Aim

The potential effects of heavy metals on non-alcoholic fatty liver disease (NAFLD) remain unknown. We investigated the sex-specific relationships of blood lead (BPb), mercury (BHg), and cadmium (BCd) levels with hepatic steatosis (HS) and fibrosis (HF).

Method

We included 4420 participants from the 2016–2017 Korea National Health and Nutrition Examination Survey. High-risk alcoholics and patients with chronic hepatitis B or C infections or liver cirrhosis were excluded. We calculated the hepatic steatosis index (HSI) and fibrosis-4 index (FIB-4) values; we defined the presence of HS and HF as an HSI ≥ 36 and FIB-4 score >2.67, respectively. We adjusted for age, smoking and alcohol consumption statuses, hypertension, obesity, diabetes, hypertriglyceridemia, and BPb, BHg, and BCd levels.

Result

In males (n = 1860), the HSI was correlated negatively with the BPb level and positively with the BHg level (both p < 0.01). The FIB-4 score was correlated positively with the BPb and BCd levels (both p < 0.01). In females (n = 2560), the HSI and FIB-4 score were correlated positively with the BPb, BHg, and BCd levels (all p < 0.01). After adjustments, the BHg level increased the risk of HS in both males (OR = 1.065, p = 0.003) and females (OR = 1.061, p = 0.048), and the BCd level increased the risk of HF in females (OR = 1.668, p = 0.012).

Conclusion

Blood heavy metal levels were generally correlated positively with the HSI and FIB4 score, more so in females than males. The BHg level was associated with HS in males and females, and the BCd level was associated with HF in females. Further studies on NAFLD progression according to heavy metal status and sex are warranted.

中文翻译：

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血铅、汞和镉水平对肝脂肪变性和纤维化的性别特异性影响：韩国全国横断面研究。

目的

重金属对非酒精性脂肪性肝病 (NAFLD) 的潜在影响仍然未知。我们研究了血铅 (BPb)、汞 (BHg) 和镉 (BCd) 水平与肝脂肪变性 (HS) 和纤维化 (HF) 的性别特异性关系。

方法

我们纳入了 2016-2017 年韩国国家健康和营养检查调查的 4420 名参与者。高危酗酒者和慢性乙型或丙型肝炎感染或肝硬化患者被排除在外。我们计算了肝脂肪变性指数 (HSI) 和纤维化 4 指数 (FIB-4) 值；我们将 HS 和 HF 的存在定义为 HSI ≥ 36 和 FIB-4 得分 >2.67。我们调整了年龄、吸烟和饮酒状况、高血压、肥胖、糖尿病、高甘油三酯血症以及 BPb、BHg 和 BCd 水平。

结果

在男性 (n = 1860) 中，HSI 与 BPb 水平呈负相关，与 BHg 水平呈正相关（均 p < 0.01）。FIB-4 评分与 BPb 和 BCd 水平呈正相关（均 p < 0.01）。在女性（n = 2560）中，HSI 和 FIB-4 评分与 BPb、BHg 和 BCd 水平呈正相关（所有 p < 0.01）。调整后，BHg 水平增加了男性 (OR = 1.065, p = 0.003) 和女性 (OR = 1.061, p = 0.048) 的 HS 风险，BCd 水平增加了女性 (OR = 1.668) HF 的风险, p = 0.012)。

结论

血液重金属水平通常与 HSI 和 FIB4 评分呈正相关，女性的相关性高于男性。BHg 水平与男性和女性的 HS 相关，BCd 水平与女性的 HF 相关。根据重金属状态和性别对 NAFLD 进展进行进一步研究是有必要的。