Blood ethylene oxide levels in relation to the progression of hepatic steatosis and liver fibrosis: a cross-sectional study

Abstract

Background: Ethylene oxide (EO) may cause liver damage or transient liver function impairment in humans. The purpose of this study was to investigate the relationship between ethylene oxide exposure and hepatic fibrosis and hepatic steatosis in adults. Methods: Cross-sectional data were selected from 4531 participants in the 2013-2020 National Health and Nutrition Examination Survey (NHANES). The FIB-4 index and the HSI hepatic steatosis index were used to evaluate liver fibrosis and liver fat content. Men with serum ALT > 30 IU/L and women with serum ALT > 19 IU/L were defined as non-alcoholic fatty liver patients, and FIB-4 > 1.3 was defined as liver fibrosis of different degrees. The relationship between ethylene oxide hemoglobin adjunct (HbEO), inflammatory biomarkers, and liver fibrosis and fatty liver was evaluated using restricted cubic spline plots and multivariate linear regression models. Mediation analysis was used to further evaluate their relevance. Results: HbEO levels in adults were negatively correlated with the FIB-4 index and HSI index [Q1 VS. Q4, FIB-4: β=0.12 (-0.17, -0.07), HSI: β=-1.30(-1.77, -0.83); p < 0.05], and were negatively associated with liver fibrosis and the risk of non-alcoholic fatty liver disease after correction for confounders [liver fibrosis: OR=0.70(0.49, 1.01), non-alcoholic fatty liver disease: OR=0.89(0.73, 1.08); p < 0.05]. The levels of alkaline phosphatase, leukocytes, lymphocytes, and neutrophils were negatively correlated with the FIB-4 index but positively correlated with the HSI index (all p < 0.05). Mediated analysis showed that exposure to ethylene oxide had different effects on the FIB-4 index and the HSI index through inflammatory mediators. Conclusions: The present study results show that ethylene oxide exposure is negatively correlated with liver fibrosis and the prevalence of non-alcoholic fatty liver disease and suggest that inflammatory mediators may mediate the relationship between them, but they are not the only mediators, and the mechanism is complex. Further studies are needed to explore how ethylene oxide affects liver function.