Protective effects of B vitamins and antioxidants on the risk of arsenic-related skin lesions in Bangladesh

Environ Health Perspect. 2008 Aug;116(8):1056-62. doi: 10.1289/ehp.10707.


Background: An estimated 25-40 million of the 127 million people of Bangladesh have been exposed to high levels of naturally occurring arsenic from drinking groundwater. The mitigating effects of diet on arsenic-related premalignant skin lesions are largely unknown.

Objectives: The purpose of this study was to clarify the effects of the vitamin B group (thiamin, riboflavin, niacin, pyridoxine, and cobalamin) and antioxidants (vitamins A, C, and E) on arsenic-related skin lesions.

Methods: We performed a cross-sectional study using baseline data from the Health Effects of Arsenic Longitudinal Study (HEALS), 2000-2002, with individual-level, time-weighted measures of arsenic exposure from drinking water. A total of 14,828 individuals meeting a set of eligibility criteria were identified among 65,876 users of all 5,996 tube wells in the 25-km(2) area of Araihazar, Bangladesh; 11,746 were recruited into the study. This analysis is based on 10,628 subjects (90.5%) with nonmissing dietary data. Skin lesions were identified according to a structured clinical protocol during screening and confirmed with further clinical review.

Results: Riboflavin, pyridoxine, folic acid, and vitamins A, C, and E significantly modified risk of arsenic-related skin lesions. The deleterious effect of ingested arsenic, at a given exposure level, was significantly reduced (ranging from 46% reduction for pyridoxine to 68% for vitamin C) for persons in the highest quintiles of vitamin intake.

Conclusions: Intakes of B-vitamins and antioxidants, at doses greater than the current recommended daily amounts for the country, may reduce the risk of arsenic-related skin lesions in Bangladesh.

Keywords: B vitamins; Bangladesh; antioxidants; arsenic; skin lesions.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antioxidants / administration & dosage
  • Antioxidants / pharmacology*
  • Arsenic*
  • Ascorbic Acid / administration & dosage
  • Ascorbic Acid / pharmacology
  • Bangladesh
  • Cross-Sectional Studies
  • Environmental Exposure
  • Female
  • Humans
  • Male
  • Middle Aged
  • Precancerous Conditions / chemically induced
  • Precancerous Conditions / prevention & control*
  • Risk Factors
  • Skin Diseases / chemically induced
  • Skin Diseases / prevention & control*
  • Vitamin A / administration & dosage
  • Vitamin A / pharmacology
  • Vitamin B Complex / administration & dosage
  • Vitamin B Complex / pharmacology*
  • Vitamin E / administration & dosage
  • Vitamin E / pharmacology


  • Antioxidants
  • Vitamin A
  • Vitamin B Complex
  • Vitamin E
  • Arsenic
  • Ascorbic Acid