Individual and joint association between per- and polyfluoroalkyl substances and skeletal muscle among 6-9 years old children in China
By Xue-Mei Liao, Li-Zi Lin, Wan-Ting He, Yun-Ting Zhang, Si-Hui Guo, Shu-Jun Liang, Zhen Hong, Zhe-Qing Zhang, Guang-Hui Dong, and Qin-Zhi Wei
Int J Hyg Environ Health
June 9, 2026
DOI: 10.1016/j.ijheh.2026.114844
Background
Per- and polyfluoroalkyl substances (PFAS) raise growing concerns regarding developmental impacts. Limited evidence exists on their effects on childhood skeletal muscle health, warranting urgent investigation. We aimed to examine the associations of PFAS with skeletal muscle health in children.
Methods
We conducted a cross-sectional study recruiting 422 children (238 boys, 184 girls) from five kindergartens or elementary schools in Guangzhou, China. Skeletal muscle, including appendicular skeletal muscle mass (ASM), appendicular skeletal muscle mass index (ASMI), and appendicular skeletal muscle mass weight ratio, was measured by dual-energy X-ray bone densitometry. Jamar® Plus + Hand Dynamometer was used to measure handgrip strength. The plasma concentrations of 16 PFAS were determined by ultra-performance liquid chromatography-mass spectrometry. Demographic information and dietary intake were collected by questionnaires. We analyzed individual and joint associations between 16 PFAS and skeletal muscle using a multiple linear regression model and a Bayesian kernel machine regression model.
Results
The estimated difference of ASMI for perfluorodecanoic acid, perfluoroundecanoic acid, perfluorododecanoic acid were -0.150 (95%CI: -0.233, -0.066) kg/m, -0.125 (95%CI: -0.183, -0.068) kg/m, and -0.115 (95%CI: -0.180, -0.049) kg/m, respectively. ASM was inversely associated with PFDA (β=-0.215, 95%CI: -0.354, -0.076), PFUdA (β=-0.206, 95%CI: -0.301, -0.110), and PFDoA (β=-0.191, 95%CI: -0.298, -0.084), respectively. PFAS was jointly associated with skeletal muscle, and associations varied significantly by sex.
Conclusions
In this pediatric population, PFAS has a potential adverse impact on muscle development. These findings highlight the importance of considering muscle-specific physiological outcomes when evaluating the health impacts of environmental exposures.
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