Mediating Role of Liver Dysfunction in the Association
between Arsenic Exposure and Diabetes in Chinese Adults: A Nationwide
Cross-Sectional Study of China National Human Biomonitoring (CNHBM)
2017–2018
Inconsistent
results have been reported regarding the association
between low-to-moderate arsenic (As) exposure and diabetes. The effect
of liver dysfunction on As-induced diabetes remains unclear. The cross-sectional
study included 10,574 adults from 2017–2018 China National
Human Biomonitoring. Urinary total As (TAs) levels were analyzed as
markers of As exposure. Generalized linear mixed models and restricted
cubic splines models were used to examine the relationships among
TAs levels, serum alanine aminotransferase (ALT) and aspartate aminotransferase
(AST) concentrations, and diabetes prevalence. Mediating analysis
was performed to assess whether liver dysfunction mediated the association
between TAs and diabetes. Overall, the OR (95% CI) of diabetes in
participants in the second, third, and fourth quartiles of TAs were
1.08 (0.88, 1.33), 1.17 (0.94, 1.45), and 1.52 (1.22, 1.90), respectively,
in the fully adjusted models compared with those in the lowest quartile.
Serum ALT was positively associated with TAs and diabetes. Additionally,
mediation analyses showed that ALT mediated 4.32% of the association
between TAs and diabetes in the overall population and 8.86% in the
population without alcohol consumption in the past year. This study
suggested that alleviating the hepatotoxicity of As could have implications
for both diabetes and liver disease.