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

Xingying Chen; Feng Tian; Jianfeng Wu; Lan Liu; Ye Li; Genfeng Yu; Hualin Duan; Yuqi Jiang; Siyang Liu; Yajun He; Yaosheng Luo; Cheng Song; Huaizhi Li; Yongqian Liang; Heng Wan; Jie Shen

doi:10.3389/fnut.2022.1059675

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

Front Nutr. 2022 Nov 22:9:1059675. doi: 10.3389/fnut.2022.1059675. eCollection 2022.

Authors

Xingying Chen¹, Feng Tian², Jianfeng Wu³, Lan Liu¹, Ye Li¹, Genfeng Yu¹, Hualin Duan¹, Yuqi Jiang¹, Siyang Liu¹, Yajun He¹, Yaosheng Luo¹, Cheng Song¹, Huaizhi Li⁴, Yongqian Liang¹, Heng Wan¹, Jie Shen¹

Affiliations

¹ Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China.
² Health Management Division, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China.
³ Nantong Haimen People's Hospital, Haimen Hospital of Nantong University, Nantong, China.
⁴ Shenzhen University General Hospital, Shenzhen University, Shenzhen, Guangdong, China.

Abstract

Objective: Although 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.

Methods: Data 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.

Results: After 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.

Conclusions: All 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.

Keywords: NAFLD; NHANES (National Health and Nutrition Examination Survey); liver fibrosis; phthalates; vibration-controlled transient elastography.