Annals of Occupational and Environmental Medicine

Original Article

Association between serum perfluoroalkyl substances concentrations and non-alcoholic fatty liver disease among Korean adults: a cross-sectional study using the National Environmental Health Survey cycle 4: Yong Tae Park, Eui Yup Chung, Chang Ho Chae, Young Hoon Lee; Ann Occup Environ Med 2024;36:e10. Published online April 8, 2024; DOI: https://doi.org/10.35371/aoem.2024.36.e10

Abstract Abstract in Korean PDF PubReader ePub

Background

Perfluoroalkyl substances (PFAS) are widely used in industry and daily life due to their useful properties. They have a long half-life, accumulate in the body, and there is evidence that they are associated with biomarkers of lipid metabolism and liver damage. This may suggest non-alcoholic fatty liver disease (NAFLD) caused by PFAS. However, since there has been no study analyzing the relationship between PFAS and NAFLD in the entire population in Korea. We sought to confirm the relationship between serum PFAS concentration and NAFLD prevalence in Korean adults using the Korean National Environmental Health Survey (KoNEHS) cycle 4.

Methods

The study was conducted on 2,529 subjects in 2018–2019 among KoNEHS participants. For the diagnosis of NAFLD, the hepatic steatosis index (HSI) was used, and the geometric mean and concentration distribution of serum PFAS were presented. Logistic regression was performed to confirm the increase in the risk of NAFLD due to changes in PFAS concentration, and the odds ratio and 95% confidence interval (CI) were calculated.

Results

In both adjusted and unadjusted models, an increased odds ratio was observed with increasing serum concentrations of total PFAS and perfluorooctane sulfonate (PFOS) in the non-obese group. In the adjusted model, the odds ratios for serum total PFAS and PFOS were 6.401 (95% CI: 1.883–21.758) and 7.018 (95% CI: 2.688–18.319).

Conclusions

In this study, a higher risk of NAFLD based on HSI was associated with serum total PFAS, PFOS in non-obese group. Further research based on radiological or histological evidence for NAFLD diagnosis and long-term prospective studies are necessary. Accordingly, it is necessary to find ways to reduce exposure to PFAS in industry and daily life.

대한민국 성인의 혈청 과불화화합물 농도와 비알코올성 지방간 질환의 연관성 : 제4기 국민환경보건 기초조사를 이용한 단면연구
목적
과불화 화합물(이하 PFAS)는 그 유용한 특성들로 인하여 산업 및 일상생활에 널리 사용되는 물질이다. 이들은 긴 반감기를 지녀 생체 내에 축적되며, 지질 대사 및 간 손상의 바이오마커들과 연관이 있다는 여러 증거들이 있다. 이는 PFAS와 비알코올성 지방간(이하 NAFLD)의 연관성을 시사할 수 있다. 그러나 국내 전체 인구를 대상으로 PFAS와 NAFLD간의 연관성을 분석한 연구는 없었기에 제4주기 국민환경보건 기초조사를 이용하여 대한민국 성인에서 혈청 PFAS의 농도와 NAFLD 유병률 간의 연관성을 확인하고자 하였다.
방법
제4주기 국민환경보건 기초조사 참여자 중 2018-2019년 대상자 2595명을 대상으로 연구를 진행하였다. NAFLD의 진단을 위해 Hepatic Steatosis Index(이하 HSI)를 사용하였으며, 혈청 PFAS의 기하평균 및 농도 분포를 제시하였다. PFAS의 농도 변화에 따른 NAFLD의 위험도 증가를 확인하기 위하여 로지스틱 회귀분석을 시행하였으며 이에 대한 교차비와 95% 신뢰구간을 산출하였다.
결과
조정되지 않은 모델 및 조정된 모델의 비만하지 않은 그룹에서 혈청 총 PFAS, PFOS의 농도 증가에 따른 교차비의 증가를 확인할 수 있었다. 조정된 모델에서 혈청 총 PFAS 및 PFOS의 교차비는 각각 6.401 (95% CI 1.883–21.758) and 7.018 (95% CI 2.688-18.319)으로 나타났다.
결론
본 연구에서 HSI에 기초한 NAFLD의 더 높은 위험은 비만하지 않은 군에서 혈청 총 PFAS 및 PFOS와 유의한 연관성을 보였다. PFAS에 의한 NAFLD 발생의 위험에 대한 영상 또는 조직 병리에 기반한 추가 연구가 필요하며, 일상 생활 및 산업 전반에 있어 PFAS에의 노출을 줄이기 위한 방법의 모색이 필요하다.

Citations

Citations to this article as recorded by

Diabetes and male fertility disorders
Andrea Graziani, Raffaele Scafa, Giuseppe Grande, Alberto Ferlin
Molecular Aspects of Medicine.2024; 99: 101303. CrossRef

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Original Article

A study on the relationship between Alcohol Use Disorders Identification Test and liver function test in blue-collar workers: Jin Guhn Sohn, Hae Rhan Song, Kwang Young Lee, Jin Ha Kim, Ho Chan Kim; Korean Journal of Occupational and Environmental Medicine 2003;15(3):281-289. Published online September 30, 2003; DOI: https://doi.org/10.35371/kjoem.2003.15.3.281

Abstract PDF

OBJECTIVES
The purpose of this study was to investigate the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the relationship between AUDIT score and liver function test.
METHODS
AUDIT questionnaires were distributed to 440 blue-collar workers. We compared liver function test with firstly, normal and hazardous drinking as defined by WHO, and secondly, with normal, hazardous and harmful drinking as measured by Kim et al.(1999). We also compared influencing factors on abnormal liver function.
RESULTS
By simple analysis in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 2.81) based on the guideline of WHO. By chi-square test for linear trend in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 1.23) and harmful drinking (odds ratio 2.14) based on the guideline of Kim et al.By multiple logistic regression analysis, abnormal liver function was significantly affected by AUDIT questionnaires No. 1-3 (odds ratio- high risk 2.39), age (odds ratio- thirties 1.95, forties 2.40, fifties 3.85), BMI (odds ratio- overweight 1.66, obesity 4.53), guideline by WHO (odds ratio- hazardous drinking 2.10), and guideline by Kim et al (odds ratio- harmful drinking 2.20) CONCLUSIONS: We found that the problem of alcohol drinking as measured by AUDIT was significantly associated with abnormal liver function. Therefore we suggest that AUDIT will be useful for the predictive test of abnormal liver function and screening test of hazardous and harmful drinking.

Citations

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Effects of nutrition education on nutrition-related knowledge, dietary habits, and nutrient intakes of alcoholic patients
An Na Kim, Hyeon-Sook Lim
Journal of Nutrition and Health.2014; 47(4): 277. CrossRef
Nutrient Intake Status of Korean Drinkers: Analysis of Data from Korea National Health and Nutrition Examination Survey (KNHANES), 2011
Hyung-Tae Kim, Sung-Soo Chun, Sun-Hee Joung, Mi-Eun Yun
Journal of the Korean Dietetic Association.2013; 19(4): 343. CrossRef
Psychometric Properties of the Alcohol Use Disorders Identification Test: A Korean Version
Sun S. Kim, Elsie E. Gulick, Kyoung A. Nam, Seong-Ho Kim
Archives of Psychiatric Nursing.2008; 22(4): 190. CrossRef

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Original Article

A Study on Liver Function Indices in Male Lead Workers: Young Hwangbo, Yong Bae Kim, Gap Soo Lee, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee; Korean Journal of Occupational and Environmental Medicine 2002;14(3):270-279. Published online September 30, 2002; DOI: https://doi.org/10.35371/kjoem.2002.14.3.270

Abstract PDF

OBJECTIVES
To evaluate the effects of lead on the liver function indices in male lead workers.
METHODS
The study comprised of 274 lead workers and 113 non-lead workers who were confirmed not to have HBsAg (Hepatitis B surface Antigen). Blood lead (PbB), blood zinc protoporphyrin (ZPP) and urinary delta-aminolevulinic acid (ALAU) were selected as parameters for monitoring exposure to lead while aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT) and gamma-glutamyltransferase (gamma-GTP) were chosen as parameters for monitoring liver function. Demographic information, such as age, smoking and drinking histories were collected. The duration of work for the lead workers, and their BMI(body mass index), were also obtained.
RESULTS
After adjusting for possible confounders {age, BMI, work duration, smoking (pack-year) and drinking (bottles of Soju consumed per week)}, blood lead was observed to be a significant variable from the logistic regression analysis of the abnormalities of SGOT( >35 IU/L), with an odds ratio of 1.04 (95 % CI, 1.008-1.066). The amount of alcohol drunk (odds ratio 1.28: 95 % CI, 1.054-1.549) and BMI (odds ratio 1.24: 95 % CI, 1.075-1.421) were also significant variables. From the multiple linear regression analyses, blood lead was significantly, and positively, associated with SGOT (p<0.05).
CONCLUSIONS
These findings suggest that exposure to lead may have an effect on SGOT in male lead workers.

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Effect of Pork Consumption on Renal and Hematochemical Indices in Workers Occupationally Exposed to Unclean Environments
Chan-Kyu Han, Jeong-Hae Rho, Bog-Hieu Lee
Korean Journal for Food Science of Animal Resources.2008; 28(1): 91. CrossRef

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Original Article

The Association of Exposure to Organic Solvents with Liver Function: Chi Young Ann, Kyung Jong Lee, Jae Bum Park, Jae Yeon Jang, Moon Jong Kim; Korean Journal of Occupational and Environmental Medicine 2001;13(1):64-74. Published online March 31, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.1.64

Abstract PDF

OBJECTIVES
This study was conducted to evaluate the association of cumulative exposure to organic solvent with liver function.
METHODS
We conducted a cross sectional study. 461 male workers who perform painting job at a shipyard and use organic solvents routinely and 125 workers of the same shipyard who never have been exposed to organic solvents were studied. All subjects who were confirmed not having HBsAg surveyed their age, BMI(body mass index), alcohol drinking and smoking history, and examined liver function test (SGOT, SGPT, gamma-GTP, Total protein, albumin, total bilirubin, direct bilirubin). The amount of cumulative exposure (CE) to mixed organic solvents were measured by biological monitoring method using their metabolites in urine.
RESULTS
The CE was observed as a significant variable with logistic regression analysis on abnormality of SGOT(>35IU/L), SGPT(>40IU/L) and gamma-GTP(>63IU/L), their odds ratio were 1.10 (95 %CI, 1.02-1.20), 1.10 (95 %CI, 1.01-1.19), and 1.10 (95 %CI, 1.01-1.19) each.
CONCLUSIONS
Therefore we suggest that the cumulative exposure to mixed organic solvents might be a significant variable on abnormal liver function indices (SGOT, SGPT,gamma-GTP) in male shipyard workers

Citations

Citations to this article as recorded by

Liver function alterations among workers in the shoe industry due to combined low-level exposure to organic solvents
Nina Umicevic, Jelena Kotur-Stevuljevic, Vesna Paleksic, Danijela Djukic-Cosic, Evica Antonijevic Miljakovic, Aleksandra Buha Djordjevic, Marijana Curcic, Zorica Bulat, Biljana Antonijevic
Drug and Chemical Toxicology.2022; 45(4): 1907. CrossRef
Estimating Benzene Exposure Level over Time and by Industry Type through a Review of Literature on Korea
Donguk Park, Sangjun Choi, Kwonchul Ha, Hyejung Jung, Chungsik Yoon, Dong-Hee Koh, Seunghun Ryu, Soogeun Kim, Dongmug Kang, Kyemook Yoo
Safety and Health at Work.2015; 6(3): 174. CrossRef
The effect of exposure to a mixture of organic solvents on liver enzymes in an auto manufacturing plant
Saber Mohammadi, Amirhoushang Mehrparvar, Yasser Labbafinejad, Mir Saeed Attarchi
Journal of Public Health.2010; 18(6): 553. CrossRef

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Original Article

Incidence of Abnormal Liver Function and Risk Factors in Male Employees: Young Ae Ha, Kyeong Dong Chung, Byung Yeol Chun; Korean Journal of Occupational and Environmental Medicine 2000;12(1):59-69. Published online March 31, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.1.59

Abstract PDF: OBJECTIVES
This study was conducted to estimate the incidence of abnormal liver function and risk factors in male employees of an industry in Ulsan City.
METHODS
Five hundreds and seventy nine male employees were selected as the study cohort and 533(92.1%) of them were followed after one year. The blood sample was collected to test for AST, ALT, gamma-GTP, total-cholesterol, fasting blood sugar and a self-administered questionnaire on life style was done. General characteristics(age, marital status, educational level), job department, exposure status for organic solvents, life style(alcohol, smoking, exercise, diet), past history of liver disease, family history of liver disease, drug intake, HBsAg, blood glucose, total-cholesterol were considered as risk factors. The result of liver function test after 1 year follow-up was treated as dependent variable. The operational definition of abnormal liver function was as follows; those who had abnormal liver functions in the two repeated tests with one month interval.
RESULTS
The annual incidence of abnormal liver function was 9.6 per 100 and age-standardized incidence was 9.5. BMI, alcohol, past history of liver disease, and meat intake were significantly related to the incidence(p<0.05). In multiple logistic regression analysis, BMI(RR=2.70, 95% CI=1.41-5.16) and alcohol(RR=1.98, 95% CI=1.08-3.60) were proved as the significant variables. By stratified analysis considering changing pattern of alcohol and BMI, the relative risk of the BMI normal-normal and alcohol intake high-high group was 2.24(95% CI=1.09-4.62) and that of the BMI obese-obese and alcohol intake high-high group was 5.66(95% CI=2.69-11.88) compared with that of BMI normal-normal and alcohol intake low-low group.
CONCLUSIONS
The age-standardized annual incidence of abnormal liver function was 9.5 per 100 in male employees. Thus, an active effort for reducing alcohol intake and controlling BMI should be done to reduce the incidence.

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