Abstract：
BACKGROUND: Although evidence on the association between per- and polyfluoroalkyl substances (PFASs) and human health outcomes has grown exponentially, specific health outcomes and their potential associations with PFASs have not been conclusively evaluated.
METHODS: We conducted a comprehensive search through the databases of PubMed, Embase, and Web of Science from inception to February 29, 2024, to identify systematic reviews with meta-analyses of observational studies examining the associations between the PFASs and multiple health outcomes. The quality of included studies was evaluated using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool, and credibility of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. The protocol of this umbrella review (UR) had been registered in PROSPERO (CRD 42023480817).
RESULTS: The UR identified 157 meta-analyses from 29 articles. Using the AMSTAR measurement tool, all articles were categorized as of moderate-to-high quality. Based on the GRADE assessment, significant associations between specific types of PFASs and low birth weight, tetanus vaccine response, and triglyceride levels showed high certainty of evidence. Moreover, moderate certainty of evidence with statistical significance was observed between PFASs and health outcomes including lower BMI z-score in infancy, poor sperm progressive motility, and decreased risk of preterm birth as well as preeclampsia. Fifty-two (33%) associations (e.g., PFASs and gestational hypertension, cardiovascular disease, etc) presented low certainty evidence. Additionally, eighty-five (55%) associations (e.g., PFASs with infertility, lipid metabolism, etc) presented very low certainty evidence.
CONCLUSIONS: High certainty of evidence supported that certain PFASs were associated with the incidence of low birth weight, low efficiency of the tetanus vaccine, and low triglyceride levels.
METHODS: We conducted a comprehensive search through the databases of PubMed, Embase, and Web of Science from inception to February 29, 2024, to identify systematic reviews with meta-analyses of observational studies examining the associations between the PFASs and multiple health outcomes. The quality of included studies was evaluated using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool, and credibility of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. The protocol of this umbrella review (UR) had been registered in PROSPERO (CRD 42023480817).
RESULTS: The UR identified 157 meta-analyses from 29 articles. Using the AMSTAR measurement tool, all articles were categorized as of moderate-to-high quality. Based on the GRADE assessment, significant associations between specific types of PFASs and low birth weight, tetanus vaccine response, and triglyceride levels showed high certainty of evidence. Moreover, moderate certainty of evidence with statistical significance was observed between PFASs and health outcomes including lower BMI z-score in infancy, poor sperm progressive motility, and decreased risk of preterm birth as well as preeclampsia. Fifty-two (33%) associations (e.g., PFASs and gestational hypertension, cardiovascular disease, etc) presented low certainty evidence. Additionally, eighty-five (55%) associations (e.g., PFASs with infertility, lipid metabolism, etc) presented very low certainty evidence.
CONCLUSIONS: High certainty of evidence supported that certain PFASs were associated with the incidence of low birth weight, low efficiency of the tetanus vaccine, and low triglyceride levels.
摘要：
背景：尽管关于全氟烷基物质和多氟烷基物质（PFASs）与人类健康结果之间关联的证据呈指数级增长，具体的健康结局及其与PFASs的潜在关联尚未得到最终评估.
方法：我们通过PubMed的数据库进行了全面的搜索，Embase,和WebofScience从开始到2024年2月29日，以确定系统评价和荟萃分析的观察性研究，检查PFAS与多种健康结局之间的关联。纳入研究的质量使用A测量工具评估系统评价（AMSTAR）工具，并使用建议分级来评估证据的可信度，评估,发展,和评估（等级）标准。该总括审查（UR）的方案已在PROSPERO（CRD42023480817）中注册。
结果：UR从29篇文章中确定了157个荟萃分析。使用AMSTAR测量工具，所有文章均被归类为中至高质量.根据等级评估，特定类型的PFAS与低出生体重之间存在显着关联，破伤风疫苗反应，和甘油三酯水平显示出较高的证据确定性。此外，在PFAS和健康结局之间观察到具有统计学意义的证据的中度确定性，包括婴儿期较低的BMIz评分，精子进行性运动性差，降低早产和先兆子痫的风险。52个(33%)协会(例如，PFASs与妊娠期高血压,心血管疾病,等)提出了低确定性证据。此外,85个(55%)协会(例如，患有不孕症的PFASs，脂质代谢，等)提出了确定性非常低的证据。
结论：证据的高度确定性支持某些PFAS与低出生体重的发生率有关，破伤风疫苗的低效率，和低甘油三酯水平。
方法：我们通过PubMed的数据库进行了全面的搜索，Embase,和WebofScience从开始到2024年2月29日，以确定系统评价和荟萃分析的观察性研究，检查PFAS与多种健康结局之间的关联。纳入研究的质量使用A测量工具评估系统评价（AMSTAR）工具，并使用建议分级来评估证据的可信度，评估,发展,和评估（等级）标准。该总括审查（UR）的方案已在PROSPERO（CRD42023480817）中注册。
结果：UR从29篇文章中确定了157个荟萃分析。使用AMSTAR测量工具，所有文章均被归类为中至高质量.根据等级评估，特定类型的PFAS与低出生体重之间存在显着关联，破伤风疫苗反应，和甘油三酯水平显示出较高的证据确定性。此外，在PFAS和健康结局之间观察到具有统计学意义的证据的中度确定性，包括婴儿期较低的BMIz评分，精子进行性运动性差，降低早产和先兆子痫的风险。52个(33%)协会(例如，PFASs与妊娠期高血压,心血管疾病,等)提出了低确定性证据。此外,85个(55%)协会(例如，患有不孕症的PFASs，脂质代谢，等)提出了确定性非常低的证据。
结论：证据的高度确定性支持某些PFAS与低出生体重的发生率有关，破伤风疫苗的低效率，和低甘油三酯水平。
