Xu Congxi, Li Zhi, Hao Shirui, Zhang Jian, Li Jinlong, Liang Kuopeng, Wang Xiaojuan, Zhang Yi, Zhao Guangyuan, Bai Mengyun, Liu Dengxiang, Wang Jitao
Hebei Provincial Key Laboratory of Cirrhosis and Portal Hypertension, Xingtai People's Hospital of Hebei Medical University, Xingtai, Hebei, China.
Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China.
Front Public Health. 2025 Apr 4;13:1573760. doi: 10.3389/fpubh.2025.1573760. eCollection 2025.
Cadmium (Cd) accumulates in the body over time, damaging organs such as the liver, kidneys, and brain. Some researchers have suggested that elevated blood Cd levels may contribute to the onset and progression of nonalcoholic fatty liver disease (NAFLD). However, only a few studies have explored the relationship between Cd exposure and long-term health outcomes in patients with NAFLD. This study aimed to evaluate the predictive value of blood cadmium levels for mortality risk in patients with NAFLD.
This study analyzed data from 13,450 patients with NAFLD in the National Health and Nutrition Examination Survey (NHANES) database, covering the years 1999 to 2018. Patients were categorized into three groups based on their blood Cd levels. The relationship between blood cadmium concentrations and all-cause, cardiovascular, and cancer mortality in NAFLD patients was assessed using Cox proportional hazards regression while accounting for potential confounders. Results were visualized using Kaplan-Meier and restricted cubic spline (RCS) curves. Stratified analyses were performed for validation of the robustness of the results.
After adjusting for all covariates, blood Cd levels were positively associated with all-cause, cardiovascular, and cancer mortality in patients with NAFLD, showing a significant linear dose-response relationship. Specifically, for each unit increase in Log-transformed blood cadmium concentration, the risk of all-cause mortality increased by 191% (HR = 2.91, 95% CI: 2.39-3.53); cardiovascular mortality risk increased by 160% (HR = 2.6, 95% CI: 1.80-3.76); and cancer mortality risk increased by 279% (HR = 3.79, 95% CI: 2.54-5.65). Stratified analysis confirmed the robustness of these findings.
Our study suggests that high Blood Cd levels adversely affect the prognosis of patients with NAFLD. Individuals with NAFLD should be aware of Cd exposure and take preventive measures. Moreover, stricter environmental protection policies may be necessary to reduce Cd exposure.
镉（Cd）会随着时间在体内蓄积，损害肝脏、肾脏和大脑等器官。一些研究人员认为，血液中镉水平升高可能会导致非酒精性脂肪性肝病（NAFLD）的发生和发展。然而，只有少数研究探讨了镉暴露与NAFLD患者长期健康结局之间的关系。本研究旨在评估血液镉水平对NAFLD患者死亡风险的预测价值。
本研究分析了1999年至2018年国家健康与营养检查调查（NHANES）数据库中13450例NAFLD患者的数据。根据患者的血液镉水平将其分为三组。在考虑潜在混杂因素的情况下，使用Cox比例风险回归评估NAFLD患者血液镉浓度与全因、心血管和癌症死亡率之间的关系。结果用Kaplan-Meier和限制立方样条（RCS）曲线进行可视化。进行分层分析以验证结果的稳健性。
在对所有协变量进行调整后，血液镉水平与NAFLD患者的全因、心血管和癌症死亡率呈正相关，呈现出显著的线性剂量反应关系。具体而言，对数转换后的血液镉浓度每增加一个单位，全因死亡风险增加191%（HR = 2.91，95% CI：2.39 - 3.53）；心血管死亡风险增加160%（HR = 2.6，95% CI：1.80 - 3.76）；癌症死亡风险增加279%（HR = 3.79，95% CI：2.54 - 5.65）。分层分析证实了这些发现的稳健性。
我们的研究表明，高血液镉水平对NAFLD患者的预后有不利影响。NAFLD患者应注意镉暴露并采取预防措施。此外，可能需要更严格的环境保护政策来减少镉暴露。
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