{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T03:51:34Z","timestamp":1789876294212,"version":"4.0.1"},"reference-count":41,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,10,25]]},"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Metabolic factors are major risk factors for non-alcoholic fatty liver disease although other factors may also contribute to development of fatty liver disease. We explored the association between exposure to soil heavy metals and prevalence of fatty liver disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed data from patients diagnosed with fatty liver disease in 2014 at the Health Evaluation Centre of Chang-Hua Christian Hospital (n=1137). We used residency data provided in the records of the Health Evaluation Centre and data for soil metal concentrations from a nationwide survey conducted by the Environmental Protection Administration of Taiwan. We studied the correlations between the severity of fatty liver disease and concentrations of soil heavy metals (arsenic, mercury, cadmium, chromium, copper, nickel, lead and zinc).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of moderate to severe fatty liver disease in our study was 26.5%. Using univariate and multivariate analysis, we demonstrated that the presence of soil heavy metals was a significant risk factor for fatty liver disease in men (OR 1.83, 95% CI 1.161 to 2.899, p=0.009). With stratification by body mass index (BMI) and gender, lean men with a BMI &lt;24 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      were the most susceptible to soil heavy metals (OR 5.059, 95% CI 1.628 to 15.728, p&lt;0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study suggested a significant association between exposure to soil heavy metals and fatty liver disease in lean men.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-014215","type":"journal-article","created":{"date-parts":[[2017,1,23]],"date-time":"2017-01-23T21:30:56Z","timestamp":1485207056000},"page":"e014215","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":54,"title":["Association between soil heavy metals and fatty liver disease in men in Taiwan: a cross sectional study"],"prefix":"10.1136","volume":"7","author":[{"given":"Yen-Chih","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ie-Bin","family":"Lian","sequence":"additional","affiliation":[{"name":"Institute of Statistics and Information Science, National Changhua University of Education, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chew-Teng","family":"Kor","sequence":"additional","affiliation":[{"name":"Internal Medicine Research Centre, Changhua Christian Hospital, Changhua, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Chu","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan"},{"name":"School of Medicine, Chung-Shan Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Yuan","family":"Su","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Tzu","family":"Chang","sequence":"additional","affiliation":[{"name":"Institute of Statistics and Information Science, National Changhua University of Education, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Fen","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Health Evaluation, Changhua Christian Hospital, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Wen","family":"Su","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan"},{"name":"School of Medicine, Chung-Shan Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maw-Soan","family":"Soon","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,1,23]]},"reference":[{"key":"2025121403115432000_7.1.e014215.1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2004.09.013"},{"key":"2025121403115432000_7.1.e014215.2","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1002\/hep.22246","article-title":"Cirrhosis and liver failure in nonalcoholic fatty liver disease: molehill or mountain?","volume":"47","author":"Charlton","year":"2008","journal-title":"Hepatology"},{"key":"2025121403115432000_7.1.e014215.3","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2013.34"},{"key":"2025121403115432000_7.1.e014215.4","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50161"},{"key":"2025121403115432000_7.1.e014215.5","first-page":"283","article-title":"Nonalcoholic fatty liver disease","volume":"8","author":"Schaffner","year":"1986","journal-title":"Prog Liver Dis"},{"key":"2025121403115432000_7.1.e014215.6","first-page":"2661","article-title":"Etiology and prevalence of abnormal serum alanine aminotransferase levels in a general population in Northeast China","volume":"124","author":"Zhang","year":"2011","journal-title":"Chin Med J"},{"key":"2025121403115432000_7.1.e014215.7","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1104316"},{"key":"2025121403115432000_7.1.e014215.8","unstructured":"Brunekreef B , Beelen R , Hoek G , et al . 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