Abstract：
Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide. Epidemiological studies have reported that exposure of the population to environmental endocrine-disrupting chemicals (EDCs) is associated with NAFLD. However, EDCs are of different types, and there are inconsistencies in the relevant evidence and descriptions, which have not been systematically summarized so far. Therefore, this study aimed to determine the association between population exposure to EDCs and NAFLD. Three databases, including PubMed, Web of science, and Embase were searched, and 27 articles were included in this study. Methodological quality, heterogeneity, and publication bias of the included studies were assessed using the Newcastle-Ottawa scale, I2 statistics, Begg\'s test, and Egger\'s test. The estimated effect sizes of the included studies were pooled and evaluated using the random-effects model (I2 > 50 %) and the fixed-effects model ( I2 < 50 %). The pooled-estimate effect sizes showed that population exposure to Phthalates (PAEs) (OR = 1.18, 95 % CI:1.03-1.34), cadmium (Cd) (OR = 1.37, 95 % CI:1.09-1.72), and bisphenol A (OR = 1.43, 95 % CI:1.24-1.65) were positively correlated with the risk of NAFLD. Exposure to mercury (OR =1.46, 95 % CI:1.17-1.84) and Cd increased the risk of \"elevated alanine aminotransferase\". On the contrary, no significant association was identified between perfluoroalkyl substances (OR =0.99, 95 % CI:0.93-1.06) and NAFLD. However, female exposure to perfluorooctanoic acid (OR =1.82, 95 % CI:1.01-3.26) led to a higher risk of NAFLD than male exposure. In conclusion, this study revealed that EDCs were risk factors for NAFLD. Nonetheless, the sensitivity analysis results of some of the meta-analyses were not stable and demonstrated high heterogeneity. The evidence for these associations is limited, and more large-scale population-based studies are required to confirm these findings.
摘要：
非酒精性脂肪性肝病（NAFLD）是世界范围内慢性肝病的主要原因之一。流行病学研究报告，人群暴露于环境内分泌干扰化学物质（EDC）与NAFLD有关。然而,EDC有不同的类型，相关证据和描述存在不一致之处，到目前为止还没有系统地总结。因此,本研究旨在确定人群EDC暴露与NAFLD之间的关联.三个数据库,包括PubMed,WebofScience,Embase被搜查了,本研究纳入了27篇文章。方法学质量,异质性，纳入研究的发表偏倚使用纽卡斯尔-渥太华量表进行评估，I2统计，Begg\'stest,和Egger的测试。使用随机效应模型(I2>50%)和固定效应模型(I2<50%)合并和评估纳入研究的估计效应大小。汇总估计效应大小表明，人口暴露于邻苯二甲酸酯(PAEs)(OR=1.18，95%CI：1.03-1.34)，镉（Cd）（OR=1.37，95%CI：1.09-1.72），和双酚A(OR=1.43,95%CI:1.24-1.65)与NAFLD风险呈正相关。暴露于汞（OR=1.46，95%CI：1.17-1.84）和Cd会增加“丙氨酸转氨酶升高”的风险。相反,全氟烷基物质(OR=0.99,95%CI:0.93-1.06)与NAFLD之间无显著关联.然而,女性暴露于全氟辛酸(OR=1.82,95%CI:1.01-3.26)导致NAFLD的风险高于男性暴露。总之,这项研究显示EDC是NAFLD的危险因素.尽管如此，部分meta分析的敏感性分析结果不稳定,且表现出高度异质性.这些关联的证据是有限的，需要更大规模的基于人群的研究来证实这些发现。
