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In Reply: To address the concern raised by Dr Tseng, we further adjusted our analyses for family history of diabetes, use of hormone therapy, and use of dietary supplements. The results did not change appreciably. The ratios of the geometric means comparing participants with and without diabetes were 1.27 (95% confidence interval [CI], 1.04-1.55) for total arsenic, 1.10 (95% CI, 0.93-1.29) for dimethylarsinate, and 0.92 (95% CI, 0.68-1.24) for arsenobetaine.

Tseng also questioned the adequacy of urine arsenic levels as a surrogate marker for dosage of arsenic exposure. Urine arsenic is an established biomarker of arsenic exposure in drinking water¹ that integrates multiple sources to serve as a marker of overall arsenic exposure.² In addition, urine speciation can be used to evaluate arsenic metabolism and to differentiate inorganic from organic arsenic exposure.³ This is important because organic arsenicals, mostly found in seafood, seem to have little or no toxicity compared . . . [Full Text of this Article]

Ana Navas-Acien, MD, PhD
anavas@jhsph.edu
Department of Environmental Health Sciences

Eliseo Guallar, MD, DrPH
Department of Epidemiology
Johns Hopkins University Bloomberg School of Public Health
Baltimore, Maryland

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