The Disease Burden of Dietary Exposure to Inorganic Arsenic in Denmark, 2018
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ORIGINAL PAPER
The Disease Burden of Dietary Exposure to Inorganic Arsenic in Denmark, 2018 Lea S. Jakobsen1 · Freja A. Fabricius1 · Janna Nissen1 · Tue Christensen2 · Rikke Andersen1 · Morten Poulsen1 · Sara M. Pires1 Received: 28 August 2019 / Revised: 11 November 2019 / Accepted: 13 November 2019 © Springer Nature B.V. 2019
Abstract Arsenic is a naturally occurring metalloid in soil, air, water and food in organic and inorganic forms. Several epidemiological studies have shown that inorganic arsenic (i-As) is carcinogenic to humans. Previous studies have raised concern about dietary i-As exposure from various sources, including brown rice. We estimated the burden of disease in terms of disabilityadjusted life years (DALY) of lung, bladder and skin cancer caused by dietary exposure to i-As in Denmark. Moreover, we investigated the impact of different rice-consumption scenarios of white and brown rice. We combined exposure assessment with dose response relationships of i-As exposure and lifetime risk of each cancer type to estimate the annual incidence due to i-As exposure. Associated DALY was calculated based on national health statistics. We estimated 0.57 extra cancer cases and 4.5 DALY [95% UI 4.2–4.8] in the Danish population in 2018. Even though rice was found not to be the main contributor of i-As, substitution of white and parboiled rice by brown rice resulted in a 32.7% increase in DALY compared to the current consumption of rice. The estimated number of cancer cases due to dietary i-As equals 0.006% of the annual incidence of the three cancer types in Denmark. Our estimates exclude exposure to i-As from drinking water and other beverages, which should be accounted for in future estimates. Our study highlights the need for deriving national-specific estimates of food borne disease burden to allow for comparison and prioritization. Keywords Inorganic arsenic · Dietary exposure · Cancer · Disease burden · DALY
Introduction Arsenic is a metalloid naturally present in the earth’s crust, as well as an anthropogenic pollutant, thus widely distributed in the environment (soil, air and water). Arsenic can be present in organic and inorganic forms, where the latter is toxic to humans (Hughes et al. 2011). Humans are mainly exposed to inorganic arsenic (i-As) through drinking water and foods (EFSA 2014; IARC 2012). The occurrence Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12403-019-00334-8) contains supplementary material, which is available to authorized users. * Lea S. Jakobsen [email protected] 1
Division for Diet, Diease Prevention and Toxicology, Technical University of Denmark, Kgs. Lyngby, Denmark
Division of Risk Assessment and Nutrition, Kgs. Lyngby, Denmark
2
of i-As in foods is a result of uptake from the soil or contaminated irrigation water by crops, or as a result of cooking practices using contaminated water, e.g. for boiling (EFSA 2009; IARC 2012). Exposure to i-As is associated with a wide range of adverse health effects includ
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