Abstract
Background: Exposure to lead (Pb), cadmium (Cd), and mercury (Hg) has been reported to be associated with liver-related diseases. However, studies examining the association between heavy metal exposure and liver injury in a large population are scant and characterized by inconsistent results. This study aimed to evaluate the association between levels of heavy metal exposure and liver injury in the general population. Methods: Data for 2953 participants aged 19 years or more obtained from the Korean National Environmental Health Survey (KoNEHS) Cycle 3 (2015–2017) were used. The associations between levels of blood or urine heavy metals (Pb, Cd, and Hg) and liver function biomarkers [aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT)] were evaluated using multiple linear regression analysis. Results: Regarding the blood Pb (BPb), AST was higher in those of the 4th quartile, ALT was higher in those of the 2nd and 4th quartiles, and GGT was higher in those of the 3rd and 4th quartiles than in the 1st quartile. For urinary Cd (UCd), AST was higher in those of the 4th quartile; ALT was higher in those of the 2nd, 3rd, and 4th quartiles; and GGT was higher in the 4th quartile than in the 1st quartile. For the blood Hg (BHg), AST was higher in those of the 2nd and 4th quartile, ALT was higher in those of the 2nd, 3rd, and 4th quartiles; and GGT was higher in those of the 3rd and 4th quartiles than in the 1st quartile. There was no significant difference between urinary Hg (UHg) and liver function markers. Conclusion: Heavy metal exposure showed an association with liver injury among the general adult population in Korea. Further studies are required to clarify the relationship between heavy metals and liver injury.
Highlights
Heavy metals are emitted into the environment from both natural and industrial activities [1]
Pb and Hg concentrations were significantly higher in men, while Cd concentrations were higher in women, and the heavy metal concentrations increased with age
The blood Pb (BPb) and blood Hg (BHg) concentrations show highest values of 1.88 and 3.05, respectively, in the 60–69and 50–59-years age groups, while the urinary Cd (UCd) concentrations were highest at 0.59
Summary
Heavy metals are emitted into the environment from both natural and industrial activities [1]. Lead (Pb) is released from exhaust gas, paints, and industrial wastes [1,2]; cadmium (Cd) is released from batteries, pigments, coatings, and plating substances [3]; and mercury (Hg) is released from thermometers, bulbs, dental fillers, pharmaceutical products, and pesticides [4]. Ingestion, inhalation, and dermal absorption are the main routes of heavy metal exposure to humans [5]. Heavy metals have the properties of accumulating in selected tissues of the human body and the potential to be toxic even at low levels of exposure [6]. Heavy metal exposure was associated with nonalcoholic fatty liver (NAFLD), nonalcoholic steatohepatitis (NASH), and hepatic fibrosis [7,8]. Liver cells are exposed to chemicals, which can lead to liver dysfunction, cell damage, and organ failure [13,14,15,16]
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