ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1564302
This article is part of the Research TopicHuman Health Affected by Changing Ecological Environment in the Rapid UrbanizationView all 8 articles
Inflammatory and metabolic markers mediate the association between urinary metals and nonalcoholic fatty liver disease in U.S. adults: A Cross-Sectional Study
Provisionally accepted
- 1Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- 2Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai, China
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Background: Nonalcoholic fatty liver disease (NAFLD) is a global public health problem. Inflammation, oxidative stress, and insulin resistance are involved in its development and progression. Although the etiology of NAFLD remains unclear, environmental factors are increasingly recognized as non-negligible risk factors. This study evaluated urinary metals associated with NAFLD risk and the mediating roles of inflammatory and metabolic markers. Methods: Using the National Health and Nutrition Examination Survey (NHANES), we analyzed urinary metal concentrations (Ba, Cd, Co, Cs, Mo, Pb, Sb, Tl, Tu) in 3,948 U.S. adults. Multivariate logistic regression and weighted quantile sum (WQS) regression were used to assess single and mixed metal associations with NAFLD risk. Inflammatory markers (NPAR, NLR) and the fatty liver index (FLI) were evaluated as mediators. Results: Ba, Cd, Cs, Mo, Tl, and Tu were positively associated with NAFLD risk (OR 1.29–1.48, P < 0.05). Mixed exposure analysis showed consistent associations (OR 1.48, 95% CI 1.06–2.06). Metals negatively correlated with inflammatory markers but positively with metabolic markers. Mediation analysis revealed that the associations of metals with NAFLD risk were mediated by inflammatory and metabolic markers, with proportions ranging from 16.89% to 69.39% (P < 0.05). Conclusions: Urinary metal exposure may increase NAFLD risk through inflammation and metabolic dysfunction. Monitoring environmental metals and addressing these pathways could reduce NAFLD risk.
Keywords: heavy metals, Non-alcoholic fatty liver disease, Inflammatory markers, WQS regression, Mediating effect
Received: 21 Jan 2025; Accepted: 08 May 2025.
Copyright: © 2025 Li, Lv, Yang, Yang and Yin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Minyi Yin, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, Shanghai, China
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