{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T01:19:31Z","timestamp":1788484771683,"version":"build-2803163510"},"reference-count":105,"publisher":"Walter de Gruyter GmbH","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_reveh-2025-0089_abs_001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_reveh-2025-0089_abs_002\">\n                    <jats:title>Content<\/jats:title>\n                    <jats:p>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\u202f% confidence intervals (CIs) for each metal. Subgroup analyses explored variations by geographical region, exposure assessment methodology, liver biomarkers, and study characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_reveh-2025-0089_abs_003\">\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>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\u202f% CI: 2.16\u20139.87), followed by lead (SMD=5.48, 95\u202f% CI: 0.63\u201310.33), mercury (SMD=5.15, 95\u202f% CI: 0.21\u201310.51), and arsenic (SMD=1.52, 95\u202f% CI: 0.53\u20132.52). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_reveh-2025-0089_abs_004\">\n                    <jats:title>Outlook<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/reveh-2025-0089","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T12:36:14Z","timestamp":1761654974000},"page":"109-141","source":"Crossref","is-referenced-by-count":3,"title":["Metals exposure and biomarkers of liver damage: a systematic review and meta-analysis of observational studies"],"prefix":"10.1515","volume":"41","author":[{"given":"Ibrahim","family":"Issah","sequence":"first","affiliation":[{"name":"Department of Biological, Environmental and Occupational Health Sciences , University of Ghana, School of Public Health , Accra , Ghana"},{"name":"West Africa Center for Global Environmental & Occupational Health , College of Health Sciences, University of Ghana , Legon , Accra , Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serwaa A.","family":"Bawua","sequence":"additional","affiliation":[{"name":"Department of Biological, Environmental and Occupational Health Sciences , University of Ghana, School of Public Health , Accra , Ghana"},{"name":"West Africa Center for Global Environmental & Occupational Health , College of Health Sciences, University of Ghana , Legon , Accra , Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Arko-Mensah","sequence":"additional","affiliation":[{"name":"Department of Biological, Environmental and Occupational Health Sciences , University of Ghana, School of Public Health , Accra , Ghana"},{"name":"West Africa Center for Global Environmental & Occupational Health , College of Health Sciences, University of Ghana , Legon , Accra , Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mabel S.","family":"Duah","sequence":"additional","affiliation":[{"name":"Department of Biological, Environmental and Occupational Health Sciences , University of Ghana, School of Public Health , Accra , Ghana"},{"name":"West Africa Center for Global Environmental & Occupational Health , College of Health Sciences, University of Ghana , Legon , Accra , Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley V.","family":"Simpson","sequence":"additional","affiliation":[{"name":"West Africa Center for Global Environmental & Occupational Health , College of Health Sciences, University of Ghana , Legon , Accra , Ghana"},{"name":"Department of Bacteriology , Noguchi Memorial Institute for Medical Research, University of Ghana , Legon , Accra , Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5498-5958","authenticated-orcid":false,"given":"Thomas P.","family":"Agyekum","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Health and Safety , School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology , Kumasi , Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olalekan A.","family":"Uthman","sequence":"additional","affiliation":[{"name":"Warwick Applied Health , Warwick Centre for Global Health, Warwick Medical School, University of Warwick , Coventry , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius N.","family":"Fobil","sequence":"additional","affiliation":[{"name":"Department of Biological, Environmental and Occupational Health Sciences , University of Ghana, School of Public Health , Accra , Ghana"},{"name":"West Africa Center for Global Environmental & Occupational Health , College of Health Sciences, University of Ghana , Legon , Accra , Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"2026032504575230539_j_reveh-2025-0089_ref_001","doi-asserted-by":"crossref","unstructured":"Ozougwu, JC. 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