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      Addressing the Challenge of Potentially Hazardous Elements in the Reduction of Hypertension, Diabetes and Chronic Kidney Disease in the Caribbean

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          Abstract

          Background.

          Environmental surveys have characterized trace elements such as lead (Pb), cadmium (Cd) and arsenic (As) as potential risk factors for non-communicable diseases. There have been few studies conducted in the Caribbean region to explore, define or clarify such findings locally. Furthermore, local pollution control efforts are often juxtaposed against more seemingly immediate economic concerns in poor communities.

          Objectives.

          The present commentary is a call to action for the evaluation of potentially hazardous elements as potential risk indicators and/or factors of common noncommunicable diseases in the Caribbean.

          Discussion.

          Findings from Jamaican studies have identified exposure to potentially hazardous elements (PHE) via water, food, and other anthropogenic activities to the detriment of the resident population. Several attempts have been made to abate toxic metal exposure in children with relative success. However, high levels of PHE have been noted in vulnerable populations such as patients with hypertension, diabetes mellitus and chronic kidney disease. Currently, there is low priority towards infrastructure building within the Caribbean region that would promote and sustain long term monitoring and better inform environmental polices impacting chronic diseases.

          Conclusions.

          Further investigations are needed to clarify the role that PHE play in increasing the risk or progression of non-communicable diseases, especially in vulnerable groups.

          Competing Interests.

          The authors declare no competing financial interests.

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          Most cited references60

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          Heavy Metals and Human Health: Mechanistic Insight into Toxicity and Counter Defense System of Antioxidants

          Heavy metals, which have widespread environmental distribution and originate from natural and anthropogenic sources, are common environmental pollutants. In recent decades, their contamination has increased dramatically because of continuous discharge in sewage and untreated industrial effluents. Because they are non-degradable, they persist in the environment; accordingly, they have received a great deal of attention owing to their potential health and environmental risks. Although the toxic effects of metals depend on the forms and routes of exposure, interruptions of intracellular homeostasis include damage to lipids, proteins, enzymes and DNA via the production of free radicals. Following exposure to heavy metals, their metabolism and subsequent excretion from the body depends on the presence of antioxidants (glutathione, α-tocopherol, ascorbate, etc.) associated with the quenching of free radicals by suspending the activity of enzymes (catalase, peroxidase, and superoxide dismutase). Therefore, this review was written to provide a deep understanding of the mechanisms involved in eliciting their toxicity in order to highlight the necessity for development of strategies to decrease exposure to these metals, as well as to identify substances that contribute significantly to overcome their hazardous effects within the body of living organisms.
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            Arsenic exposure and prevalence of type 2 diabetes in US adults.

            High chronic exposure to inorganic arsenic in drinking water has been related to diabetes development, but the effect of exposure to low to moderate levels of inorganic arsenic on diabetes risk is unknown. In contrast, arsenobetaine, an organic arsenic compound derived from seafood intake, is considered nontoxic. To investigate the association of arsenic exposure, as measured in urine, with the prevalence of type 2 diabetes in a representative sample of US adults. Cross-sectional study in 788 adults aged 20 years or older who participated in the 2003-2004 National Health and Nutrition Examination Survey (NHANES) and had urine arsenic determinations. Prevalence of type 2 diabetes across intake of arsenic. The median urine levels of total arsenic, dimethylarsinate, and arsenobetaine were 7.1, 3.0, and 0.9 mug/L, respectively. The prevalence of type 2 diabetes was 7.7%. After adjustment for diabetes risk factors and markers of seafood intake, participants with type 2 diabetes had a 26% higher level of total arsenic (95% confidence interval [CI], 2.0%-56.0%) and a nonsignificant 10% higher level of dimethylarsinate (95% CI, -8.0% to 33.0%) than participants without type 2 diabetes, and levels of arsenobetaine were similar to those of participants without type 2 diabetes. After similar adjustment, the odds ratios for type 2 diabetes comparing participants at the 80th vs the 20th percentiles were 3.58 for the level of total arsenic (95% CI, 1.18-10.83), 1.57 for dimethylarsinate (95% CI, 0.89-2.76), and 0.69 for arsenobetaine (95% CI, 0.33-1.48). After adjustment for biomarkers of seafood intake, total urine arsenic was associated with increased prevalence of type 2 diabetes. This finding supports the hypothesis that low levels of exposure to inorganic arsenic in drinking water, a widespread exposure worldwide, may play a role in diabetes prevalence. Prospective studies in populations exposed to a range of inorganic arsenic levels are needed to establish whether this association is causal.
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              Social Determinants of Racial Disparities in CKD.

              Significant disparities in CKD rates and outcomes exist between black and white Americans. Health disparities are defined as health differences that adversely affect disadvantaged populations, on the basis of one or more health outcomes. CKD is the complex result of genetic and environmental factors, reflecting the balance of nature and nurture. Social determinants of health have an important role as environmental components, especially for black populations, who are disproportionately disadvantaged. Understanding the social determinants of health and appreciating the underlying differences associated with meaningful clinical outcomes may help nephrologists treat all their patients with CKD in an optimal manner. Altering the social determinants of health, although difficult, may embody important policy and research efforts, with the ultimate goal of improving outcomes for patients with kidney diseases, and minimizing the disparities between groups.
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                Author and article information

                Journal
                J Health Pollut
                hapn
                J Health Pollut
                Journal of Health & Pollution
                Black Smith Institute
                2156-9614
                June 2021
                17 June 2021
                : 11
                : 30
                : 210613
                Affiliations
                [1 ]Department of Physics, Faculty of Science and Technology, University of the West Indies, Mona, Jamaica
                [2 ]Department of Medicine, University Hospital of the West Indies, Kingston, Jamaica
                [3 ]Earth and Environmental Sciences, University of Ottawa, Ottawa, ON, Canada
                [4 ]The Biotechnology Centre, Faculty of Science and Technology, University of the West Indies, Mona , Jamaica
                [5 ]Department of Basic Medical Sciences, The University of the West Indies, Mona, Jamaica
                Author notes
                Corresponding author: Adwalia Fevrier-Paul, afpaul23@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-3427-0194
                https://orcid.org/0000-0001-8701-6731
                https://orcid.org/0000-0001-7092-9382
                https://orcid.org/0000-0002-7123-9743
                Article
                10.5696/2156-9614-11.30.210613
                8276730
                34268000
                af85541e-6754-4de6-906e-be6ac66452e7
                © Pure Earth 2021

                This is an Open Access article distributed in accordance with Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 28 January 2021
                : 16 April 2021
                Page count
                Pages: 6
                Categories
                Commentary

                potentially hazardous elements,chronic kidney disease,non-communicable diseases in the caribbean

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