Mapping the association between environmental pollutants and steatotic liver disease: a systematic review and meta-analysis

Abstract Introduction Environmental pollution poses increasing threats to public health, particularly in metabolic disorders. Steatotic liver disease (SLD) is characterized by metabolic dysfunctions of the liver and affects over one-third of the global population. However, whether exposure to environmental pollutants would increase the risk of SLD remains poorly understood. Aim To evaluate the association between exposure to environmental pollutants and the SLD risk. Methods A systematic search of Medline, Embase, and Web of Science databases, along with manually reviewed reference lists, was conducted from inception until May 30, 2025. Observational studies reporting quantitative effect estimates of environmental pollutants and SLD risk in adults were included, following PRISMA and MOOSE guidelines. Random-effect models were applied to pool the data. Results A total of 34 studies were included. Environmental pollutants in this study were categorized as air pollutants, endocrine-disrupting chemicals (EDCs), and heavy metals. Significant associations with increased SLD risk were observed for particulate matter (PM2.5: OR = 1.23; PM10: OR = 1.07; PM1: OR = 1.45) and nitrogen dioxide (NO 2 : OR = 1.19) per 10 μg/m³ increase. Among EDCs, exposure to bisphenol A (BPA: OR = 1.42), MECPP (OR = 1.43), MEHHP (OR = 1.54), MEOHP (OR = 1.38), and PFOA (OR = 1.23) was correlated with elevated SLD risk. Exposure to heavy metals, including lead (Pb: OR = 1.61), cadmium (Cd: OR = 2.32), mercury (Hg: OR = 2.41), barium (Ba: OR = 1.16), arsenic (As: OR = 1.09), and cobalt (Co: OR = 1.18) was significantly associated with increased SLD risk. Conclusions Exposure to a wide range of environmental pollutants significantly increased SLD risk, underscoring the need for public health interventions to mitigate pollutant exposure and its contribution to SLD development.