Jaeyong Lee, Mun-Joo Bae, Mi-Ji Kim, Sung Soo Oh, Ki Soo Park, Chan Joo Lee, Sungha Park, Seung-Koo Lee, Sang-Baek Koh, Hyeon Chang Kim, Changsoo Kim, Jaelim Cho
J Prev Med Public Health. 2025;58(6):563-571. Published online July 12, 2025
Objectives Polycyclic aromatic hydrocarbons (PAHs), byproducts of incomplete combustion of organic compounds, have been linked to various adverse health outcomes; however, evidence associating PAHs with liver damage remains inconsistent. This study aimed to investigate the relationship between PAH exposure and liver enzyme levels among firefighters, who have an increased risk of PAH exposure.
Methods A total of 961 firefighters were included in the study. Urinary concentrations of 4 PAH metabolites (2-naphthol, 2-hydroxyfluorene, 1-hydroxyphenanthrene, and 1-hydroxypyrene) were measured and categorized into quartiles. Serum levels of liver enzymes, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were evaluated. Age, smoking status, alcohol consumption, body mass index (BMI), job position, and self-reported disease history were adjusted as covariates. Multivariable linear regression analyses were conducted to assess the association between PAH metabolites and serum AST and ALT levels. Logistic regression analyses evaluated associations between PAH metabolites and abnormal AST and ALT levels, defined as 40 IU/L or higher.
Results Participants in the highest quartile of urinary 2-naphthol had an increased risk of abnormal ALT levels compared to those in the lowest quartile (odds ratio, 2.00; 95% confidence interval, 1.09 to 3.65). No significant associations were observed for the other PAH metabolites. The association between urinary 2-naphthol and abnormal ALT levels did not differ significantly by smoking status, alcohol consumption, or BMI.
Conclusions Elevated urinary 2-naphthol levels were associated with abnormal liver enzyme levels among firefighters, suggesting that monitoring and managing PAH exposure may help protect liver health in this occupational group.
Summary
Korean summary
이 연구는 한국 소방관을 대상으로 요중 다환방향족탄화수소 대사체와 간 효소 수치의 연관성을 조사하였다. 연구 결과, 요중 2-naphthol 수치가 가장 높은 사분위수에 속하는 참가자들은 가장 낮은 사분위수와 비교하여 비정상 ALT 수치를 보일 위험이 유의하게 높았다. 이러한 결과는 다환방향족탄화수소 노출을 모니터링하고 관리하는 것이 소방관의 간 건강 보호에 중요한 역할을 할 수 있음을 시사한다.
Key Message
This study investigated the association between urinary polycyclic aromatic hydrocarbon (PAH) metabolites and serum liver enzyme levels among Korean firefighters. Results showed that participants in the highest quartile of urinary 2-naphthol had a significantly increased odds of having abnormal ALT levels compared to those in the lowest quartile. These findings suggest that monitoring and managing PAH exposure may play an important role in protecting the liver health of firefighters.
Objectives C-reactive protein (CRP), an inflammatory biomarker, has been widely used as a preclinical marker predictive of morbidity and mortality. Although many studies have reported a positive association between CRP and mortality, uncertainty still remains about this association in various populations, especially in rural Korea.
Methods A total of 23 233 middle-aged participants (8862 men and 14 371 women) who were free from cardiovascular disease, cancer, and acute inflammation (defined by a CRP level ≥10 mg/L) were drawn from 11 rural communities in Korea between 2005 and 2011. Blood CRP concentration was analyzed as a categorical variable (low: 0.0-0.9 mg/L; intermediate: 1.0-3.0 mg/L; high: 3.1-9.9 mg/L) as well as a continuous variable. Each participant’s vital status through December 2013 was confirmed by death statistics from the National Statistical Office. Cox proportional hazard models were used to assess the independent association between CRP and mortality after adjusting for other risk factors.
Results The total quantity of observed person-years was 57 975 for men and 95 146 for women, and the number of deaths was 649 among men and 367 among women. Compared to the low-CRP group, the adjusted hazard ratio for all-cause mortality of the intermediate group was 1.17 (95% confidence interval [CI], 0.98 to 1.40) for men and 1.27 (95% CI, 1.01 to 1.61) for women, and the corresponding values for the high-CRP group were 1.98 (95% CI, 1.61 to 2.42) for men and 1.41 (95% CI, 1.03 to 1.95) for women. Similar trends were found for CRP evaluated as a continuous variable and for cardiovascular mortality.
Conclusions Higher CRP concentrations were associated with higher mortality in a rural Korean population, and this association was more prominent in men than in women.
Summary
Citations
Citations to this article as recorded by
Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study Ju-Yeun Lee, Ji Hoon Hong, Sangjun Lee, Seokyung An, Aesun Shin, Sue K. Park, Tariq Jamal Siddiqi PLOS ONE.2022; 17(6): e0270510. CrossRef
Association of serum high-sensitivity C reactive protein with risk of mortality in an Asian population: the Health Examinees cohort Sang-Ah Lee, Sung Ok Kwon, Hyerim Park, Xiao-Ou Shu, Jong-Koo Lee, Daehee Kang BMJ Open.2022; 12(7): e052630. CrossRef
Associations of C-reactive protein and fibrinogen with mortality from all-causes, cardiovascular disease and cancer among U.S. adults Junxiu Liu, Yanan Zhang, Carl J. Lavie, Fred K. Tabung, Jiting Xu, Qingwei Hu, Lixia He, Yunxiang Zhang Preventive Medicine.2020; 139: 106044. CrossRef
Sex differences in the association between self-rated health and high-sensitivity C-reactive protein levels in Koreans: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey Se-Won Park, Seong-Sik Park, Eun-Jung Kim, Won-Suk Sung, In-Hyuk Ha, Boyoung Jung Health and Quality of Life Outcomes.2020;[Epub] CrossRef