Kim Johanna Inhyang, Kim Bung-Nyun, Lee Young Ah, Shin Choong Ho, Hong Yun-Chul, Døssing Lise Dalgaard, Hildebrandt Gustav, Lim Youn-Hee
Department of Psychiatry, Hanyang University Medical Center, 222 Wangsimni-ro, Seondong-gu, Seoul 04763, Republic of Korea.
Division of Children and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, 103 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea.
Sci Total Environ. 2023 Jun 25;879:163081. doi: 10.1016/j.scitotenv.2023.163081. Epub 2023 Mar 25.
There is evidence that exposure to perfluoroalkyl substances (PFAS) is associated with attention-deficit/hyperactivity disorder (ADHD) symptoms. Previous studies have focused on prenatal exposure to PFAS, and only few studies have examined the associations of early-childhood exposure, especially at low exposure levels. This study explored the association between early-childhood exposure to PFAS and ADHD symptoms later in childhood. In 521 children, we measured the serum levels of six PFAS in peripheral blood at the ages of 2 and 4 years, including perfluorooctanoate (PFOA), perfluornonanoicacid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), perfluorohexane sulfonic acid (PFHxS), and perfluorooctane sulfonate (PFOS). The ADHD Rating Scale IV (ARS) was utilized to measure ADHD traits at 8 years of age. We explored the relationship between PFAS and ARS scores using Poisson regression models after adjusting for potential confounders. Levels of exposure to individual PFAS and the summed value were divided into quartiles to examine possible nonlinear relationships. All six PFAS exhibited inverted U-shaped curves. Children in the 2nd and 3rd quartile levels of each PFAS showed higher ARS scores than those in the1 quartile level. Below the 3rd quartile of the summed levels of six PFAS (ΣPFAS), a doubling of the ΣPFAS was associated with an 20.0 % (95 % CI: 9.5 %, 31.5 %) increase in ADHD scores. However, at the age of 4 years, none of the evaluated PFAS exhibited linear or nonlinear associations with the ARS scores. Thus, school-aged children may be vulnerable to the neurotoxic effects of exposure to PFAS at age 2 that contribute to ADHD, particularly at low to mid-levels.
有证据表明，接触全氟烷基物质（PFAS）与注意力缺陷多动障碍（ADHD）症状有关。以往的研究主要集中在产前接触PFAS，只有少数研究探讨了儿童早期接触PFAS的关联，尤其是低暴露水平下的情况。本研究探讨了儿童早期接触PFAS与儿童后期ADHD症状之间的关联。在521名儿童中，我们测量了他们在2岁和4岁时外周血中六种PFAS的血清水平，包括全氟辛酸（PFOA）、全氟壬酸（PFNA）、全氟癸酸（PFDA）、全氟十一烷酸（PFUnDA）、全氟己烷磺酸（PFHxS）和全氟辛烷磺酸（PFOS）。使用ADHD评定量表第四版（ARS）来测量8岁时的ADHD特征。在调整潜在混杂因素后，我们使用泊松回归模型探讨了PFAS与ARS评分之间的关系。将个体PFAS的暴露水平和总和值分为四分位数，以检查可能的非线性关系。所有六种PFAS均呈现倒U形曲线。每种PFAS处于第二和第三四分位数水平的儿童的ARS评分高于第一四分位数水平的儿童。在六种PFAS总和水平（ΣPFAS）的第三四分位数以下，ΣPFAS翻倍与ADHD评分增加20.0%（95%CI：9.5%，31.5%）相关。然而，在4岁时，所评估的PFAS均未与ARS评分呈现线性或非线性关联。因此，学龄儿童可能易受2岁时接触PFAS的神经毒性影响，这可能导致ADHD，尤其是在低至中等暴露水平时。
