title: Cadmium exposure and liver disease among US adults.
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.
authors: Department of Surgery, Division of Surgical Oncology, Johns Hopkins University School of Medicine, Blalock 688 600 N. Wolfe Street, Baltimore, MD 21287, USA.
authors: Omar
authors: O
authors: Hyder
authors: Michael
authors: M
authors: Chung
authors: David
authors: D
authors: Cosgrove
authors: Joseph M
authors: JM
authors: Herman
authors: Zhiping
authors: Z
authors: Li
authors: Amin
authors: A
authors: Firoozmand
authors: Ahmet
authors: A
authors: Gurakar
authors: Ayman
authors: A
authors: Koteish
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000328:Adult; D002104:Cadmium / Q000633:toxicity*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D004781:Environmental Exposure / Q000009:adverse effects*; D005234:Fatty Liver / Q000139:chemically induced* / Q000401:mortality; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000139:chemically induced; D065626:Non-alcoholic Fatty Liver Disease; D014481:United States / Q000453:epidemiology
chemical_list: D002104:Cadmium
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