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Long-term exposure to fine particulate matter and non-alcoholic fatty liver disease: a prospective cohort study
  1. Shengzhi Sun1,2,
  2. Qingqing Yang1,
  3. Qingxin Zhou1,
  4. Wangnan Cao3,4,
  5. Siwang Yu5,
  6. Siyan Zhan1,
  7. Feng Sun1
  1. 1 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
  2. 2 Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts, USA
  3. 3 Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
  4. 4 Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island, USA
  5. 5 Department of Molecular and Cellular Pharmacology, Peking University School of Pharmaceutical Sciences, Beijing, China
  1. Correspondence to Dr Feng Sun, Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing 100191, China; sunfeng{at}

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Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease and is associated with a higher risk of all-cause and cause-specific morbidity and mortality.1–3 Animal studies suggest that air pollution may play a role in the development of NAFLD.4 5 However, evidence from human studies is limited.6

Here, we prospectively estimated the association between long-term exposure to fine particulate matter (PM2.5) and risk of NAFLD in 58 026 Taiwan residents who received a standard medical screening programme between 2001 and 2016. We excluded participants with (a) missing values of covariates; (b) excess alcohol intake; (c) liver disease at baseline; (d) NAFLD at baseline and (e) only one medical examination (online supplemental figure S1). The final analytic sample included 35 614 participants for fatty liver index (FLI)-based cohort and 34 741 participants for hepatic steatosis index (HSI)-based cohort. We defined the incident NAFLD as the first occurrence of values of FLI>30 or HSI>36, which have been validated in the Asian population.7 8 We estimated annual PM2.5 levels at participants’ residential addresses using multiple satellite-based aerosol optical depth data combined with a chemical transport model.9 Physical examinations were conducted by trained technicians …

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  • SS and QY contributed equally.

  • Correction notice This article has been corrected since it published Online First. A typographical error has been corrected in table 1.

  • Contributors SS and QY analysed the data, drafted the manuscript and are the guarantors. SZ and FS designed, revised and supervised the study. All authors revised the manuscript and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.