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Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults

BACKGROUND & AIMS: Per- and polyfluoroalkyl substances (PFAS) are widespread pollutants with demonstrated hepatotoxicity. Few studies have examined the association between PFAS and fatty liver disease (FLD) risk in an adult population. METHODS: In this cross-sectional study of participants from...

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Autores principales: Zhang, Xinyuan, Zhao, Longgang, Ducatman, Alan, Deng, Chuanjie, von Stackelberg, Katherine Ellen, Danford, Christopher J., Zhang, Xuehong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10033989/
https://www.ncbi.nlm.nih.gov/pubmed/36968216
http://dx.doi.org/10.1016/j.jhepr.2023.100694
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author Zhang, Xinyuan
Zhao, Longgang
Ducatman, Alan
Deng, Chuanjie
von Stackelberg, Katherine Ellen
Danford, Christopher J.
Zhang, Xuehong
author_facet Zhang, Xinyuan
Zhao, Longgang
Ducatman, Alan
Deng, Chuanjie
von Stackelberg, Katherine Ellen
Danford, Christopher J.
Zhang, Xuehong
author_sort Zhang, Xinyuan
collection PubMed
description BACKGROUND & AIMS: Per- and polyfluoroalkyl substances (PFAS) are widespread pollutants with demonstrated hepatotoxicity. Few studies have examined the association between PFAS and fatty liver disease (FLD) risk in an adult population. METHODS: In this cross-sectional study of participants from the 2017–2018 National Health and Nutrition Examination Survey, serum PFAS were measured, and FLD cases were ascertained by vibration-controlled transient elastography. Logistic regression models were used to examine the association between circulating PFAS levels and FLD risk. Analyses were stratified into non-alcoholic FLD and alcoholic FLD risk groups by alcohol intake status, as well as controlling for other risk factors, including personal demographics, lifestyle factors, and related health factors. RESULTS: Among 1,135 eligible participants, 446 had FLD. For FLD risk, the multivariable-adjusted odds ratio per log-transformed SD increase (OR(SD)) in perfluorohexane sulfonate (PFHxS) was 1.13 (95% CI 1.01–1.26). The association between PFHxS and FLD appeared stronger among individuals with obesity or high-fat diets (both pinteraction <0.05). When limiting the analysis to 212 heavy drinkers (≥2 drinks/day for women and ≥3 drinks/day for men), significantly higher risk of alcoholic FLD was found for higher levels of perfluorooctanoic acid (OR(SD) 1.79; 95% CI 1.07–2.99), PFHxS (OR(SD) 2.06; 95% CI 1.17–3.65), and perfluoroheptane sulfonic acid (OR(SD) 1.44; 95% CI 1.00–2.07), and marginally significant higher risk for total PFAS (OR(SD) 2.12; 95% CI 0.99–4.54). In never or light drinkers, we did not observe any significant association between PFAS and non-alcoholic FLD. Significant positive associations were found for PFAS with aspartate aminotransferase, gamma-glutamyl transaminase, total bilirubin, and albumin (β ranged from 0.008 to 0.101, all p <0.05). CONCLUSIONS: Higher serum PFAS was moderately associated with FLD risk and worse liver function in the general population, and among those with independent risk factors, including heavy alcohol intake, obesity, or high-fat diets, PFAS increased the risk. These results suggest synergistic effects on hepatic steatosis between PFAS exposures as measured through biomonitoring data and lifestyle risk factors in a nationally representative US population. IMPACT AND IMPLICATIONS: The per- and polyfluoroalkyl substances (PFAS) may convey higher risk for chronic liver disease in humans. Among 1,135 US adults in the 2017–2018 National Health and Nutrition Examination Survey, we found that higher serum PFAS was associated with higher fatty liver disease risk and worse liver function, especially among those with liver disease risk factors, including heavy alcohol intake, obesity, or high-fat diets. Continuously monitoring PFAS in the population and examining how they potentiate risk to the liver are essential.
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spelling pubmed-100339892023-03-24 Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults Zhang, Xinyuan Zhao, Longgang Ducatman, Alan Deng, Chuanjie von Stackelberg, Katherine Ellen Danford, Christopher J. Zhang, Xuehong JHEP Rep Research Article BACKGROUND & AIMS: Per- and polyfluoroalkyl substances (PFAS) are widespread pollutants with demonstrated hepatotoxicity. Few studies have examined the association between PFAS and fatty liver disease (FLD) risk in an adult population. METHODS: In this cross-sectional study of participants from the 2017–2018 National Health and Nutrition Examination Survey, serum PFAS were measured, and FLD cases were ascertained by vibration-controlled transient elastography. Logistic regression models were used to examine the association between circulating PFAS levels and FLD risk. Analyses were stratified into non-alcoholic FLD and alcoholic FLD risk groups by alcohol intake status, as well as controlling for other risk factors, including personal demographics, lifestyle factors, and related health factors. RESULTS: Among 1,135 eligible participants, 446 had FLD. For FLD risk, the multivariable-adjusted odds ratio per log-transformed SD increase (OR(SD)) in perfluorohexane sulfonate (PFHxS) was 1.13 (95% CI 1.01–1.26). The association between PFHxS and FLD appeared stronger among individuals with obesity or high-fat diets (both pinteraction <0.05). When limiting the analysis to 212 heavy drinkers (≥2 drinks/day for women and ≥3 drinks/day for men), significantly higher risk of alcoholic FLD was found for higher levels of perfluorooctanoic acid (OR(SD) 1.79; 95% CI 1.07–2.99), PFHxS (OR(SD) 2.06; 95% CI 1.17–3.65), and perfluoroheptane sulfonic acid (OR(SD) 1.44; 95% CI 1.00–2.07), and marginally significant higher risk for total PFAS (OR(SD) 2.12; 95% CI 0.99–4.54). In never or light drinkers, we did not observe any significant association between PFAS and non-alcoholic FLD. Significant positive associations were found for PFAS with aspartate aminotransferase, gamma-glutamyl transaminase, total bilirubin, and albumin (β ranged from 0.008 to 0.101, all p <0.05). CONCLUSIONS: Higher serum PFAS was moderately associated with FLD risk and worse liver function in the general population, and among those with independent risk factors, including heavy alcohol intake, obesity, or high-fat diets, PFAS increased the risk. These results suggest synergistic effects on hepatic steatosis between PFAS exposures as measured through biomonitoring data and lifestyle risk factors in a nationally representative US population. IMPACT AND IMPLICATIONS: The per- and polyfluoroalkyl substances (PFAS) may convey higher risk for chronic liver disease in humans. Among 1,135 US adults in the 2017–2018 National Health and Nutrition Examination Survey, we found that higher serum PFAS was associated with higher fatty liver disease risk and worse liver function, especially among those with liver disease risk factors, including heavy alcohol intake, obesity, or high-fat diets. Continuously monitoring PFAS in the population and examining how they potentiate risk to the liver are essential. Elsevier 2023-02-03 /pmc/articles/PMC10033989/ /pubmed/36968216 http://dx.doi.org/10.1016/j.jhepr.2023.100694 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Article
Zhang, Xinyuan
Zhao, Longgang
Ducatman, Alan
Deng, Chuanjie
von Stackelberg, Katherine Ellen
Danford, Christopher J.
Zhang, Xuehong
Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults
title Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults
title_full Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults
title_fullStr Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults
title_full_unstemmed Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults
title_short Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults
title_sort association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in us adults
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10033989/
https://www.ncbi.nlm.nih.gov/pubmed/36968216
http://dx.doi.org/10.1016/j.jhepr.2023.100694
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