Relationship between tap water hardness, magnesium, and calcium concentration and mortality due to ischemic heart disease or stroke in The Netherlands

The Multidisciplinary Approach in the Management of Patients with Kidney Stone Disease-A State-of-the-Art Review

Kidney stone disease has a multifactorial etiology, and evolving dietary habits necessitate continuous updates on the impact of dietary components on lithogenesis. The relationship between diseases influenced by lifestyle, such as obesity and diabetes, and kidney stone risk underscores the need for comprehensive lifestyle analysis. Effective management of kidney stones requires a multidisciplinary approach, involving collaboration among nutritionists, urologists, nephrologists, and other healthcare professionals to address the complex interactions between diet, lifestyle, and individual susceptibility. Personalized dietary therapy, based on each patient's unique biochemical and dietary profile, is essential and necessitates comprehensive nutritional assessments. Accurate dietary intake evaluation is best achieved through seven-day, real-time dietary records. Key factors influencing urinary risk include fluid intake, dietary protein, carbohydrates, oxalate, calcium, and sodium chloride. Personalized interventions, such as customized dietary changes based on gut microbiota, may improve stone prevention and recurrence. Current research suggests individualized guidance on alcohol intake and indicates that tea and coffee consumption might protect against urolithiasis. There is potential evidence linking tobacco use and secondhand smoke to increased kidney stone risk. The effects of vitamins and physical activity on kidney stone risk remain unresolved due to mixed evidence. For diseases influenced by lifestyle, conclusive evidence on targeted interventions for nephrolithiasis prevention is lacking, though preliminary research suggests potential benefits. Management strategies emphasize lifestyle modifications to reduce recurrence risks, support rapid recovery, and identify predisposing conditions, highlighting the importance of these changes despite inconclusive data.

Mediatory role of the serum mineral level and discharge disability of stroke survivors

Background

Possible association between minerals contributing and mortality related to stroke were seen, but prospective data on the relation of vitamin D, magnesium and calcium serum levels with stroke were inconsistent. Consideration about the potential health effects of minerals and nutrients, the current study was conducted.

Methods

This analytical cross-sectional study was conducted on 216 stroke survivors who were referred to the Ayatollah Rouhani Hospital of Babol, Iran. Demographic characteristics, clinical variables, and serum mineral levels were completed in the checklist. Admit score and discharge scale of these patients were determined according to the National Institute of Health Stroke Scale. A path model was constructed to explore the interrelationship between variables and to verify the relationship between variables and disability discharges.

Results

Of 216 stroke patients, 185 (85.6%) cases were ischemic. The discharge status of 29 (12.9%) cases were severe or expired. The patients with moderate and severe admit scores, hemorrhagic stroke type, diabetes mellitus, hypertension and live in the village significantly had a poor discharge disability scale (all of p<0.05). Of all direct paths, Mg (β=-2.85), and among indirect paths, calcium(β=-3.59) had the highest effect on the discharge scale. Only mg had affected the discharge scale through direct and indirect (β=-2.45) paths and had the greatest reverse effect on the discharge scale (β=-5.30; totally).

Conclusion

Hypomagnesemia and hypocalcemia play a mediatory role in poor outcomes. Especially, hypomagnesemia was the direct parameter for poor outcomes. The independent role of each mineral in this issue is difficult to define and suggested for future study.

The Relationship between Mortality from Cardiovascular Diseases and Total Drinking Water Hardness: Systematic Review with Meta-Analysis

BACKGROUND

Interest in water chemical activity, its content, and its impact on human health has greatly increased throughout the last decade. Some studies suggest that drinking water with high hardness may have preventative effects on cardiovascular diseases. This study aims to investigate the association between drinking water hardness and cardiovascular disease (CVD) mortality.

METHODS

The study selection process was designed to find the association between drinking water hardness and CVDs mortality. The search included both qualitative and quantitative research and was performed in three databases: Web of Science (Clarivate Analytics, Ann Arbor, MI, USA), PubMed (National Institute of Health, Bethesda, MA, USA), and Scopus (Elsevier, RELX Group plc, London, UK). The project was registered in the International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD42020213102.

RESULTS

Seventeen studies out of a total of twenty-five studies qualitatively analyzed indicated a significant relation between total water hardness and protection from CVD mortality. The quantitative analysis concluded that high drinking water hardness has a significantly lowering effect on mortality from CVDs, however, the heterogeneity was high.

CONCLUSIONS

This systematic literature review shows that total water hardness could affect CVD prevention and mortality. Due to the many confounding factors in the studies, more research is needed.

Assessment of drinking water safety in the Netherlands using nationwide exposure and mortality data

BACKGROUND

Although drinking water in the Netherlands is generally accepted as safe, public concern about health risks of long-term intake still exist.

OBJECTIVE

The aim was to explore associations between drinking water quality for nitrate, water hardness, calcium and magnesium and causes-of-death as related to cardiovascular diseases amongst which coronary heart disease and colorectal cancer.

METHODS

We used national administrative databases on cause-specific mortality, personal characteristics, residential history, social economic indicators, air quality and drinking water quality for parameters specified by the EU Drinking Water Directive. We put together a cohort of 6,998,623 persons who were at least 30 years old on January 1, 2008 and lived for at least five years on the same address. The average drinking water concentration over 2000-2010 at the production stations were used as exposure indicators. We applied age stratified Cox proportional hazards models.

RESULTS

Magnesium was associated with a reduced risk for mortality due to coronary heart diseases: HR of 0.95 (95% CI: 0.90, 0.99) per 10 mg/L increase. For mortality due to cardiovascular diseases, a 100 mg/L increase in calcium was associated with a HR of 1.08 (95% CI: 1.03, 1.13) and an increase of 2.5 mmol/L of water hardness with a HR of 1.06 (95% CI: 1.01, 1.10). The results show an elevated risk for coronary heart disease mortality at calcium concentrations below 30 mg/L, but over the whole exposure range no exposure response relation was observed. For other combinations of drinking water quality parameters and cause-specific mortality studied, no statistical significant associations were identified.

CONCLUSION

We identified in this explorative study a protective effect of magnesium for the risk of mortality to coronary heart disease. Also we found an increased risk of mortality due to cardiovascular disease associated with the concentration of calcium and the water hardness in drinking water.

Calcium and magnesium in drinking water and risk of myocardial infarction and stroke-a population-based cohort study

BACKGROUND

The implication of calcium and magnesium in drinking water for cardiovascular disease is unclear.

OBJECTIVES

To assess the association of the concentration of calcium and magnesium in drinking water with incidence of myocardial infarction and stroke, accounting for dietary mineral intake.

METHODS

We linked drinking water monitoring data to residential information of 26,733 women from the population-based Swedish Mammography Cohort, who completed a 96-item FFQ at baseline. Drinking water was categorized into low (magnesium <10 mg/L and calcium <50 mg/L) or high (magnesium ≥10 mg/L or calcium ≥50 mg/L) mineral concentration. Incident cases of myocardial infarction and stroke types were ascertained 1998-2019 using the National Patient Register.

RESULTS

The mean ± SD concentration of calcium and magnesium in drinking water was 29 ± 7 mg/L and 5 ± 1 mg/L in the low-exposed area and 52 ± 20 mg/L and 10 ± 3 mg/L in the high-exposed area, respectively. During 16 years of follow-up, we ascertained 2023, 2279, and 452 cases of myocardial infarction, ischemic stroke, and hemorrhagic stroke, respectively. High drinking water calcium and magnesium was associated with lower risk of ischemic and hemorrhagic stroke HRs of 0.87 (95% CI: 0.80, 0.95) and 0.78 (95% CI: 0.65, 0.95), whereas the HR for myocardial infarction was 0.93 (95% CI: 0.85, 1.02). In separate analyses, only drinking water magnesium, not calcium, remained associated with ischemic stroke (HR: 0.69; 95% CI: 0.54, 0.88).

CONCLUSIONS

Drinking water with a high concentration of calcium and magnesium, particularly magnesium, may lower the risk of stroke in postmenopausal women.

The Risk of CVDs from Desalinated Seawater: A Nested Case-Control Study

The aim of this paper was to assess the association between desalinated seawater and cardiovascular diseases (CVDs). We conducted a nested case-control prospective study on a cohort of 7806 subjects who live on an island of China that lacks fresh water. From this cohort, we identified 140 paired CVD cases and matched controls by sex and age during the same period. Questionnaires were used in order to investigate basic sociodemographic information and risk factors for CVDs, and urine samples were collected to measure calcium and magnesium levels. Using these data we developed and tested both univariate and multivariate logistic regression models. We observed no significant differences in risk of CVDs between groups with desalinated seawater and fresh water intake. From multivariate logistic regression, we found that obesity (OR = 5.38, 95% CI: 1.05–27.45), physical activity (OR = 0.35, 95% CI: 0.16–0.75), hypertension (OR = 3.61, 95% CI: 1.58–8.25), alcohol consumption (OR = 2.57, 95% CI: 1.02–6.47), and irritability (OR = 4.30, 95% CI: 1.93–9.60) were associated with an increased risk of CVD. In this population, we found no association between desalinated seawater intake and CVDs; the incidence of CVDs was primarily related to lifestyle.

Drinking water magnesium and cardiovascular mortality: A cohort study in Denmark, 2005-2016

INTRODUCTION

Cardiovascular diseases are globally a major cause of death. Magnesium deficiency is associated with several diseases including cardiovascular diseases.

OBJECTIVE

To examine if a low concentration of magnesium in drinking water is associated with increased cardiovascular mortality and mortality due to acute myocardial infarction and stroke.

METHODS

A nationwide population-based cohort study using national health registries was used. A total of 4,274,132 individuals aged 30 years or more were included. Magnesium concentration in drinking water was estimated by linkage of residential addresses in the period 2005-2016 with the national drinking water quality monitoring database. The association between magnesium concentration in drinking water and cardiovascular mortality and mortality due to acute myocardial infarction and stroke was examined using a Poisson regression of number of deaths and logarithmic transformation of follow-up time as offset. The incidence rate ratio (IRR) was adjusted for differences in age, sex, calendar year, cohabitation, country of origin, and socioeconomic status.

RESULTS

Median magnesium concentration in drinking water at inclusion was 12.4 mg/L (range: 1.37-54.2 mg/L). The adjusted IRR for cardiovascular mortality was 0.96 (95% CI: 0.94; 0.97) for the lowest magnesium quintile (<6.5 mg/L) as compared to the highest magnesium quintile (>21.9 mg/L). The adjusted IRR for mortality due to acute myocardial infarction and stroke was 1.22 (1.17; 1.27) and 0.96 (0.93; 0.99), respectively, for the lowest magnesium quintile as compared to the highest quintile A decreasing mortality due to acute myocardial infarction was seen with an increasing magnesium concentration in a dose-response manner.

CONCLUSION

Low concentrations of magnesium in drinking water were associated with an increased mortality due to acute myocardial infarction. Low concentrations of magnesium in drinking water were associated with decreased cardiovascular mortality, and mortality due to stroke.

Association between magnesium in drinking water and atrial fibrillation incidence: a nationwide population-based cohort study, 2002-2015

BACKGROUND

Atrial fibrillation (AF) is a common heart rhythm disorder and a risk factor of adverse cardiovascular diseases. Established causes do not fully explain the risk of AF and unexplained risk factors might be related to the environment, e.g. magnesium in drinking water. Low magnesium levels in drinking water might be associated with higher risk of cardiovascular diseases including AF. With detailed individual data from nationwide registries and long-term magnesium exposure time series, we had a unique opportunity to investigate the association between magnesium in drinking water and AF.

OBJECTIVE

We evaluated the association between magnesium concentration in drinking water and AF risk.

METHODS

A nationwide register-based cohort study (2002-2015) was used including individuals aged ≥30 years. Addresses were linked with water supply areas (n = 2418) to obtain time-varying drinking water magnesium exposure at each address. Five exposure groups were defined based on a 5-year rolling time-weighted average magnesium concentration. AF incidence rate ratios (IRRs) between exposure groups were calculated using a Poisson regression of incidence rates, adjusted for sex, age, and socioeconomic position. Robustness of results was investigated with different exposure definitions.

RESULTS

The study included 4,264,809 individuals (44,731,694 person-years) whereof 222,998 experienced an incident AF. Magnesium exposure ranged from 0.5 to 62.0 mg/L (mean = 13.9 mg/L). Estimated IRR (95% CI) compared to the referent exposure group (< 5 mg/L) was 0.98 (0.97-1.00) for the second lowest exposure group (5-10 mg/L), and 1.07 (1.05-1.08) for the two highest exposure groups (15-62 mg/L). Strongest positive associations were observed among those aged ≥80 years and with lowest education group. An inverse association was found among individuals with highest education group.

CONCLUSION

There might be a small beneficial effect on AF of an increase in magnesium level in drinking water up to 10 mg/L, though an overall positive association was observed. The unexpected positive association and different associations observed for subgroups suggest a potential influence of unaccounted factors, particularly in vulnerable populations. Future research on magnesium in drinking water and cardiovascular diseases needs to focus on contextual risk factors, especially those potentially correlating with magnesium in drinking water.

Association between plasma copper levels and first stroke: a community-based nested case-control study

BACKGROUND AND AIMS

Uncertainty remains regarding the association between the risk of stroke and plasma copper levels in population with copper mostly in normal range due to limited data. We examined the association between baseline plasma copper and risk of first stroke in Chinese community-dwelling population.

METHODS

We conducted a nested case control study from 'H-type Hypertension and Stroke Prevention and Control Project'. A total of 1255 first stroke cases and 1255 controls matched for age, sex and study site were included in the analysis. Conditional logistic regression analyses were performed to evaluate the association between plasma copper and first stroke.

RESULTS

The overall mean of copper was 15.90 (2.66) μmol/L. In total, 94.26% participants' copper concentration was in the normal range by Mayo Clinic laboratory reference values. Smoothing curve showed that the associations of plasma copper with first stroke and its subtypes were linear. Each standard deviation (SD) increment of plasma copper was independently and positively associated with risk of first stroke [odds ratio (OR): 1.17, 95% confidence interval (CI): 1.07-1.28]. The multivariable ORs with 95% CIs for total stroke, ischemic stroke and hemorrhagic stroke in the highest versus the lowest quartile of plasma copper were 1.49 (1.16-1.90; P-trend = 0.001), 1.46 (1.12-1.92; P-trend = 0.004) and 2.05 (0.95-4.38; P-trend = 0.050), respectively.

CONCLUSIONS

Baseline plasma copper was positively associated with risk of first ischemic stroke in an approximately linear fashion among Chinese community population (80.32% hypertensives), although their copper levels were mostly within the normal range according to current reference values. Our findings warrant additional investigation.

Dual-Modal Assay Kit for the Qualitative and Quantitative Determination of the Total Water Hardness Using a Permanent Marker Fabricated Microfluidic Paper-Based Analytical Device

A dip-and-read microfluidic paper-based analytical device (µPAD) was developed for the qualitative and quantitative detection of the total hardness of water. To create well-defined hydrophobic barriers on filter paper, a regular office printer and a commercially available permanent marker pen were utilized as a quick and simple technique with easily accessible equipment/materials to fabricate µPAD in new or resource-limited laboratories without sophisticated equipment. After a wettability and barrier efficiency analysis on the permanent marker colors, the blue and green ink markers exhibited favorable hydrophobic properties and were utilized in the fabrication of the developed test devices. The device had five reaction and detection zones modeled after the classification given by the World Health Organization (WHO), so qualitatively it determined whether the water was ‘soft’, ‘moderately hard’, ‘hard’, or ‘very hard’ by changing color from blue to pink in about 3 min. The device was also used to introduce an alternative colorimetric reaction for quantitative analysis of the water hardness without the need for ethylenediaminetetraacetic acid (EDTA) and without compromising the simplicity and low cost of the device. The developed µPAD showed a calculated limit of detection (LOD) of 0.02 mM, which is at least 80% less than those of commercially available test strips and other reported µPADs, and the results of the real-world samples were consistent with those of the standard titration (with EDTA). In addition, the device exhibited stability for 2 months at room and frigid condition (4 °C) and at varying harsh temperatures from 25 to 100 °C. The results demonstrate that the developed paper-based device can be used for rapid, on-site analysis of water with no interferences and no need for a pipette for sample introduction during testing.

Production of Vegetables and Artichokes Is Associated with Lower Cardiovascular Mortality: An Ecological Study

Mortality due to cardiovascular disease (CVD), including cerebrovascular disease (CED) and ischaemic heart disease (IHD), was considerably different in eight municipalities of the province of Castellón, Community of Valencia (Spain) during the period of 1991-2011. In addition, these villages showed differences in agricultural practices and production. Since high vegetable consumption has been linked to decreased all-cause, CVD, and CED mortalities, we hypothesized that the diversity in vegetable and artichoke production, used as proxies for their consumption, could be associated with the diversity of mortality rates. In order to test our hypothesis, we estimated the smoothed standardized mortality ratios (SMRs) of CVD, CED, and IHD mortalities and a directed, age-adjusted mortality rate (AMR). We used a multilevel linear regression analysis to account for the ecological nature of our study. After adjustment, the CVD and CED SMRs were inversely associated with vegetable and artichoke production, with a reduction in SMRs for CVD: -0.19 (95% Confidence Interval [CI] -0.31 to -0.07) and -0.42 (95% CI -0.70 to -0.15) per hectare/10³ inhabitants, respectively. The SMRs for CED also decreased: -0.68 (95% CI -1.61 to -0.19) and -1.47 (95% CI -2.57 to -0.36) per hectare/10³ inhabitants, respectively. The SMRs for IHD were not associated with vegetal and artichoke production. When the directed AMR was used, CED mortality was consistent with the previous results, whereas the CVD mortality association was lost. Our results indicate that vegetable and artichoke production may act as protective factors of CED and CVD mortalities.

Bioluminescent Ratiometric Indicator for Analysis of Water Hardness in Household Water

Water hardness (WH) is a useful parameter for testing household water, such as drinking, cooking, and washing water. Many countries around the world use pipeline water in their houses, but there is a need to monitor the WH because hard water has a negative impact on appliances. Currently, WH is often measured using chemical dye-based WH indicators, and these techniques require expensive equipment, and trained personnel. Therefore, a low-cost and simple measurement method has been desired. Here, we report LOTUS-W, which consists of a luciferase, Nanoluc, a yellow fluorescent protein Venus, and a Ca2+/Mg2+ detection domain of human centrin 3. The binding of Ca2+/Mg2+ to this indicator changes the conformation of human centrin 3, and induces bioluminescence resonance energy transfer (BRET) from Nanoluc to Venus, which changes its emission spectrum about 140%. The dissociation constants of LOTUS-W for Ca2+/Mg2+ are approximately several mM, making it suitable for measuring WH in the household water. With this indicator in combination with a smartphone, we have demonstrated that it is possible to evaluate WH easily and quickly. This novel indicator has the potential to be used for measuring not only household water but also water used in the food industry, etc.

Environmental heavy metals and cardiovascular diseases: Status and future direction

Cardiovascular disease (CVD) and environmental degradation are leading global health problems of our time. Recent studies have linked exposure to heavy metals to the risks of CVD and diabetes, particularly in populations from low- and middle-income countries, where concomitant rapid development occurs. In this review, we 1) assessed the totality, quantity, and consistency of the available epidemiological studies, linking heavy metal exposures to the risk of CVD (including stroke and coronary heart disease); 2) discussed the potential biological mechanisms underlying some tantalizing observations in humans; and 3) identified gaps in our knowledge base that must be investigated in future work. An accumulating body of evidence from both experimental and observational studies implicates exposure to heavy metals, in a dose-response manner, in the increased risk of CVD. The limitations of most existing studies include insufficient statistical power, lack of comprehensive assessment of exposure, and cross-sectional design. Given the widespread exposure to heavy metals, an urgent need has emerged to investigate these putative associations of environmental exposures, either independently or jointly, with incident CVD outcomes prospectively in well-characterized cohorts of diverse populations, and to determine potential strategies to prevent and control the impacts of heavy metal exposure on the cardiometabolic health outcomes of individuals and populations.

Water hardness zoning of Isfahan Province, Iran, and its relationship with cardiovascular mortality, 2013-2015

BACKGROUND

Cardiovascular disease (CVD) is one of the common diseases and today, it is considered as not only an important cause of mortality but also a significant aspect of health geography. The evidence presented in the literature indicates that hard water may reduce the cases of sudden death caused by CVDs because drinking water contains significant amounts of calcium and magnesium, which play a crucial role in the electrical activity of heart. Hence, the present study aimed at investigating the relationship between water hardness and CVD mortality rate in Isfahan, Iran.

METHODS

In this ecological study, the available data regarding the cardiovascular mortality rate and water hardness have been used. Preparation of zoning map has been conducted using the Geographic Information System (GIS) software considering Inverse Distance Weighting (IDW) interpolation models. Moreover, statistical analysis has been conducted using SPSS software.

RESULTS

A reverse relationship was observed between cardiovascular mortality rate and water hardness. However, the observed relationship was not statistically significant (2013: r = -0.066, 2014: r = -0.155, 2015: r = -0.051, P > 0.050).

CONCLUSION

The results of mapping with GIS and statistical analysis with SPSS both indicated a non-significant inverse relationship between the water hardness and CVDs. However, lack of a significant relationship highlights the necessity of conducting similar studies involving larger sample sizes and wider areas of investigation to present a definitive and generalizable result.

Intake of Molecular Hydrogen in Drinking Water Increases Membrane Transporters, p-Glycoprotein, and Multidrug Resistance-Associated Protein 2 without Affecting Xenobiotic-Metabolizing Enzymes in Rat Liver

Molecular hydrogen (H2) has been shown to have antioxidant and anti-inflammatory activities that may reduce the development and progression of many diseases. In this study, hydrogen-rich water (HRW) was obtained by reacting hybrid magnesium-carbon hydrogen storage materials with water. Then, the effects of intake of HRW on the activities of xenobiotic-metabolizing enzymes, membrane transporters, and oxidative stress in rats were investigated. Rats were given HRW ad libitum for four weeks. The results showed that intake of HRW had no significant effect on the activities of various cytochrome P450 (CYP) enzymes (CYP1A1, 1A2, 2B, 2C, 2D, 2E1, 3A, and 4A), glutathione-S-transferase, and Uridine 5'-diphospho (UDP)-glucuronosyltransferase. Except for a mild lower plasma glucose concentration, intake of HRW had no effect on other plasma biochemical parameters in rats. p-Glycoprotein and multidrug resistance-associated protein (Mrp) 2 protein expressions in liver were elevated after intake of HRW. However, HRW had no significant effects on glutathione, glutathione peroxidase, or lipid peroxidation in liver. The results from this study suggest that consumption of HRW may not affect xenobiotic metabolism or oxidative stress in liver. However, intake of HRW may increase the efflux of xenobiotics or toxic substances from the liver into bile by enhancing p-glycoprotein and Mrp2 protein expressions.

Association of consumption of excess hard water, body mass index and waist circumference with risk of hypertension in individuals living in hard and soft water areas

Chronic exposure to soft drinking water increases the risk of hypertension. We conducted a cross-sectional study in 2017 in two study areas in the Poldasht County to assess the relation of hardness, body mass index and waist circumference with risk of hypertension. Total water hardness was measured by gravimetric methods. Hardness of > 180 ppm was considered to be hard drinking water. The Shiblu and Gharghologh areas had a four times higher mean total hardness level in drinking water (968.69 mg/L as CaCO₃) than the Sarisoo and Agh Otlogh (180 mg/L as CaCO₃) areas. According to the results of the study, the prehypertension prevalence in areas with high and low water hardness was calculated as 23.15% (18.11-29.15) and 46.84% (37.61-57.64), respectively. Moreover, the result showed the prevalence of hypertension and prehypertension was higher in regions with low hardness than those with high hardness, which was statistically significant (P < 0.001). The results of logistic regression showed that age, body mass index, waist circumference and hardness of drinking water were significantly related to hypertension. Accordingly, hypertension was low in people of regions with high hardness (OR 0.26, 0.17-0.42). This report examined whether total hardness in drinking water was protective against hypertension. This is an important finding for the ministry of human health as well as for the water and sewage company.

High Content of Lead Is Associated with the Softness of Drinking Water and Raised Cardiovascular Morbidity: A Review

Daily ingestion of lead (Pb), even through piped drinking water, has long time been an important issue of concern, attracting for decades research in environmental science and toxicology, and again comes to prominence because of recent high-profile cases of exposure of populations in several countries to Pb-contaminated water. Numerous studies have reported an association between Pb in water and the risk of cardiovascular pathologies. Low levels of magnesium and calcium, i.e., low degree of hardness of the drinking water, may accentuate Pb leaching from water pipes and furthermore increase Pb absorption. This review evaluates the evidence for an association between Pb exposure from drinking water and cardiovascular end points in human populations.

Contamination of arsenic, manganese and coliform bacteria in groundwater at Kushtia District, Bangladesh: human health vulnerabilities

Safe water is essential for life. Consumption of arsenic and manganese contaminated water poses a range of health effects to humans. Physico-chemical and bacteriological characteristics of groundwater at five administrative upazillas in Kushtia District, Bangladesh, have been studied to evaluate the potability of water for drinking purpose from 32 randomly selected tube wells (TWs). APHA (2012) standard analytical methods were applied for analyses of the physico-chemical and bacteriological parameters of the water samples. Arsenic, iron, and manganese content were analyzed by atomic absorption spectroscopy (AAS). The investigated parameters of water samples were found as pH 6.81-8.12, electrical conductivity (EC) 520-1,995 μs/cm, total dissolved solids (TDS) 357.8-1,372.6 mg/L, chloride 10-615 mg/L, total hardness 285-810 mg/L, arsenic (As) 0.001-0.098 mg/L, iron (Fe) 0.04-1.45 mg/L, manganese (Mn) 0.01-6.32 mg/L. About 56.25% of TWs were highly contaminated with fecal coliform (FC) and 68.75% were found to be contaminated with total coliform (TC). Results were compared with World Health Organization (WHO) and Bangladesh Drinking Standards (BDS). The concentrations of water quality parameters are much higher as compared to WHO and BDS standards. This may cause acute public health risks and make water unsuitable for direct human consumption without treatment.

Association between exposure to desalinated sea water and ischemic heart disease, diabetes mellitus and colorectal cancer; A population-based study in Israel

BACKGROUND

Drinking water (DW) is an important dietary source of magnesium. Recently, Israel has increased its use of desalinated seawater (DSW) as DW country-wide. Its negligible magnesium content, however, raises concern that consumption of DSW may be associated with hypomagnesemia and increase the risk of ischemic heart disease (IHD), diabetes mellitus (DM), and colorectal cancer (CRC).

OBJECTIVES

We tested whether there was a change in incidence of negative health outcomes (IHD, DM, and CRC) following the introduction of DSW supply in a population-based ecologic study in Israel.

METHODS

A historical prospective analysis was applied to members aged 25-76 during 2004-2013 of Clalit Health Services (Clalit), the largest healthcare provider in Israel, using its electronic medical record database. Multivariable analyses were adjusted for age, sex, socioeconomic status, smoking status, and body mass index.

RESULTS

An increased odds ratio was found for IHD (0.96, 95% CI 0.93-0.99 at baseline and 1.06, 95% CI 1.02-1.11 at the end of the follow-up period), but no time trend was observed.

CONCLUSIONS

We found that the risk for IHD increased during the study period. The risks for DM and CRC were unchanged. Long term studies are needed for assessing the risk for CRC due to the long latency. The higher risk for IHD has practical public health implications and raise the need to add magnesium to DSW.

Low-mineral direct drinking water in school may retard height growth and increase dental caries in schoolchildren in China

Although direct drinking water (DDW) systems that utilize a reverse-osmosis technique are thought to be harmful to children's development by reducing their daily mineral intake, few population data are available regarding this topic. We conducted an eco-epidemiological study to investigate the influence of low-mineral DDW on the development of schoolchildren. We collected developmental parameters of 13,723 girls and 16,161 boys before and after the introduction of DDW systems in 25 schools and measured the mineral levels in the DDW of each school. The DDW in 22 schools had lower-than-recommended levels of magnesium and calcium (magnesium, 10 mg/L and calcium, 20 mg/L, WHO). We found that children exposed to low-mineral DDW exhibited reduced height and diminished height increases as well as higher prevalences and incidences of hypoevolutism and dental caries (p < 0.01). This exposure was a risk factor for a greater incidence of both hypoevolutism and dental caries in children (RR = 7.110 (1.688, 29.953) and 1.813 (1.309, 2.509), respectively; p < 0.01). Our results suggest that low-mineral DDW may retard height growth and promote the incidence of dental caries in schoolchildren; thus, schools should choose DDW treatment systems that retain the minerals in water.

Dietary Intake of Magnesium or Calcium and Chemotherapy-Induced Peripheral Neuropathy in Colorectal Cancer Patients

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and severe side-effect in colorectal cancer (CRC) patients. This study assessed the association between habitual dietary intake of magnesium or calcium and prevalence and severity of chronic CIPN in CRC patients receiving adjuvant chemotherapy. For this prospective cohort study, 196 CRC patients were considered. Magnesium and calcium intake was determined using a food frequency questionnaire at diagnosis, during and after chemotherapy. Chronic CIPN was assessed 12 months after diagnosis using the quality of life questionnaire CIPN20. Prevalence ratios were calculated to assess the association between magnesium or calcium intake and the prevalence of CIPN. Multivariable linear regression analysis was used to assess the association between magnesium or calcium intake and severity of CIPN. CIPN was reported by 160 (82%) patients. Magnesium intake during chemotherapy was statistically significantly associated with lower prevalence of CIPN (prevalence ratio (PR) 0.53, 95% confidence interval (CI) 0.32, 0.92). Furthermore, higher dietary intake of magnesium during (β −1.08, 95% CI −1.95, −0.22) and after chemotherapy (β −0.93, 95% CI −1.81, −0.06) was associated with less severe CIPN. No associations were found for calcium intake and the prevalence and severity of CIPN. To conclude, we observed an association between higher dietary magnesium intake and lower prevalence and severity of CIPN in CRC patients.

Association between trace elements in the environment and stroke risk: The reasons for geographic and racial differences in stroke (REGARDS) study

The disparities in stroke mortality between blacks and whites, as well as the increased stroke mortality in the "stroke belt" have long been noted. The reasons for these disparities have yet to be fully explained. The association between trace element status and cardiovascular diseases, including stroke, has been suggested as a possible contributor to the disparities in stroke mortality but has not been fully explored. The purpose of this study is to investigate distributions of four trace elements (arsenic, mercury, magnesium, and selenium) in the environment in relation to stroke risk. The study population (N=27,770) is drawn from the Reasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort. Environmental distribution of each trace element was determined using data from the United States Geological Survey (USGS) and was categorized in quartiles. A proportional hazards model, adjusted for demographic data and stroke risk factors, was used to examine the association of interest. The results showed that higher selenium levels in the environment were associated with increased stroke risk, and the hazard ratio for the 4th quartile compared to the 1st quartile was 1.33 (95% CI: 1.09, 1.62). However, there was no statistically significant relationship between environmental arsenic, mercury or magnesium and the risk of stroke. Because of dietary and non-dietary exposure as well as bioavailability, further research using biomarkers is warranted to examine the association between these trace elements and the risk of stroke.

Cardiovascular diseases and hard drinking waters: implications from a systematic review with meta-analysis of case-control studies

This systematic review with meta-analysis, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, aims at evaluating the potential correlation between magnesium and calcium concentration in drinking waters and the risk of cardiovascular diseases (CVD), which impose a considerable burden in high-income countries. Included studies were of the case-control studies type. From an initial list of 643 potentially eligible articles, seven studies were finally retained in the quantitative analysis. Since each one of them assessed different ion concentrations, subjects exposed to the highest concentration versus those exposed to the lowest concentration were compared. By including an overall figure of 44,000 subjects, the result suggests a protective effect of the ions on CVD prevention, with an effect-size (ES) of 0.82 (95% confidence interval CI = [0.70-0.95], p-value = 0.008) for calcium, and ES = 0.75 (95% CI = [0.66-0.86], p-value = 0.000) for magnesium. Hard water consumption seems to be protective against CVD. However, the high heterogeneity (I² = 75.24, p-value = 0.001 for calcium; I² = 72.96, p-value = 0.0024 for magnesium) and the existence of publication bias limits the robustness and generalizability of these findings. Further high-quality studies are needed to reproduce and confirm these results.

Potable water quality monitoring of primary schools in Magura district, Bangladesh: children's health risk assessment

Safe potable water is essential for good health. Worldwide, school-aged children especially in the developing countries are suffering from various water-borne diseases. In the study, drinking water supplies for primary school children were monitored at Magura district, Bangladesh, to ensure safe potable water. APHA standard analytical methods were applied for determining the physicochemical parameters of the water samples. For determination of the essential physicochemical parameters, the samples were collected from 20 randomly selected tube wells of primary schools at Magura. The metal contents, especially arsenic (As), iron (Fe), and manganese (Mn), in the water samples were analyzed by atomic absorption spectroscopy. The range of physicochemical parameters found in water samples were as follows: pH 7.05-9.03, electrical conductivity 400-2340 μS/cm, chloride 10-640 mg/L, hardness 200-535 mg/L as CaCO₃, and total dissolved solids 208-1216 mg/L. The level of metals in the tube well water samples were as follows: As 1 to 55 μg/L, Fe 40 to 9890 μg/L, and Mn 10 to 370 μg/L. Drinking water parameters of Magura district did not meet the requirement of the World Health Organization drinking water quality guideline, or the Drinking Water Quality Standards of Bangladesh.

Desalinated seawater supply and all-cause mortality in hospitalized acute myocardial infarction patients from the Acute Coronary Syndrome Israeli Survey 2002-2013

BACKGROUND

Consuming desalinated seawater (DSW) as drinking water (DW) may reduce magnesium in water intake causing hypomagnesemia and adverse cardiovascular effects.

METHODS

We evaluated 30-day and 1-year all-cause mortality of acute myocardial infarction (AMI) patients enrolled in the biannual Acute Coronary Syndrome Israeli Survey (ACSIS) during 2002-2013. Patients (n=4678) were divided into 2 groups: those living in regions supplied by DSW (n=1600, 34.2%) and non-DSW (n=3078, 65.8%). Data were compared between an early period [2002-2006 surveys (n=2531) - before desalination] and a late period [2008-2013 surveys (n=2147) - during desalination].

RESULTS

Thirty-day all-cause-mortality was significantly higher in the late period in patients from the DSW regions compared with those from the non-DSW regions (HR=2.35 CI 95% 1.33-4.15, P<0.001) while in the early period there was no significant difference (HR=1.37 CI 95% 0.9-2, P=0.14). Likewise, there was a significantly higher 1-year all-cause mortality in the late period in patients from DSW regions compared with those from the non-DSW regions (HR=1.87 CI 95% 1.32-2.63, P<0.0001), while in the early period there was no significant difference (HR=1.17 CI 95% 0.9-1.5, P=0.22). Admission serum magnesium level (M±SD) in the DSW regions (n=130) was 1.94±0.24mg/dL compared with 2.08±0.27mg/dL in 81 patients in the non-DSW (P<0.0001).

CONCLUSIONS

Higher 30-day and 1-year all-cause mortality in AMI patients, found in the DSW regions may be attributed to reduced magnesium intake secondary to DSW consumption.

Magnesium Levels in Drinking Water and Coronary Heart Disease Mortality Risk: A Meta-Analysis

Epidemiological studies have demonstrated inconsistent associations between drinking water magnesium levels and risk of mortality from coronary heart disease (CHD); thus, a meta-analysis was performed to assess the association between them. Relevant studies were searched by the databases of Cochrane, EMBASE, PubMed and Web of Knowledge. Pooled relative risks (RR) with their 95% CI were calculated to assess this association using a random-effects model. Finally, nine articles with 10 studies involving 77,821 CHD cases were used in this study. Our results revealed an inverse association between drinking water magnesium level and CHD mortality (RR = 0.89, 95% CI = 0.79-0.99, I² = 70.6). Nine of the 10 studies came from Europe, and the association was significant between drinking water magnesium level and the risk of CHD mortality (RR = 0.83, 95% CI = 0.69-0.98). In conclusion, drinking water magnesium level was significantly inversely associated with CHD mortality.

Chemical composition of groundwater and relative mortality for cardiovascular diseases in the Slovak Republic

The study deals with the analysis of relationship between chemical composition of the groundwater/drinking water and the data on relative mortality for cardiovascular diseases (ReI) in the Slovak Republic. Primary data consist of the Slovak national database of groundwater analyses (20,339 chemical analyses, 34 chemical elements/compounds) and data on ReI collected for the 10-year period (1994-2003). The chemical and health data were unified in the same form and expressed as the mean values for each of 2883 municipalities within the Slovak Republic for further analysis. Artificial neural network was used as mathematic method for model data analysis. The most significant chemical elements having influence on ReI were identified together with their limit values (maximal acceptable, minimal necessary and optimal). Based on the results of calculations, made through the neural networks, the following ten chemical elements/parameters in the groundwater were defined as the most significant for ReI: Ca + Mg (mmol l(-1)), Ca, Mg, TDS, Cl, HCO3, SO4, NO3, SiO2 and PO4. The obtained results document the highest relationship between ReI and the groundwater contents of Ca + Mg (mmol l(-1)), Ca and Mg. Following limit values were set for the most significant groundwater chemicals/parameters: Ca + Mg 4.4-7.6 mmol l(-1), Ca > 89.4 mg l(-1) and Mg 42-78.1 mg l(-1). At these concentration ranges, the relative mortality for cardiovascular diseases in the Slovak Republic reaches the lowest levels. These limit values are about twice higher in comparison with the current Slovak valid guideline values for the drinking water.

First report on the association of drinking water hardness and endothelial function in children and adolescents

INTRODUCTION

This study aims to investigate the relationship of water hardness and its calcium and magnesium content with endothelial function in a population-based sample of healthy children and adolescents.

MATERIAL AND METHODS

This case-control study was conducted in 2012 among 90 individuals living in two areas with moderate and high water hardness in Isfahan County, Iran. The flow-mediated dilatation (FMD) of the brachial artery and the serum levels of soluble adhesion molecules (sICAM-1, sVCAM-1) were measured as surrogate markers of endothelial function, and high-sensitivity C-reactive protein (hs-CRP), as a marker of inflammation.

RESULTS

Data of 89 participants (51% boys, mean age 14.75 (2.9) years) were complete. Those participants living in the area with high water hardness had higher FMD, hs-CRP, and soluble adhesion molecules (sICAM-1, sVCAM-1) than their counterparts living in the area with moderate water hardness. Multiple linear regression analysis showed that after adjustment for confounding factors of age, gender, body mass index, healthy eating index and physical activity level, total water hardness, as well as water content of calcium and magnesium, had a significant positive relationship with FMD. The corresponding associations were inverse and significant with soluble adhesion molecules (p < 0.05).

CONCLUSIONS

This study, which to the best of our knowledge is the first of its kind in the pediatric age group, suggests that water hardness, as well as its calcium and magnesium content, may have a protective role against early stages of atherosclerosis in children and adolescents.

Does water hardness have preventive effect on cardiovascular disease?

BACKGROUND

The aim of this study is to investigate the association of calcium and magnesium concentration of drinking water with cardiovascular disease (CVDs) in urban and rural areas of a city in Iran.

METHODS

This case-control study was conducted in 2012 in Khansar County in Isfahan province, Iran. We used the official data of the Provincial health center regarding the chemical analysis data of urban and rural areas including the hardness, calcium and magnesium content of drinking water. Data of patients hospitalized for CVD in the only specialty hospital of the city was gathered for the years of 2010 and 2011.

RESULTS

In 2010, water calcium content above 72 mg/L was associated with reduced number of CVDs in 1000 population; whereas in 2011 this decrease in CVDs was observed for calcium levels of more than 75 mg/L. In 2010, the level of water Mg content ranged from 23 to 57 mg/L. By increasing Mg hardness level above 31 mg/L in 2010 and above 26 mg/L in 2011 were associated with decreased number of CVDs in 1000 people. decrease.

CONCLUSIONS

Our study suggests favorable protective effects of water hardness, mainly water magnesium content, on CVDs. Water hardness, as well as calcium and magnesium content of drinking water may have a protective role against CVDs. Further experimental studies are necessary to determine the underlying mechanisms and longitudinal studies are required to study the clinical impacts of the current findings.

The impact of a Mediterranean diet and healthy lifestyle on premature mortality in men and women

BACKGROUND

The Mediterranean diet has been associated with reduced mortality; few studies have investigated the combined impact of the Mediterranean diet with other modifiable lifestyle factors.

OBJECTIVES

The objectives were to investigate the association between adherence to the Mediterranean diet and total mortality and to estimate the overall impact of a combined healthy lifestyle on premature death.

DESIGN

In 1986 a cohort of 120,852 men and women aged 55-69 y provided information on dietary and other lifestyle habits. A mortality follow-up until 1996 was established by linkage to the Dutch Central Bureau of Genealogy. A combined lifestyle score was constructed by allocating one point per the following healthy lifestyle factors: adhering to the Mediterranean diet, nonsmoking, normal weight [BMI (in kg/m(2)): 18.5 to <25], and regular physical activity. The lifestyle score ranged from 0 to 4 points (least healthy to healthiest). The multivariate case-cohort analysis was based on 9691 deaths and 3576 subcohort members.

RESULTS

Adherence to the Mediterranean diet was significantly related to lower mortality in women but not significantly in men. The healthy lifestyle score was strongly inversely related to mortality in women and men. When the least-healthy to the healthiest lifestyle scores were compared, HRs of 4.07 (95% CI: 2.59, 6.40; P-trend <0.001) and 2.61 (95% CI: 1.79, 3.80; P-trend <0.001) were shown in women and men, respectively. For the same comparison, the mortality rate advancement period ("aging effect") was 15.1 y (95% CI: 9.9, 20.2 y) in women and 8.4 y (95% CI: 5.0, 11.8 y) in men.

CONCLUSION

This study suggests that adherence to 4 modifiable healthy lifestyle factors can substantially reduce premature mortality in women and men.