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Cadmium Exposure and Liver Disease among US Adults

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

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.

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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

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, Johns Hopkins University School of Medicine, Blalock 688 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Omar Hyder, Michael Chung, Amin Firoozmand & Timothy M. Pawlik

  2. Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David Cosgrove

  3. Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Joseph M. Herman

  4. Department of Medicine, Division of Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Zhiping Li, Ahmet Gurakar & Ayman Koteish

Authors
  1. Omar Hyder
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  2. Michael Chung
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  3. David Cosgrove
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  4. Joseph M. Herman
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  5. Zhiping Li
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  6. Amin Firoozmand
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  7. Ahmet Gurakar
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  8. Ayman Koteish
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  9. Timothy M. Pawlik
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Correspondence to Timothy M. Pawlik.

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Hyder, O., Chung, M., Cosgrove, D. et al. Cadmium Exposure and Liver Disease among US Adults. J Gastrointest Surg 17, 1265–1273 (2013). https://doi.org/10.1007/s11605-013-2210-9

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  • DOI: https://doi.org/10.1007/s11605-013-2210-9

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