**1.8. Evidence in Guanajuato, Mexico: food and water security**

During 2002–2003, the State Public Health Laboratory of Guanajuato found, in two communities of the state, San Agustín of the municipality of Irapuato and Cútaro in Acámbaro, amounts of arsenic in well water (0.950 and 0.109 mg/L, respectively), greater than the permissible limits established by the WHO, and the Secretary of Health of Mexico. These communities have been studied for several years, adding other populations, where this metalloid has also been found.

Next, in **Table 2**, a chronology of the studies published and in the process of publication is presented. The first studies were based on identifying a relationship between the consumption of water contaminated with arsenic and the presence of arsenic in the hair of children living in two communities, which had a relationship (n = 55, p < 0.0001) [35]. In addition, a survey of mothers of children of the previous study revealed that 90–94% of them use well water for different culinary preparations such as broths, soups or beans, even with the knowledge that this source of water is contaminated with arsenic, according to the participants, this is done for lack of economic resources to acquire drinking water [10].


Another study, derived from being able to identify other factors of exposure to As, even though 11% drank tap water and 24.4% both tap water and tap water, even though the population was alerted about concentrations of the metalloid, most reported that in their homes tap water was used to prepare food under cooking as well as in the preparation of flavor water or fruit.

**Table 2.** Compilation of main evidence of the conditioning factors in environmental nutrition and food security of

Monroy-Torres y cols [37] To identify the state of food security and access to water in Mexican households, using

Monroy-Torres R et al. [36] The objective of this study was to describe the perception of the beneficiaries of the

Monroy Torres R et al. [10] The chronic exposition to arsenic has been linked to various health problems, and some

exposition to arsenic, like cancer, diabetes and hypertension.

Monroy-Torres R et al. [35] This cross-sectional study measures the arsenic level in school children exposed to

the source of arsenic exposure.

2009–2018, in Guanajuato, México.

a validated scale applied in 352 households in rural and urban communities, as well as a pilot scale to assess access to water. Where a 73% of households were classified as food secure (level 1), 15% as being mildly food insecure (level 2), 7% were considered food insecure at a moderate level (level 3) and only 4% were households with severe food insecurity (level 4). At all food security levels interviewees were worried about not having enough access to water, and in the last 3 months 50% of households experiences water scarcity. Most of the households used tap water to prepare the milk for the children, as well as for personal hygiene. 25% of the interviews reported that water availability has declined in their households, while the cost of water has increased. Food security cannot be conceived without taking into account the water situation. The majority of the households report lack of access to enough water, which usually does not meet the conditions of safety for human consumption and food preparation.

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Oportunidades program, about food and nutrition security in Atarjea, Guanajuato. A descriptive and qualitative approach study was carried out in 10 families, with a population under 10 years old, in two Atarjea localities. A nutritional and validated food safety survey was applied. Families and doctors do not perceive that the program is fair. New and constant evaluations are suggested to the program by external personnel and by the same beneficiaries of the program. On a proportional basis, families presented food insecurity with moderate hunger and mild food insecurity.

studies have been winged as a source of exposition, in addition to water and food. In some communities in the state of Guanajuato levels were detected outside the rule of arsenic in drinking water. OBJECTIVE: To describe the accessibility to safe water for consumption and preparation food in a community exposed to groundwater with arsenic. MATERIAL Y METHODS: Survey conducted across in55 housewives from 27 to 55 years of age. The questions were about the use of well water in the preparation in food such as broths, soups, beans, water, fruit; ingestion milk background; main crops in the community, raising cat le and source of drinking water for them. RESULTS: The 90% of housewives used well water for drinking and preparing their food. With regard to the consumption of the well of milk, 24 (44%) consumed milk brand and 31 (44%) consumed cow's milk. The well water was used for livestock and to irrigate crops. CONCLUSIONS: It is emerging that seeks strategies for the population for to have access to water safe, and that health risks are predictable with these sources of

contaminated well water in a rural area in México. Arsenic was measured in hair by hydride generation atomic absorption spectrophotometry. Overall, 110 children were included (average 10 years-old). Among 55 exposed children, mean arsenic level on hair was 1.3 mg/kg (range < 0.006–5.9). All unexposed children had undetectable arsenic levels. The high level of arsenic in water was associated to the level in hair. However, exposed children drank less well water at school or at home tan unexposed children, suggesting that the use of contaminated water to cook beans, broths or soups may be

**References Main evidence**


**References Main evidence**

48 Arsenic - Analytical and Toxicological Studies

Our objective was to measure the effect of multivitamin supplementation on the nutritional status and urinary excretion of arsenic in adolescents exposed to this metal through drinking water. With an intervention study was carried out on 45 adolescents, exposed to arsenic in drinking water, who were given a daily multivitamin supplement for 4 weeks. The nutritional status, and the levels of arsenic in urine and drinking water were evaluated weekly. The main results were Basal nutritional intake was low for protein, fiber, folic acid, vitamin B2, B6, B12, E, C, selenium and iron, increasing its consumption through the supplement during the intervention and with an increase of approximately 1 g/dL of hemoglobin in all participants. At the end of the intervention the participants presented increase of fat-free mass and decrease in the percentage of body fat. The urinary excretion of arsenic, was greater [35.91 μg/gCr (95% CI = 23.2– 74.8 μg/gCr)] in the first week of intervention (p < 0.05) compared to baseline levels of urinary arsenic [43.2 μg/gCr (95% CI = 30.8–117.6 μg/gCr)] and an average of As in water of 96.2 ± 7.5 μg/L. Four-week multivitamin supplementation in the adolescent population studied improved nutritional status and increased metalloid excretion

We analyze the experience in households in the State of Guanajuato, Mexico that suffer from limitations regarding access to water in quality and quantity. A survey of 17 items was applied to 352 households (female heads of household) to measure experiences regarding access to water, in addition to food security, schooling and sociodemographic aspects. Where 33.4% of households reported concern about not having access to water and 74.8% did not have access. 70.8% had to buy water to drink and 5.7% got sick and related it to water consumption. 65.6% of households showed food insecurity. The correlation was significant for the level of education of female heads of household, households with children under 1 and 12 years old with the use of tap water, preparing powdered milk for children, and for food at home and water. These experiences of households around access to water contribute to the discussion and development of

The objective of the present work was to identify the presence of risk factors of exposure to arsenic contamination in water, in population living in areas where high levels of this metalloid have been detected. For the identification of the risk factors that could intensify the metalloid exposure, an analytical and transversal study was carried out. For the measurement of food security, a scale validated for Latin America and the Caribbean was applied to 30 heads of family responsible for food, in addition to 30 items, with a three-month time limitation that measured the main risk factors of exposition, which were integrated from the derived risk factors selected from previous studies in the communities exposed to the metalloid and from the scientific literature collected so far. The main risk factors were: food insecurity in 70% of households, 63% worried about not having access to water, lack of access and availability of drinking water and 4% did not have access to water during the last 3 months, since 40% used well, pipe or tap water without previous treatment to prepare food, and 83.3% used to prepare beverages; Other risk factors to consider were the education level of the head of the family and access to public services. The identification of the main risk factors will allow the design of a validation scale, for screening and preventing possible arsenic poisoning in communities exposure to arsenic in water in addition to measuring food

communities of the state of Guanajuato exposed to arsenic and to identify some indicators of nutritional risk that contribute to the health effects of the metal. With a transversal design, a survey was applied to 30 family heads, who were selected from a previous study, culinary practices, food consumption, sociodemographic characteristics were evaluated. Culinary and food practices were detected as risk indicators in a population exposed to arsenic. Therefore, these practices should be considered as indicators in the evaluation of the health effects of exposure to the metalloid and other

significantly in the first and second post-intervention weeks.

scales that insecurity to water, considering food security.

Monroy-Torres R et al. [38] The objective of the study was to evaluate feeding and nutrition practices in

Effect of four-week multivitamin supplementation on nutritional status and urinary excretion of arsenic

in adolescents *Rebeca Monroy-Torres, Espinoza Pérez JA, Ramirez Gomez X, Carrizalez Yañez L, Linares-Segovia B, Mejía* 

*Saavedra JJ*

*Aceptado 2018, en la revista de Nutrición Hospitalaria*

*Experiences around the lack of access to water in homes in the State of Guanajuato, Mexico Rebeca Monroy Torres, Jaime Naves Sánchez, Hugo Melgar-Quiñonez* (Enviado a publicación a la revista Española de Nutrición Comunitaria)

Monroy-Torres y Espinoza-

security.

pollutants.

Pérez [39]

**Table 2.** Compilation of main evidence of the conditioning factors in environmental nutrition and food security of 2009–2018, in Guanajuato, México.

Another study, derived from being able to identify other factors of exposure to As, even though 11% drank tap water and 24.4% both tap water and tap water, even though the population was alerted about concentrations of the metalloid, most reported that in their homes tap water was used to prepare food under cooking as well as in the preparation of flavor water or fruit. The use of direct water from the tap was treated with drops of chlorine or silver nitrate, which reflects that the population has knowledge about the microbiological form of disinfection, but not for the removal of metals or other toxic substances. The trust that people perceived that they used tap water for food, because they use to boiling the water became drinkable and safe. But it is known to boil water from food or with food, only eliminate microbiological and non toxicological risks, such as eliminating arsenic in water [10, 35].

in comparison with basal levels of urinary arsenic [43.2 μg/g Cr (IC95% = 30.8–117.6 μg/g

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Other data of interest of the study were a higher percentage of body fat in women (women 27.4 vs. 17.2% in men), where it is known that the presence of obesity generates an inflammatory process [41]. A high BMI has been associated with alterations in the metabolism and excretion of As, due to the relationship between sex hormones, as main donor of methyl groups, in addition to SAM, is the choline, its secretion is influenced by the presence of estrogen. Therefore, a higher risk of toxicity in men could be expected, although it is also known that adolescents have better methylation than the adult population [23, 42, 43]. The consumption of vitamin B6 and folic acid were low, they are essential nutrients for the formation of methionine, which in turn is required in the metabolism of As and in the formation of the SAM cofactor, part of the arsenic methylation process; and on the other hand nutrients such as vitamin C and vitamin E, are recognized antioxidants in reducing oxidative damage caused by arsenic. The nutritional contribution improved with the supplementation, for the case of hemoglobin it increased almost 1 gram during the 4 weeks of treatment [42, 44] as well as polyphenols present in some of the components of the multivitamin (broccoli extract, cranberry, etc.), although they did not have an important effect in the excretion of arsenic, can provide protection to the organism from the oxidative stress that is being produced by exposure to arsenic in these adolescents [44]. In relation to fiber, a deficiency in its consumption is associated with a higher probability of the appearance of dermatological lesions since fiber could decrease the absorption of arsenic in the gastrointestinal tract [30, 44, 45]. Soluble fiber (fructo-oligosaccharides), acts as a prebiotic, and therefore, to a better metabolism of As [44, 45]. Many of the foods consumed traditionally in Mexico are rich in fructo-oligosaccharides, such as beans and other legumes [38]. The consumption of fruits and vegetables has been low among the young population as well as greater food insecurity in Guanajuato households (71.2% of food insecurity), which represents

a low consumption of antioxidants that have an important role in As metabolism [46].

overweight, obesity, and anemia mainly.

**2. Conclusion**

risks from exposure to arsenic.

This is the first study, which addressed the analysis of the effect of a 4-week vitamin and mineral supplementation, integrating dietary and nutritional variables. Therefore, the interaction of diet and the environment should be studied, as well as the integration of problems such as

Adequate nutrition in childhood and adolescence as well as in all stages of life, should not only be promoted to prevent chronic degenerative diseases, which entails an inflammatory problem, it is important to equip people with the mechanisms that promote the greatest excretion of the metalloid combined with adequate growth and development. There are environmental factors that cannot be avoided, such as exposure to heavy metals through natural sources such as water, but food and water security as determinants of the mitigation of health

Cr) (p < 0.05) with an average water with As of 96.2 ± 7.5 μg/L.

The first evidence in two communities of the state of Guanajuato (Cútaro and San Agustín) of the presence of arsenic in water and food consumption, biological incorporation to metal, together with environmental factors such as feeding and nutrition practices, socioeconomic, deficiency in public services and lack of access to an innocuous source of water, reflect a risk to the health of the inhabitants of these communities. On the other hand, the evidence shows that the greater the deterioration of the nutritional status, the greater the harmful effects in the organism derived from exposure to arsenic. In addition, several studies show that the consumption of several nutrients, in isolation, improves the detoxification of the metal and reduces the damage to the organism [36–39].

The poor nutritional status in these populations, either due to the excess or nutritional deficiency, the history that supplementation with some nutrients improves the nutritional status, and therefore, the metabolism of the metal in the body, besides that there is no evidence of treatment with A multivitamin supplementation scheme in school population exposed to arsenic are factors that justify the analysis of a multivitamin supplementation plus a dietary regime, on the urinary excretion of arsenic in the school population of the communities of San Agustín and Cútaro as well as others that there are high levels of the metal [40].

The theme of the study of food and water security, derived from the experience of studies in the population of Guanajuato, as intervention proposals from the nutritional clinic, derived from the basis of its metabolism (absorption and excretion) where the consumption of nutrients and access to nutrients is through food and these when people have food security [6] and food security achieved an adequate nutritional status and thus a way to mitigate the toxicity problems of the metalloid. Reason for which the designs of the studies integrated the dietary evaluation and the nutritional status until to design a clinical nutritional intervention study in a follow-up population, entitled "*Effect of a multivitamin supplementation of 4 weeks on the nutritional status and urinary excretion of arsenic in adolescents*." The main objective was to measure the effect of multivitamin supplementation on nutritional status and urinary excretion of arsenic in 45 adolescents exposed to the metalloid through drinking water. The vitamin supplement was given daily, for 4 weeks, and to the adolescents. Nutritional status, arsenic levels in urine and drinking water were measured too. The main findings were a low intake for proteins, fiber, folic acid, vitamin B<sup>2</sup> , B6 , B12, E, C, selenium, and iron, increasing their consumption through the supplement during the intervention, and with an increase of approximately 1 g/dL of hemoglobin, increase in fat-free mass, decrease in the percentage of body fat, with a higher urinary excretion of arsenic [35.91 μg/g Cr (95% CI = 23.2–74.8 μg/g Cr)] from the 1st week of intervention, which was statistically significant in comparison with basal levels of urinary arsenic [43.2 μg/g Cr (IC95% = 30.8–117.6 μg/g Cr) (p < 0.05) with an average water with As of 96.2 ± 7.5 μg/L.

Other data of interest of the study were a higher percentage of body fat in women (women 27.4 vs. 17.2% in men), where it is known that the presence of obesity generates an inflammatory process [41]. A high BMI has been associated with alterations in the metabolism and excretion of As, due to the relationship between sex hormones, as main donor of methyl groups, in addition to SAM, is the choline, its secretion is influenced by the presence of estrogen. Therefore, a higher risk of toxicity in men could be expected, although it is also known that adolescents have better methylation than the adult population [23, 42, 43]. The consumption of vitamin B6 and folic acid were low, they are essential nutrients for the formation of methionine, which in turn is required in the metabolism of As and in the formation of the SAM cofactor, part of the arsenic methylation process; and on the other hand nutrients such as vitamin C and vitamin E, are recognized antioxidants in reducing oxidative damage caused by arsenic. The nutritional contribution improved with the supplementation, for the case of hemoglobin it increased almost 1 gram during the 4 weeks of treatment [42, 44] as well as polyphenols present in some of the components of the multivitamin (broccoli extract, cranberry, etc.), although they did not have an important effect in the excretion of arsenic, can provide protection to the organism from the oxidative stress that is being produced by exposure to arsenic in these adolescents [44]. In relation to fiber, a deficiency in its consumption is associated with a higher probability of the appearance of dermatological lesions since fiber could decrease the absorption of arsenic in the gastrointestinal tract [30, 44, 45]. Soluble fiber (fructo-oligosaccharides), acts as a prebiotic, and therefore, to a better metabolism of As [44, 45]. Many of the foods consumed traditionally in Mexico are rich in fructo-oligosaccharides, such as beans and other legumes [38]. The consumption of fruits and vegetables has been low among the young population as well as greater food insecurity in Guanajuato households (71.2% of food insecurity), which represents a low consumption of antioxidants that have an important role in As metabolism [46].

This is the first study, which addressed the analysis of the effect of a 4-week vitamin and mineral supplementation, integrating dietary and nutritional variables. Therefore, the interaction of diet and the environment should be studied, as well as the integration of problems such as overweight, obesity, and anemia mainly.
