Metals exposure and biomarkers of liver damage: a systematic review and meta-analysis of observational studies
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Ibrahim Issah
, Serwaa A. Bawua
, John Arko-Mensah , Mabel S. Duah , Shirley V. Simpson , Thomas P. Agyekum, Olalekan A. Uthman
and Julius N. Fobil
Abstract
Introduction
Environmental exposure to metals represents a significant global health concern, yet the hepatotoxic potential of these contaminants remains incompletely characterized. This systematic review and meta-analysis aimed to quantify the association between exposure to metals and liver damage as indicated by liver enzyme alterations.
Content
We conducted a comprehensive search of electronic databases for epidemiological studies that examined associations between metal exposure and liver enzymes. Using random-effects models, we calculated pooled standardized mean differences (SMDs) with 95 % confidence intervals (CIs) for each metal. Subgroup analyses explored variations by geographical region, exposure assessment methodology, liver biomarkers, and study characteristics.
Summary
Thirty-nine studies met inclusion criteria. All four metals showed significant positive associations with liver damage, with cadmium exhibiting the strongest association (SMD=5.98, 95 % CI: 2.16–9.87), followed by lead (SMD=5.48, 95 % CI: 0.63–10.33), mercury (SMD=5.15, 95 % CI: 0.21–10.51), and arsenic (SMD=1.52, 95 % CI: 0.53–2.52). Metal-specific patterns of liver enzyme alterations were observed: arsenic primarily affected transaminases (ALT, AST), while cadmium, mercury, and lead showed stronger associations with AST and GGT.
Outlook
This systematic review and meta-analysis provides robust evidence that environmental exposure to arsenic, cadmium, mercury, and lead is significantly associated with liver damage across diverse populations.
Funding source: Ibrahim Issah was supported by the National Institute of Environmental Health Sciences and the Fogarty International Center of the National Institutes of Health under grant #D43TW009345 awarded to the Northern Pacific Global Health Fellows Program.
Award Identifier / Grant number: D43TW009345
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Research ethics: Not applicable.
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Informed consent: Not applicable.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Authorship contribution statement: I·I.: Conceptualization, Methodology, Data curation, writing-original draft; writing – review and editing; S.A.B.: Writing-review and editing; J-AM: Writing – review and editing; MSD: Writing – review and editing; SVS: writing – review and editing; TPA: Writing-review and editing, OAU: Methodology, Software, Formal analysis, Writing – review and editing; and JF: Supervision, Writing – review and editing.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: The data that support the findings of this study are available from the corresponding author, [II], upon reasonable request.
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