REFERENCES
1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78:1966-86.
2. Zhang L, El-Shabrawi M, Baur LA, et al. An international multidisciplinary consensus on pediatric metabolic dysfunction-associated fatty liver disease. Med. 2024;5:797-815.e2.
3. Lee EJ, Choi M, Ahn SB, et al. Prevalence of nonalcoholic fatty liver disease in pediatrics and adolescents: a systematic review and meta-analysis. World J Pediatr. 2024;20:569-80.
4. Miao L, Targher G, Byrne CD, Cao YY, Zheng MH. Current status and future trends of the global burden of MASLD. Trends Endocrinol Metab. 2024;35:697-707.
5. Sun DQ, Targher G, Byrne CD, et al. An international Delphi consensus statement on metabolic dysfunction-associated fatty liver disease and risk of chronic kidney disease. Hepatobiliary Surg Nutr. 2023;12:386-403.
6. Zhou XD, Targher G, Byrne CD, et al. An international multidisciplinary consensus statement on MAFLD and the risk of CVD. Hepatol Int. 2023;17:773-91.
7. Mann JP, Valenti L, Scorletti E, Byrne CD, Nobili V. Nonalcoholic fatty liver disease in children. Semin Liver Dis. 2018;38:1-13.
8. Deierlein AL, Rock S, Park S. Persistent endocrine-disrupting chemicals and fatty liver disease. Curr Environ Health Rep. 2017;4:439-49.
9. Pan K, Xu J, Xu Y, Wang C, Yu J. The association between endocrine disrupting chemicals and nonalcoholic fatty liver disease: a systematic review and meta-analysis. Pharmacol Res. 2024;205:107251.
10. Ghassabian A, Vandenberg L, Kannan K, Trasande L. Endocrine-disrupting chemicals and child health. Annu Rev Pharmacol Toxicol. 2022;62:573-94.
12. Dong Y, Zhai L, Zhang L, Jia L, Wang X. Bisphenol A impairs mitochondrial function in spleens of mice via oxidative stress. Mol Cell Toxicol. 2013;9:401-6.
13. Shaibi T, Balug HN, Ben-Othman ME, et al. Exposure to low-dose bisphenol A induces spleen damage in a murine model: potentially through oxidative stress? Open Vet J. 2022;12:23-32.
14. Li D, Suh S. Health risks of chemicals in consumer products: a review. Environ Int. 2019;123:580-7.
15. Rivera-Núñez Z, Kinkade CW, Zhang Y, et al. Phenols, parabens, phthalates and puberty: a systematic review of synthetic chemicals commonly found in personal care products and girls' pubertal development. Curr Environ Health Rep. 2022;9:517-34.
16. Braun JM. Early-life exposure to EDCs: role in childhood obesity and neurodevelopment. Nat Rev Endocrinol. 2017;13:161-73.
17. Cai S, Fan J, Ye J, Rao X, Li Y. Phthalates exposure is associated with non-alcoholic fatty liver disease among US adults. Ecotoxicol Environ Saf. 2021;224:112665.
18. Kim D, Yoo ER, Li AA, et al. Elevated urinary bisphenol A levels are associated with non-alcoholic fatty liver disease among adults in the United States. Liver Int. 2019;39:1335-42.
19. Lei R, Xue B, Tian X, et al. The association between endocrine disrupting chemicals and MAFLD: evidence from NHANES survey. Ecotoxicol Environ Saf. 2023;256:114836.
20. Park B, Kim B, Kim CH, Oh HJ, Park B. Association between endocrine-disrupting chemical mixtures and non-alcoholic fatty liver disease with metabolic syndrome as a mediator among adults: A population-based study in Korea. Ecotoxicol Environ Saf. 2024;276:116310.
21. Verstraete SG, Wojcicki JM, Perito ER, Rosenthal P. Bisphenol a increases risk for presumed non-alcoholic fatty liver disease in Hispanic adolescents in NHANES 2003-2010. Environ Health. 2018;17:12.
22. Midya V, Colicino E, Conti DV, et al. Association of prenatal exposure to endocrine-disrupting chemicals with liver injury in children. JAMA Netw Open. 2022;5:e2220176.
23. Xiang S, Dong J, Li X, Li C. Urine phthalate levels and liver function in US adolescents: analyses of NHANES 2007-2016. Front Public Health. 2022;10:843971.
24. Zhang Y, Dong T, Hu W, et al. Association between exposure to a mixture of phenols, pesticides, and phthalates and obesity: comparison of three statistical models. Environ Int. 2019;123:325-36.
25. Billionnet C, Sherrill D, Annesi-Maesano I. Estimating the health effects of exposure to multi-pollutant mixture. Ann Epidemiol. 2012;22:126-41.
26. Huc L, Lemarié A, Guéraud F, Héliès-Toussaint C. Low concentrations of bisphenol A induce lipid accumulation mediated by the production of reactive oxygen species in the mitochondria of HepG2 cells. Toxicol In Vitro. 2012;26:709-17.
27. Su HY, Lai CS, Lee KH, Chiang YW, Chen CC, Hsu PC. Prenatal exposure to low-dose di-(2-ethylhexyl) phthalate (DEHP) induces potentially hepatic lipid accumulation and fibrotic changes in rat offspring. Ecotoxicol Environ Saf. 2024;269:115776.
28. Nowak K, Jabłońska E, Ratajczak-Wrona W. Immunomodulatory effects of synthetic endocrine disrupting chemicals on the development and functions of human immune cells. Environ Int. 2019;125:350-64.
29. Liu K, Tang S, Liu C, et al. Systemic immune-inflammatory biomarkers (SII, NLR, PLR and LMR) linked to non-alcoholic fatty liver disease risk. Front Immunol. 2024;15:1337241.
30. He P, Zhang Y, Ye Z, et al. A healthy lifestyle, life's essential 8 scores and new-onset severe NAFLD: a prospective analysis in UK biobank. Metabolism. 2023;146:155643.
31. Wang L, Yi J, Guo X, Ren X. Associations between life's essential 8 and non-alcoholic fatty liver disease among US adults. J Transl Med. 2022;20:616.
32. Aimuzi R, Xie Z, Qu Y, Jiang Y, Luo K. Associations of urinary organophosphate esters metabolites and diet quality with nonalcoholic/metabolic dysfunction-associated fatty liver diseases in adults. Ecotoxicol Environ Saf. 2023;254:114720.
33. Liu Q, Fan G, Bi J, et al. Associations of polychlorinated biphenyls and organochlorine pesticides with metabolic dysfunction-associated fatty liver disease among Chinese adults: effect modification by lifestyle. Environ Res. 2024;240:117507.
34. Zhang Y, Fu Y, Guan X, et al. Associations of ambient air pollution exposure and lifestyle factors with incident dementia in the elderly: a prospective study in the UK Biobank. Environ Int. 2024;190:108870.
35. Lee JH, Kim D, Kim HJ, et al. Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis. 2010;42:503-8.
36. Yang M, Su W, Li H, et al. Association of per- and polyfluoroalkyl substances with hepatic steatosis and metabolic dysfunction-associated fatty liver disease among patients with acute coronary syndrome. Ecotoxicol Environ Saf. 2023;264:115473.
37. Hu P, Pan C, Su W, et al. Associations between exposure to a mixture of phenols, parabens, and phthalates and sex steroid hormones in children 6-19 years from NHANES, 2013-2016. Sci Total Environ. 2022;822:153548.
38. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79:1542-56.
39. Tudurachi BS, Anghel L, Tudurachi A, Sascău RA, Stătescu C. Assessment of inflammatory hematological ratios (NLR, PLR, MLR, LMR and monocyte/HDL-cholesterol ratio) in acute myocardial infarction and particularities in young patients. Int J Mol Sci. 2023;24:14378.
40. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20:6212-22.
41. World Health Organization (WHO). Child growth standards; 2006. Available from: https://www.who.int/toolkits/child-growth-standards/standards/body-mass-index-for-age-bmi-for-age [Last accessed on 12 Sep 2025].
42. Ku PW, Steptoe A, Liao Y, Hsueh MC, Chen LJ. A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants. BMC Med. 2018;16:74.
43. Lau JH, Nair A, Abdin E, et al. Prevalence and patterns of physical activity, sedentary behaviour, and their association with health-related quality of life within a multi-ethnic Asian population. BMC Public Health. 2021;21:1939.
44. Chau JY, Grunseit AC, Chey T, et al. Daily sitting time and all-cause mortality: a meta-analysis. PLoS One. 2013;8:e80000.
45. Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320:2020-8.
46. Hirshkowitz M, Whiton K, Albert SM, et al. National sleep foundation's sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1:40-3.
47. Shams-White MM, Pannucci TE, Lerman JL, et al. Healthy eating index-2020: review and update process to reflect the dietary guidelines for Americans,2020-2025. J Acad Nutr Diet. 2023;123:1280-8.
48. Huang S, Zhong D, Lv Z, et al. Associations of multiple plasma metals with the risk of metabolic syndrome: A cross-sectional study in the mid-aged and older population of China. Ecotoxicol Environ Saf. 2022;231:113183.
49. Carrico C, Gennings C, Wheeler DC, Factor-Litvak P. Characterization of weighted quantile sum regression for highly correlated data in a risk analysis setting. J Agric Biol Environ Stat. 2015;20:100-20.
50. Bobb JF, Valeri L, Claus Henn B, et al. Bayesian kernel machine regression for estimating the health effects of multi-pollutant mixtures. Biostatistics. 2015;16:493-508.
51. Wu L, Zhang J, Xin Y, et al. Associations between phenols, parabens, and phthalates and depressive symptoms: The role of inflammatory markers and bioinformatic insights. Ecotoxicol Environ Saf. 2024;286:117191.
52. Feng C, Yang B, Wang Z, et al. Relationship of long-term exposure to air pollutant mixture with metabolic-associated fatty liver disease and subtypes: a retrospective cohort study of the employed population of Southwest China. Environ Int. 2024;188:108734.
53. Takefuji Y. Drug-induced inflammation: a review of literature. Chem Biol Interact. 2024;404:111282.
54. Gofton C, Upendran Y, Zheng MH, George J. MAFLD: how is it different from NAFLD? Clin Mol Hepatol. 2023;29:S17-31.
55. Kasongo AA, Leroux M, Amrouche-Mekkioui I, Belhadji-Domecq M, Aguer C. BPA exposure in L6 myotubes increased basal glucose metabolism in an estrogen receptor-dependent manner but induced insulin resistance. Food Chem Toxicol. 2022;170:113505.
56. Gear RB, Belcher SM. Impacts of bisphenol A and ethinyl estradiol on male and female CD-1 mouse spleen. Sci Rep. 2017;7:856.
57. Shi X, Wang W, Feng J, Ma X, Xu M, Wang C. Gender-specific abdominal fat distribution and insulin resistance associated with organophosphate esters and phthalate metabolites exposure. Environ Pollut. 2024;349:123959.
58. Shoshtari-Yeganeh B, Zarean M, Mansourian M, et al. Systematic review and meta-analysis on the association between phthalates exposure and insulin resistance. Environ Sci Pollut Res Int. 2019;26:9435-42.
59. Zhou J, Shu R, Yu C, et al. Exposure to low concentration of trifluoromethanesulfonic acid induces the disorders of liver lipid metabolism and gut microbiota in mice. Chemosphere. 2020;258:127255.
60. Somani SM, Khalique A. Distribution and metabolism of 2,4-dichlorophenol in rats. J Toxicol Environ Health. 1982;9:889-97.
61. Zhang W, Shen XY, Zhang WW, Chen H, Xu WP, Wei W. Di-(2-ethylhexyl) phthalate could disrupt the insulin signaling pathway in liver of SD rats and L02 cells via PPARγ. Toxicol Appl Pharmacol. 2017;316:17-26.
62. Kratochvil I, Hofmann T, Rother S, et al. Mono(2-ethylhexyl) phthalate (MEHP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) but not di(2-ethylhexyl) phthalate (DEHP) bind productively to the peroxisome proliferator-activated receptor γ. Rapid Commun Mass Spectrom. 2019;33 Suppl 1:75-85.
63. Ding Y, Gao K, Liu Y, et al. Transcriptome analysis revealed the mechanism of the metabolic toxicity and susceptibility of di-(2-ethylhexyl)phthalate on adolescent male ICR mice with type 2 diabetes mellitus. Arch Toxicol. 2019;93:3183-206.
64. Yu L, Yang M, Cheng M, et al. Associations between urinary phthalate metabolite concentrations and markers of liver injury in the US adult population. Environ Int. 2021;155:106608.
65. Lucas A, Herrmann S, Lucas M. The role of endocrine-disrupting phthalates and bisphenols in cardiometabolic disease: the evidence is mounting. Curr Opin Endocrinol Diabetes Obes. 2022;29:87-94.
66. Chen L, Chen J, Xie CM, Zhao Y, Wang X, Zhang YH. Maternal disononyl phthalate exposure activates allergic airway inflammation via stimulating the phosphoinositide 3-kinase/akt pathway in rat pups. Biomed Environ Sci. 2015;28:190-8.
67. Zhang Y, Qian H, Wang J, et al. Di-(2-ethylhexyl) phthalate (DEHP) promoted hepatic lipid accumulation by activating Notch signaling pathway. Environ Toxicol. 2023;38:1628-40.
68. Michalopoulou E, Thymis J, Lampsas S, et al. The triad of risk: linking MASLD, cardiovascular disease and type 2 diabetes; from pathophysiology to treatment. J Clin Med. 2025;14:428.
69. Kim H, Kil M, Han C. Urinary phthalate metabolites and anemia: findings from the Korean national environmental health survey (2015-2017). Environ Res. 2022;215:114255.
70. Li CL, Yao ZY, Zhang YF, et al. Bisphenols exposure and non-alcoholic fatty liver disease: from environmental trigger to molecular pathogenesis. Front Endocrinol. 2025;16:1606654.
71. Pirozzi C, Lama A, Annunziata C, et al. Oral bisphenol A worsens liver immune-metabolic and mitochondrial dysfunction induced by high-fat diet in adult mice: cross-talk between oxidative stress and inflammasome pathway. Antioxidants. 2020;9:1201.
72. Zhang Y, Wang S, Zhao T, et al. Mono-2-ethylhexyl phthalate (MEHP) promoted lipid accumulation via JAK2/STAT5 and aggravated oxidative stress in BRL-3A cells. Ecotoxicol Environ Saf. 2019;184:109611.
