Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea.
Int J Hyg Environ Health. 2024 Aug;261:114427. doi: 10.1016/j.ijheh.2024.114427. Epub 2024 Jul 19.
To explore the effect of mixed exposure to per- and polyfluoroalkyl substances (PFAS) on metabolic syndrome (MetS).
This cross-sectional study used data from the Korean National Environmental Health Survey Cycle 4 (2018-2020). The serum concentrations of five PFAS (perfluorooctanoic acid [PFOA], perfluorooctanesulfonic acid [PFOS], perfluorohexanesulfonic acid, perfluorononanoic acid [PFNA], and perfluorodecanoic acid [PFDeA]) were measured, and the relative potency factor approach was employed for the mixture of PFAS (Cmix) assessment. MetS was diagnosed if the patient satisfied three of five criteria: central obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure (BP), and elevated glycated hemoglobin (HbA1c). Age, sex, smoking, drinking, and exercise status were considered as covariates. The risk of MetS for single and mixed exposure to PFAS was analyzed using binomial regression and Bayesian kernel machine regression (BKMR).
A total of 2984 (male:female = 1:1.3; age range, 19-80 years) adults were enrolled. The prevalence of MetS was 45.6%. Each PFAS and Cmix levels were higher in participants with MetS than in those without MetS. Cmix increased the risk of elevated BP and HbA1c, and eventually MetS (odds ratio [OR] = 2.00, 95% confidence interval [CI] 1.11-3.60 per logCmix; OR = 1.57, 95% CI 1.07-2.31 in the highest quartile of Cmix [Q4] vs. the lowest [Q1]). Sex-specific analyses revealed that the impact of Cmix was valid in females but not in males (Cmix Q4 vs. Q1: OR = 1.01, 95% CI 0.57-1.8 in males; OR = 2.30, 95% CI 1.38-3.84 in females). In the BKMR analysis, mixed exposure to PFAS dose-dependently increased the risk of MetS, particularly in females. Among single exposures, PFNA contributed significantly to the cumulative effect.
Mixed exposure to PFAS was associated with a higher risk of MetS in females. Further studies on potential health concerns associated with PFAS mixtures are warranted.
探讨同时接触全氟和多氟烷基物质（PFAS）对代谢综合征（MetS）的影响。
本横断面研究使用了韩国国家环境健康调查周期 4（2018-2020 年）的数据。测量了血清中五种 PFAS（全氟辛酸 [PFOA]、全氟辛烷磺酸 [PFOS]、全氟己烷磺酸、全氟壬酸 [PFNA]和全氟癸酸 [PFDeA]）的浓度，并采用相对效力因子法评估 PFAS 混合物（Cmix）。如果患者满足以下五个标准中的三个，就诊断为 MetS：中心性肥胖、甘油三酯升高、高密度脂蛋白胆固醇降低、血压升高和糖化血红蛋白（HbA1c）升高。年龄、性别、吸烟、饮酒和运动状况被视为协变量。采用二项式回归和贝叶斯核机器回归（BKMR）分析单因素和混合因素暴露于 PFAS 对 MetS 的风险。
共纳入 2984 名成年人（男：女=1：1.3；年龄范围 19-80 岁）。MetS 的患病率为 45.6%。与无 MetS 者相比，MetS 者的各 PFAS 和 Cmix 水平均较高。Cmix 增加了高血压和 HbA1c 升高以及最终 MetS 的风险（比值比[OR]每 logCmix 增加 2.00，95%置信区间[CI]为 1.11-3.60；Cmix 四分位间距[Q4]与最低[Q1]相比，OR 为 1.57，95%CI 为 1.07-2.31）。性别特异性分析显示，Cmix 的影响在女性中有效，但在男性中无效（男性 Cmix Q4 与 Q1：OR 为 1.01，95%CI 为 0.57-1.8；女性 OR 为 2.30，95%CI 为 1.38-3.84）。在 BKMR 分析中，混合暴露于 PFAS 与 MetS 的风险呈剂量依赖性增加，尤其是在女性中。在单项暴露中，PFNA 对累积效应有显著贡献。
混合接触 PFAS 与女性 MetS 风险增加相关。需要进一步研究 PFAS 混合物相关的潜在健康问题。
