Per- and polyfluoroalkyl substances and bone mineral content in early adolescence: Modification by diet and physical activity

BACKGROUND

Per- and polyfluoroalkyl substance (PFAS) exposures may negatively impact bone mineral accrual, but little is known about potential mitigators of this relation. We assessed whether associations of PFAS and their mixture with bone mineral content (BMC) in adolescence were modified by diet and physical activity.

METHODS

We included 197 adolescents enrolled in a prospective pregnancy and birth cohort in Cincinnati, Ohio (2003-2006). At age 12 years, we collected serum for PFAS measurements and used dual-energy x-ray absorptiometry to measure BMC. We calculated dietary calcium intake and Health Eating Index (HEI) scores from repeated 24-h dietary recalls, physical activity scores using the Physical Activity Questionnaire for Older Children (PAQ-C), and average moderate to vigorous physical activity (MVPA) based on accelerometry. We estimated covariate-adjusted differences in BMC z-scores per interquartile range (IQR) increase of individual PFAS concentrations using linear regression and per simultaneous IQR increase in all four PFAS using g-computation. We evaluated effect measure modification (EMM) using interaction terms between each modifier and PFAS.

RESULTS

Higher serum perfluorooctanoic acid, perfluorooctanesulfonic acid, and perfluorononanoic acid concentrations and the PFAS mixture were associated with lower BMC z-scores. An IQR increase in all PFAS was associated with a 0.27 (-0.54, 0.01) lower distal radius BMC z-score. Associations with lower BMC were generally stronger among adolescents classified as < median for calcium intake, HEI scores, or MVPA compared to those ≥ median. The difference in distal radius BMC z-score per IQR increase in all PFAS was -0.38 (-0.72, -0.04) for those with

CONCLUSION

Healthy, calcium-rich diets and higher intensity physical activity may mitigate the adverse impact of PFAS on adolescent bone health.

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Key Words

• Adolescent health
• Bone mineral content
• Calcium
• Diet
• Perfluoroalkyl substances
• Physical activity

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MESH Headings Collapse

Grants

• R01 ES028277 NIEHS NIH HHS

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Affiliation(s)

Jessie P Buckley Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Junyi Zhou Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
Katherine M Marquess Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
Bruce P Lanphear Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
Kim M Cecil Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
Aimin Chen Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
Clara G Sears Christina Lee Brown Envirome Institute, Department of Medicine, Division of Environmental Medicine, University of Louisville, KY, USA
Yingying Xu Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
Kimberly Yolton Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
Heidi J Kalkwarf Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
Joseph M Braun Department of Epidemiology, Brown University, Providence, USA
Jordan R Kuiper Department of Environmental and Occupational Health, The George Washington University Milken Institute School of Public Health, Washington, D.C., USA

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