Invited Perspective: PFAS and the Childhood Obesity Phenotype-Challenges and Opportunities
By Nikos Stratakis and Martine Vrijheid
Environ Health Perspect
June 7, 2023
DOI: 10.1289/EHP12713
Childhood obesity represents a public health crisis with serious long-term consequences.1 The “metabolism-disrupting chemical” hypothesis postulates that environmental chemicals with endocrine-disrupting ability have the potential to alter the body’s metabolic systems, especially when exposure occurs during sensitive developmental periods, and to increase susceptibility to higher adiposity.2 In line with this hypothesis, per- and polyfluoroalkyl substances (PFAS), a group of manmade chemicals, have received increased attention for their potential obesogenic effects. These chemicals have been widely used in various industrial and commercial applications,3 and owing to their perfluorinated carbon moieties, they are characterized by physical stability, chemical resistance, and environmental persistence. Detectable blood levels have been reported in population studies around the world.4–7 Given that exposures are chronic and widespread across the general population, even modest increases in the relative risk of adverse health effects can translate into a large number of cases of obesity and other related metabolic complications at the population level.
In their new study, Liu et al.8 relied on the Environmental influences on Child Health Outcomes (ECHO) consortium to examine associations between prenatal exposure to PFAS (assessed through maternal serum or plasma concentrations) and childhood obesity. Although not the first to report on this subject, the new study addresses key elements that previous work did not delve into,9 including assessment of sex-specific effects and examination of PFAS exposures as a mixture. The authors found that higher gestational exposure to PFAS was associated with a slightly higher risk of overweight or obesity in children 2–5 years of age, with no evidence of sex specificity. As expected, measured PFAS concentrations were significantly correlated. This probably reflects common exposure sources and provides evidence in favor of the notion that PFAS should be examined and managed as a class.
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