Toxin-associated fatty liver disease common in 9/11 first responders

Last Updated: 2020-05-07

By Megan Brooks

NEW YORK (Reuters Health) - A study has found high rates of non-alcoholic fatty liver disease (NAFLD) among first responders to the 9/11 World Trade Center attack, likely stemming from exposure to toxins released at the disaster site.

Toxin-associated fatty liver disease (TAFLD) is a recently coined term that describes fatty liver secondary to chemical and occupational exposure, lead researcher Dr. Mishal Reja, of Robert Wood Johnson University Hospital, in Newark, New Jersey, explained at an April 29 Digestive Disease Week (DDW) press briefing.

"9/11 first responders were exposed to large doses of occupational and industrial toxins linked to liver disease," he noted.

Using data from the World Trade Center Health Program, the researchers evaluated the incidence of fatty liver secondary to toxin exposure in 243 first responders (93% male). They were primarily referred to the program for gastrointestinal symptoms including dysphagia (14%) and heartburn (68%).

The primary outcome was prevalence of hepatic steatosis, defined by the hepatic steatosis index (HSI) of greater than 36, which has a sensitivity of about 93% for fatty liver.

Nearly 83% of 9/11 first responders had fatty liver disease, compared to the range of 24% to 45% found in the general U.S. population. This high prevalence in first responders is "concerning and can be explained by their exposure to toxins," Dr. Reja told the briefing.

Obese first responders were three times more likely to have fatty liver disease, but age, sex, smoking status and comorbid conditions were not predictors of fatty liver. The most common comorbidities in the first responders were gastroesophageal reflux disease, hypertension, diabetes, chronic rhinosinusitis and obstructive sleep apnea.

"These findings show that 9/11 responders need to be particularly concerned about fatty liver disease and they must be examined more closely for it. They should be especially careful in managing their diet and any related comorbidities because their risk for fatty liver disease is compounded by their toxin exposure," Dr. Reja said.

"It is believed that occupational and industrial toxins can disrupt endocrine signaling that is implicated in obesity, metabolic syndrome and diabetes, which can lead to a host of life-threatening conditions, including liver cancer and cirrhosis," Dr. Reja noted.

Looking ahead, the researchers hope to compare liver ultrasounds of first responders to a control group of the general population to gather more detailed information on the rate of toxin-associated fatty liver.

The study had no commercial funding.

SOURCE: https://bit.ly/2YDzhiU Digestive Disease Week (DDW) 2020.