Phthalates exposure is associated with non-alcoholic fatty liver disease among US adults

Cai, Shengguan; Fan, Jiaqi; Ye, Jianhong; Rao, Xianming; Li, Yingjun

doi:10.1016/j.ecoenv.2021.112665

Cited by 30 publications

(20 citation statements)

References 41 publications

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“…An earlier study including 5,800 Korea adults indicated that the higher quartiles of MEHHP showed significant higher ORs of NAFLD defined by HSI ( 12 ). Recently, another cross-sectional study with 4,206 American subjects demonstrated that DEHP metabolites exposure was independently associated with NAFLD defined by HSI and results maintained when defined as US FLI ( 13 ). In accordance with the two above studies, our research showed similar positive associations of MECPP and MEHHP with NAFLD measured by VCTE.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…In addition, we also calculated HSI and US FLI. In this study, NAFLD was defined as HSI > 36 and the cut-off of US FLI to diagnose NAFLD is 30 or higher (13). The HSI and US FLI were calculated as follows: HSI = 8 * ALT (IU/L)/AST (IU/L) + body mass index (BMI, kg/m 2 ) +2 (if female) +2 (if type 2 diabetes).…”

Section: Definition Of Nafld and Liver Fibrosismentioning

confidence: 99%

“…Two epidemiological studies have analyzed the relationship between exposure to traditional phthalates and NAFLD, in which NAFLD was defined by the US fatty liver index (US FLI) or the hepatic steatosis index (HSI) based on serum markers ( 12 , 13 ). However, these serum biomarkers can be normal in patients with NAFLD and impacted by comorbid conditions, which may not be sufficiently sensitive in NAFLD definition and potentially underestimate the true population prevalence of NAFLD ( 14 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Associations of phthalates with NAFLD and liver fibrosis: A nationally representative cross-sectional study from NHANES 2017 to 2018

Chen

Tian

et al. 2022

Front. Nutr.

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ObjectiveAlthough phthalates are common environmental pollutants, few studies have focused on the relationship of phthalates exposure with non-alcoholic fatty liver disease (NAFLD) or liver fibrosis, and especially, the alternative phthalates have been questioned in recent years about whether they are better choices. Thus, this study aimed to explore the associations of exposure to major phthalates or alternative phthalates with NAFLD and liver fibrosis.MethodsData of 1450 adults from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were collected. The urinary metabolite concentrations of di-2-ethylhexyl phthalate (DEHP), diisononyl phthalate (DINP) and diisodecyl phthalate (DIDP) were detected. Controlled attenuation parameter (CAP) and median liver stiffness measurement (LSM) were acquired for quantitative diagnosis of NAFLD and liver fibrosis by vibration-controlled transient elastography. Multivariate logistic regression analysis and linear regression analysis were performed to examine the associations between phthalates and NAFLD and liver fibrosis.ResultsAfter adjustment of the potential factors, the prevalence of NAFLD was significantly elevated among those in the fourth quartile of mono-(2-ethyl-5-carboxypentyl) phthalate (OR, 95%CI = 2.719, 1.296, 5.700, P = 0.016), mono (2-ethyl-5-hydroxyhexyl) phthalate (OR, 95%CI = 2.073, 1.111, 3.867, P = 0.037). No significant association was found between the alternative phthalates and NAFLD. The similar result was gained by linear regression analysis that MECPP was still significantly associated with Ln CAP (Q4 vs. Q1: β, 95%CI = 0.067, 0.017, 0.118, P = 0.027). After adjustment for the same covariates, no significant association between phthalates and liver fibrosis was found in logistics regression analysis.ConclusionsAll in all, higher prevalence of NAFLD is correlated with DEHP but not DINP or DIDP in American adults. There is no significant relationship between phthalates and liver fibrosis defined as LSM ≥ 8 Kpa. Nevertheless, further research is needed to provide evidence of causality.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Definition Of Nafld and Liver Fibrosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Associations of phthalates with NAFLD and liver fibrosis: A nationally representative cross-sectional study from NHANES 2017 to 2018

Chen

Tian

et al. 2022

Front. Nutr.

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“…A number of diseases, including cardiovascular disease, type 2 diabetes mellitus, chronic kidney disease, and cancer, are associated with the increasing incidence of NAFLD [ 10 , 11 , 12 ]. Recent epidemiological studies have shown an association between phthalates and various types of liver damage, including NAFLD [ 13 , 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of Nonalcoholic Fatty Liver Disease Is Associated with Urinary Phthalate Metabolites Levels in Adults with Subclinical Hypothyroidism: Korean National Environmental Health Survey (KoNEHS) 2012–2014

Yang

Choi

Yang

2022

IJERPH

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Nonalcoholic fatty liver disease (NAFLD) is a condition of excess accumulation of fats in the liver. Thyroid dysfunction is commonly observed in adult populations with NAFLD. In subjects with thyroid dysfunction, phthalates, which are chemical compounds widely used to increase the flexibility of various plastic products, may increase the risk of NAFLD prevalence. Therefore, our study aimed to evaluate the relationship between the levels of urinary phthalate metabolites and the risk of NAFLD stratified by the levels of thyroid-stimulating hormone (TSH). Data (n = 2308) were obtained from the Korean National Environmental Health Survey II (2012–2014). Using the hepatic steatosis index, participants were classified into non-NAFLD (<30) and NAFLD (>36) groups. Participants with euthyroidism were defined as 0.45–4.5 mIU/L for serum TSH and normal thyroxine (T4) levels (n = 2125). Subclinical hypothyroidism (SCH) was defined as a higher TSH level (4.5–10 mIU/L) with normal total T4 levels in the serum (n = 183). A multivariate analysis was performed to assess the association of the urinary phthalate concentration with the risk of NAFLD after stratification based on the thyroid hormone levels. The levels of phthalate metabolites in urine were not significantly associated with NAFLD in adults with euthyroidism. However, a significant increased risk of NAFLD in those with SCH was observed in the fourth quartile of mono (2-ethyl-5-hydroxyhexyl) phthalate (odds ratio (OR) 13.59, 95% confidence interval (CI) 12.13–86.44), mono (2-ethyl-5-oxohexyl) phthalate (OR 8.55, 95% CI 1.20–60.53), mono-(2-ethyl-5-carboxypentyl) phthalate (OR 9.06, 95% CI 1.78–45.96), and mono-benzyl phthalate (OR 6.05, 95% CI 1.62–22.54) compared to those of the lowest quartile after being adjusted with covariates. In conclusion, the levels of phthalate metabolites in urine are positively associated with NAFLD in adults with SCH. More experimental studies are needed to clarify the risk of NAFLD caused by phthalate exposure in cases with poor thyroid function.

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Marine Microplastics: Abundance, Ecotoxic Consequences of Associated Anthropogenic Contaminants and Interactions with Microorganisms

Tarafdar

Mohamed

Kwon

2023

Energy, Environment, and Sustainability

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Phthalates exposure is associated with non-alcoholic fatty liver disease among US adults

Cited by 30 publications

References 41 publications

Associations of phthalates with NAFLD and liver fibrosis: A nationally representative cross-sectional study from NHANES 2017 to 2018

Associations of phthalates with NAFLD and liver fibrosis: A nationally representative cross-sectional study from NHANES 2017 to 2018

Risk of Nonalcoholic Fatty Liver Disease Is Associated with Urinary Phthalate Metabolites Levels in Adults with Subclinical Hypothyroidism: Korean National Environmental Health Survey (KoNEHS) 2012–2014

Marine Microplastics: Abundance, Ecotoxic Consequences of Associated Anthropogenic Contaminants and Interactions with Microorganisms

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