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. 2025 Mar 12:13:1545164.
doi: 10.3389/fpubh.2025.1545164. eCollection 2025.

Association of ethylene oxide exposure with serum neurofilament light chain levels among American adults

Xiuwen Yang #  1 , Huaili Feng #  1 , Ting You  1 , Zhaoyi Liu  1 , Fanwei Sun  2 , Chengzhi Chen  1 , Jingfu Qiu  1
Affiliations

Association of ethylene oxide exposure with serum neurofilament light chain levels among American adults

Xiuwen Yang et al. Front Public Health. .

Abstract

Objective: To explore the relationship between Ethylene oxide (EO) expousure and serum neurofilament light chain (NfL).

Method: A data of 559 adults from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) was analyzed, and the relationship between log-transformed EO hemoglobin adducts (HbEO) and serum NfL levels was assessed using multiple linear regression models and restricted cubic spline functions. Stratified analysis was conducted to explore the correlations within different subgroups. Mediation analysis was employed to investigate potential mediating factors.

Results: The higher HbEO levels were consistently associated with elevated serum NfL concentrations among the study participants (β = 0.07, 95%CI: 0.00-0.14; p = 0.044), and serum NfL levels increased with rising HbEO levels (p for trend = 0.013). The restricted cubic spline results confirmed the linear relationship between serum NfL and HbEO. Subgroup analysis indicated a significant positive correlation, particularly among non-Hispanic white people, individuals aged 40-59, and heavy drinkers.

Conclusion: These findings highlighted the neurotoxic potential of EO and underscored the importance of monitoring EO exposure to mitigate its adverse health effects.

Keywords: NHANES; adults; ethylene oxide; neurofilament light chain; neurotoxicity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the inclusion of the study population.
Figure 2
Figure 2
A directed acyclic graph (DAG) represents potential covariates and mediating variables in the relationship between ln-HbEO (exposure) and ln-sNfL (outcome). Yellow circles represent the common ancestry variable (i. e., confounders) between the exposure variables and the outcome variables, and green circles represent the potential mediating variables.
Figure 3
Figure 3
β (95%CI) of ln-sNfL across quartiles of ln-HbEO in multiple linear regression models, as well as the trend test.
Figure 4
Figure 4
Restricted Cubic Spline (RCS) plots of the relationship between ln-HbEO and ln-sNfL. Adjusted for gender, age, ethnicity, annual household income, education level, alcohol consumption and serum cotinine.
Figure 5
Figure 5
Mediation analysis of the relationship between EO exposure and serum NfL levels. (A) Blood pressure [(i) systolic pressure, (ii) diastolic pressure]. (B) Blood glucose [(i) HbA 1 c, (ii) fasting blood glucose]. (C) Blood lipids [(i) HDL, (ii) LDL, (iii) total cholesterol, (iv) triglycerides]. (D) Body mass index. (E) The potential mediating role of serum NfL levels in the relationship between EO and depression.
See this image and copyright information in PMC

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