PFAS Concentrations and Cardiometabolic Traits in Highly Exposed Children and Adolescents

Abstract

Background: Residents of a large area of north-eastern Italy were exposed for decades to high concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFAS) via drinking water. Despite the large amount of evidence in adults of a positive association between serum PFAS and metabolic outcomes, studies focusing on children and adolescents are limited. We evaluated the associations between serum PFAS concentrations that were quantifiable in at least 40% of samples and lipid profile, blood pressure (BP) and body mass index (BMI) in highly exposed adolescents and children. Methods: A cross-sectional analysis was conducted in 6669 adolescents (14–19 years) and 2693 children (8–11 years) enrolled in the health surveillance program of the Veneto Region. Non-fasting blood samples were obtained and analyzed for perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides. Low-density lipoprotein cholesterol (LDL-C) was calculated. Systolic and diastolic BP were measured, and BMI z-score accounting for age and sex was estimated. The associations between ln-transformed PFAS (and categorized into quartiles) and continuous outcomes were assessed using generalized additive models. The weighted quantile sum regression approach was used to assess PFAS-mixture effects for each outcome. Analyses were stratified by gender and adjusted for potential confounders. Results: Among adolescents, significant associations were detected between all investigated PFAS and TC, LDL-C, and to a lesser extent HDL-C. Among children, PFOS and PFNA had significant associations with TC, LDL-C and HDL-C, while PFOA and PFHxS had significant associations with HDL-C only. Higher serum concentrations of PFAS, particularly PFOS, were associated with lower BMI z-score. No statistically significant associations were observed between PFAS concentrations and BP. These results were confirmed by the multi-pollutant analysis. Conclusions: Our study supports a consistent association between PFAS concentration and serum lipids, stronger for PFOS and PFNA and with a greater magnitude among children compared to adolescents, and a negative association of PFAS with BMI.

PFAS levels and determinants of variability in exposure in European teenagers – Results from the HBM4EU aligned studies (2014–2021)

“…In this study, significantly higher concentrations of all four PFAS were observed in boys compared to girls. Similar results were previously observed in children and adolescents ( Canova et al, 2021 ) as well as in adults ( Calafat et al, 2007 ). For adolescent girls, menstruation could be an elimination pathway for PFAS, resulting in lower levels of PFAS in blood ( Colles et al, 2020 ), however, we did not have data on menarche available in all studies.…”

Developmental toxicant exposures and sex-specific effects on epigenetic programming and cardiovascular health across generations

“…For example, PFAS have been associated with increased blood pressure in several different populations of children and adolescents, with some studies identifying sex differences [ 48 ] and others not [ 169 , 170 ]. Other studies, however, have observed no effects on blood pressure [ 171 , 172 ].…”

Per- and polyfluoroalkyl substances concentrations are associated with an unfavorable cardio-metabolic risk profile: findings from two population-based cohort studies

“…Alternatively, it is possible that the timing and duration of a person's exposure impact the effect. For example, early life exposure reportedly has more severe consequences than late-life exposure (Canova et al 2021). Finally, it may be that the intensity of exposure, rather than cumulative exposure, is an important determinant of the physiological impact of PFAS exposure.…”