BACKGROUND AND AIM: Perfluoroalkyl acids (PFAAs) are water/stain resistant compounds resistant to metabolic degradation, making them environmentally stable, mobile and bioaccumulative. This leads to high concentrations in wildlife species essential to the cultural identity and subsistence of Arctic populations, including the Inuit. Our objective was to characterize the distribution and exposure determinants of PFAAs among the Inuit adults of Nunavik. METHODS: The study included 443 randomly selected Nunavik residents (Nunavimmiut) aged 16-82 years who participated in the Qanuilirpitaa? 2017 Nunavik Inuit Health Survey. Associations between plasma concentrations of nine PFAAs and country food consumption, drinking water source, and traditional activity participation were examined using multiple linear regression models. RESULTS:PFAAs concentrations among Nunavimmiut were up to seven times higher than those in the general adult Canadian population. After adjustment, above-median consumption of marine mammal, fish, and game bird were associated with increased concentrations of perfluorooctanoic-acid (PFOA), perfluorononanoic-acid (PFNA), perfluorodecanoic-acid (PFDA), perfluoroundecanoic-acid (PFUndA), perfluorohexanesulfonic-acid (PFHxS), and perfluorooctanesulfonic-acid (PFOS). Of note, marine mammal consumption ≥1/week was associated with a 43.2-53.5% increase in PFNA, PFDA, PFUndA, PFHxS, and PFOS (p-values≤0.008). In addition, the omega-3 to omega-6 polyunsaturated fatty acids ratio in red blood cell membranes, indicative of marine mammal and fish consumption, was linearly associated with higher long-chain PFAAs (PFNA, PFDA, PFUdA), including a 97.3% (95% CI: 81.9-115.7%) increase in PFNA, and a 146.2% (95% CI: 118.1-181.1%) increase in PFDA, when contrasting the fourth versus the first quartile of the omega-3/omega-6 ratio. There were no associations between PFAAs and drinking water sources or traditional activities. CONCLUSIONS:The results speak to the importance of characterizing PFAAs exposure in Arctic communities for improved public health messaging on country foods and to provide evidence for actions aimed at reducing PFAAs exposure in the Arctic to protect the exceptional quality of country foods in Nunavik. KEYWORDS: pfas, Community-engaged research, Environmental disparities, Exposure assessment, Long-term exposure, Environmental epidemiology