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Arsenic exposure and risk of nonalcoholic fatty liver disease (NAFLD) among U.S. adolescents and adults: an association modified by race/ethnicity, NHANES 2005-2014.
Environ Health. 2018 01 15; 17(1):6.EH

Abstract

BACKGROUND

While associated with obesity, the cause of the rapid rise in prevalence of nonalcoholic fatty liver disease (NAFLD) in children, which is highest among Hispanics, is not well understood. Animal experiments have demonstrated that arsenic exposure contributes to liver injury. Our objective was to examine the association between arsenic exposure and NAFLD in humans and to determine if race/ethnicity modifies the association.

METHODS

Urinary inorganic arsenic concentrations among those ≥12 years in the National Health and Nutrition Examination Survey, 2005-2014 were used to assess the cross-sectional association with serum alanine aminotransferase (ALT) levels, a marker of liver dysfunction. We excluded high alcohol consumers (>4-5 drinks/day; n = 939), positive hepatitis B or C (n = 2330), those missing body mass index (n = 100) and pregnant women (n = 629) for a final sample of 8518. Arsenic was measured using liquid chromatography coupled with mass spectrometry and ALT was measured using standard methods. Sampling weights were used to obtain national estimates. Due to lack of normality, estimates were log transformed and are presented as geometric means. Logistic regression models controlling for age, sex, income, and weight category estimate adjusted odd ratios (aOR) of elevated ALT by quartile of arsenic and tested for effect modification by race/ethnicity and weight. Elevated ALT was defined as >25 IU/L and >22 IU/L for boys and girls ≤17 years, respectively and >30 IU/L and >19 IU/L for men and women, respectively.

RESULTS

Among all, aOR of elevated ALT were higher among those in the highest vs. lowest arsenic quartile (referent), 1.4 (95% confidence interval [CI]: 1.1, 1.7) with a borderline significant interaction (p = 0.07) by race/ethnicity but not weight (p = 0.4). In analysis stratified by race/ethnicity, aOR of elevated ALT among those in the 4th quartile were higher among Mexican Americans, 2.0 (CI: 1.3, 3.1) and non-Hispanic whites only, aOR 1.4 (CI: 1.1, 1.8) despite the fact that obesity prevalence was highest among non-Hispanic blacks.

CONCLUSIONS

Our findings demonstrate a positive association between urinary arsenic exposure and risk of NAFLD among U.S. adolescents and adults that is highest among Mexican Americans and among those obese, regardless of race/ethnicity.

Authors+Show Affiliations

Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. jean.a.welsh@emory.edu. Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA, USA. jean.a.welsh@emory.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

29334960

Citation

Frediani, Jennifer K., et al. "Arsenic Exposure and Risk of Nonalcoholic Fatty Liver Disease (NAFLD) Among U.S. Adolescents and Adults: an Association Modified By Race/ethnicity, NHANES 2005-2014." Environmental Health : a Global Access Science Source, vol. 17, no. 1, 2018, p. 6.
Frediani JK, Naioti EA, Vos MB, et al. Arsenic exposure and risk of nonalcoholic fatty liver disease (NAFLD) among U.S. adolescents and adults: an association modified by race/ethnicity, NHANES 2005-2014. Environ Health. 2018;17(1):6.
Frediani, J. K., Naioti, E. A., Vos, M. B., Figueroa, J., Marsit, C. J., & Welsh, J. A. (2018). Arsenic exposure and risk of nonalcoholic fatty liver disease (NAFLD) among U.S. adolescents and adults: an association modified by race/ethnicity, NHANES 2005-2014. Environmental Health : a Global Access Science Source, 17(1), 6. https://doi.org/10.1186/s12940-017-0350-1
Frediani JK, et al. Arsenic Exposure and Risk of Nonalcoholic Fatty Liver Disease (NAFLD) Among U.S. Adolescents and Adults: an Association Modified By Race/ethnicity, NHANES 2005-2014. Environ Health. 2018 01 15;17(1):6. PubMed PMID: 29334960.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arsenic exposure and risk of nonalcoholic fatty liver disease (NAFLD) among U.S. adolescents and adults: an association modified by race/ethnicity, NHANES 2005-2014. AU - Frediani,Jennifer K, AU - Naioti,Eric A, AU - Vos,Miriam B, AU - Figueroa,Janet, AU - Marsit,Carmen J, AU - Welsh,Jean A, Y1 - 2018/01/15/ PY - 2017/07/05/received PY - 2017/12/28/accepted PY - 2018/1/17/entrez PY - 2018/1/18/pubmed PY - 2018/12/18/medline KW - Alanine aminotransferase KW - Arsenic KW - Hispanic KW - NHANES KW - Nonalcoholic fatty liver disease (NAFLD) KW - Obesity SP - 6 EP - 6 JF - Environmental health : a global access science source JO - Environ Health VL - 17 IS - 1 N2 - BACKGROUND: While associated with obesity, the cause of the rapid rise in prevalence of nonalcoholic fatty liver disease (NAFLD) in children, which is highest among Hispanics, is not well understood. Animal experiments have demonstrated that arsenic exposure contributes to liver injury. Our objective was to examine the association between arsenic exposure and NAFLD in humans and to determine if race/ethnicity modifies the association. METHODS: Urinary inorganic arsenic concentrations among those ≥12 years in the National Health and Nutrition Examination Survey, 2005-2014 were used to assess the cross-sectional association with serum alanine aminotransferase (ALT) levels, a marker of liver dysfunction. We excluded high alcohol consumers (>4-5 drinks/day; n = 939), positive hepatitis B or C (n = 2330), those missing body mass index (n = 100) and pregnant women (n = 629) for a final sample of 8518. Arsenic was measured using liquid chromatography coupled with mass spectrometry and ALT was measured using standard methods. Sampling weights were used to obtain national estimates. Due to lack of normality, estimates were log transformed and are presented as geometric means. Logistic regression models controlling for age, sex, income, and weight category estimate adjusted odd ratios (aOR) of elevated ALT by quartile of arsenic and tested for effect modification by race/ethnicity and weight. Elevated ALT was defined as >25 IU/L and >22 IU/L for boys and girls ≤17 years, respectively and >30 IU/L and >19 IU/L for men and women, respectively. RESULTS: Among all, aOR of elevated ALT were higher among those in the highest vs. lowest arsenic quartile (referent), 1.4 (95% confidence interval [CI]: 1.1, 1.7) with a borderline significant interaction (p = 0.07) by race/ethnicity but not weight (p = 0.4). In analysis stratified by race/ethnicity, aOR of elevated ALT among those in the 4th quartile were higher among Mexican Americans, 2.0 (CI: 1.3, 3.1) and non-Hispanic whites only, aOR 1.4 (CI: 1.1, 1.8) despite the fact that obesity prevalence was highest among non-Hispanic blacks. CONCLUSIONS: Our findings demonstrate a positive association between urinary arsenic exposure and risk of NAFLD among U.S. adolescents and adults that is highest among Mexican Americans and among those obese, regardless of race/ethnicity. SN - 1476-069X UR - https://www.unboundmedicine.com/medline/citation/29334960/Arsenic_exposure_and_risk_of_nonalcoholic_fatty_liver_disease__NAFLD__among_U_S__adolescents_and_adults:_an_association_modified_by_race/ethnicity_NHANES_2005_2014_ L2 - https://ehjournal.biomedcentral.com/articles/10.1186/s12940-017-0350-1 DB - PRIME DP - Unbound Medicine ER -