Associations between serum isomers of perfluoroalkyl acids and metabolic syndrome in adults: Isomers of C8 Health Project in China

By Wan-Lin Ye, Zan-Xiong Chen, Yan-Qi Xie, Min-Li Kong, Qing-Qing Li, Shu Yu, Chu Chu, Guang-Hui Dong, and Xiao-Wen Zeng
Environ Res
November 17, 2020
DOI: 10.1016/j.envres.2020.110430


Exposure to perfluoroalkyl acids (PFAAs) is known to be associated with metabolic disorders. However, whether PFAAs isomers are associated with metabolic syndrome (MetS) still remains unknown.


To explore the association between serum PFAAs isomers and MetS.


We recruited 1501 adults from a cross-sectional study, the "Isomer of C8 Health Project in China" to investigate the associations between PFAAs isomers and MetS. A total of 20 PFAAs including the isomers of PFOS and PFOA were detected. Logistic regression models and restricted cubic spline models were used to evaluate the relationship of serum PFAAs isomers exposure with MetS and its components as well after adjusting for covariates.


The MetS prevalence in our study was 43.0%. The serum levels of both PFOS and PFOA isomers were higher in participants with MetS than that in non-MetS (p < 0.05). We found positive associations for per natural log-transformed ng/mL of branched perfluorooctane sulfonate (br-PFOS) (odds ratio (OR) = 1.18, 95% confidence interval (CI): 1.01, 1.38)) linear perfluoronanoic acid (n-PFOA) (OR=1.35, 95% CI: 1.16, 1.58) and perfluoro-6-methylpheptanoic acid (6m-PFOA) (OR=1.32, 95% CI: 1.11-1.57) with higher odds of MetS after covariates adjustment, while null association was observed for linear isomers of PFOS (OR=1.09, 95% CI: 0.94, 1.25). We found a nonlinear dose-response relationship with a "threshold" effect in serum br-PFOS isomers with MetS, in which the odds of MetS increased quickly with increase serum br-PFOS isomers under low exposure (p for nonlinearity = 0.030).


We report new evidence of associations between PFAAs isomers and MetS and the nonlinearity of dose-response relationship with br-PFOS isomers. Our findings indicate that more attention is needed to pay on the nonlinearity of dose-response relationship when investigate the association of PFAAs isomers with human health.

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