Clinical relevance of environmental manganese exposure with liver stiffness and steatosis detected by transient elastography in adults.

Global manganese pollution to air and water is a significant threat to human health. The associations between manganese and liver stiffness and steatosis have not been reported in epidemiological studies. This study aimed to explore the clinical relevance of blood manganese with liver stiffness and steatosis in adults from the 2017-2018 National Health and Nutrition Examination Survey (N = 4,192). Subjects with excessive alcohol consumption and hepatitis B or C infection were excluded. Liver stiffness and steatosis were detected by transient elastography. Logistic regression and restricted cubic splines were adopted to explore the non-linear dose-response relationships. In multivariate analysis, while higher blood manganese concentrations were not associated with liver stiffness in the total sample and in males, an increased odds of significant liver fibrosis was found with higher blood manganese concentrations (tertile 3 vs. tertile 1) in females [odds ratios (95% confidence intervals): 2.34 (1.32-4.14), P trend < 0.01] and in other races [1.47 (1.05-2.05), P trend = 0.03]. Higher blood manganese concentrations were associated with liver steatosis in the total sample [1.33 (1.04-1.70), P trend = 0.03], in females [1.58 (1.02-2.44), P trend = 0.04], in other races [1.91 (1.50-2.43), P trend < 0.01], and in obese subjects [2.29 (1.13-4.65), P trend = 0.02]. Dose-response analysis showed that the departures from non-linear relationships between blood manganese concentrations and significant liver fibrosis (P