Associations between per- and polyfluoroalkyl substances, liver function, and daily alcohol consumption in a sample of U.S. adults

Short-chain per- and polyfluoroalkyl substances associate with elevated alanine aminotransferase: Cross-sectional analysis results from the STRIVE cohort

BACKGROUND

The impact of short-chain, low molecular weight polyfluoroalkyl substances (PFAS) and long-chain, high molecular weight PFAS on elevated alanine aminotransferase (ALT) remains unclear. Additionally, demographic and behavioral factors influencing PFAS levels in the U.S. population are not well understood.

OBJECTIVES

To examine (1) associations between short- and long-chain PFAS mixtures and elevated ALT, and (2) participant characteristics linked to PFAS levels.

METHODS

This study included 378 adults (196 with detailed liver disease evaluations and 135 with cirrhosis), aged 40-75 years, from the Southern Liver Health Study (STRIVE), an ongoing prospective cohort. Logistic regression assessed associations between serum PFAS and elevated ALT. Quantile g-computation evaluated PFAS mixture effects, while linear regression identified demographic and behavioral factors linked to PFAS levels.

RESULTS

A one-quartile increase in short-chain PFAS mixture levels was associated with higher odds of elevated ALT (adjusted odds ratio [aOR], 95% confidence interval [CI]: 2.14, 1.31-3.50; P=0.002) and higher log-transformed ALT levels (adjusted β, 95% CI: 0.09, 0.01-0.17; P=0.02). Long-chain PFAS mixtures showed no significant association. Individually, perfluoroheptanoic acid (a short-chain PFAS) (aOR, 95% CI: 1.51, 1.001-2.27; P=0.049) and perfluorohexanesulfonic acid (a long-chain PFAS) (aOR, 95% CI: 1.53, 1.08-2.15; P=0.015) were positively associated with elevated ALT. PFAS levels were lower in bottled water users but higher in current alcohol users. Males and older individuals exhibited higher long-chain PFAS levels, whereas non-water drinkers and current everyday smokers had lower levels of long-chain PFAS.

DISCUSSION

Higher short-chain PFAS mixture levels were linked to elevated ALT, with individual PFAS levels varying by sex and lifestyle factors. Limiting short-chain PFAS exposure may help prevent liver injury.

The effect and potential mechanisms of per- and polyfluoroalkyl substances (PFAS) exposure on kidney stone risk

Exposure to per- and polyfluoroalkyl substances (PFAS) may be associated with an increased prevalence of some kidney diseases. Kidney stones are common and have a high prevalence of kidney diseases. However, there is no evidence for the effect and potential mechanisms of PFAS on kidney stone risk. In this study, we designed a cross-sectional study using the National Health and Nutrition Examination Surveys (NHANES) data from 2017 to 2020. Our results revealed that PFAS were positively associated with kidney stone risk, and PFDA was the main contributing compound among PFAS. The triglyceride-glucose (TyG) index and the systemic immune-inflammatory (SII) index had significant mediation effects. In addition, target proteins, such as IL-6, TNF, ALB, IL-1B, and AKT1, and signaling pathways, including TNF and IL-17 pathways, might be potential mechanisms of PFAS in promoting kidney stone risk. In conclusion, PFAS, especially PFDA, increases the risk of kidney stones by the mediation effects of the TyG index and SII index. TNF and IL-17 signaling pathways may be potential mechanisms. Our findings provide new evidence for the effects and potential mechanisms of PFAS exposure in increasing kidney stone risk. However, in the future, it is still imperative to further explore and validate the underlying mechanisms of PFAS-induced kidney stone formation through experimental studies.

Association between exposure to 35 environmental pollutants and mortality from cerebrovascular diseases: A long-term prospective study

Environmental pollutants have been implicated in various detrimental health effects. However, the specific relationship between environmental pollutant exposure and the risk of cerebrovascular disease mortality remains uncertain. This study aimed to comprehensively explore the potential relationship between environmental pollutant exposure and risk of cerebrovascular disease mortality in the U.S. population. Data on 35 types of environmental pollutant exposure were extracted from the National Health and Nutrition Examination Survey (NHANES). Cerebrovascular disease-related deaths were ascertained from the National Center for Health Statistics, with mortality follow-up data available until December 31, 2019. Weighted univariable and multivariable Cox regression analyses were employed to evaluate the association between environmental pollutants and mortality from cerebrovascular diseases. A total of 11,643 participants were included for organochlorine pesticides, 11,912 for brominated flame retardants, 13,797 for per- and polyfluoroalkyl substances, and 14,560 for phthalates, with a median follow-up of 8.6 years. The average age of participants was approximately 46 years, with male participants comprising around 48 % of the cohort. Four types of organochlorine pesticides (hexachlorobenzene, oxychlordane, 2,2-Bis(4-chlorophenyl)-1,1-dichloroethene, and trans-nonachlor), perfluorooctanoic acid, and mono-n-butyl phthalate were found to be associated with an increased risk of cerebrovascular disease mortality. Furthermore, the composite environmental index derived from these six pollutants also demonstrated a significant correlation with elevated cerebrovascular disease mortality risk. This prospective study provides evidence of an association between certain environmental pollutant exposure (especially for organochlorine pesticides) and risk of cerebrovascular disease mortality. These findings provide new insights into potential prevention strategies for this disease mortality from the perspective of environmental pollutant exposure.

Triglycerides mediate the relationships of per- and poly-fluoroalkyl substance (PFAS) exposure with nonalcoholic fatty liver disease (NAFLD) risk in US participants

Nonalcoholic fatty liver disease (NAFLD) is recognized as a significant public health problem worldwide. Several clinical studies have investigated the associations between Per- and poly-fluoroalkyl substances (PFAS) compounds with the risk of NAFLD in general adults, but the mediating effect of triglycerides (TG) was remained unexplored. In this study, 6990 individuals from the National Health and Nutrition Examination Survey (NHANES, 2003-2018) database were enrolled. Firstly, the results of generalized linear models (GLM) and restricted cubic splines (RCS) revealed positive associations of PFAS compounds with NAFLD risk score and liver function, and nearly linear E-R curves indicated no safe threshold. Meanwhile, weighted quantile sum (WQS) regression demonstrated the relationships between PFAS mixtures with NAFLD risk score and liver function, as well as perfluorooctanoic acid (PFOA) was identified as the main contributor to the increased NAFLD risk. Then, mediation analysis was conducted to explore whether serum lipids mediate the relationships. It further highlighted significant mediation effects of TG, with the mediated proportion ranging from 10.4 % to 42.9 %. Finally, sensitivity and stratified analyses were performed, confirming the reliability of these findings. Notably, significant associations were observed in individuals with a BMI ≥ 28, highlighting that these relationships were particularly evident in obese participants. In conclusion, our study suggested that PFAS mixtures exposure may influence NAFLD risk score by mediating TG in human metabolism. This result could provide more comprehensive epidemiological evidence and guide clinical applications.

Association of per- and polyfluoroalkyl substances with the antioxidant bilirubin across pregnancy

BACKGROUND

In mechanistic and preliminary human studies, prenatal exposure to per- and polyfluoroalkyl substances (PFAS) is associated with oxidative stress, a potential contributor to maternal liver disease. Bilirubin is an endogenous antioxidant abundant in the liver that may serve as a physiological modulator of oxidative stress in pregnant people. Hence, our objective was to estimate the association between repeated measures of PFAS and bilirubin during pregnancy.

METHODS

The study population included 332 participants in the Atlanta African American Maternal-Child Cohort between 2014 and 2020. Serum samples were collected up to two times (early pregnancy: 6-18 gestational weeks; late pregnancy: 21-36 gestational weeks) for the measurement of perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and total bilirubin. We analyzed single PFAS with linear mixed effect regression and a mixture of the four PFAS with quantile g-computation. Models were repeated with a multiplicative interaction term to explore effect modification by study visit.

RESULTS

Overall, PFHxS was positively associated with bilirubin (β = 0.08, 95 % CI = 0.01, 0.15). We also found during late pregnancy, there was a positive association of PFHxS and the PFAS mixture with bilirubin (β = 0.12, 95 % CI = 0.02, 0.22; ψ = 0.19, 95 % CI = 0.03, 0.34, respectively). Finally, study visit modified the PFOA-bilirubin association (interaction p-value = 0.09), which was greater during early pregnancy (β = 0.08, 95 % CI = 0.01, 0.15).

CONCLUSION

In a prospective cohort of pregnant African Americans, an increase in PFOA, PFHxS, and the PFAS mixture was associated with an increase in bilirubin. Our results suggest that, depending on pregnancy stage, prenatal PFAS exposure disrupts the maternal liver antioxidant capacity.

Structural investigation of the complexation between vitamin B12 and per- and polyfluoroalkyl substances: Insights into degradation using density functional theory

Environmental remediation of per- and polyfluoroalkyl substances (PFAS) has become a significant research topic in recent years due to the fact that these materials are omnipresent, resistant to degradation and thus environmentally persistent. Unfortunately, they have also been shown to cause health concerns. PFAS are widely used in industrial applications and consumer products. Vitamin B12 (B12) has been identified as being catalytically active towards a variety of halogenated compounds such as PFAS. It has also been shown to be effective when using sulfide as a reducing agent for B12. This is promising as sulfide is readily available in the environment. However, there are many unknowns with respect to PFAS interactions with B12. These include the reaction mechanism and B12's specificity for PFAS with certain functionalization(s). In order to understand the specificity of B12 towards branched PFAS, we examined the atomistic interactions between B12 and eight different PFAS molecules using Density Functional Theory (B3LYP/cc-pVDZ). The PFAS test set included linear PFAS and their branched analogs, carboxylic acid and sulfonic acid headgroups, and aromatic and non-aromatic cyclic structures. Conformational analyses were carried out to determine the lowest energy configurations. This analysis showed that small chain PFAS such as perfluorobutanoic acid interact with the cobalt center of B12. Bulkier PFAS prefer to interact with the amine and carbonyl groups on the sidechains of the B12 ring system. Furthermore, computed complexation energies determined that, in general, branched PFAS (e.g. perfluoro-5-methylheptane sulfonic acid) interact more strongly than linear molecules (e.g. perfluorooctanesulfonic acid). Our results indicate that it may be possible to alter the interactions between B12 and PFAS by synthetically modifying the sidechains of the ring structure.

Mechanisms of colon toxicity induced by long-term perfluorooctanoic acid exposure in mice

Perfluorooctanoic acid (PFOA), a persistent organic pollutant known for its chemical stability, is widely dispersed in the environment, posing significant health risks to mammals through various exposure routes such as ingestion, inhalation, and dermal contact. In this study, mice were exposed to PFOA (0, 0.2, 2 mg/L) through drinking water for 180 days to investigate its toxic effects on the colon. We identified differentially expressed genes through RNA sequencing and validated the impact of PFOA on the expression of these genes in colon tissue. Our findings revealed that long-term exposure to PFOA caused inflammatory bowel disease (IBD)-like damage to the mouse colon. We found PFOA could induce damage to the intestinal barrier. Inhibition of the Wnt signaling pathway following PFOA exposure results in impaired stem cell function in the colon of mice. Furthermore, PFOA activated the PPAR signaling pathway, disrupting cellular lipid metabolism in colon tissues. Additionally, PFOA induced inflammatory responses in colon tissue, facilitating NLR family, pyrin domain containing 3 (NLRP3) inflammasome activation and cell apoptosis. This study offers a thorough understanding of the mechanisms responsible for the damage to mouse colon tissue resulting from long-term exposure to PFOA.

Characterizing Important Dietary Exposure Sources of Perfluoroalkyl Acids in Inuit Youth and Adults in Nunavik Using a Feature Selection Tool

BACKGROUND

Previous studies have identified the consumption of country foods (hunted/harvested foods from the land) as the primary exposure source of perfluoroalkyl acids (PFAA) in Arctic communities. However, identifying the specific foods associated with PFAA exposures is complicated due to correlation between country foods that are commonly consumed together.

METHODS

We used venous blood sample data and food frequency questionnaire data from the Qanuilirpitaa? ("How are we now?") 2017 (Q2017) survey of Inuit individuals ≥ 16 y of age residing in Nunavik (n = 1,193 ). Adaptive elastic net, a machine learning technique, identified the most important food items for predicting PFAA biomarker levels while accounting for the correlation among the food items. We used generalized linear regression models to quantify the association between the most predictive food items and six plasma PFAA biomarker levels. The estimates were converted to percent changes in a specific PFAA biomarker level per standard deviation increase in the consumption of a food item. Models were also stratified by food type (market or country foods).

RESULTS

Perfluorooctanesulfonic acid (PFOS), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) were associated with frequent consumption of beluga misirak (rendered fat) [14.6%; 95% confidence interval (CI): 10.3%, 18.9%; 14.6% (95% CI: 10.1%, 19.0%)], seal liver [9.3% (95% CI: 5.0%, 13.7%); 8.1% (95% CI: 3.5%, 12.6%)], and suuvalik (fish roe mixed with berries and fat) [6.0% (95% CI: 1.3%, 10.7%); 7.5% (95% CI: 2.7%, 12.3%)]. Beluga misirak was also associated with higher concentrations of perfluorohexanesulphonic acid (PFHxS) and perfluorononanoic acid (PFNA), albeit with lower percentage changes. PFHxS, perfluorooctanoic acid (PFOA), and PFNA followed some similar patterns, with higher levels associated with frequent consumption of ptarmigan [6.1% (95% CI: 3.2%, 9.0%); 5.1% (95% CI: 1.1%, 9.1%); 5.4% (95% CI: 1.8%, 9.0%)]. Among market foods, frequent consumption of processed meat and popcorn was consistently associated with lower PFAA exposure.

CONCLUSIONS

Our study identifies specific food items contributing to environmental contaminant exposure in Indigenous or small communities relying on local subsistence foods using adaptive elastic net to prioritize responses from a complex food frequency questionnaire. In Nunavik, higher PFAA biomarker levels were primarily related to increased consumption of country foods, particularly beluga misirak, seal liver, suuvalik, and ptarmigan. Our results support policies regulating PFAA production and use to limit the contamination of Arctic species through long-range transport. https://doi.org/10.1289/EHP13556.

Preparation, Structural Identification, and Screening of Egg-Derived Peptides with Facilitating Alcohol Metabolism Activity

The aim of this study was to obtain egg-derived peptides with facilitating alcohol metabolism (EPs) by enzymolysis, to identify their structures, and screen small polypeptides with higher activity by molecular docking. The optimum conditions for preparing EPs with facilitating alcohol metabolism were obtained by a single factor experiment, adding 2% Protamex and performing enzymolysis for 3 h with a liquid-material ratio of 35:1. The dose-response relationship experiment showed that 800 mg/kg·bw EPs played a better role in facilitating alcohol metabolism. EPs contained 40% hydrophobic amino acids (HAA), including 9.24% Leu. Eighty-four peptides were identified by HPLC-MS/MS and four peptides with potential activation of alcohol dehydrogenase were further selected by molecular docking. The tetrapeptide Trp-Ile-Val-Asp (WIVD) with the highest binding energy reached -7.16 kcal/mol. These findings suggest that egg is a good source for the preparation of peptides with facilitating alcohol metabolism activity.

Interaction between the oxidative balance score and serum per- and poly-fluoroalkyl substances (PFASs) on liver health: analysis of the NHANES 2007-2018 dataset

BACKGROUND

Per- and poly-fluoroalkyl substances (PFASs) are pervasive synthetic compounds, prompting investigations into their intricate interactions with lifestyle factors and health indicators because of their enduring environmental presence and bioaccumulation. This study aimed to explore the effects of the oxidative balance score (OBS) and PFAS on liver-related indices.

METHODS

Twenty dietary and lifestyle factors were used to calculate the OBS. The serum concentrations of PFASs were measured, and their sum was calculated for analysis. The levels of liver markers were also evaluated. Linear regression models and interaction analyses were used to assess the associations between OBS, PFAS concentrations, and liver indices.

RESULTS

The results revealed an inverse association between high OBS and perfluorooctane sulfonic acid concentration, as well as the sum of PFAS concentrations. OBS was positively associated with liver markers. The PFAS concentrations were positively associated with total bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels. Interaction analyses revealed significant interactions between OBS and specific PFASs for alkaline phosphatase (interaction P < 0.05). Possible interactions were also found between OBS and specific PFASs for ALT, and AST levels (interaction P < 0.10).

CONCLUSIONS

This study clarified the association between total PFAS and OBS. This association was significant mainly for diet-related OBS. PFAS and OBS are associated with liver-related indicators in the blood.

The Association of Perfluoroalkyl Substance Exposure and a Serum Liver Function Marker in Korean Adults

Perfluoroalkyl substances (PFAS), widely used throughout industry and daily life, are currently one of the environmental pollutants garnering the most attention worldwide. Recently, environmental pollutants have had a high profile as one of the main causes of chronic liver disease, such as non-alcoholic fatty liver disease. Research on PFAS is actively underway. Although Korea has a remarkably high prevalence of chronic liver disease, and it continues to increase, only a few studies have revealed the relationship between PFAS and liver disease. In addition, regulations on PFAS in Korea are delayed compared to developed countries, such as Europe and the United States, and public interest is insufficient compared to others. Therefore, we would like to investigate the exposure of Koreans to PFAS in the blood and examine the relationship between these substances and markers of liver function (AST, ALT, and GGT). This study was based on the results of the Korean National Environmental Health Survey (KoNEHS) 2018–2020 (Cycle 4), and a total of 2961 subjects were selected. The concentration of PFAS in the blood of Korean adults was measured to be significantly higher based on the geometric mean compared to the results of recently investigated American adults based on the National Health and Nutrition Examination Survey (NHANES, 2017-2018). A multivariable linear regression analysis adjusted for age, sex, body mass index (BMI), smoking status, alcohol intake, and regular exercise was performed to examine changes in three liver function markers as the serum PFAS concentration increased. We found that some of the five PFAS (PFOA, PFOS, PFHxS, PFNA, and PFDeA) were significantly associated with increased liver enzymes. It is necessary to recognize the threat of PFAS to the human body and to discuss regulations and alternatives in earnest. Continuous follow-up studies are required through a well-designed cohort.

Association of per- and polyfluoroalkyl substances with hepatic steatosis and metabolic dysfunction-associated fatty liver disease among patients with acute coronary syndrome

Etiology of hepatic steatosis and metabolic dysfunction-associated fatty liver disease (MAFLD) among acute coronary syndrome (ACS) remains unclear. Existing studies suggested the potential role of per- and polyfluoroalkyl substances (PFAS) in comorbidity of hepatic steatosis among ACS patients. Therefore, we conducted a cross-sectional study based on the ACS inpatients to assess the associations of plasma PFAS congeners and mixtures with hepatic steatosis and MAFLD. This study included 546 newly diagnosed ACS patients. Twelve PFAS were quantified using ultra-high-performance liquid chromatography-tandem mass spectrometry. Hepatic steatosis was defined by hepatic steatosis index (HSI). MAFLD was defined as the combination of hepatic steatosis based on the risk factor calculation with metabolic abnormalities. Generalized linear model was used to examine the associations of PFAS congeners with HSI and MAFLD. Adaptive elastic net (AENET) was further used for PFAS congeners selection. Mixture effects were also assessed with Bayesian kernel machine regression model (BKMR). Congeners analysis observed significant greater percent change of HSI for each doubling in PFOS (1.82%, 95% CI: 0.87%, 2.77%), PFHxS (1.17%, 95% CI: 0.46%, 1.89%) and total PFAS (1.84%, 95% CI: 0.56%, 3.14%). Moreover, each doubling in PFOS (OR=1.42, 95% CI: 1.13, 1.81), PFHxS (OR=1.31, 95% CI: 1.09, 1.59) and total PFAS (OR=1.43, 95% CI: 1.06, 1.94) was associated with increased risk of MAFLD. In AENET regression, only PFOS presented significant positive associations with HSI. Mixture analysis indicated significant positive associations between PFAS mixtures and HSI. This is the first study to demonstrate associations of PFAS congeners and mixtures with hepatic steatosis and MAFLD among ACS patients, which provides hypothesis into the mechanisms behind comorbidity of hepatic steatosis among ACS patients, as well as tertiary prevention of ACS.