Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, 19122, USA.
BMC Public Health. 2024 Aug 29;24(1):2354. doi: 10.1186/s12889-024-19761-7.
Both ambient air pollution and lifestyle factors contribute to the incidence of non-alcoholic fatty liver disease (NAFLD), but previous studies usually focused on single-factor associations. We aimed to assess the joint associations of ambient air pollution and lifestyle with the NAFLD risk and investigate whether lifestyle modifies the association of air pollution with NAFLD risk.
A total of 417,025 participants from the UK Biobank were included in this study. Annual average concentrations of NO, NO, PM, PM, and PM were estimated. A composite lifestyle score was determined based on physical activity, alcohol intake, smoking status, dietary patterns, sedentary time, and sleep duration. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), as well as the population attributable fraction (PAF). Potential additive interactions of air pollution with lifestyle were also examined by the relative excess risk due to the interaction (RERI) and the attributable proportion due to the interaction (AP).
4752 (1.14%) incident NAFLD events were recorded. Long-term exposure to air pollutants and an unhealthy lifestyle were significantly associated with the increased risk of incident NAFLD. Lifestyle was the primary factor of incident NAFLD, with a PAF of 37.18% (95% CI: 29.67%, 44.69%). In addition, a significant additive interaction between air pollution and lifestyle for NAFLD risk was observed (RERI: 0.36, 95% CI: 0.09-0.63).
Long-term exposure to ambient air pollutants and poor lifestyle were jointly associated with a higher risk of NAFLD.
环境空气污染和生活方式因素均会导致非酒精性脂肪性肝病（NAFLD）的发生，但既往研究通常关注单因素相关性。本研究旨在评估环境空气污染和生活方式与 NAFLD 风险的联合相关性，并探讨生活方式是否会改变空气污染与 NAFLD 风险的相关性。
本研究共纳入来自英国生物库的 417025 名参与者。评估了 NO、NO、PM、PM 和 PM 的年均浓度。根据体力活动、饮酒量、吸烟状况、饮食模式、久坐时间和睡眠时间确定综合生活方式评分。采用 Cox 比例风险回归模型估计风险比（HR）及其 95%置信区间（CI）和人群归因分数（PAF）。还通过交互超额相对危险度（RERI）和交互归因比例（AP）来评估空气污染与生活方式之间潜在的附加交互作用。
共记录了 4752 例（1.14%）新发 NAFLD 事件。长期暴露于空气污染物和不健康的生活方式与新发 NAFLD 风险增加显著相关。生活方式是新发 NAFLD 的主要因素，人群归因分数为 37.18%（95%CI：29.67%，44.69%）。此外，还观察到空气污染与生活方式对 NAFLD 风险的显著附加交互作用（RERI：0.36，95%CI：0.09-0.63）。
长期暴露于环境空气污染物和不良生活方式与 NAFLD 风险增加相关，且二者之间具有显著的附加交互作用。
