Physical Activity- and Alcohol-dependent Association Between Air Pollution Exposure and Elevated Liver Enzyme Levels: An Elderly Panel Study

Objectives: The deleterious effects of air pollution on various health outcomes have been demonstrated. However, few studies have examined the effects of air pollution on liver enzyme levels. Methods: Blood samples were drawn up to three times between 2008 and 2010 from 545 elderly individuals who regularly visited a community welfare center in Seoul, Korea. Data regarding ambient air pollutants (particulate matter ${\leq}2.5{\mu}m$ [$PM_{2.5}$], nitrogen dioxide [$NO_2$], ozone [$O_3$], carbon monoxide, and sulfur dioxide) from monitoring stations were used to estimate air pollution exposure. The effects of the air pollutants on the concentrations of three liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and ${\gamma}$-glutamyltranspeptidase [${\gamma}$-GTP)]) were evaluated using generalized additive and linear mixed models. Results: Interquartile range increases in the concentrations of the pollutants showed significant associations of $PM_{2.5}$ with AST (3.0% increase, p=0.0052), ALT (3.2% increase, p=0.0313), and ${\gamma}$-GTP (5.0% increase, p=0.0051) levels; $NO_2$ with AST (3.5% increase, p=0.0060) and ALT (3.8% increase, p=0.0179) levels; and $O_3$ with ${\gamma}$-GTP (5.3% increase, p=0.0324) levels. Significant modification of these effects by exercise and alcohol consumption was found (p for interaction <0.05). The effects of air pollutants were greater in non-exercisers and heavy drinkers. Conclusions: Short-term exposure to air pollutants such as $PM_{2.5}$, $NO_2$, and $O_3$ is associated with increased liver enzyme levels in the elderly. These adverse effects can be reduced by exercising regularly and abstinence from alcohol.