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Nonalcoholic fatty liver disease (NAFLD) is now the most prevalent pediatric chronic liver disease, affecting an estimated 8% of the general pediatric population and 34% of children with obesity. It is expected to become the leading cause of liver pathology, liver failure and indication for liver transplantation in children in the next decade. Toxicological studies and limited epidemiologic evidence support a link between early life air pollution exposure and liver injury. Non-invasive clinical biomarkers can help assess liver injury and suspected NAFLD. This study evaluated the associations of prenatal and childhood air pollution and traffic exposure with biomarkers of child liver injury.
The study population included 1103 children from the “Human Early Life Exposome (HELIX)” project. Liver injury biomarkers, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and cytokeratin 18 (CK-18), were measured in serum between ages 6-10 years. Air pollutant exposures were based on land-use regression or dispersion models and included nitrogen dioxide, particulate matter &le 10μm, and particulate matter &le 2.5μm. Markers of traffic included traffic density on nearest road and load in 100 meters buffer, and inverse distance to nearest road. Exposure assignments were made to residential address during whole pregnancy period (prenatal) or to residential and school addresses for year preceding outcome assessment (childhood). Generalized additive models were fitted, adjusting for potential confounders selected using directed acyclic graphs.
Prenatal and childhood air pollution exposures were not associated with liver injury biomarkers in childhood. Results for traffic markers were null, except for a positive association between closer proximity to road prenatally and higher AST. There was no consistent evidence of an interaction with child sex or child overweight/obese status for any exposure.
This study did not find prenatal or childhood air pollution or traffic exposure to be associated with biomarkers of liver injury in children.