Abstract Continuous exposure to pesticides is associated with both short- and long-term health effects, contributing to cellular and organelle toxicity. Pesticide exposure may also impair the function of internal organs, leading to adverse health outcomes. This study aimed to investigate the association between pesticide exposure and alterations in hematological and biochemical parameters among Thai agricultural workers. Whole blood, serum, plasma, and urine samples were collected from healthy male and female volunteers (control group, n = 57) and farm workers (exposure group, n = 61). A questionnaire was administered to collect personal information and daily lifestyle behaviors. Hematological indices and blood chemistry parameters were subsequently analyzed. Red blood cell count, hemoglobin concentration, and hematocrit levels were significantly decreased (P < 0.05) in female farm workers. Butyrylcholinesterase levels were significantly reduced in male farm workers. There were no statistically significant differences in inflammatory indices between the groups; however, these markers tended to be slightly higher among farm workers. In addition, linear regression analysis demonstrated that the frequency of pesticide use was significantly associated with changes in blood biochemical markers. In summary, our findings indicate that mixed pesticide exposure is associated with alterations in hematological parameters and cholinesterase activity, although no distinct changes were observed in other biochemical markers. These results may contribute to improved agricultural safety practices and support the development of public health services within the community.

Keywords: butyrylcholinesterase, hematological parameters, pesticide exposure

Funding: This research was supported by the Thailand Science Research and Innovation Fund and the University of Phayao (Grant No. 1864/2567).

Citation:  Sillawatthumrong, N., Insuan, O., Chueahongthong, F., Srisuwan, W., Saoin, S., Daorueang, D., Khamchun, S., Intachai, K., Sansai, P., Muangsue, N., and Boriboonwong, E. 2026.  Assessment of pesticide exposure and its effects on biochemical and hematological parameters in agricultural communities. Natural and Life Sciences Communications. 25(3): e2026051.

Graphical Abstract:

INTRODUCTION

Over 3,000,000 people worldwide are exposed to insecticides annually (Ather et al., 2008). Reports on agricultural chemical use in the northern Thailand indicate that the most widely used pesticides are herbicides and insecticides, particularly those in the organophosphate and carbamate classes (Intayoung et al., 2021; Naksen et al., 2023; Jaitham et al., 2024). Pesticide residues can bind tightly to soil particles and pass into water sources, resulting in human consumption, which may lead to bioaccumulation of toxic compounds in the body (Ather et al., 2008). Organophosphate and carbamate pesticides are cholinesterase inhibitors that overstimulate muscles throughout the body, leading to apnea and death from paralysis of the diaphragm (Leibson and Lifshitz, 2008; Lionetto et al., 2013; King et al., 2015; Reddy et al., 2020; Thongjan et al., 2025). Clinical manifestations commonly associated with organophosphate and carbamate poisoning include generalized muscle weakness, dizziness, nausea, excessive sweating, hypotension, bradycardia, and respiratory distress, reflecting their impact on neuromuscular and autonomic functions (Ather et al., 2008; Klaasen, 2008; Lionetto et al., 2013). Toxicity caused by herbicides, such as paraquat and glyphosate, leads to an increased generation of intracellular reactive oxygen species (ROS), resulting in lipid peroxidation and subsequent damage to cells and organelles (Jaitham et al., 2024).  Moreover, mixed pesticide exposure has been linked to a range of adverse health effects, including skin irritation, respiratory tract discomfort, endocrine disruption, neurotoxicity, and an increased risk of chronic diseases, underscoring its significance as a public health concern (Lionetto et al., 2013).

In Thailand, many farmers handle pesticides without adequate knowledge of proper safety procedures, which is associated with increased health risks. Most of the population in Phayao Province, Thailand, is involved in agriculture and extensively uses pesticides to enhance crop yield. Continuous exposure to these chemicals can result in both short- and long-term health effects, leading to various adverse outcomes (Arafa et al., 2013).  A field survey conducted in Mae Chai District, Phayao Province, revealed that the local population expressed a need for support and intervention to address community health problems caused by pesticide use, which has contributed to a range of health issues among residents. Numerous studies have investigated the effects of pesticide use on human health (Aroonvilairat et al., 2015; Hassanin et al., 2018; Bunsri et al., 2023). Previous reports indicated that pesticide users experience significant alterations in hematological indices and blood biochemistry parameters compared to non-users, suggesting an elevated risk of hematological abnormalities as well as hepatic and renal dysfunction (Leili et al., 2022; Bunsri et al., 2023). Furthermore, a study on the effects of organochlorine, organophosphate, and carbamate pesticide exposure in farm workers found that these agents led to a decrease in overall white blood cell count (Piccoli et al., 2019).

Additionally, it has been reported that the combined use of multiple pesticides increases the production of free radicals, particularly reactive oxygen species, which play a crucial role in inducing apoptosis and various pathological conditions (Bagchi et al., 1995). Previous studies have shown that exposure to pesticides increases liver enzymes levels, indicating hepatic injury (Bunsri et al., 2023; Lozano-Paniagua et al., 2023). In particular, prolonged exposure to cholinesterase-inhibiting agricultural pesticides has been associated with significant abnormalities in liver function tests (Karami-Mohajeri et al., 2017; Hassanin et al., 2018; Khan et al., 2023). Furthermore, kidney injury has been reported in farm workers exposed to paraquat (Mueangkhiao et al., 2020). Long-term pesticide exposure (glyphosate, paraquat, iprodione) was significantly correlated with elevated urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL), which is markers indicative of kidney injury. Serum creatinine (Cr) levels, skin rashes and facial irritation were associated with glyphosate exposure (Manfo et al., 2020; Mueangkhiao et al., 2020). 

However, available data on the hematological and biochemical effects of pesticide exposure in Thailand remain limited, particularly regarding studies on biomarkers that are specifically indicative of toxic responses to pesticide exposure.  Therefore, the purpose of this study was to investigate the effects of pesticide toxicity on hematological parameters, as well as liver and kidney functions in a group of Thai farm workers and to examine the factors influencing pesticide exposure and associated blood biochemical markers. The findings of this study can be applied to promote safer agricultural practices, thereby supporting the improvement of public health services within these communities.

MATERIALS AND METHODS

Participant enrollment and area

This study was conducted in an intensely agricultural area in Mae Chai District, Phayao Province, Thailand. The sample size for this study was determined using the G*Power program for an independent two-sample t-test, assuming a medium effect size (d = 0.5), a statistical power of 80%, and a significance level of 5%. To account for an anticipated 10% dropout rate, the calculated sample size was increased accordingly.  One hundred and eighteen healthy adults, aged 20–70 years, were enrolled in this study, including 61 farm workers (27 men and 34 women) who had been exposed to pesticides in the plantation area and 57 control participants (21 men and 36 women) who lived in the same district but engaged in other occupations. Control participants were screened to ensure the absence of both environmental and secondary exposure to pesticides. Those living within 500 meters of agricultural fields or cohabiting with agricultural workers were excluded. Controls were recruited from the same district to maintain comparable sociodemographic and environmental conditions, while ensuring no occupational or significant environmental pesticide exposure, thereby minimizing geographic confounding.

Data collection was conducted between December 2024 and January 2025.  Information obtained from the participants by research staff, using a questionnaire, included personal information, agricultural activities, name of pesticide, duration of employment in farming, personal protective equipment (PPE) use, lifetime adverse reactions post‑exposure, and behaviors in daily lifestyle. Participants who had a congenital disease, chronic disease, or were taking other medicines or cholinesterase inhibitors were excluded.  The study was approved by the University of Phayao Human Ethics Committee, Thailand (Project No. UP-HEC 1.2/113/67). Informed consent was obtained from all the participants prior to commencement of the study. All patient data were kept confidential.

Blood and urine sample collection

Blood samples were collected via venipuncture. The collected blood was placed into two EDTA tubes (2.5 ml per tube). The remaining blood (5 ml) was transferred into a clotted blood tube and allowed to clot completely for at least 30 min. Serum and plasma were separated by centrifugation at 3,000 rpm for 15 min. Whole blood in the EDTA tubes was used for complete blood count (CBC) analysis. A 30 ml random urine sample was obtained from each participant on a scheduled date, placed in a plastic container, kept on a cold pack, and subsequently transported to the laboratory for analysis.

Hematology and blood biochemistry analysis

Blood specimens were analyzed within 24 h. Complete blood and differential cell counts were determined using DYMIND DF55 (Shenzhen Dymind Biotechnology Co., Ltd., China). The complete blood count (CBC) analysis provided various hematological parameters, including white blood cells (WBC), neutrophil, lymphocyte, monocyte, eosinophil, basophil, red blood cells (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and platelets (PLT).

For renal and liver function tests, BUN, creatinine (Cr), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were measured using a Sysmex BX3010 clinical chemistry analyzer (Sysmex, Japan). Urinary microalbumin levels were analyzed using an Alinity C clinic al chemistry analyzer (Abbott, USA). Neutrophil Gelatinase-associated Lipocalin (NGAL) levels were measured using a commercial sandwich enzyme-linked immunosorbent assay kit (ELISA) (R&D Systems, USA). The estimated GFR (eGFR) was calculated based on the serum creatinine level using CKD-EPI 2021 estimating equations (Ilori et al., 2025).

CKD-EPI:

eGFR =142 ×min (Cr/A, 1) B × max (Cr/A, 1) −1.2 × 0.9938Age × (1.012 if female) where (A) was 0.7 for women and 0.9 for men, and (B) was −0.241 for women and −0.302 for men

REFIT:

eGFR =142 ×min(Cr/A, 1)B × max(Cr/A, 1)−1.2 × 0.9938Age × (1.012 if female)

where (A) was 0.7 for women and 0.9 for men, and (B) was −0.241 for women and −0.302 for men

Determination of butyrylcholinesterase (BChE) in plasma

Plasma BChE levels were measured using a modified version of Ellman’s method (Ellman et al., 1961). First, 3,000 µl of 5,5-dithiobisnitrobenzoic acid solution was used to set the zero baseline. Then, 20 µl of the diluted sample was added and mixed gently. After that, 50 µl of 5% butyryl thiocholine iodide was added and mixed. Next, the absorbance of the solution was measured at 405 nm. Finally, BChE activity was calculated and reported in U/L.

Inflammation indices

Inflammation indices were calculated as follows:

Neutrophile-to-lymphocyte ratio (NLR)             =   neutrophils

                                                                            lymphocytes

Platelet-to-lymphocyte ratio (PLR)                       =    platelets

                                                                               lymphocytes

Aggregate index of systemic inflammation (AISI) = (neutrophils)(monocytes)(platelets)

                                                                                        lymphocytes

Monocyte-to-lymphocyte ratio (MLR)               =   monocytes

                                                                          lymphocytes

Systemic immune inflammation index (SII))     =  (platelet)(neutrophils)

                                                                                   lymphocyte

Systemic inflammation response index (SIRI)   = (neutrophils)(monocytes)

                                                                                    Lymphocytes

Statistical analysis

Statistical analyses were performed using SPSS version 29.0 (SPSS Inc., IL, USA). The Kolmogorov–Smirnov test was used to assess the normality of the data distribution. Continuous variables are presented as mean ± standard deviation (SD). Variables that were not normally distributed were log‑transformed prior to comparison and reported as geometric mean ± SD. Independent sample t‑tests and Mann–Whitney U tests were used to compare continuous variables between the two groups, as appropriate. The χ² test was used to analyze categorical variables, such as education level. Multiple regression analysis was conducted to determine predictors of alterations in butyrylcholinesterase and red blood cell parameters associated with various factors related to pesticide use. A two‑tailed P‑value < 0.05 was considered statistically significant.

RESULTS

Demographic profile of the study population

Table 1 presents the descriptive profile data of the control group and farm workers, with average ages of 50.75 ± 13.51 and 54.38 ± 8.53 years, respectively. In addition, their respective average body mass index (BMI) was 23.92 ± 3.77 and 24.12 ± 3.05 kg/m². The survey results revealed a statistically significant difference in education levels between the two groups (P < 0.001), with the control group having a higher level of education. Most participants in both groups had received prior education. In addition, 38% of the control group and 25% of the farm workers reported alcohol consumption. Furthermore, 9% of the control group and 6% of the farm workers reported smoking. The farm workers reported an average duration of farming work of 8.5 years and working 6.2 h/day. Moreover, this group regularly used PPE, including gloves (91.8%), fabric masks (84.0%), long-sleeved shirts and long pants (91.8%), goggles (34.4%), boots (93.4%), and head covers (52.4%), as shown in Table 2. The farm workers were Thai and cultivated various fruits and vegetables, including longan, mangoes, garlic, corn, cassava, and rice. All farm workers enrolled in this study reported using multiple pesticides simultaneously for pest control. The information indicated that 97% of farm workers used mixed pesticides, including paraquat (39.3%), glyphosate (29.5%), and 2,4-dichlorophenoxyacetic acid (3.27%), for weed control. Other pesticides included avermectins and milbemycins (46.0%), organophosphates (7.3%), and carbamates (0.7%). Table 3 shows the various abnormal symptoms after pesticide use, including skin irritation (39.3%), nausea (30.0%), stinging eyes (28.0%), stinging nose (28.0%), throat irritation (8.2%), rash (8.2%), runny nose without fever (6.6%), and muscle spasms (1.6%).

Table 1. Descriptive profile of the control population (N = 57) and farm workers (N = 61) included in the study.

Note: Independent sample t‑tests (*) and chi‑square tests (**) were used to compare continuous and categorical variables between the two groups, respectively. Continuous data are presented as mean ± SD.

Table 2. Demographic profile and overview of pesticide use among farm workers.

Note: a Mean (Min–Max), whereas categorical data are reported as frequencies (n) and percentages.

Table 3. Abnormal symptoms after pesticide use.

Evaluation of hematological and biochemical parameters

A significant difference was observed in the red blood cell count in female farm workers exhibiting lower values than those in the control group. Additionally, hemoglobin and hematocrit levels were significantly reduced in female farm workers (P < 0.001). Notably, no statistically significant changes were detected in the other hematological parameters (Table 4).  Regarding biochemical parameters, there were no significant differences in liver enzyme levels, including AST and ALT, between the groups. Furthermore, renal function markers such as BUN, urine microalbumin, and eGFR also showed no significant differences. It was also observed that the mean serum NGAL levels in female farmers were significantly different from those in female controls (P < 0.001).  In addition, mean serum creatinine levels in both groups remained within the normal reference range (Table 5).

Determination of BChE activity and inflammatory indices

Plasma BChE levels in the farm workers were lower than those in the control group. BChE enzyme levels in male participants from both groups were 4,873.44 ± 810.06 and 4,593 ± 766.72 U/L (control group and farm worker group, respectively). A statistically significant difference (P = 0.007) was observed in BChE enzyme levels between male participants in the control and farm worker groups, with values of 5,150.29 ± 340.53 and 4,675.07 ± 721.49 U/L, respectively. As shown in Figure 1, no significant differences were observed in any of the inflammatory indices (NLR, PLR, AISI, MLR, SII, and SIRI) between the two groups. However, the NLR, PLR, AISI, MLR, SII, and SIRI values in the farm worker group demonstrated only slight increases compared with those in the control group.

Evaluation of association between factors related to pesticide application and changes in serum BChE activity and hematological indices

Predictive associations between factors influencing the use of agricultural pesticides and alterations in butyrylcholinesterase activity and red blood cell parameters were examined using multiple linear regression, as shown in Table 6. The factors considered in the analysis included duration of farm work, number of working hours per day, the amount of agricultural pesticides applied, and the frequency of pesticide use. The model summary indicated R‑square (R²) values of 0.051, 0.054, and 0.064 for BChE, hemoglobin, and hematocrit levels respectively. The findings demonstrated that a higher frequency of pesticide use was significantly associated with increases in BChE activity, hemoglobin concentration, and hematocrit levels.

Table 4. Hematological indices of control and farm worker participants.

Note: Mann-Whitney U test (a) and Independent‑sample t‑tests (b) were used to compare continuous and categorical variables between the two groups, respectively. Continuous data are presented as mean ± SD.  # Data are presented as geometric means ± SD. * Significant differences compared to the control group at P < 0.05.

Table 5. Blood chemistry parameters, and urine microalbumin levels of control and farm worker participants.

Note: Mann-Whitney U test (a) and Independent‑sample t‑tests (b) were used to compare continuous and categorical variables between the two groups, respectively. Continuous data are presented as mean ± SD.  # Data are presented as geometric means ± SD. * Significant differences compared to the control group at P < 0.05.

Table 6. Multiple linear regression predicting alteration of butyrylcholine and red blood cell parameters from pesticide use.

 Note: * Significant differences compared to the control group at P < 0.05.

Figure 1. Inflammatory index between the control group and farm worker group. (A) NLR; (B) PLR; (C); AISI; (D) MLR; (E) SII, and (F) SIRI.

DISCUSSION

This study aimed to assess the effects of pesticide (herbicide, organophosphate and carbamate) toxicity on hematological indices and blood biochemical parameters, including liver function, kidney function, and BChE among Thai farm workers, as well as to identify factors associated with mixed pesticide exposure and changes in blood biochemical markers. We found that the adverse symptoms resulting from pesticide use included stinging eyes, throat irritation, nasal irritation with a runny nose, nausea, skin irritation, and muscle spasms. Additionally, data on PPE usage among farm workers revealed the improper use of protective equipment, such as wearing ordinary cloth masks and non-standard safety goggles, reflecting a lack of knowledge and awareness in this regard. The use of standard and proper PPE, changing clothes immediately after pesticide exposure, as well as washing hands and showering after farm work are important practices that can significantly enhance personal safety (Gesesew et al., 2016; Muñoz-Quezada et al., 2016; Silva et al., 2016). Post-exposure behavior has also been found to play a role in pesticide toxicity. For example, some farm workers washed their hands with only water after handling pesticides, while many waited until they finished working all day on the farm before returning home to shower. This inadequate and delay in decontamination increases the risk of prolonged exposure to pesticides (Prince-Guerra et al., 2020).

The effects of mixed-pesticide exposure on hematological indices in this study showed that pesticide exposure was associated with decreased levels of red blood cells, hemoglobin, and hematocrit. However, no significant changes were observed in white blood cell, neutrophil, monocyte, lymphocyte, and platelet counts. These findings are consistent with those of several previous studies that were unable to demonstrate a clear association between mixed-pesticide exposure and hematological parameters among farm workers. Previous study in orchid farm workers who use mixed-pesticide (paraquat, organophosphate, carbamate and thiophthalimide) found no significant differences in hematological parameters between subjects with high mixed-pesticide exposure and those with no exposure (Aroonvilairat et al., 2015). A study on organophosphate‑exposed farm workers with 2 to 9 years of farming experience found that leukocyte counts were higher in exposed workers compared to non‑exposed individuals (Arafa et al., 2013). According to a study involving grape garden farm workers, organophosphorus‑exposed workers showed a decrease in leukocyte count compared to unexposed individuals, while no significant differences were observed in erythrocytes, hemoglobin, or other hematological parameters (Gaikwad et al., 2015).  Moreover, a study involving cut‑flower farm workers exposed to avermectin and organophosphate pesticides reported significant associations with hemoglobin levels, hematocrit, red blood cell counts, and white blood cell counts (Del Prado‑Lu, 2007).  It has been reported that organophosphate pesticide exposure leads to hematological changes, including increased monocyte, lymphocyte, and platelet indices, alongside decreased hemoglobin, MCH, and MCHC levels (Leili et al., 2022). Moreover, a study conducted among farm workers in China who were exposed to organophosphate pesticides found that both short‑ and long‑term exposure affected blood cells and nervous system functions (Hu et al., 2015). Previous research has demonstrated that long‑term exposure to ivermectin, a derivative of the avermectin class, produces marked alterations in hematological parameters in experimental animals. The study reported slight reductions in hemoglobin, red blood cell count, hematocrit, and MCV, as well as increases in neutrophils, monocytes, and platelets (Mosa et al., 2025). Nevertheless, it has been reported that simultaneous exposure to multiple insecticides may affect hematological indices differently (Hassanin et al., 2018). These effects may vary depending on the type of chemical involved and the individual’s susceptibility to these substances (Lee et al., 2002).

Our finding found that AST and ALT showed no significant differences between the groups and remained within normal reference limits.  Although most investigations on occupational pesticide exposure have documented increased levels of aminotransferases (AST and ALT) associated with pyrethroids, methyl-carbamates exposure (Lozano-Paniagua et al., 2023). Related studies have reported no significant alterations in ALT (Hernández et al., 2006; Gaikwad et al., 2015), in AST (Hsiao et al., 2009), or in both enzymes (Aroonvilairat et al., 2015; Benedetti et al., 2018; Mehta et al., 2025). Although some biomarkers of pesticide exposure indicate only short‑term exposure, long‑term liver toxicity can gradually develop over time. This mismatch between the timing of exposure assessment and the onset of adverse effects may limit our ability to detect chronic liver impacts in this study.

This study found that kidney function parameters, including BUN, creatinine, NGAL, and eGFR, showed no significant differences between the farm worker and control groups. NGAL concentration is a sensitive biomarker for early detection of acute kidney injury and is considered indicative of tubular-specific damage (Jacobson et al., 2021). Previous research suggested that unchanged NGAL levels may be a consequence of the simultaneous use of multiple types of pesticides, and that pesticide exposure does not result in detectable alterations in kidney function (Mueangkhiao et al., 2020). Additionally, NGAL levels in both groups were within the normal range. It has been reported that greenhouse farm workers are exposed to pyrethroids, methyl-carbamates pesticides during both high and low exposure periods; during the low exposure period, no significant changes in microalbuminuria, eGFR, or serum creatinine levels were observed, indicating normal glomerular function (Lozano-Paniagua et al., 2023). However, several reports have shown that both the duration of exposure and the concentration of pesticides can affect kidney function. (Hernández et al., 2006; Damalas and Abdollahzadeh, 2016).

Organophosphate and carbamate pesticides are inhibitors of BChE. The main toxic metabolite in the liver arising from oxidative desulfuration by cytochrome P450 enzymes is oxon, which binds tightly to the esterase site of cholinesterase, resulting in enzyme aging (Reddy et al., 2020). Accumulation of acetylcholine at cholinergic synapses results in the overstimulation of muscarinic and nicotinic cholinergic receptors (Lionetto et al., 2013). Symptoms of toxicity include increased sweating and salivation, bronchial secretion, bronchoconstriction, increased gastrointestinal motility, diarrhea, tremors, muscular twitching, and various central nervous system effects (Dundar, 2014). In this study, the serum BChE levels of male farmers were found to be significantly decreased compared with those of the control group. However, to obtain more comprehensive results, we plan to further incorporate analyses of herbicide‑specific biomarkers, such as urinary herbicide metabolites, in future studies. This will allow us to more accurately reflect and characterize the toxicological effects associated with herbicides in combination with insecticides.

The effects of mixed-pesticide exposure on biochemical and inflammatory indices, no clear biochemical changes were observed. This may be due to other contributing factors, such as the insufficient duration of exposure to cause chronic or significant alterations (Damalas and Abdollahzadeh, 2016). Although our study did not detect significant differences in inflammatory indices (NLR, PLR, AISI, MLR, SII, and SIRI) between the two groups, these indices tended to be slightly higher among farm workers.  Chronic exposure to insecticides can lead to increased white blood cell count, platelet count, and NLR (Nejatifar et al., 2022). NLR and PLR have been reported to be elevated in individuals with severe poisoning, whereas PLR values decrease in individuals exposed to insecticides (Dundar, 2014). Moreover, other indicators, such as AISI, MLR, and SIRI, have been reported to be significantly increased in individuals who experience high pesticide exposure (Ruíz-Arias et al., 2023).

In this study, the frequency of pesticide use was identified as the most influential factor contributing to changes in biochemical indicators, particularly hematological parameters and BChE enzyme levels. This aligns with previous findings reporting that reductions in BChE levels are associated with combined use of organophosphates and carbamates, frequent pesticide application, and ineffective use of personal protective equipment (Krenz et al., 2015). Moreover, lifetime pesticide exposure, frequency of use, and the types of pesticides applied have been shown to significantly affect hematological values (Piccoli et al., 2019).

CONCLUSION

In summary, our findings indicate that agricultural workers exposed to multiple classes of pesticides were associated with abnormal symptoms such as skin irritation, nausea, and eye stinging.  Pesticide exposure also resulted in alterations in red blood cell count, hemoglobin levels, and hematocrit. In addition, butyrylcholinesterase levels were decreased. Future studies should include populations with higher exposure intensity and incorporate analyses of biomarkers that are more specific to mixture of pesticide exposure, thereby enabling a clearer assessment of organ‑specific toxic effects.

ACKNOWLEDGEMENTS

We sincerely thank all participants and the School of Allied Health Sciences, University of Phayao, for their support in providing equipment and laboratory facilities.

AUTHOR CONTRIBUTIONS

Natthapak Sillawatthumrong: Designed (Lead), Conducted all the Experiments (Lead), Wrote the Manuscript (Lead); Orapin Insuan, Fah Chueahongthong, Wibhasiri Srisuwan, Somphot Saoin, Daoyot Daorueang, Supaporn Khamchun and Kannaporn Intachai: Performed Data Collection (Equal), Sample Collection (Equal), Laboratory Analysis (Equal), Data Analysis (Supporting); Plubplung Sansai, Noppadon Muangsue and Ekkapong Boriboonwong: Data Collection (Supporting), Laboratory Analysis (Supporting). All the authors have read and approved the final version of the manuscript.

CONFLICT OF INTEREST

The authors declare that they hold no competing interests.

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