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<p>The liver is a vital organ for detoxification, and its health can be evaluated using biomarkers such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), along with indices like the AST-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4). Although hepatotoxic effects of lead (Pb) or arsenic (As) exposure have been widely studied, evidence on co-exposure or specific Asspecies is limited. This study assessed the association of individual and combined exposure to Pb and urinary As species (arsenite [As<sup>3+</sup>], arsenate [As<sup>5+</sup>], monomethylarsonic acid [MMA], dimethylarsinic acid [DMA]) with liver function and fibrosis in 199 young adults (aged 20–29 years) in Taiwan. The median blood Pb concentration was 8.14&#xa0;µg/L, while median urinary As concentrations (µg/g-creatinine) were: As<sup>3+</sup>: 1.35, As<sup>5+</sup>: 0.99, MMA: 3.76, DMA: 31.85, inorganic As: 2.74, and SumAs: 41.91. Median AST, ALT, APRI, and FIB-4 were 18 IU/L, 14 IU/L, 0.219, and 0.410, respectively. Adjusted models showed blood Pb was significantly associated with AST and FIB-4, while DMA and SumAs were positively associated with APRI. Generalized additive models indicated nonlinear associations of As<sup>3+</sup> and Pb with AST, DMA with APRI, and Pb with FIB-4. Logistic regression showed Pb alone significantly increased the risk of elevated AST, ALT, and FIB-4. Combined exposure to high Pb and high DMA or SumAs levels increased the risk of elevated AST, while high Pb exposure increased ALT risk regardless of As species levels. High Pb with DMA or MMA conferred the greatest risks for APRI ≥ 0.284 and FIB-4 ≥ 0.511. These findings suggest that even low-level Pb and As exposure, alone or combined, may contribute to impaired liver function and increased fibrosis risk in young adults.</p>

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Combined Associations of Lead and Arsenic Species with Liver Dysfunction and Hepatic Fibrosis Among Young Adults in Taiwan

  • 期刊论文

  • 发表日期：

    2026年5月26日

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  • Kai-Wei Liao,
  • Chih-Wen Wang,
  • Wei-Lun Hung,
  • Ya-Ling Chen,
  • Yee-How Say,
  • Yang-Ching Chen,
  • Wei-Shan Chin

摘要

The liver is a vital organ for detoxification, and its health can be evaluated using biomarkers such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), along with indices like the AST-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4). Although hepatotoxic effects of lead (Pb) or arsenic (As) exposure have been widely studied, evidence on co-exposure or specific Asspecies is limited. This study assessed the association of individual and combined exposure to Pb and urinary As species (arsenite [As3+], arsenate [As5+], monomethylarsonic acid [MMA], dimethylarsinic acid [DMA]) with liver function and fibrosis in 199 young adults (aged 20–29 years) in Taiwan. The median blood Pb concentration was 8.14 µg/L, while median urinary As concentrations (µg/g-creatinine) were: As3+: 1.35, As5+: 0.99, MMA: 3.76, DMA: 31.85, inorganic As: 2.74, and SumAs: 41.91. Median AST, ALT, APRI, and FIB-4 were 18 IU/L, 14 IU/L, 0.219, and 0.410, respectively. Adjusted models showed blood Pb was significantly associated with AST and FIB-4, while DMA and SumAs were positively associated with APRI. Generalized additive models indicated nonlinear associations of As3+ and Pb with AST, DMA with APRI, and Pb with FIB-4. Logistic regression showed Pb alone significantly increased the risk of elevated AST, ALT, and FIB-4. Combined exposure to high Pb and high DMA or SumAs levels increased the risk of elevated AST, while high Pb exposure increased ALT risk regardless of As species levels. High Pb with DMA or MMA conferred the greatest risks for APRI ≥ 0.284 and FIB-4 ≥ 0.511. These findings suggest that even low-level Pb and As exposure, alone or combined, may contribute to impaired liver function and increased fibrosis risk in young adults.