Associations between Per-and Polyfluoroalkyl Substances Exposures and Blood Lipid Levels among Adults—A Meta-Analysis

By Binkai Liu, Lu Zhu, Molin Wang, and Qi Sun
May 4, 2023
DOI: 10.1289/EHP11840


Associations between per- and polyfluoroalkyl substances (PFAS) and blood lipid levels in humans were mixed.


The objective of this meta-analysis was to summarize associations between PFAS and blood lipids in adults.


A literature search was conducted on PubMed and Web of Science for articles published through 13 May 2022 that examined associations between PFAS and blood lipids, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triacylglycerols (TGs). Inclusion criteria included the presence of associations between five PFAS (PFOA, PFOS, PFHxS, PFDA, and PFNA) and four blood lipid measures (TC, HDL-C, LDL-C, and TGs) in adults. Data on study characteristics and PFAS–lipid associations were extracted. Assessments of individual study quality were performed. Associations of changes of blood lipid levels corresponding to 1 interquartile range (IQR)-unit increase of blood PFAS levels were pooled using random effects models. Dose–response relationships were examined.


Twenty-nine publications were included in the present analyses. Every IQR increase of PFOA was significantly associated with a 2.1 milligram per deciliter2.1-mg/dL2.1-mg/dL increase in TC (95% CI: 1.2, 3.0), a 1.3 milligrams per deciliter1.3-mg/dL1.3-mg/dL increase in TGs (95% CI: 0.1, 2.4), and a 1.4 milligrams per deciliter1.4-mg/dL1.4-mg/dL increase in LDL-C (95% CI: 0.6, 2.2). PFOS was also significantly associated with TC and LDL-C levels, and the corresponding values were 2.6 (95% CI: 1.5, 3.6) and 1.9 (95% CI: 0.9, 3.0), respectively. Associations of PFOS and PFOA with HDL-C levels were largely null. For minor PFAS species, PFHxS was significantly associated with higher levels of HDL-C [0.8 (95% CI: 0.5, 1.2)]. Inverse associations were observed between PFDA and TGs [negative 5.0−5.0−5.0 (95% CI: negative 8.1−8.1−8.1, negative 1.9−1.9−1.9)] and between PFNA and TGs [negative 1.7−1.7−1.7 (95% CI: negative 3.5−3.5−3.5, negative 0.02−0.02−0.02)], whereas a positive association was observed between PFDA and HDL-C [1.4 (95% CI: 0.1, 2.7)]. Nonsignificant nonlinear dose–response relationships were identified for associations of PFOA and PFOS with certain blood lipids.


PFOA and PFOS were significantly associated with TC and LDL-C levels in adults. Whether these findings may translate into an elevated cardiovascular disease risk associated with PFAS exposure warrants further investigation.


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