Associations of non-essential metals and their mixture with non-alcoholic fatty liver disease in Chinese older adults

非必需金属及其混合物与我国老年人非酒精性脂肪性肝病的相关性

Authors：Xue Shi, Ziwei Tian, Yuan Wang, Xuqiu Cheng, Yuantao Zhang, Xianwei Guo, Yan Zhang, Bing Hu, Changliu Liang, Jun Wang, Fangbiao Tao, Linsheng Yang

Source：Environmental Geochemistry And Health

DOI:10.1007/s10653-025-02539-0

Abstract

Background:Research investigating the impact of the non-essential metal (NEM) mixture on non-alcoholic fatty liver disease (NAFLD) among the elderly is presently insufficient. This study investigated the relationships between individual NEMs, their mixtures, and NAFLD in elderly individuals residing in Chinese communities.

Methods:The analysis included 2741 participants drawn from the baseline survey of a longitudinal study. Urinary concentrations of aluminum (Al), gallium (Ga), arsenic (As), cesium (Cs), barium (Ba), thallium (Tl), uranium (U), and cadmium (Cd) were quantified using inductively coupled plasma mass spectrometry (ICP-MS). NAFLD diagnosis was determined using abdominal ultrasound imaging. Logistic regression and restricted cubic spline (RCS) models were utilized to evaluate the relationships between individual NEMs and NAFLD. Additionally, Bayesian kernel machine regression (BKMR) and quantile-based computation regression (QGC) models were employed to assess the impact of the NEM mixture on NAFLD.

Results:After adjusting for covariates, Tl was significantly associated with an increased likelihood of NAFLD (OR 1.26, 95% CI 1.10-1.44). Both RCS and BKMR models confirmed a linear relationship between urine Tl and the risk of NAFLD. Additionally, both BKMR and QGC models highlighted a significant connection between the NEMs mixture and NAFLD, identifying Tl as the primary driver. Significant interactions were observed between Tl and Ba, as well as between Tl and hypertension (P_interaction=0.055) and Tl and central obesity (P_interaction=0.008), collectively demonstrating synergistic impacts on NAFLD risk.

Conclusions:The NEM mixture is associated with a higher risk of NAFLD in Chinese old adults, with Tl as the primary contributor. Additional investigation is required to validate these findings and shed light on underlying biological pathways through which co-exposure to NEMs contribute to NAFLD.

Keywords:BKMR; Non-alcoholic fatty liver disease; Non-essential metal; QGC

摘要

背景：目前关于非必需金属（NEM）混合物对老年人非酒精性脂肪肝病（NAFLD）影响的研究尚不充分。本研究旨在探讨中国社区中老年人个体非必需金属、其混合物与NAFLD之间的关联。

方法：分析纳入了纵向研究基线调查中的2741名参与者。采用电感耦合等离子体质谱法（ICP-MS）测定尿液中铝（Al）、镓（Ga）、砷（As）、铯（Cs）、钡（Ba）、铊（Tl）、铀（U）和镉（Cd）的浓度。非酒精性脂肪性肝病（NAFLD）的诊断基于腹部超声影像。采用逻辑回归和限制性立方样条（RCS）模型评估单一NEM与NAFLD之间的关联。此外，还运用贝叶斯核机器回归（BKMR）和分位数基计算回归（QGC）模型评估NEM混合物对NAFLD的影响。

结果：调整协变量后，Tl与NAFLD发生风险显著相关（OR 1.26，95% CI 1.10-1.44）。RCS和BKMR模型均证实尿液Tl与NAFLD风险之间存在线性关系。此外，BKMR和QGC模型均显示NEM混合物与NAFLD存在显著关联，并识别铊为主要驱动因素。铊与钡之间、铊与高血压（P_interaction=0.055）以及铊与中心性肥胖（P_interaction=0.008）之间均观察到显著交互作用，共同表明其对NAFLD风险具有协同影响。

结论：NEM混合物与中国老年人群中NAFLD风险升高相关，其中Tl是主要贡献因素。需进一步研究验证这些发现，并揭示NEMs共同暴露通过哪些潜在生物学途径促进NAFLD发生。

关键词：BKMR；非酒精性脂肪性肝病；非必需金属；QGC