The association between NAFLD and advanced liver fibrosis with urinary heavy metal based on the NHANES 2013-2018

Abstract

Background Chronic liver disease poses an escalating health challenge on a global scale. It has been suggested that prolonged exposure to heavy metals could potentially contribute to the development of non-alcoholic fatty liver disease (NAFLD). Our study aimed to assess the correlation between urinary levels of specific heavy metals, including Ba, Cd, Co, Cs, Hg, Mo, Pb, Sb, Sn, Ti, and Ur, and the occurrence of NAFLD and advanced liver fibrosis within the general population of the United States. Methods In our study, we conducted a thorough analysis using data from the NHANES spanning from 2013 to 2018. To examine the correlation between urinary heavy metal concentration and the prevalence of NAFLD and advanced liver fibrosis, we employed a multivariable analysis that accounted for various factors such as sociodemographic characteristics, lifestyle factors, hypertension, and T2DM. This allowed us to control for potential confounding variables and obtain reliable findings regarding the association between urinary heavy metal concentration and the occurrence of NAFLD and advanced liver fibrosis. Results We employed multiple logistic regression models to examine the data, and the results revealed noteworthy findings. Higher levels of urinary Ba, Cd, Co, Pb, Sb, Sn, Tu, and Ur exhibited a significant positive association with NAFLD. Additionally, as the concentration of Cd, Pb, Sb, and Sn increased in urine, the likelihood of advanced liver fibrosis also significantly increased. These findings underscore the significant positive associations between the levels of specific heavy metals in urine and both NAFLD and advanced liver fibrosis. Conclusion The findings of this study suggest a significant association between elevated urinary Ba, Cd, Co, Pb, Sb, Sn, Tu, Ur concentration and NAFLD while a significant correlation was also found between higher urinary levels of Cd, Pb, Sb, Sn and advanced liver fibrosis.