Background: Nonalcoholic fatty liver disease (NAFLD) is becoming a global health problem. Bisphenol A (BPA), one of most widely used environmental chemicals, is suspected to be a contributor to the development NAFLD. This study was performed to examine the relationship between human BPA levels and risk of NAFLD. Methods: The data (n = 3476 adults: 1474 men and 2002 women) used in this study were obtained from the Korean National Environmental Health Survey III (2015-2017). BPA levels were measured in urine samples. NAFLD was defined using hepatic steatosis index after exclusion of other causes of hepatic diseases. Results: There was a significant linear relationship between the elevated urinary BPA concentrations and risk of NAFLD. In a univariate analysis, odds ratio (OR) of the highest quartile of urinary BPA level was 1.47 [95% confidence interval (CI) 1.11-1.94] compared to the lowest quartile. After adjusted with covariates, the ORs for NAFLD in the third and fourth quartiles were 1.31 [95% CI 1.03-1.67] and 1.32 [95% CI 1.03–1.70], respectively. Conclusions: Urinary BPA levels are positively associated with the risk of NAFLD in adults. Further experimental studies are needed to understand the molecular mechanisms of BPA on NAFLD prevalence.

Mercury is widely distributed in the environment, and a plausible association between mercury exposure and hepatic damage has been reported. Non-alcoholic fatty liver disease (NAFLD), which comprises a spectrum of liver diseases, has recently been recognized in non-obese subjects. However, there have been no studies on the relationship between internal mercury levels and NAFLD in non-obese individuals. Therefore, we investigated the association between blood mercury levels and NAFLD in non-obese subjects. Cross-sectional data (n = 5919) were obtained from the Korean National Environmental Health Survey (2012–2014). NAFLD was defined using the hepatic steatosis index (HSI). Blood mercury levels were log-transformed and divided into quartiles based on a weighted sample distribution. The association between blood mercury levels and NAFLD was analyzed using a multivariate logistic analysis after body mass index stratification. The geometric mean of blood mercury in the overweight group was significantly higher than that of the non-obese group (p < 0.001). The weighted frequencies of patients with NAFLD based on the HSI were 3.0–7.2% for the non-obese subjects and 52.3–63.2% for the overweight subjects. In the multivariate analysis, blood mercury levels were positively associated with NAFLD for both the overweight and non-obese groups (all p for trend < 0.001). Increased blood mercury levels are closely associated with NAFLD. In particular, mercury could be a risk factor for NAFLD in the non-obese population.