He Xingyi, Zhang Shipeng, Bai Qinglin, Pan Moshen, Jiang Yanjie, Liu Weiwei, Li Wei, Gong Yuanyuan, Li Xueping
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, PR China.
School of Economics, Shanghai University of Finance and Economics, Shanghai 200433, PR China.
Ecotoxicol Environ Saf. 2025 Jan 1;289:117469. doi: 10.1016/j.ecoenv.2024.117469. Epub 2024 Dec 9.
A systematic review and meta-analysis were used to investigate the relationship between air pollution exposure and the prevalence of non-alcoholic fatty liver disease (NAFLD) and its related cirrhosis. Through this study, we hope to clarify the potential public health risks of air pollution as an environmental exposure factor.
Through a comprehensive and systematic search of the EMBASE, PubMed, Web of Science, and Cochrane library databases, studies published up to March 30, 2024, that met the eligibility criteria were identified. The meta-analysis aimed to determine the association between air pollution exposure and NAFLD risk. Subgroup analyses were conducted based on regional economic development after adjusting for confounding factors. The combined odds ratio (OR) was calculated, publication bias was assessed using funnel plots, and consideration was given to heterogeneity among study-specific relative risks.
This review included 14 observational studies (including 7 cohort studies and 7 cross-sectional studies) involving 43,475,41 participants. The pooled analysis showed that PM, NO, PM, PM, passive smoking, PM, and air pollution from solid fuels were positively associated with the incidence and prevalence of NAFLD and its related cirrhosis. The risk ratios for PM, NO, PM, PM, passive smoking, and air pollution from solid fuels for NAFLD and its related cirrhosis were 1.33 (95 % CI: 1.25, 1.42), 1.19 (95 % CI: 1.14, 1.23), 1.27 (95 % CI: 1.05, 1.55), 1.05 (95 % CI: 1.00, 1.11), 1.53 (95 % CI: 1.12, 2.09), 1.50 (95 % CI: 0.86, 2.63), and 1.18 (95 % CI: 0.85, 1.63), respectively. In contrast, the risk ratio for O was 0.75 (95 % CI: 0.69, 0.83), suggesting that O may lower the incidence and prevalence of NAFLD and its related cirrhosis. We also conducted subgroup analyses based on the level of national development to examine the impact of PM on NAFLD and its related cirrhosis. The results showed that the risk of NAFLD and its related cirrhosis associated with PM in developing countries was 1.41 (95 % CI: 1.29, 1.53), which was higher than 1.20 (95 % CI: 1.12, 1.29) in developed countries.
The study findings show that PM, NO, PM, PM, passive smoking, PM, and air pollution from solid fuels can increase an individual's risk of developing NAFLD and its related cirrhosis; while O can reduce the risk. In developing countries, the risk level of NAFLD and its related cirrhosis due to PM is higher than that in developed countries.
采用系统评价和荟萃分析来研究空气污染暴露与非酒精性脂肪性肝病（NAFLD）及其相关肝硬化患病率之间的关系。通过本研究，我们希望阐明空气污染作为一种环境暴露因素的潜在公共卫生风险。
通过全面系统地检索EMBASE、PubMed、Web of Science和Cochrane图书馆数据库，确定截至2024年3月30日发表的符合纳入标准的研究。荟萃分析旨在确定空气污染暴露与NAFLD风险之间的关联。在调整混杂因素后，根据区域经济发展情况进行亚组分析。计算合并比值比（OR），使用漏斗图评估发表偏倚，并考虑各研究特异性相对风险之间的异质性。
本综述纳入了14项观察性研究（包括7项队列研究和7项横断面研究），涉及4347541名参与者。汇总分析表明，颗粒物（PM）、氮氧化物（NO）、PM、PM、被动吸烟、PM以及固体燃料产生的空气污染与NAFLD及其相关肝硬化的发病率和患病率呈正相关。PM、NO、PM、PM、被动吸烟以及固体燃料产生的空气污染导致NAFLD及其相关肝硬化的风险比分别为1.33（95%CI：1.25，1.42）、1.19（95%CI：1.14，1.23）、1.27（95%CI：1.05，1.55）、1.05（95%CI：1.00，1.11）、1.53（95%CI：1.12，2.09）、1.50（95%CI：0.86，2.63）和1.18（95%CI：0.85，1.63）。相比之下，臭氧（O）的风险比为0.75（95%CI：0.69，0.83），表明臭氧可能降低NAFLD及其相关肝硬化的发病率和患病率。我们还根据国家发展水平进行了亚组分析，以研究PM对NAFLD及其相关肝硬化的影响。结果显示，发展中国家与PM相关的NAFLD及其相关肝硬化风险为1.41（95%CI：1.29，1.53），高于发达国家的1.20（95%CI：1.12，1.29）。
研究结果表明，PM、NO、PM、PM、被动吸烟、PM以及固体燃料产生的空气污染会增加个体患NAFLD及其相关肝硬化的风险；而臭氧可降低该风险。在发展中国家，PM导致的NAFLD及其相关肝硬化的风险水平高于发达国家。
