Exposure to Perfluorinated Alkyl Substances and Health Outcomes in Children: A Systematic Review of the Epidemiologic Literature.

Kristen Rappazzo,Evan Coffman,Erin Hines

doi:10.3390/ijerph14070691

Abstract

Perfluoroalkyl substances (PFAS), chemicals used to make products stain and stick resistant, have been linked to health effects in adults and adverse birth outcomes. A growing body of literature also addresses health effects in children exposed to PFAS. This review summarizes the epidemiologic evidence for relationships between prenatal and/or childhood exposure to PFAS and health outcomes in children as well as to provide a risk of bias analysis of the literature. A systematic review was performed by searching PubMed for studies on PFAS and child health outcomes. We identified 64 studies for inclusion and performed risk of bias analysis on those studies. We determined that risk of bias across studies was low to moderate. Six categories of health outcomes emerged. These were: immunity/infection/asthma, cardio-metabolic, neurodevelopmental/attention, thyroid, renal, and puberty onset. While there are a limited number of studies for any one particular health outcome, there is evidence for positive associations between PFAS and dyslipidemia, immunity (including vaccine response and asthma), renal function, and age at menarche. One finding of note is that while PFASs are mixtures of multiple compounds few studies examine them as such, therefore the role of these compounds as complex mixtures remains largely unknown.

Highlights

Perfluoroalkyl substances (PFAS) are highly stable carbon fluorine compounds that have been used since the 1940s as surfactants in products for stain-proof and grease-proof applications.Through biomonitoring the United States (US) population, it is known that certain PFAS are ubiquitous in the US population [1]
We conducted the search in two forms: (1) “simple” wherein PFAS terms were limited to PFOA, perfluorooctane sulfonate (PFOS), PFAS, and PFC and full where all PFAS terms (Table S1) were used
PFAS are often studied as individual compounds but exist as complex mixtures in the environment, and the often studied as individual compounds but exist as complex mixtures in the environment, and the role of of these these mixtures mixtures in in children’s children’s health health is is captured captured

Summary

Introduction

Through biomonitoring the US population, it is known that certain PFAS are ubiquitous in the US population [1] These compounds include perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), and perfluorononanoic acid (PFNA), among others. Like many other environmental compounds, it has been demonstrated that children have a higher body burden, i.e., elevated serum concentrations of a PFAS, versus adults [1,3]. This is thought to be due to mouthing behaviors, time spent on the floor closer to dust sources, different body size to surface area ratios across ages, exposure through placental transfer, or breastfeeding [4]

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