 1)) and less than the analytical limit of detection of 1 microg l(- 1) (相似文献   

Intra-individual variability in toenail arsenic concentrations in a Michigan population, USA

Arsenic concentration in toenail clippings is used as a biomarker of exposure in epidemiological studies, often under the assumption that a single measurement represents long-term exposure. For this assumption to hold, the measured arsenic concentrations must be stable over time, yet temporal variability has not been adequately assessed. This study aims to evaluate temporal variability in multiple toenail samples collected from a population exposed to drinking water arsenic levels <100 microg/l. Our objectives are to investigate factors responsible for biomarker variability and to assess the suitability of single versus multiple measurements for determining exposure in epidemiological studies. Multiple toenail and drinking water samples were collected from 254 participants enrolled in a case-control study of arsenic exposure and bladder cancer in Michigan, USA; participants also answered questions on water consumption. Toenail samples collected an average of 14 months apart were positively correlated, although a substantial amount of variability was detected (r=0.43, P<0.0001, n=236). Arsenic concentration in drinking water was stable and small changes in drinking water arsenic concentration did not explain variability in toenail arsenic concentration. Change in drinking water consumption, however, was significant in predicting differences in toenail arsenic concentration. Stronger correlations between drinking water arsenic concentration and intake and toenail arsenic concentration were observed when two toenail samples were averaged, suggesting that multiple measurements may more accurately reflect exposure. When exposure was categorized into tertiles and other pre-determined categories, 25-40% of exposures were differentially classified. Only a small percentage (<4%), however, were classified as having low exposure using a single measurement and high exposure when an average of two measurements was used. These results suggest that the use of multiple measurements is unlikely to affect exposure classification of individuals into high- or low-exposure groups; however, collection of multiple samples may be advantageous for more refined exposure classification.     

Cancer incidence and high environmental arsenic concentrations in rural populations: Results of an ecological study

A number of ecological studies have suggested associations between arsenic in drinking water and increased rates of some cancers. To investigate associations in areas with high environmental arsenic concentrations, geographical areas with surface soil inorganic arsenic concentrations of >100 mg/kg and/ or drinking water arsenic concentrations >0.01 mg/l were selected and the relationship with cancer incidence explored. Standardised incidence rates (SIRs) for cancer were generated for 22 areas between 1982 and 1991 using Victorian Cancer Registry data and Victorian cancer rates as a baseline. SIRs were also generated for combined areas according to environmental exposure type, i.e. whether an area had high soil and/or high water arsenic concentrations. The SIRs for both males and females for the combined 22 areas were increased for all cancers 1.06 (95% confidence interval, CI; 1.03-1.09), prostate cancer 1.14 (1.05-1.23), kidney cancer 1.16 (0.98-1.37), melanoma 1.36 (1.24-1.48), chronic myeloid leukemia 1.54 (1.13-2.10) and breast cancer in females 1.10 (1.03-1.18). When stratifying into exposure categories, the SIR for prostate cancer was significant at 1.20 (1.06-1.36) for the high soil/high water category only. No significant dose- response relationship between drinking water and individual cancers was observed. Of the a priori cancers associated with environmental arsenic exposure, only prostate cancer incidence was significantly elevated in this study. This result was likely confounded by a number of factors and was limited by low power and exposure misclassification.     

Skin cancer risk in relation to toenail arsenic concentrations in a US population-based case-control study

Arsenic is a known carcinogen specifically linked to skin cancer occurrence in regions with highly contaminated drinking water or in individuals who took arsenic-containing medicines. Presently, it is unknown whether such effects occur at environmental levels found in the United States. To address this question, the authors used data collected on 587 basal cell and 284 squamous cell skin cancer cases and 524 controls interviewed as part of a case-control study conducted in New Hampshire between 1993 and 1996. Arsenic was determined in toenail clippings using instrumental neutron activation analysis. The odds ratios for squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) were close to unity in all but the highest category. Among individuals with toenail arsenic concentrations above the 97th percentile, the adjusted odds ratios were 2.07 (95% confidence interval (CI): 0.92, 4.66) for SCC and 1.44 (95% CI: 0.74, 2.81) for BCC, compared with those with concentrations at or below the median. While the risks of SCC and BCC did not appear elevated at the toenail arsenic concentrations detected in most study subjects, the authors cannot exclude the possibility of a dose-related increase at the highest levels of exposure experienced in the New Hampshire population.     

Environmental and toenail metals concentrations in copper mining and non mining communities in Zambia

Copper mining contributes to increased concentrations of metals in the environment, thereby increasing the risk of metals exposure to populations living in and around mining areas. This study investigated environmental and toenail metals concentrations of non-occupational human exposure to metals in 39 copper-mining town residents and 47 non-mining town residents in Zambia. Elevated environmental concentrations were found in samples collected from the mining town residents. Toenail concentrations of cobalt (GM 1.39 mg/kg), copper (GM 132 mg/kg), lead (21.41 mg/kg) selenium (GM 0.38 mg/kg) and zinc (GM 113 mg/kg) were significantly higher in the mining area and these metals have previously been associated with copper mining. Residence in the mining area, drinking water, dust and soil metals concentrations were the most important contributors to toenail metals concentrations. Further work is required to establish the specific pathways of exposure and the health risks of elevated metals concentrations in the copper mining area.     

Measurement of low levels of arsenic exposure: a comparison of water and toenail concentrations

A study was conducted to evaluate toenail arsenic concentrations as a biologic marker of drinking water arsenic exposure. Study subjects were controls in a US population-based case-control study of nonmelanoma skin cancer, randomly selected from drivers' license records (those < 65 years of age) and Medicare enrollment files (those > or = 65 years of age). Between 1994 and 1997, a total of 540 controls were interviewed and toenail samples of sufficient weight were collected from 506 (93.7%) of these. Beginning in 1995, a sample of tap water was taken from the participants' homes; a total of 217 (98.6%) water samples were obtained from the 220 subjects interviewed. Arsenic determinations were made from toenail samples using neutron activation analysis. Water samples were analyzed using hydride-generation magnet sector inductively coupled mass spectrometry. Among 208 subjects with both toenail and water measurements, the correlation (r) between water and nail arsenic was 0.65 (p < 0.001) among those with water arsenic concentrations of 1 microg/liter or higher and 0.08 (p = 0.31) among those with concentrations below 1 microg/liter (overall r = 0.46, p < 0.001). Our data suggest that toenail samples provide a useful biologic marker for quantifying low-level arsenic exposure.     

Estimating water supply arsenic levels in the New England Bladder Cancer Study

Background: Ingestion of inorganic arsenic in drinking water is recognized as a cause of bladder cancer when levels are relatively high (≥ 150 µg/L). The epidemiologic evidence is less clear at the low-to-moderate concentrations typically observed in the United States. Accurate retrospective exposure assessment over a long time period is a major challenge in conducting epidemiologic studies of environmental factors and diseases with long latency, such as cancer.Objective: We estimated arsenic concentrations in the water supplies of 2,611 participants in a population-based case–control study in northern New England.Methods: Estimates covered the lifetimes of most study participants and were based on a combination of arsenic measurements at the homes of the participants and statistical modeling of arsenic concentrations in the water supply of both past and current homes. We assigned a residential water supply arsenic concentration for 165,138 (95%) of the total 173,361 lifetime exposure years (EYs) and a workplace water supply arsenic level for 85,195 EYs (86% of reported occupational years).Results: Three methods accounted for 93% of the residential estimates of arsenic concentration: direct measurement of water samples (27%; median, 0.3 µg/L; range, 0.1–11.5), statistical models of water utility measurement data (49%; median, 0.4 µg/L; range, 0.3–3.3), and statistical models of arsenic concentrations in wells using aquifers in New England (17%; median, 1.6 µg/L; range, 0.6–22.4).Conclusions: We used a different validation procedure for each of the three methods, and found our estimated levels to be comparable with available measured concentrations. This methodology allowed us to calculate potential drinking water exposure over long periods.     

Evaluation of exposure to arsenic in residential soil

In response to concerns regarding arsenic in soil from a pesticide manufacturing plant, we conducted a biomonitoring study on children younger than 7 years of age, the age category of children most exposed to soil. Urine samples from 77 children (47% participation rate) were analyzed for total arsenic and arsenic species related to ingestion of inorganic arsenic. Older individuals also provided urine (n = 362) and toenail (n = 67) samples. Speciated urinary arsenic levels were similar between children (geometric mean, geometric SD, and range: 4.0, 2.2, and 0.89-17.7 microg/L, respectively) and older participants (3.8, 1.9, 0.91-19.9 microg/L) and consistent with unexposed populations. Toenail samples were < 1 mg/kg. Correlations between speciated urinary arsenic and arsenic in soil (r = 0.137, p = 0.39; n = 41) or house dust (r = 0.049, p = 0.73; n = 52) were not significant for children. Similarly, questionnaire responses indicating soil exposure were not associated with increased urinary arsenic levels. Relatively low soil arsenic exposure likely precluded quantification of arsenic exposure above background.     

Breast-feeding protects against arsenic exposure in Bangladeshi infants

BACKGROUND: Chronic arsenic exposure causes a wide range of health effects, but little is known about critical windows of exposure. Arsenic readily crosses the placenta, but the few available data on postnatal exposure to arsenic via breast milk are not conclusive. AIM: Our goal was to assess the arsenic exposure through breast milk in Bangladeshi infants, living in an area with high prevalence of arsenic-rich tube-well water. METHODS: We analyzed metabolites of inorganic arsenic in breast milk and infant urine at 3 months of age and compared them with detailed information on breast-feeding practices and maternal arsenic exposure, as measured by concentrations in blood, urine, and saliva. RESULTS: Arsenic concentrations in breast-milk samples were low (median, 1 microg/kg; range, 0.25-19 microg/kg), despite high arsenic exposures via drinking water (10-1,100 microg/L in urine and 2-40 microg/L in red blood cells). Accordingly, the arsenic concentrations in urine of infants whose mothers reported exclusive breast-feeding were low (median, 1.1 microg/L; range, 0.3-29 microg/L), whereas concentrations for those whose mothers reported partial breast-feeding ranged from 0.4 to 1,520 microg/L (median 1.9 microg/L). The major part of arsenic in milk was inorganic. Still, the infants had a high fraction (median, 87%) of the dimethylated arsenic metabolite in urine. Arsenic in breast milk was associated with arsenic in maternal blood, urine, and saliva. CONCLUSION: Very little arsenic is excreted in breast milk, even in women with high exposure from drinking water. Thus, exclusive breast-feeding protects the infant from exposure to arsenic.     

Environmental exposure and fingernail analysis of arsenic and mercury in children and adults in a Nicaraguan gold mining community

Gold mining can release contaminants, including mercury, into the environment, and may increase exposure to naturally occurring elements such as arsenic. The authors investigated environmental and human tissue concentrations of arsenic and mercury in the gold mining town of Siuna, Nicaragua. The study involved 49 randomly selected households in Siuna, from whom a questionnaire along with environmental and fingernail samples were collected. Environmental samples indicated that mercury concentrations in drinking water, although generally low, were higher near the mine site. Arsenic concentrations were elevated in water and soil samples, but their distribution was unrelated to the mining site. Mercury concentrations in fingernail samples were correlated with residential proximity to the mine, drinking water concentrations, occupation, and, among children, with soil concentrations. Fingernail arsenic concentrations correlated with drinking water concentrations among adults who consumed higher levels, and with soil concentrations among children. Fingernail analysis helped to identify differential exposure pathways in children and adults. Mercury and arsenic uptake via soil exposure in children warrants further consideration.     

Maternal arsenic exposure associated with low birth weight in Bangladesh

OBJECTIVE: To characterize the effects of maternal arsenic exposure on birth weight. METHODS: Hair, toenail, and drinking water samples were collected from pregnant women (n = 52) at multiple time points during pregnancy and from their newborns after birth. Total arsenic was measured using inductively coupled plasma-mass spectrometry. The association between arsenic and birth weight was investigated using linear and logistic regression models. RESULTS: Maternal hair arsenic measured early in pregnancy was associated with decreased birth weight (beta = -193.5 +/- 90.0 g, P = 0.04). Maternal hair and drinking water arsenic levels measured at first prenatal visit were significantly correlated with newborn hair arsenic level (rho = 0.32, P = 0.04 and rho = 0.31, P = 0.04). CONCLUSIONS: Results suggest that maternal arsenic exposure early in pregnancy negatively affects newborn birth weight and that maternal hair provides the best integrated measure of arsenic exposure.     

石门雄黄矿地区居民砷暴露研究

目的：研究砷污染地区居民砷暴露水平的分布特征。方法：分析污染区和对照区环境样品和居民头发砷含量。结果：污染区三个村土壤砷含量８４．１７～２９６．１９ｍｇ／ｋｇ。河水砷含量达０．５～１４．５ｍｇ／Ｌ，井水、自来水、食物含砷量一般符合国家卫生标准。砷摄入量１９５～１１２９μｇ／ｄ。居民头发砷含量中位数为０．９７２～２．４５９μｇ／ｇ。发砷值随年龄增加而增加。结论：石门雄黄矿附近地区河水砷污染严重，以河水为饮用水源的居民砷暴露水平达到甚至超过国内外重大慢性砷中毒案例的暴露水平，应引起重视     

Markers of low level arsenic exposure for evaluating human cancer risks in a US population

Epidemiologic studies conducted in the US have not previously detected an association between regional drinking water arsenic concentrations and corresponding cancer occurrence or mortality rates. To improve our estimation of cancer risk and arsenic exposure in the USA, we have investigated the reliability of several exposure markers. In the current study, we specifically evaluated the long-term reproducibility of tap water and toenail concentrations of arsenic, and the relation between water, toenail, and urinary measurement. Subjects included 99 controls in our case-control study on whom we requested a household tap water sample and toenail clipping three to five years apart. Additionally, participants were asked to provide a first morning void sample at the second interview. Tap water arsenic concentrations ranged from undetectable (<0.01 microg/L) to 66.6 microg/L. We found a significant correlation between both replicate water and toenail samples (intraclass correlation coefficient = 0.85, 95% confidence interval = 0.79-0.89 for water, and intraclass correlation coefficient = 0.60, 95% confidence interval = 0.48-0.70 for toenails). The inter-method correlations for water, urinary and toenail arsenic were all statistically significant (r = 0.35, p = 0.0024 for urine vs water; r = 0.33, p = 0.0016 for toenail vs water and r = 0.36, p = 0.0012 for urine vs toenails). Thus, we found both toenail and water measurements of arsenic reproducible over a three- to five-year period. Our data suggest that biologic markers may provide reliable estimates of internal dose of low level arsenic exposure that can be used to assess cancer risk.     

Rice consumption and urinary concentrations of arsenic in US adults

Exposure to inorganic arsenic in the general population occurs mainly from drinking water and food sources. This study examined the association between rice consumption and urinary concentrations of arsenic in US adults, aged 20–85 years, in the 2003–2006 National Health and Nutrition Examination Survey. Significantly higher geometric means of creatinine-corrected urinary concentrations of total arsenic (TAs) and dimethylarsinic acid (DMA) were found in participants who consumed rice more than twice per week, compared to the reference group. Multivariate logistic regression analysis revealed a statistically significant association between rice consumption and urinary concentrations of TAs [odds ratio (OR) = 1.51 (1.08, 2.09)] and DMA [OR = 2.24 (1.57, 3.21)] after adjustment for demographic variables, seafood intake (the main source of organic arsenic), and source of drinking water. Furthermore, significant variations in rice consumption and urinary concentrations of arsenic were observed in different racial groups. This study demonstrated that rice consumption contributed to inorganic arsenic exposure in US adults.     

Association between arsenic exposure from a coal-burning power plant and urinary arsenic concentrations in Prievidza District,Slovakia

To assess the arsenic exposure of a population living in the vicinity of a coal-burning power plant with high arsenic emission in the Prievidza District, Slovakia, 548 spot urine samples were speciated for inorganic As (Asinorg), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), and their sum (Assum). The urine samples were collected from the population of a case-control study on nonmelanoma skin cancer (NMSC). A total of 411 samples with complete As speciations and sufficient urine quality and without fish consumption were used for statistical analysis. Although current environmental As exposure and urinary As concentrations were low (median As in soil within 5 km distance to the power plant, 41 micro g/g; median urinary Assum, 5.8 microg/L), there was a significant but weak association between As in soil and urinary Assum(r = 0.21, p < 0.01). We performed a multivariate regression analysis to calculate adjusted regression coefficients for environmental As exposure and other determinants of urinary As. Persons living in the vicinity of the plant had 27% higher Assum values (p < 0.01), based on elevated concentrations of the methylated species. A 32% increase of MMA occurred among subjects who consumed homegrown food (p < 0.001). NMSC cases had significantly higher levels of Assum, DMA, and Asinorg. The methylation index Asinorg/(MMA + DMA) was about 20% lower among cases (p < 0.05) and in men (p < 0.05) compared with controls and females, respectively.     

Arsenic concentrations in prediagnostic toenails and the risk of bladder cancer in a cohort study of male smokers

At high concentrations, inorganic arsenic can cause bladder cancer in humans. However, it is unclear whether low exposure to inorganic arsenic in drinking water (<100 microg/liter) is related to bladder cancer risk. No study has been known to use biomarkers to assess the relation between individual arsenic exposure and bladder cancer risk. Toenail samples provide an integrated measure of internal arsenic exposure and reflect long-term exposure. The authors examined the relation between toenail arsenic levels and bladder cancer risk among participants in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a cohort of Finnish male smokers aged 50-69 years. Data for 280 incident bladder cancer cases, identified between baseline (1985-1988) and April 1999, were available for analysis. One control was matched to each case on the basis of age, toenail collection date, intervention group, and smoking duration. Arsenic levels in toenail samples were determined by using neutron activation analysis. Logistic regression analyses were performed to estimate odds ratios. Arsenic toenail concentrations in this Finnish study were similar to those reported in US studies (range: 0.02-17.5 microg/g). The authors observed no association between inorganic arsenic concentration and bladder cancer risk (odds ratio = 1.13, 95% confidence interval: 0.70, 1.81 for the highest vs. lowest quartile). These findings suggest that low-level arsenic exposure is unlikely to explain a substantial excess risk of bladder cancer.     

Arsenic in drinking water in the Los Altos de Jalisco region of Mexico.

OBJECTIVE: To establish the degree of contamination by arsenic in drinking water in the Los Altos de Jalisco (LAJ) region of west-central Mexico, and to estimate the levels of exposure that residents of the area face. METHODS: Total arsenic concentration (the sum of all arsenic forms, organic and inorganic) was determined for 129 public water wells in 17 municipal capitals (cabeceras municipales) of the LAJ region, using inductively coupled plasma-optical emission spectroscopy. For most of the wells, water samples were taken in both November 2002 and October 2003. The levels of exposure to arsenic were estimated for babies (10 kg), children (20 kg), and adults (70 kg). RESULTS: Mean concentrations of arsenic higher than the Mexican national guideline value of 25 micro g/L were found in 44 (34%) of the 129 wells. The mean concentration of total arsenic for the 129 wells ranged from 14.7 micro g/L to 101.9 micro g/L. The highest concentrations were found in well water samples collected in the cities of Mexticacán (262.9 micro g/L), Teocaltiche (157.7 micro g/L), and San Juan de los Lagos (113.8 micro g/L). Considering the global mean concentration for all the wells in each of the 17 cities, the mean concentration of arsenic exceeded the Mexican guideline value in 7 of the cities. However, the global mean concentration in all 17 cities was higher than the World Health Organization guideline value of 10 micro g/L for arsenic. The range of the estimated exposure doses to arsenic in drinking water was 1.1-7.6 micro g/kg/d for babies, 0.7-5.1 micro g/kg/d for children, and 0.4-2.7 micro g/kg/d for adults. CONCLUSIONS: At the exposure doses estimated in the LAJ region, the potential health effects from chronic arsenic ingestion include skin diseases, gastrointestinal effects, neurological damage, cardiovascular problems, and hematological effects. While all the residents may not be affected, an important fraction of the total population of the LAJ region is under potential health risk due to the ingestion of high levels of arsenic. Epidemiological studies to determine the arsenic levels in the blood, hair, and nails of humans should be conducted in the LAJ region to help assess the relationship between the prevalence of health problems and the chronic ingestion of arsenic.     

Assessment of cancer risk and environmental levels of arsenic in New Hampshire

The Agency for Toxic Substances and Disease Registry (ATSDR) and the United States (US) Environmental Protection Agency (EPA) Office of Solid Waste and Emergency Response (OSWER) list arsenic as a major concern for Superfund sites and the environment at large. Arsenic is clearly linked to skin, bladder, and lung cancer occurrence in populations highly exposed to arsenic occupationally, medicinally, or through contaminated drinking water (Agency for Toxic Substances and Disease Registry, 1999; IARC, 1987). While these studies have identified important adverse health effects, they cannot provide risk information at lower levels of exposure such as those commonly found in the US. Additionally, precise measurement of exposure is critical to assessing risk in populations consuming relatively trace amounts of arsenic. In New Hampshire, domestic wells serve roughly 40% of the population, and about 10% of these contain arsenic concentrations in the controversial range of 10 to 50 micrograms/l. New Hampshire, along with other states in New England, has among the highest bladder cancer mortality rates in the country. Therefore, we are conducting a population-based epidemiologic study in New Hampshire (1) to assess the risk of skin and bladder cancer associated with arsenic exposure in a US population, (2) to evaluate methods of quantifying individual exposure to arsenic at low to moderate levels, and (3) to explore alternative models of determining the dose-response relationship at the lower end of exposure. Our findings to date indicate that toenail arsenic concentrations are a reliable, long-term biomarker of total arsenic exposure and reflect arsenic intake by drinking water containing 1 microgram/l or more. We found that urinary arsenic cannot be detected consistently in a population for which drinking water arsenic is primarily below 50 micrograms/l. Lastly, our data suggest that use of a biologic marker along with alternative statistical approaches may aid detection of the levels at which arsenic may affect cancer occurrence in the US.     

Spatial and temporal variations in arsenic exposure via drinking-water in northern Argentina

This study evaluated the spatial, temporal and inter-individual variations in exposure to arsenic via drinking-water in Northern Argentina, based on measurements of arsenic in water, urine, and hair. Arsenic concentrations in drinking-water varied markedly among locations, from <1 to about 200 microg/L. Over a 10-year period, water from the same source in San Antonio de los Cobres fluctuated within 140 and 220 microg/L, with no trend of decreasing concentration. Arsenic concentrations in women's urine (3-900 microg/L, specific weight 1.018 g/mL) highly correlated with concentrations in water on a group level, but showed marked variations between individuals. Arsenic concentrations in hair (range 20-1,500 microg/kg) rather poorly correlated with urinary arsenic, possibly due to external contamination. Thus, arsenic concentration in urine seems to be a better marker of individual arsenic exposure than concentrations in drinking-water and hair.     

Urinary arsenic species, toenail arsenic, and arsenic intake estimates in a Michigan population with low levels of arsenic in drinking water

The large disparity between arsenic concentrations in drinking water and urine remains unexplained. This study aims to evaluate predictors of urinary arsenic in a population exposed to low concentrations (≤50?μg/l) of arsenic in drinking water. Urine and drinking water samples were collected from a subsample (n=343) of a population enrolled in a bladder cancer case-control study in southeastern Michigan. Total arsenic in water and arsenic species in urine were determined using ICP-MS: arsenobetaine (AsB), arsenite (As[III]), arsenate (As[V]), methylarsenic acid (MMA[V]), and dimethylarsenic acid (DMA[V]). The sum of As[III], As[V], MMA[V], and DMA[V] was denoted as SumAs. Dietary information was obtained through a self-reported food intake questionnaire. Log(10)-transformed drinking water arsenic concentration at home was a significant (P<0.0001) predictor of SumAs (R(2)=0.18). Associations improved (R(2)=0.29, P<0.0001) when individuals with less than 1?μg/l of arsenic in drinking water were removed and further improved when analyses were applied to individuals who consumed amounts of home drinking water above the median volume (R(2)=0.40, P<0.0001). A separate analysis indicated that AsB and DMA[V] were significantly correlated with fish and shellfish consumption, which may suggest that seafood intake influences DMA[V] excretion. The Spearman correlation between arsenic concentration in toenails and SumAs was 0.36 and between arsenic concentration in toenails and arsenic concentration in water was 0.42. Results show that arsenic exposure from drinking water consumption is an important determinant of urinary arsenic concentrations, even in a population exposed to relatively low levels of arsenic in drinking water, and suggest that seafood intake may influence urinary DMA[V] concentrations.