Health issues in upper Citarum: obesity and (agro)chemicals

Chiho Watanabe Dept Human Ecology

Graduate Sch of Medicine U Tokyo

Interlinkage meeting; May 27, 2014

Profile of ENVrionmental REsearch in Rural Asia 2006-2009

• Bangladesh, China, Indonesia, Nepal, PNG, Vietnam approx. 5,500 participants from 32 rural communities (some “urban” included as the “control”) • focus: - Impact of the changing lifestyle (changing subsistence) on health (and environment) in rural Asia > communities were so selected to reflect different lifestyle within each area. - Exposure to (Agro)chemical, industrial chemicals, and metals among villagers. - nutritional status (including lean/overweight) among adults (“Double burden”) • household survey in Upper Citarum. -5 villages: 50 households/village with schoolchildren - Sampling of biological media (blood, urine, saliva) - Interview: demographic, socioeconomic status, food consumption, physical activity (GPS/accelerometer).

* Collaboration with Institute of Ecology, UNPAD for West Java survey.

Pop. In Asian developing countries： total/rural （3.6/2.2 bil） (FAO, 2000)

Subsistence transition and life/health

Self-consuming, sustainable, domestic slush-and-burn (tuber), paddy field

Market-dependent, risk-taking Adopting new technology, incld chemicals

Vegetables/coffee/tropical fruits banana/rubber

Traditional agriculture

Cash crop-oriented agriculture

subsistence transition

Effects on life/health ・chemical exposures⇒ biomarkers of effects ・shortened ? Labor hours ・improved food, nutrition

Effects on local environment ・introduction of chemicals⇒ water quality, products, ・changes in the land usage （forest converted into cultivating field）

Chemicals: pesticides, Fertilizers, food additives, Plastics, undegradables

2008

B= agri culture to pisciculture (Sagulin 1985) pop 8,034 HH 2,133 (2001) Agriculture activity = low

P= paddy-field & cash-crop 950-1,450 m ASL Pop. 9,555 HH 3,200 (2002)

C= vegetable & dairy farming 1,200-1,600 m ASL pop 5,070 HH1,300 (2002 ) Agriculture activity = high

Study sites

P (control)

C (agricultural)

B (pisciculture)

B C T P S 1way ANOVA

Hb [g/dL] （NOT adjusted for

altitude）

♂ 13.9 14.2 15.0 13.9 14.2 **

♀ 12.8 13.2 13.5 12.7 12.2 ***

Uinrary Zn [μg/gCre］

♂ 721 433 632 645 409 *

♀ 499 484 430 389 298 ns

Urinary Se [μg/gCre］

♂ 34 21 30 25 21 ***

♀ 35 25 30 21 22 ***

Height [cm] ♂ 159.7 159.8 161.2 159.6 160.7 ns

♀ 149.3 147.6 150.9 149.1 150.0 *

BMI ♂ 21.3 20.8 21.3 20.5 21.7 ns

♀ 24.1 23.2 24.8 22.6 24.2 *

%fat ♂ 17.3 16.5 17.0 16.8 19.4 ns

♀ 35.4 33.8 35.4 32.9 35.8 ns

MUAC ♂ 25.5 25.7 26.7 24.8 26.6 ns

♀ 27.8 25.8 28.0 25.1 27.0 *

Salivary cortisol

[ng/mL]

♂ 1.3 1.9 1.4 1.6 1.4 *

♀ 1.4 2.1 1.9 1.7 1.3 *

Examples of the Effect variables （Z) nutritional status and stress

B C T P S ANOVA

Spraying Pesticides

% （Q42）

♂ ４ 65 31 10 4 ***

♀ 2 0 0 0 5 ns

AcｈE/Hb ♂ 3.9 4.0 4.4 4.3 4.１ ***

♀ 3.4 3.6 3.9 3.6 3.5 **

Urinary DAP ［% detected］

♂ 50 57 64 31 56 ＊

♀ 38 31 49 23 49 ns

Urinary As ［ng/mgCre]

♂ 75 80 83 81 61 ns

♀ 88 101 76 76 63 ns

Urinary Cd ［ng/mgCre]

♂ 0.93 0.41 0.68 0.83 0.65 *

♀ 1.61 1.06 0.94 0.70 0.69 ***

Urinary Pb ［ng/mgCre]

♂ 5.5 2.9 3.8 1.5 1.5 ***

♀ 5.5 2.3 3.7 1.2 1.6 ***

Exposure to chemicals

Relationship between effect (Z) and descriptor (Y) “nutritional status” domain – PC1 = “high energy” status

MALES ＝ high only in S (urban) FEMALES ＝high in B，T in addition to S． PC1 load： females ＞males （partly due to higher %fat）． non-farming, & chem-dep farming were associated with “high energy”

P（paddy）

S（urban）

B（fish） T（dairy）

C（vege）

MALES FEMALES S（urban）

Effects (Z) and descriptors (Y): stress (physical/psychological)

Saslivary cortisol concentration; would reflect both physiological psychological stresses． Both non-farming¥chem-dep farming >> lower stress

males females

P（paddy）

S（urban）

B（fish） T（dairy） C（vege）

Obesity (risk for chronic dis.)

ESA Human Ecology: SYMP-19 @Pittsiburge 100805

BMI males BMI females

N mean Under (<18.5)

Over (>25)

N mean Under (<18.5)

Over (>25)

West Java, Indonesia

Vairous area, Nepal

11

GPS/accerelometer plot of an individual

ENVRERA West Java lifestyle change and health; findings

• Most of the health-associated variables showed inter-community difference, some (e.g. nutrition) were positively and others (e.g., stress) were negatively associated with “urban” characteristics. • Substantial proportion of lean and overweight individuals were observed within each community. “Fat females and lean males” was the predominating pattern; a feature of West Java population (among the six countries surveyed). This indicated the impacts of “lifestyle change” may not be identical on males and females. • Exposure of children to agrochemical (organophosphate pestides) were less extensive compared to that of children living in a rural area in Japan, and the levels were not associated with the intensity of agricultural activity. While exposure to metal elements like Cd and Pb did not seem extensive, the level of As was somewhat elevated.