Environmental Science and Pollution Research

, Volume 26, Issue 30, pp 31384–31391 | Cite as

Associations between mercury exposure and the risk of nonalcoholic fatty liver disease (NAFLD) in US adolescents

  • Runsen Chen
  • Yang Xu
  • Cheng Xu
  • Yaqin Shu
  • Siyu Ma
  • Changgui Lu
  • Xuming MoEmail author
Research Article


Little is known regarding the effects of environmental mercury (Hg) exposure on liver dysfunction in adolescents. We aimed to explore the association between Hg exposure and the risk of nonalcoholic fatty liver disease (NAFLD) in the adolescent population. The cross-sectional associations between blood Hg concentrations and serum alanine aminotransferase (ALT) levels, a surrogate for suspected NAFLD, were evaluated using data from adolescents (aged 12–17 years old) who participated in the National Health and Nutrition Examination Survey (NHANES), 1999–2014. A final sample of 6389 adolescents was analysed. Elevated ALT was defined as > 25 IU/L and > 22 IU/L for boys and girls ≤ 17 years old, respectively. Odds ratios (ORs) of Hg levels in association with serum ALT levels were estimated using a logistic regression after adjusting for gender, age, ethnicity, serum cotinine, body mass index, the poverty income ratio, and NHANES cycles. The median blood Hg level was 0.73 ± 0.91 μg/L amongst US adolescents. In the adjusted model, the ORs of elevated ALT levels of those in the 4th quartile were higher amongst non-Hispanic white adolescents (OR = 1.76, 95% CI 1.20, 2.59; P = 0.035) and those who were normal or underweight (OR = 1.41, 95% CI 1.08, 1.85; P = 0.020). No association was observed for the other variables. Our results indicate that the positive association between blood Hg exposure and the risk of NAFLD in US adolescents is the highest amongst non-Hispanic white and those who are normal or underweight, regardless of ethnicity. More research is necessary to confirm this association and to clarify the potential mechanisms.


NHANES Mercury Adolescent Nonalcoholic fatty liver disease (NAFLD) Alanine aminotransferase 


Author contribution

Runsen Chen and Yang Xu wrote the main manuscript text, Yaqin Shu and Siyu Ma prepared Tables 1, 2, and 3, and Changgui Lu prepared Fig. 1. Cheng Xu and Xuming Mo were responsible for the accuracy of all content in the proof. All authors reviewed the manuscript.

Funding information

This work was supported by funding from the National Key Research and Development Program of China (2017YFC1308105; 2016YFC1101001); Key Project supported by Medical Science and Technology Development Foundation, Nanjing Department of Health (201723006).

Compliance with ethical standards

Ethics approval and consent to participate

The consent form was signed by participants in the survey, and participants consented to storing specimens of their blood for future research. The CDC/NCHS Ethics Review Board (ERB) approved the NHANES study and gave approval for public dissemination.

Consent for publication

Non applicable. There is no individual level data in our publication.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Runsen Chen
    • 1
  • Yang Xu
    • 1
  • Cheng Xu
    • 1
  • Yaqin Shu
    • 1
  • Siyu Ma
    • 1
  • Changgui Lu
    • 2
  • Xuming Mo
    • 1
    Email author
  1. 1.Department of Cardiothoracic SurgeryChildren’s Hospital of Nanjing Medical UniversityNanjingChina
  2. 2.Department of Pediatric SurgeryChildren’s Hospital of Nanjing Medical UniversityNanjingChina

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