Close association of PFASs exposure with hepatic fibrosis than steatosis: evidences from NHANES 2017-2018

Wenli Cheng; Min Li; Luyun Zhang; Cheng Zhou; Xinyu Zhang; Chenyu Zhu; Luyi Tan; Hui Lin; Wenjuan Zhang; Wenji Zhang

doi:10.1080/07853890.2023.2216943

Close association of PFASs exposure with hepatic fibrosis than steatosis: evidences from NHANES 2017-2018

Ann Med. 2023 Dec;55(1):2216943. doi: 10.1080/07853890.2023.2216943.

Authors

Wenli Cheng^{1

2}, Min Li¹, Luyun Zhang¹, Cheng Zhou¹, Xinyu Zhang¹, Chenyu Zhu¹, Luyi Tan¹, Hui Lin³, Wenjuan Zhang¹, Wenji Zhang²

Affiliations

¹ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, P.R. China.
² Guangdong Provincial Engineering & Technology Research Center for Tobacco Breeding and Comprehensive Utilization, Key Laboratory of Crop Genetic Improvement of Guangdong Province, Crops Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, Guangdong, P. R. China.
³ Department of Radiation Oncology, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China.

Abstract

Multiple animals and in vitro studies have demonstrated that perfluoroalkyl and polyfluoroalkyl substances (PFASs) exposure causes liver damage associated with fat metabolism. However, it is lack of population evidence for the correlation between PFAS exposure and nonalcoholic fatty liver disease (NAFLD). A cross-sectional analysis was performed of 1150 participants aged over 20 from the US. Liver ultrasound transient elastography was to identify the participants with NAFLD and multiple biomarkers were the indicators for hepatic steatosis and hepatic fibrosis. Logistics regression and restricted cubic splines models were used to estimate the association between PFASs and NAFLD. PFASs had not a significant association with NAFLD after adjustment. The hepatic steatosis indicators including fatty liver index, NAFLD liver fat score, and Framingham steatosis index were almost not significantly correlated with PFASs exposure respectively. But fibrosis indicators including fibrosis-4 index (FIB-4), NAFLD fibrosis score, and Hepamet fibrosis score were positively correlated with each type of PFASs exposure. After adjustment by gender, age, race, education, and poverty income rate, there was also a significant correlation between PFOS and FIB-4 with 0.07 (0.01, 0.13). The mixed PFASs were associated with FIB-4, with PFOS contributing the most (PIP = 1.000) by the Bayesian kernel machine regression model. The results suggested PFASs exposure appeared to be more closely associated with hepatic fibrosis than steatosis, and PFOS might be the main cause of PFASs associated with hepatic fibrosis.Key messagesCurrent exposure doses of PFAS did not significantly change the risk of developing NAFLD.PFASs exposure appeared to be more closely associated with hepatic fibrosis than steatosis.PFOS might be the main cause of PFASs associated with hepatic fibrosis.

Keywords: Bayesian kernel machine regression (BKMR); Generalized linear model (GLM); Nonalcoholic fatty liver disease (NAFLD); Perfluoroalkyl and polyfluoroalkyl substances (PFASs); Restricted cubic spline (RCS).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bayes Theorem
Cross-Sectional Studies
Fibrosis
Fluorocarbons* / adverse effects
Humans
Liver Cirrhosis / diagnostic imaging
Liver Cirrhosis / epidemiology
Liver Cirrhosis / etiology
Non-alcoholic Fatty Liver Disease* / complications
Non-alcoholic Fatty Liver Disease* / diagnostic imaging
Non-alcoholic Fatty Liver Disease* / epidemiology
Nutrition Surveys

Substances

Fluorocarbons

Grants and funding

This work was funded by the Guangdong Basic and Applied Basic Research Foundation (2021A1515011220, 2023A1515010353); the Foundation of Director of Crops Research Institute, Guangdong Academy of Agricultural Sciences (202205); Special fund for scientific innovation strategy-construction of high-level Academy of Agriculture Science (R2018YJ-YB3002, R2022PY-QY004) and the National Natural Science Foundation of China (81903319).