ArticleEnvironmental health perspectives2017
Arsenic and Obesity: A Comparison of Urine Dilution Adjustment Methods.
Article in Environmental health perspectives, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers.
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Who cites it
34 citing papers in PubMed, 83 citations in OpenAlex.
- Article
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- The hidden danger: prolonged exposure to inorganic contaminants and kidney health in adolescents.Renal failure · 2025Article
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- Association of serum albumin to creatinine ratio with mortality in patients with aortic disease: a cohort study.Scientific reports · 2025Article
- Novel evidence of arsenic-related excess adiposity and its implication in the risk of cardiometabolic diseases.Environmental research · 2025Article
- Metal mixtures and adiposity indicators in women from Northern Mexico.Biometals : an international journal on the role of metal ions in biology, biochemistry, and medicine · 2025Article
- Variable power functional dilution adjustment of spot urine.Scientific reports · 2025Article
- The role of age and sex in non-linear dilution adjustment of spot urine arsenic.BMC nephrology · 2024Article
- Metabolic Derangement by Arsenic: a Review of the Mechanisms.Biological trace element research · 2024Review
- Review
- Urinary concentrations of polycyclic aromatic hydrocarbon metabolites and childhood obesity.Heliyon · 2023Article
- Association between Heavy Metals, Metalloids and Metabolic Syndrome: New Insights and Approaches.Toxics · 2023Review
- Association of obesity, diabetes, and hypertension with arsenic in drinking water in the Comarca Lagunera province (north-central Mexico).Scientific reports · 2023Article
- Article
- Elevated serum albumin-to-creatinine ratio as a protective factor on outcomes after heart transplantation.Frontiers in cardiovascular medicine · 2023Article
- Associations of Phthalate Metabolites and Bisphenol A Levels with Obesity in Children: The Korean National Environmental Health Survey (KoNEHS) 2015 to 2017.Endocrinology and metabolism (Seoul, Korea) · 2022Article
- Is Arsenic Exposure a Risk Factor for Metabolic Syndrome? A Review of the Potential Mechanisms.Frontiers in endocrinology · 2022Review
- Novel Strategies for Assessing Associations Between Selenium Biomarkers and Cardiometabolic Risk Factors: Concentration, Visit-to-Visit Variability, or Individual Mean? Evidence From a Repeated-Measures Study of Older Adults With High Selenium.Frontiers in nutrition · 2022Article
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
introductionA commonly used approach to adjust for urine dilution in analyses of biomarkers is to adjust for urinary creatinine. However, creatinine is a product of muscle mass and is therefore associated with body mass. In studies of urinary analytes and obesity or obesity-related outcomes, controlling for creatinine could induce collider stratification bias. We illustrate this phenomenon with an analysis of urinary arsenic.
objectiveWe aimed to evaluate various approaches of adjustment for urinary dilution on the associations between urinary arsenic concentration and measures of obesity.
methodsUsing data from the National Health and Nutrition Examination Survey, we regressed body mass index (BMI) and waist-to-height ratios on urinary arsenic concentrations. We compared eight approaches to account for urine dilution, including standardization by urinary creatinine, osmolality, and flow rates, and inclusion of these metrics as independent covariates. We also used a recently proposed method known as covariate-adjusted standardization.
resultsInverse associations between urinary arsenic concentration with BMI and waist-to-height ratio were observed when either creatinine or osmolality were used to standardize or as covariates. Not adjusting for dilution, standardizing or adjusting for urinary flow rate, and using covariate-adjusted standardization resulted in null associations observed between arsenic concentration in relation to BMI and waist-to-height ratio.
conclusionsOur findings suggest that arsenic exposure is not associated with obesity, and that urinary creatinine and osmolality may be colliders on the causal pathway from arsenic exposure to obesity, as common descendants of hydration and body composition. In studies of urinary biomarkers and obesity or obesity-related outcomes, alternative metrics such as urinary flow rate or analytic strategies such as covariate-adjusted standardization should be considered. https://doi.org/10.1289/EHP1202.
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