Study On The Relationship Between Mixed Metal Exposure And The Risk Of Non-alcoholic Fatty Liver In Coal Miners

Objective:Non-alcoholic fatty liver disease(NAFLD)has become a common disease in China with the development of modern industry in the past two decades.The influencing factors of NAFLD include heredity,life style,living environment and so on.China is rich in coal resources and widely distributed,and workers in the mining industry have become the key exposure objects of metals and other environmental pollutants.It has been found that exposure to metal pollutants increases the risk of NAFLD.Therefore,this study hopes to analyze the metal elements most related to the risk of NAFLD by investigating the level of metals in the urine and the prevalence of NAFLD in the workers of a large coal mining group in Shanxi,so as to provide a scientific basis for coal miners and people living in mining areas to formulate prevention and control strategies for NAFLD.Methods:The target objects are randomly selected from the target group by two-stage cluster random sampling,and the research objects are determined by screening and eliminating those who are missing information.The subjects were investigated by questionnaire,physical examination and general data collection,and urine was collected to determine the level of metal in the urine of workers.Descriptive analysis,Logistic regression analysis,restricted cubic spline,weighted quantile sum and Bayesian kernel machine regression were used to analyze the relationship between mixed metal exposure and the risk of NAFLD.Results:1.NAFLD distribution: a total of 1803 subjects,including 451 NAFLD patients and1352 non-NAFLD patients,the crude prevalence rate was 33.4%.2.Analysis of factors related to NAFLD: Chi-square test showed that there were significant differences in prevalence among groups based on sex,age,job position,working years,current tea drinking,daily energy intake,BMI,hypertension and metabolic syndrome.Through LASSO regression analysis,14 factors most related to the prevalence of NAFLD were found,which were As,Ba,Cd,Cu,Mo,Si,Tl,sex,education level,type of work,working hours,daily energy intake,BMI and metabolic syndrome.3.Correlation analysis between urinary metal and NAFLD: polymetallic Logistic regression model was used to analyze the relationship between urinary metal and the risk of NAFLD.The results showed that Ba,Cd,Cu,Mo,Si and Tl had significant effects on the risk of NAFLD.The trend test of As,Ba,Cu,Mo and Si had statistical significance.Restricted cubic spline analysis showed that there was a significant linear relationship between Cd,Cu,Si and the risk of NAFLD,and a significant non-linear correlation between Tl and the risk of NAFLD.The results of weighted quantile sum(WQS)analysis showed that the effects of Cd,Ba and Tl on the outcome were negative,of which Tl effect was the highest,while Si,As,Cu and Mo had a positive effect on the risk of NAFLD,among which Mo had the highest contribution.The combined OR of Si,As,Cu and Mo on the outcome was 1.343(95% CI1.090 1.656).Bayesian kernel machine regression(BKMR)model analysis showed that Si had a significant positive effect on the outcome,and the effect of Si on the outcome increased with the increase of metal concentration.There is interaction between Si and Tl.Conclusion:1.The exposure of Ba,Cd,Cu,Mo,Si and Tl in urine of coal miners has a significant effect on the risk of NAFLD.There is a significant linear correlation between the urine concentration of Ba,Cd,Cu,Mo,Si and the outcome,and a non-linear correlation between Tl and the risk of NAFLD.2.Si,As,Cu and Mo have a positive effect on the risk of NAFLD,among which Mo has the highest effect,and Tl has the highest effect among the metals that are negatively correlated with the risk of NAFLD.3.The effect of Si on the risk of NAFLD increased with the increase of concentration,and the effect was statistically significant.There was a potential interaction between Si and Tl.