Abstract
BACKGROUND AND AIM: Per- and polyfluoroalkyl substances (PFAS) are ubiquitous in the environment and in serum of the U.S. population. Studies have suggested adverse effects of PFAS exposure on liver function, but the role of alcohol consumption on this association is unclear. We sought to evaluate these relationships in a sample of the U.S. general population. METHODS: Using data from the National Health and Nutrition Examination Survey (2003-2016) (N=11,794), we examined the five most historically prevalent PFAS (PFOA, PFOS, PFHxS, PFNA, and PFDA). We estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between PFAS (quartiles and log-transformed continuous, ng/mL) and high levels of liver biomarkers (95%) using logistic regression models adjusted for demographic characteristics, body mass index (BMI), smoking status, and survey cycle. We evaluated interactions between PFAS and alcohol consumption and sex via stratified analyses, and conducted sub-analyses adjusting for daily alcohol intake among those with available drinking history (N=10,316). RESULTS:Serum PFOA was positively associated with an elevated level in alanine transferase (ALT) without monotonic trend (ORQ4vsQ1=1.45, CI: 0.99-2.12; p-trend=0.18), and with increased aspartate transaminase (AST) when modeled continuously (ORlog=1.15, CI: 1.02-1.30; p-trend=0.03). PFOS and PFHxS were both inversely associated with alkaline phosphatase (ALP) while the trend was statistically significant only for PFHxS (p=0.02). A non-monotonic inverse association was observed with PFOA (p-trend=0.10). The highest quartile of PFOS was associated with increased total bilirubin (ORQ4vsQ1=1.57, CI: 1.01-2.43, p-trend=0.02). No significant association was found between any PFAS and γ-glutamyl transpeptidase. We found no evidence for interactions, and adjustment for daily alcohol consumption did not change our results. CONCLUSIONS:Consistent with other studies, serum PFAS were associated with liver biomarkers, and alcohol intake did not influence these relationships. However, research in populations with more detailed information on alcohol consumption may clarify its impact. KEYWORDS: PFAS, epidemiology, biomarkers of exposure, chemical exposures
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