Non-alcoholic fatty liver disease (NAFLD) has an association with obesity and metabolic syndrome. There is a large amount of evidence pointing to the role of environmental toxins as well.

A study published recently in Annals of Hepatology aimed to demonstrate that raised blood lead levels in NAFLD patients lead to worsening liver fibrosis.

Overall, 30,172 patients from NHANES 2011-2016 met the inclusion criteria. A total of 2499 patients, aged 20-74 years, were identified to have NAFLD as per the Fatty Liver Index score, and 425 patients were identified as having advanced liver fibrosis using the NAFLD Fibrosis Score.

Elevated serum lead level was found to have an independent association with a heightened risk of advanced fibrosis (OR 5.93, 95% CI 2.88-12.24) in the highest lead quartile (Q4). A subgroup analysis, stratified by BMI, revealed a consistent significant association between advanced liver fibrosis and blood lead levels [Q4 (OR 5.78, 95% CI 0.97-33.63) and Q4 (OR 6.04, 95% CI 2.92-12.48) in BMI <30 and >30, respectively]. There was evidence of increased lead exposure among patients who were older, less educated, male, consumed alcohol and smoked tobacco.

The study clearly pointed that advanced liver fibrosis is nearly six times more likely in NAFLD patients with a heightened lead exposure.

Source: Reja D, Visaria A, Karanfilian B, Rustgi V. Blood lead level is associated with advanced liver fibrosis in patients with non-alcoholic fatty liver disease: A nationwide survey (NHANES 2011-2016). Ann Hepatol. 2020 Apr 4. pii: S1665-2681(20)30028-4.