New York, NY (July 6, 2022) – The growing incidence of a potentially cancer-causing liver disease in children is associated with prenatal exposure to several endocrine-disrupting chemicals, Mount Sinai researchers report.
It is the first comprehensive study on the association of prenatal exposure and mixtures of these chemicals and non-alcoholic fatty liver disease. The researchers used cytokeratin-18 as a novel marker for the disease in children. The findings, reported in JAMA Network Open in July, underline the importance of understanding prenatal exposure to environmental chemicals as a risk factor for non-alcoholic fatty liver disease, which is a rapidly growing issue in children that can lead to severe chronic liver disease and liver cancer in adulthood.
“These findings can inform more efficient early-life prevention and intervention strategies to address the current non-alcoholic fatty liver disease epidemic,” said Vishal Midya, PhD, first author and postdoctoral researcher in the Department of Environmental Medicine and Public Health and a member of the Mount Sinai Institute for Exposomic Research at the Icahn School of Medicine at Mount Sinai.
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 daily exposed 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 pediatric non-alcoholic fatty liver disease, and draw attention for additional investigation needed to elucidate how environmental chemical exposures may interact with genetic and lifestyle factors in the pathogenesis of liver disease.”
Non-alcoholic fatty liver disease is one of the most common liver diseases worldwide and is increasingly diagnosed in childhood—affecting 6 percent to 10 percent of the general pediatric population and approximately 34 percent of children with obesity. Endocrine-disrupting chemicals are a wide class of environmental pollutants that include several pesticides, plastics, flame retardants, and toxic metals. Examples include perfluoroalkyl substances (PFAS), also known as “forever chemicals” used in nonstick cookware and food packaging, and polybrominated diphenyl ethers (PBDEs) used as flame retardants in furniture and infant products. Endocrine-disrupting chemicals interfere with hormone and metabolic systems in people. Several experimental studies have shown that exposures to these chemicals can lead to liver injury and non-alcoholic fatty liver disease; however, until now, the potential effects of prenatal mixture exposures to these chemicals have not been studied in humans.
In this study, researchers measured 45 chemicals in the blood or urine of 1,108 pregnant women from 2003 to 2010. The chemicals included endocrine-disrupting chemicals such as PFAS, organochlorine and organophosphate pesticides, plasticizers (phenols, phthalates), PBDEs, and parabens. When the children reached the ages of 6 to 11 years old, scientists measured the levels of enzymes and cytokeratin-18 that indicate risk for liver disease in the children’s blood, finding elevated levels of those biomarkers in children who had been more highly exposed to environmental chemicals during pregnancy.
“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,” said Robert Wright, MD, MPH, Ethel H. Wise Chair of the Department of Environmental Medicine and Public Health and Co-Director of the Institute for Exposomic Research at Icahn Mount Sinai. “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.”
The study participants were enrolled in the Human Early-Life Exposome project, a collaborative network of six ongoing population-based prospective birth cohort studies from six European countries—France, Greece, Lithuania, Norway, Spain, and Britain. Limitations of this study include the inability to conduct a liver biopsy, considered the gold-standard to establish a causal link with non-alcoholic fatty liver disease, because of the risk and ethical limitations due to the children’s age.
This research was funded by the National Institute of Environmental Health Science (NIEHS) and the European Community's Seventh Framework Programme.
About the Institute for Exposomic Research
The Institute for Exposomic Research at the Icahn School of Medicine at Mount Sinai envisions a world where we prevent disease with environmental origins and improve health outcomes for all, from preconception, pregnancy, and the earliest stages of child development to adulthood and retirement age. Our mission is to understand how environmental exposures affect health, disease, and development and to translate that knowledge into new strategies for prevention and treatment. Our approach is holistic, encompassing the chemical, nutritional, and social environments and the interrelationships among them. We aim to cultivate the public consciousness necessary to make meaningful changes in policies and practices to protect health and build healthier and more just communities where we live, play, and work. We strive to accomplish this mission while training the next generation of health professionals across multiple disciplines and in collaboration with practitioners from across the Mount Sinai Health System and beyond. For more information, visit https://mountsinaiexposomics.org/
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in 4 out of 10 pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that have earned distinction by multiple indicators: It is consistently ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for numerous basic and clinical research areas. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.
JAMA Network Open