Per- and polyfluoroalkyl substances and blood lipid levels in pre-diabetic adults—longitudinal analysis of the diabetes prevention program outcomes study. (August 2019)

• Record Type: Journal Article
• Authors: Lin, Pi-I D.; Cardenas, Andres; Hauser, Russ; Gold, Diane R.; Kleinman, Ken P.; Hivert, Marie-France; Fleisch, Abby F.; Calafat, Antonia M.; Webster, Thomas F.; Horton, Edward S.; Oken, Emily
• Is Part Of: Environment international. Volume 129(2019)
• Page Start: 343
• Page End: 353
• Publication Date: 2019-08
• Subjects: ATP-II National Cholesterol Education Program adult treatment panel guideline -- CDC centers for disease control and prevention -- CI confidence interval -- CVD cardiovascular disease -- DPP diabetes prevention program -- DPPOS diabetes prevention program outcome study -- EtFOSAA 2-(N-Ethyl-perfluorooctane sulfonamido) acetic acid -- GAM generalized additive models -- HDL high-density lipoprotein -- HR hazard ratios -- LDL low-density lipoprotein -- LOD limit of detection -- MeFOSAA 2-(N-Methyl-perfluorooctane sulfonamido) acetic acid -- NHANES National Health and Nutrition Examination Surveys -- NIDDK National Institute of Diabetes and Digestive and Kidney Diseases -- n-PFOA linear PFOA -- n-PFOS linear PFOS -- PFAS per- and polyfluoroalkyl substances -- PFHxS perfluorohexane sulfonic acid -- PFNA perfluorononanoic acid -- PFOA perfluorooctanoic acid (sum of linear and branched isomers) -- PFOS perfluorooctanesulfonic acid (sum of linear and branched isomers) -- Sb-PFOA sum of perfluoromethylheptanoic and perfluorodimethylhexanoic acids -- SD standard deviation -- Sm2-PFOS sum of perfluorodimethylhexane sulfonic acid isomers -- Sm-PFOS sum of perfluoromethylheptane sulfonic acid isomers -- VLDL very low-density lipoprotein; Lipid and cholesterol -- Hyperlipidemia -- Per- and polyfluoroalkyl substances -- Environmental epidemiology -- Lifestyle intervention -- Prospective assessment; Environmental protection -- Periodicals; Environmental health -- Periodicals; Environmental monitoring -- Periodicals; Environmental Monitoring -- Periodicals; Environnement -- Protection -- Périodiques; Hygiène du milieu -- Périodiques; Environnement -- Surveillance -- Périodiques; Environmental health; Environmental monitoring; Environmental protection; Periodicals; 333.705
• DOI: 10.1016/j.envint.2019.05.027
• Languages: English
• ISSNs: 0160-4120

Abstract

Abstract: Exposure to per - and polyfluoroalkyl substances (PFASs) may interfere with lipid regulation. However, most previous studies were cross-sectional with the risk of reverse causation, suggesting a need for long-term prospective studies. We examined the relationship of baseline plasma PFAS concentrations with repeated measures of blood lipids. We included 888 prediabetic adults from the Diabetes Prevention Program (DPP) and DPP Outcomes Study, who had measurements of 6 plasma PFAS concentrations at baseline (1996–1999) and repeated measures of blood lipids over 15 years of follow-up, and were initially randomized to placebo or a lifestyle intervention. We used linear regression to examine cross-sectional associations of PFAS concentrations and lipid levels at baseline, and evaluated prospective risks of hypercholesterolemia and hypertriglyceridemia using Cox proportional hazard models, and tested for effect modification by study arm. Participants (65.9% female, 57.0% White, 65.9% aged 40–59 years) had comparable PFAS concentrations [ e.g., median (IQR) perfluorooctanoic acid (PFOA) 4.9 ng/mL (3.2)] with the general U.S. population in 1999–2000. We observed higher total cholesterol at baseline per doubling of PFOA (β: 6.1 mg/dL, 95% CI: 3.1, 9.04), perfluorohexane sulfonic acid (PFHxS, β: 2.2 mg/dL, 95% CI: 0.2, 4.3), and perfluorononanoic acid (PFNA, β: 2.9 mg/dL, 95% CI: 0.7, 5.0). Prospectively, baseline concentrations of several PFASs, including PFOA, PFOS, PFHxS and PFNA, predicted higher risks of incident hypercholesterolemia and hypertriglyceridemia, but only in the placebo group and not the lifestyle intervention group. For example, participants in the placebo group with PFOA concentration > median (4.9 ng/mL) were almost twice as likely (HR: 1.90, 95% CI: 1.25, 2.88) to develop hypertriglyceridemia compared to those ≤median. Findings suggest adverse effects of some PFASs on lipid profiles in prediabetic adults. However, the detrimental effect was attenuated with a lifestyle intervention. Highlights: PFAS may disrupt lipid regulation. We examined PFAS-lipid relationship in prediabetic adults over 15 years. Plasma PFAS concentrations had positive cross-sectional associations with total cholesterol level. Risk of dyslipidemia was elevated in relation to baseline PFAS levels. Lifestyle behaviors may attenuate the adverse effect on lipid profile.