Dong Rui, Tian Ting, Ming Chen, Zhang Ru, Xue Hong, Luo Zhenghan, Shen Chao, Ni Yunlong, Shao Jianguo, Wang Jie
Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Jiangsu, 211166, China.
Institute of Nutrition and Food Safety, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
BMC Public Health. 2025 Feb 20;25(1):709. doi: 10.1186/s12889-025-21930-1.
Environmental factors, or exposome, are non-negligible contributors to the occurrence and progression of metabolic dysfunction-associated fatty liver disease (MAFLD). Therefore, this environment-wide association study (EWAS) aimed to investigate the associations between multifarious environmental factors and MAFLD among the general adult population in the United States.
Eligible participants were obtained from the National Health and Nutrition Examination Survey 2005-2020 cycles. Survey-weighted multivariate logistic regression models were constructed to identify and tentatively validate MAFLD-associated environmental factors. The least absolute shrinkage and selection operator (LASSO) regression was conducted to identify tentatively validated environmental factors with stronger associations with MAFLD. Moreover, the importance, discrimination power, correlation patterns, subgroup-specific differences, and survey cycle heterogeneity of the identified factors were further examined by multiple statistical strategies.
A total of 14,416 participants were included in this EWAS. Among 511 candidate environmental factors, 167 were identified and tentatively validated, and 45 were preserved after the LASSO selection and correlation evaluation. In this study, most previously known factors were replicated with reduced bias, and several poorly studied environmental factors were discovered, for example, upper leg length, access to care, mid-upper arm circumference, and total trabecular bone score. Their importance, discrimination ability, pairwise correlations, subgroup variations, and heterogeneity across survey cycles were further systematically and rigorously evaluated.
This EWAS comprehensively explored the associations between environmental factors and MAFLD in the general adult population from a panoramic perspective. The findings may provide clues for further understanding this disease and promote early prevention and risk prediction strategies in the future.
环境因素，即暴露组，是代谢功能障碍相关脂肪性肝病（MAFLD）发生和进展的不可忽视的促成因素。因此，这项全环境关联研究（EWAS）旨在调查美国普通成年人群中多种环境因素与MAFLD之间的关联。
符合条件的参与者来自2005 - 2020年周期的国家健康和营养检查调查。构建了调查加权多变量逻辑回归模型，以识别并初步验证与MAFLD相关的环境因素。进行了最小绝对收缩和选择算子（LASSO）回归，以确定与MAFLD关联更强的初步验证环境因素。此外，通过多种统计策略进一步检查了所确定因素的重要性、判别能力、相关模式、亚组特异性差异和调查周期异质性。
这项EWAS共纳入了14416名参与者。在511个候选环境因素中，167个被识别并初步验证，45个在LASSO选择和相关性评估后保留下来。在本研究中，大多数先前已知的因素得到了重复验证且偏差减小，还发现了一些研究较少的环境因素，例如大腿长度、医疗服务可及性、上臂中部周长和总小梁骨评分。对它们的重要性、判别能力、成对相关性、亚组差异以及不同调查周期的异质性进行了进一步系统而严格的评估。
这项EWAS从全景角度全面探索了普通成年人群中环境因素与MAFLD之间的关联。这些发现可能为进一步了解这种疾病提供线索，并促进未来的早期预防和风险预测策略。
