Insecticide and metal exposures are associated with a surrogate biomarker for non-alcoholic fatty liver disease in the National Health and Nutrition Examination Survey 2003–2004

• Published in: Environmental science and pollution research international 2020-02, Vol.27 (6), p.6476-6487
• Main Authors: Wahlang, Banrida, Appana, Savitri, Falkner, K. Cameron, McClain, Craig J., Brock, Guy, Cave, Matthew C.
• Format: Article
• Language: English
• Subjects: Adult; Alanine; Alanine Transaminase; Aquatic Pollution; Atmospheric Protection/Air Quality Control/Air Pollution; Biomarkers; Biomarkers - metabolism; Blood levels; Chlordane; Cross-Sectional Studies; Dieldrin; Earth and Environmental Science; Ecotoxicology; Environment; Environmental Chemistry; Environmental Exposure - statistics & numerical data; Environmental Health; Environmental Pollutants - metabolism; Environmental Pollutants - toxicity; Environmental science; Exposure; Fatty liver; Female; Health risk assessment; Heavy metals; Hemochromatosis; Hepatitis; Heptachlor; Heptachlor epoxide; Humans; Insecticides; Insecticides - metabolism; Insecticides - toxicity; Levels; Lipids; Liver; Liver diseases; Male; Mercury; Mercury (metal); Metabolites; Metals - metabolism; Metals - toxicity; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic Fatty Liver Disease - metabolism; Nutrition; Nutrition Surveys; Observational studies; Organic chemistry; Organic compounds; Organochlorine pesticides; Polls & surveys; Pollutants; Quartiles; Research Article; Serum levels; United States - epidemiology; Waste Water Technology; Water Management; Water Pollution Control
• ISSN: 0944-1344; 1614-7499
• DOI: 10.1007/s11356-019-07066-x

Non-alcoholic fatty liver disease (NAFLD), the most common form of liver disease, affects over 30% of the US population. Our group and others have previously demonstrated that low-level environmental pollutant exposures were associated with increased odds ratios for unexplained alanine aminotransferase (ALT) elevation, a surrogate biomarker for NAFLD, in the adult National Health and Nutrition Examination Survey (NHANES). However, recently, more sensitive and lower ALT cutoffs have been proposed. The objective of this observational study is to utilize these ALT cutoffs to determine new associations between environmental chemicals and the surrogate NAFLD biomarker. Adult NHANES 2003–2004 participants without viral hepatitis, hemochromatosis, or alcoholic liver disease were analyzed in this cross-sectional study. ALT elevation was defined as > 30 IU/L in men and > 19 IU/L in women. Odds ratios adjusted for potential confounders for ALT elevation were determined across exposure quartiles for 17 pollutant subclasses comprised of 111 individual pollutants. The overall prevalence of ALT elevation was 37.6%. Heavy metal and organochlorine insecticide subclasses were associated with dose-dependent increased adjusted odds ratios for ALT elevation of 1.6 (95% CI 1.2–2.3) and 3.5 (95% CI 2.3–5.5) respectively, for the highest vs. lowest exposure quartiles ( p trend