{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:08:24Z","timestamp":1789384104730,"version":"build-2803163510"},"reference-count":37,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Science and Technology of Bac Giang Province","award":["07\/H\u0110-KHCN-\u0110T"],"award-info":[{"award-number":["07\/H\u0110-KHCN-\u0110T"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background\/Objectives: Occupational pesticide exposure is a recognized hepatotoxic hazard; however, biomonitoring data characterizing liver function among Vietnamese agricultural workers remain scarce. This study compared serum hepatic biomarkers between pesticide-exposed fruit farmers (exposed group) and a non-exposed reference group (unexposed group) in a northern province in Vietnam, and evaluated whether biomarker alteration varied with cumulative exposure duration. Methods: A cross-sectional study using convenience sampling was conducted from April to October 2022 among 150 adults, comprising 100 fruit farmers with \u22651 year of direct occupational pesticide exposure and 50 unexposed controls. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total and indirect bilirubin, alpha-fetoprotein (AFP), and glucose were quantified using clinical laboratory assays. Multivariable linear regression models, adjusting for age, sex, and body mass index (BMI), were used to evaluate associations between pesticide exposure duration and biomarker levels. Results: Pesticide-exposed farmers had significantly higher mean concentrations of ALT (28.88 vs. 22.36 U\/L, p = 0.002), AFP (3.06 vs. 1.16 ng\/mL, p &lt; 0.001), total bilirubin (9.93 vs. 7.74 \u03bcmol\/L, p &lt; 0.001), and indirect bilirubin (8.40 vs. 5.26 \u03bcmol\/L, p &lt; 0.001) than unexposed controls. While mean AST did not differ (p = 0.105), the proportion of abnormal AST cases was significantly higher among exposed individuals (23% vs. 8%, p = 0.043). After adjustment for age, sex, and BMI in multivariable linear regression models, prolonged exposure (&gt;10 years) remained modestly associated with higher AFP and bilirubin levels (p &lt; 0.05), while associations with ALT and AST were not statistically evident (p &gt; 0.05). Conclusions: These findings suggest a possible association between occupational pesticide exposure and subclinical hepatic alterations, supporting calls for regular health surveillance and enhanced protective measures among fruit farmers.<\/jats:p>","DOI":"10.3390\/diseases14090337","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:19:41Z","timestamp":1789381181000},"page":"337","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Liver Biomarker Levels in Farmers Occupationally Exposed to Pesticides: A Cross-Sectional Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Hung The","family":"Dang","sequence":"first","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thoa Phuong","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thu Thi Yen","family":"Pham","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinh Thi","family":"Luu","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7833-5476","authenticated-orcid":false,"given":"Ha Thi Thu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3877-4200","authenticated-orcid":false,"given":"Oanh Thi Kieu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oanh Thi Phuong","family":"Ngo","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinh Thi Tuyet","family":"Do","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ha Thi Ngoc","family":"Bui","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1793-9826","authenticated-orcid":false,"given":"Quan Hong","family":"Duong","sequence":"additional","affiliation":[{"name":"Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","unstructured":"Food and Agriculture Organization of the United Nations (2023). Pesticides Use and Trade 1990\u20132023, FAO."},{"key":"ref_2","unstructured":"Phong, L.T., and Thong, A.C. (2020). Highly Hazardous Pesticides in Vietnam: A Situational Analysis, International Pollutants Elimination Network (IPEN)."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Giang, N.D., Nguyen, V.H., Hoang, T.L., Tran, T.V.T., Huynh, T.P.L., and Nguyen, T.Q.T. (2022). Assessment of pesticide use and pesticide residues in vegetables from two provinces in Central Vietnam. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0269789"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"203","DOI":"10.17221\/69\/2017-PPS","article-title":"Pesticide use in vegetable production: A survey of Vietnamese farmers\u2019 knowledge","volume":"54","author":"Nguyen","year":"2018","journal-title":"Plant Prot. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.cbi.2016.06.003","article-title":"Effects of pesticide mixtures in human and animal models: An update of the recent literature","volume":"254","author":"Rizzati","year":"2016","journal-title":"Chem. Biol. Interact."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Khairullina, Z., Kurmangaliyeva, S., Yussupov, R., Kelimberdiyeva, E., Tryfonyuk, L., Shapambayev, N., Seidakhmetova, A., Medetbekov, T., and Tkachenko, A. (2026). Pesticides drive liver diseases through non-apoptotic regulated cell death pathways. Diseases, 14.","DOI":"10.3390\/diseases14030096"},{"key":"ref_7","first-page":"177","article-title":"Pesticide exposure and liver cancer: A review","volume":"28","author":"VoPham","year":"2017","journal-title":"Cancer Causes Control"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2713","DOI":"10.1111\/liv.15461","article-title":"Organophosphate pesticide exposure and biomarkers of liver injury\/liver function","volume":"42","author":"Li","year":"2022","journal-title":"Liver Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5846","DOI":"10.3390\/ijerph120605846","article-title":"Effect of pesticide exposure on immunological, hematological and biochemical parameters in Thai orchid farmers\u2014A cross-sectional study","volume":"12","author":"Aroonvilairat","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bunsri, S., Muenchamnan, N., Naksen, W., and Ong-Artborirak, P. (2023). The hematological and biochemical effects from pesticide exposure on Thai vegetable farmers. Toxics, 11.","DOI":"10.3390\/toxics11080707"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12995-025-00470-9","article-title":"Associations between pesticide exposure and hepatobiliary disease among agricultural workers in the Northeastern region of Thailand: A cross-sectional study","volume":"20","author":"Kopolrat","year":"2025","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"21885","DOI":"10.1038\/s41598-026-51363-8","article-title":"Effect of pesticide exposure on liver function tests and serum cholinesterase levels among floriculture industry workers in Bahir Dar, Ethiopia: A comparative cross-sectional study","volume":"16","author":"Gietie","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_13","first-page":"535","article-title":"Cancer mortality pattern in Viet Nam","volume":"8","author":"Ngoan","year":"2007","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Dang, H.V., Nguyen, L.T., Tran, H.T., Nguyen, H.T., Dang, A.K., Ly, V.D., and Frazzoli, C. (2017). Risk Factors for Non-communicable Diseases in Vietnam: A Focus on Pesticides. Front. Environ. Sci., 5.","DOI":"10.3389\/fenvs.2017.00058"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1055\/a-2540-2861","article-title":"Environmental Pollutants, Occupational Exposures, and Liver Disease","volume":"45","author":"Beier","year":"2025","journal-title":"Semin. Liver Dis."},{"key":"ref_16","unstructured":"World Health Organization (2020). The WHO Recommended Classification of Pesticides by Hazard and Guidelines to Classification, 2019, World Health Organization."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2305764","DOI":"10.1155\/2020\/2305764","article-title":"Evaluation of the effects of agro pesticides use on liver and kidney function in farmers from Buea, Cameroon","volume":"2020","author":"Manfo","year":"2020","journal-title":"J. Toxicol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"21041","DOI":"10.1038\/s41598-025-04295-8","article-title":"Neurological and organ health risks associated with pesticide mixture exposure in banana farm workers in Moungo Division, Cameroon","volume":"15","author":"Nanhah","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Manyilizu, W.B., Mdegela, R.H., Kazwala, R., Nonga, H., Muller, M., Lie, E., Skjerve, E., and Lyche, J.L. (2016). Association of long-term pesticide exposure and biologic parameters in female farm workers in Tanzania: A cross-sectional study. Toxics, 4.","DOI":"10.3390\/toxics4040025"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1515\/JBCPP.2009.20.4.335","article-title":"Occupational pesticides exposure of sprayers of grape gardens in western Maharashtra (India): Effects on liver and kidney function","volume":"20","author":"Patil","year":"2009","journal-title":"J. Basic Clin. Physiol. Pharmacol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.3923\/rjet.2009.179.185","article-title":"Hematological and biochemical alterations in occupationally pesticide-exposed workers of Riyadh municipality, Kingdom of Saudi Arabia","volume":"3","author":"Bakr","year":"2009","journal-title":"Res. J. Environ. Toxicol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.fct.2013.05.012","article-title":"Pesticide exposure and genetic variation in xenobiotic-metabolizing enzymes interact to induce biochemical liver damage","volume":"61","author":"Gil","year":"2013","journal-title":"Food Chem. Toxicol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.lfs.2015.10.013","article-title":"Occupational pesticide exposure and adverse health effects at the clinical, hematological and biochemical level","volume":"145","author":"Requena","year":"2016","journal-title":"Life Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1080\/10807039.2021.1944050","article-title":"Pesticide-induced changes in cholinesterase activity and chronic kidney disease of unknown etiology among farmers in Nakhon Ratchasima, Thailand","volume":"27","author":"Sombatsawat","year":"2021","journal-title":"Hum. Ecol. Risk Assess."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"112127","DOI":"10.1016\/j.fct.2021.112127","article-title":"Evaluation of conventional and non-conventional biomarkers of liver toxicity in greenhouse workers occupationally exposed to pesticides","volume":"151","author":"Requena","year":"2021","journal-title":"Food Chem. Toxicol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Mehta, P., Parajuli, R.P., Chronister, B.N.C., Yang, K., Barr, D.B., Tu, X.M., Lopez-Paredes, D., and Suarez-Lopez, J.R. (2025). Pesticide and liver biomarkers among Ecuadorian adolescents and adults living in agricultural settings. Toxics, 13.","DOI":"10.3390\/toxics13080685"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Panis, C., Kawassaki, A.C.B., Crestani, A.P.J., Pascotto, C.R., Bortoloti, D.S., Vicentini, G.E., Lucio, L.C., Ferreira, M.O., Prates, R.T.C., and Vieira, V.K. (2022). Evidence on human exposure to pesticides and the occurrence of health hazards in the Brazilian population: A systematic review. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.787438"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5563759","DOI":"10.1155\/2022\/5563759","article-title":"A common feature of pesticides: Oxidative stress\u2014The role of oxidative stress in pesticide-induced toxicity","volume":"2022","author":"Sule","year":"2022","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1002\/tox.22398","article-title":"Oxidative stress and genetic damage among workers exposed primarily to organophosphate and pyrethroid pesticides","volume":"32","author":"Villegas","year":"2017","journal-title":"Environ. Toxicol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.ijheh.2005.04.003","article-title":"Associations of pesticides, HCV, HBV, and hepatocellular carcinoma in Egypt","volume":"208","author":"Ezzat","year":"2005","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"11590","DOI":"10.1038\/s41598-022-15741-2","article-title":"Association between organochlorine pesticides and nonalcoholic fatty liver disease in the National Health and Nutrition Examination Survey 2003\u20132004","volume":"12","author":"Sang","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"10132","DOI":"10.1021\/acs.jafc.8b03177","article-title":"Insecticide exposure and development of nonalcoholic fatty liver disease","volume":"66","author":"Yang","year":"2018","journal-title":"J. Agric. Food Chem."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Martin-Reina, J., Casanova, A.G., Dahiri, B., Fern\u00e1ndez, I., Fern\u00e1ndez-Palac\u00edn, A., Bautista, J., Morales, A.I., and Moreno, I. (2021). Adverse health effects in women farmers indirectly exposed to pesticides. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18115909"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1093\/annhyg\/mew004","article-title":"Use of chemical pesticides in Ethiopia: A cross-sectional comparative study on knowledge, attitude and practice of farmers and farm workers in three farming systems","volume":"60","author":"Negatu","year":"2016","journal-title":"Ann. Occup. Hyg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Reddy, A.A., Reddy, M., and Mathur, V. (2024). Pesticide use, regulation, and policies in Indian agriculture. Sustainability, 16.","DOI":"10.2139\/ssrn.4850017"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3087","DOI":"10.1007\/s43621-026-03087-y","article-title":"Biopesticide market and regulatory landscape with determinants of farm-level use in India","volume":"7","author":"Reddy","year":"2026","journal-title":"Discov. Sustain."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Damalas, C.A., and Koutroubas, S.D. (2016). Farmers\u2019 exposure to pesticides: Toxicity types and ways of prevention. Toxics, 4.","DOI":"10.3390\/toxics4010001"}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/9\/337\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:54:48Z","timestamp":1789383288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/9\/337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diseases14090337"],"URL":"https:\/\/doi.org\/10.3390\/diseases14090337","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]}}}