| Summary: | An association between exposure to air pollution and liver enzymes in certain areas or older people has been reported in the literature; however, it cannot be generalized to the general population. We investigated the association between air pollution, liver enzyme levels, and alcohol consumption using nationwide data of South Korean adults. Air pollutants included particulate matter with an aerodynamic diameter ≤10 µm (PM<sub>10</sub>), nitrogen dioxide (NO<sub>2</sub>), sulfur dioxide (SO<sub>2</sub>), and carbon monoxide (CO). Liver enzymes included alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Exposure to air pollutants were significantly associated with elevation of log ALT and log AST, especially increases from 0.0073 IU/L (95% confidence interval (CI) = 0.0042, 0.0104) to 0.0251 IU/L (95% CI = 0.0132, 0.0371) per interquartile range (IQR) increase of each pollutant (all pollutants: <i>p</i> < 0.001). Association of the liver enzymes with PM<sub>10</sub> (β (95% CI) = 0.0285 IU/L (0.0201, 0.0368) for log ALT; β (95% CI) = 0.0139 IU/L (0.0079, 0.0198) for log AST) and CO (β (95% CI) = 0.0247 IU/L (0.0182, 0.0311) for log ALT; β (95% CI) = 0.0164 IU/L (0.0118, 0.0210) for log AST) were only significant among drinkers. Our findings suggest that chronic exposure to PM<sub>10</sub> and CO is a risk factor for liver enzymes increases among the general adult population who admitted to drinking alcohol.
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