Low level arsenic exposure, B-vitamins, and achievement among Uruguayan school children

Objectives: Millions of children globally, including the U.S., are exposed to low levels of arsenic from water and food. Arsenic is a known neurotoxicant at high levels but its effects at lower exposure levels are understudied. Arsenic methylation capacity, influenced by B-vitamin intake and status, potentially influences arsenic toxicity. In a cross-secitonal study of 5–8 year-old children from Montevideo, we assessed the relationship between urinary arsenic (U–As) and academic achievement, and tested for effect modification by B-vitamin intake, status, and arsenic methylation capacity. Methods: Broad math and reading scores were calculated based on six subtests (calculation, math facts fluency, applied problems, sentence reading fluency, letter word identification, passage comprehension) from the Woodcock-Muñoz Achievement Battery. B-vitamin intake was assessed from two non-consecutive 24-h dietary recalls, serum folate and vitamin B-12 levels were measured in a subset of participants. Arsenic methylation capacity was measured as the proportion of urinary monomethylarsonic acid (%MMA). Multiple imputation using chained equations was conducted to account for missing covariate and exposure data. Ordinal regressions assessed associations between U–As and achievement score tertiles in the complete case and imputed samples. A “B-vitamin index” was calculated using principal component analysis. Interactions by urinary %MMA and the B-vitamin index were assessed. Results: Median specific gravity adjusted U–As was 11.7 μg/L (range: 2.6, 50.1). We found no association between U–As and broad math and reading scores, nor effect modification by %MMA or B-vitamins. Conclusion: At low-levels of exposure, U–As does not appear to affect children's academic achievement.