Journal of Gastrointestinal Surgery

, Volume 17, Issue 7, pp 1265–1273

Cadmium Exposure and Liver Disease among US Adults

  • Omar Hyder
  • Michael Chung
  • David Cosgrove
  • Joseph M. Herman
  • Zhiping Li
  • Amin Firoozmand
  • Ahmet Gurakar
  • Ayman Koteish
  • Timothy M. Pawlik
Original Article

DOI: 10.1007/s11605-013-2210-9

Cite this article as:
Hyder, O., Chung, M., Cosgrove, D. et al. J Gastrointest Surg (2013) 17: 1265. doi:10.1007/s11605-013-2210-9

Abstract

Background

Effects of chronic cadmium exposure on liver disease and liver-related mortality are unknown. We evaluated the association of creatinine-corrected urinary cadmium levels with hepatic necroinflammation, non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), liver-related mortality, and liver cancer mortality in the US general population.

Methods

We analyzed the relationship of individuals in the top quartile for urinary cadmium measured in 12,732 adults who participated in the Third National Health and Nutrition Examination Survey in 1988–1994 (NHANES III), and hepatic necroinflammation, NAFLD, and NASH. Associations between cadmium, liver-related mortality, and liver cancer mortality were evaluated in the NHANES III mortality follow-up study.

Results

The cutoffs for highest quartile of urinary cadmium per gram of urinary creatinine were 0.65 and 0.83 μg/g for men and women, respectively (P < 0.001). After multivariate adjustment for other factors including smoking, the odds ratios [95 % confidence intervals (CI)] for hepatic necroinflammation, NAFLD, and NASH associated with being in the top quartile of cadmium levels by gender, were 2.21 (95 % CI, 1.64–3.00), 1.30 (95 % CI, 1.01–1.68) and 1.95 (95 % CI, 1.11–3.41) for men and 1.26 (95 % CI, 1.01–1.57), 1.11 (95 % CI, 0.88–1.41) and 1.34 (95 % CI, 0.72–2.50) for women, respectively. The hazard ratios for liver-related mortality and liver cancer mortality for both genders were 3.42 (95 % CI, 1.12–10.47) and 1.25 (95 % CI, 0.37–4.27).

Conclusions

Environmental cadmium exposure was associated with hepatic necroinflammation, NAFLD, and NASH in men, and hepatic necroinflammation in women. Individuals in the top quartile of creatinine-corrected urinary cadmium had over a threefold increased risk of liver disease mortality but not in liver cancer related mortality.

Keywords

Liver Cadmium Steatosis Survey Mortality NHANES 

Abbreviations

NAFLD

Non-alcoholic fatty liver disease

NASH

Non-alcoholic steatohepatitis

NHANES

National Health and Nutrition Examination Survey

CI

Confidence intervals

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

BMI

Body mass index

GGT

γ-Glutamyltranspeptidase

OR

Odds ratio

HR

Hazard ratio

MT

Metallothionein

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Omar Hyder
    • 1
  • Michael Chung
    • 1
  • David Cosgrove
    • 2
  • Joseph M. Herman
    • 3
  • Zhiping Li
    • 4
  • Amin Firoozmand
    • 1
  • Ahmet Gurakar
    • 4
  • Ayman Koteish
    • 4
  • Timothy M. Pawlik
    • 1
  1. 1.Department of Surgery, Division of Surgical OncologyJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Medical OncologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of Radiation OncologyJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of Medicine, Division of HepatologyJohns Hopkins University School of MedicineBaltimoreUSA

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