Evidence from a Mount Sinai study suggests that exposure to chemicals during pregnancy may be a cause of liver disease in children.
Liver disease in children is becoming increasingly prevalent, with new research discovering that prenatal exposure to a range of harmful, endocrine-disrupting chemicals may increase the risk of the condition.
The Mount Sinai study is the first to analyse the relationship between chemical exposure during pregnancy, chemical composition, and non-alcoholic fatty liver disease in children. The team employed cytokeratin-18 as a marker for the condition, with the findings highlighting the importance of understanding the dangers of prenatal exposure to environmental chemicals.
Vishal Midya, PhD, the first author of the study and postdoctoral researcher in the Department of Environmental Medicine and Public Health and a member of the Mount Sinai Institute for Exposomic Research, said: “These findings can inform more efficient early-life prevention and intervention strategies to address the current non-alcoholic fatty liver disease epidemic.”
Damaskini Valvi, MD, PhD, MPH, senior author, Assistant Professor of Environmental Medicine and Public Health, and a member of the Mount Sinai Institute for Exposomic Research at Icahn Mount Sinai, added: “We are all exposed daily to these chemicals through the food we eat, the water we drink, and the use of consumer products.
“This is a serious public health problem. These findings show that early life exposure to many endocrine-disrupting chemicals is a risk factor for paediatric non-alcoholic fatty liver disease and draw attention to additional investigation needed to elucidate how environmental chemical exposures may interact with genetic and lifestyle factors in the pathogenesis of liver disease.”
The non-alcoholic fatty liver disease epidemic
The incidence of non-alcoholic fatty liver disease in children is rising and can result in severe chronic liver disease and liver cancer in adulthood. Non-alcoholic fatty liver disease affects 6% of 10% of the general paediatric population and 34% of children with obesity.
Endocrine-disrupting chemicals encompass a variety of environmental pollutants such as pesticides, plastics, flame retardants, and toxic metals. Endocrine-disrupting chemicals disrupt hormone and metabolic systems in the body, with previous studies finding that exposure to these chemicals can cause liver injury and non-alcoholic fatty liver disease.
However, no study until now has analysed the effects of prenatal mixture exposures to these chemicals on non-alcoholic fatty liver disease in children.
The impacts of endocrine-disrupting chemicals
The researchers examined 45 chemicals in the blood or urine of 1,108 pregnant women enrolled in the Human Early-Life Exposome project between 2003 and 2010. The project was a collaborative network of six ongoing population-based prospective birth cohort studies in France, Greece, Lithuania, Norway, Spain, and the UK.
The chemicals in the analysis included perfluoroalkyl substances (PFAS), polybrominated diphenyl ethers (PBDEs), organochlorine and organophosphate pesticides, plasticisers (phenols, phthalates), and parabens.
When the children were between six and 11 years old, the team measured enzyme cytokeratin-18 levels that indicate the risk of liver disease in children. The results demonstrated that those who had been exposed to environmental chemicals during pregnancy had elevated levels of those biomarkers.
Robert Wright, MD, Wise Chair of the Department of Environmental Medicine and Public Health and Co-Director of the Institute for Exposomic Research at Icahn Mount Sinai, concluded: “By understanding the environmental factors that accelerate fatty liver disease, we can reduce people’s risk by giving them actionable information to make informed choices that reduce the risk or impact of the disease.
“Exposomics is the wave of the future because once you’ve sequenced the human genome, which has been done, there isn’t much more you can do in genomics alone. The missing piece of the puzzle for us to understand different diseases is to measure their environmental causes, and exposomics is a way to accelerate our knowledge of how the environment is affecting our health.”