금속의 건강영향에 관한 네트워크 분석과 우산리뷰: Part 1. 비소

Network Analysis and Umbrella Review of the Health Effects of Metals: Part 1 Arsenic

Background: Arsenic (As) is a well-known human toxicant and a Group 1 carcinogen as identified by WHO and IARC. Chronic exposure through contaminated water, food, and soil has been linked to a wide range of adverse health effects, including cardiovascular, metabolic, and neurodevelopmental disorders, as well as various cancers. However, the consistency of evidence across different exposure levels, biological samples, and populations remains unclear, highlighting the need for a comprehensive synthesis of existing data. Objectives: We aimed to provide an integrated summary of current evidence on the health effects of arsenic exposure by combining text network and centrality analyses with an umbrella review of systematic reviews and meta-analyses. Methods: Following PRISMA 2020 guidelines, systematic reviews and meta-analyses published before April 2024 were identified through PubMed and Embase. Studies assessing mercury exposure in relation to human health outcomes were included, and data were synthesized to evaluate consistency and strength of associations. Results: Fourteen systematic reviews and meta-analyses were included. Text network and centrality analyses identified seven major disease groups related to arsenic exposure: perinatal, maternal, genetic, cancer, cardiovascular, toxicological, and metabolic. Among these, metabolic disorders were most frequently studied, followed by cancers and cardiovascular diseases. Extending these observations, the umbrella review revealed that arsenic exposure is associated with various adverse outcomes affecting metabolic, circulatory, and renal functions. The results suggested that arsenic exposure may increase the risks of hypertension, gestational diabetes (GDM), and chronic kidney disease (CKD), though findings were not always consistent across studies. Some research indicated that specific forms of arsenic, rather than total arsenic levels, may play a key role in determining toxicity. Overall, long-term exposure may influence health, but the magnitude of associations varied by exposure source, concentration, and population. Conclusions: This umbrella review highlights that arsenic exposure remains a significant public health concern due to its potential effects on multiple organ systems, particularly increasing the risks of hypertension, gestational diabetes, and chronic kidney disease. Continued efforts are needed to monitor exposure levels, assess differences between arsenic species, and strengthen evidence-based risk assessments to guide prevention and policy.