目的:探讨全氟和多氟烷基物质(PFAS)混合暴露对代谢综合征(MetS)的影响。
方法:这项横断面研究使用了韩国国家环境卫生调查周期4(2018-2020)的数据。五种PFAS(全氟辛酸[PFOA],全氟辛烷磺酸[全氟辛烷磺酸],全氟己磺酸,全氟壬酸[PFNA],和全氟癸酸[PFDeA])进行测量,并采用相对效价因子法对PFAS(Cmix)的混合物进行评估。如果患者满足五个标准中的三个:中心性肥胖,甘油三酯升高,降低高密度脂蛋白胆固醇,血压升高(BP),糖化血红蛋白(HbA1c)升高。年龄,性别,吸烟,饮酒,和运动状态被视为协变量。使用二项回归和贝叶斯核机回归(BKMR)分析了单次和混合暴露于PFAS的MetS风险。
结果:共2984名(男性:女性=1:1.3;年龄范围,19-80岁)的成年人参加。MetS的患病率为45.6%。MetS参与者的每个PFAS和Cmix水平高于没有MetS的参与者。Cmix增加了BP和HbA1c升高的风险,最终是MetS(每log10Cmix的比值比[OR]=2.00,95%置信区间[CI]1.11-3.60;在Cmix[Q4]的最高四分位数中,OR=1.57,95%CI1.07-2.31最低的[Q1])。性别特异性分析显示,Cmix的影响对女性有效,但对男性无效(CmixQ4与Q1:男性OR=1.01,95%CI0.57-1.8;女性OR=2.30,95%CI1.38-3.84)。在BKMR分析中,混合暴露于PFAS剂量依赖性增加MetS的风险,尤其是女性。在单次曝光中,PFNA对累积效应有显著贡献。
结论:PFAS的混合暴露与女性MetS的高风险相关。有必要进一步研究与PFAS混合物相关的潜在健康问题。
OBJECTIVE: To explore the effect of mixed exposure to per- and polyfluoroalkyl substances (PFAS) on metabolic syndrome (MetS).
METHODS: This cross-sectional study used data from the Korean National Environmental Health Survey Cycle 4 (2018-2020). The serum concentrations of five PFAS (perfluorooctanoic acid [PFOA], perfluorooctanesulfonic acid [PFOS], perfluorohexanesulfonic acid, perfluorononanoic acid [PFNA], and perfluorodecanoic acid [PFDeA]) were measured, and the relative potency factor approach was employed for the mixture of PFAS (Cmix) assessment. MetS was diagnosed if the patient satisfied three of five criteria: central obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure (BP), and elevated glycated hemoglobin (HbA1c). Age, sex, smoking, drinking, and exercise status were considered as covariates. The risk of MetS for single and mixed exposure to PFAS was analyzed using binomial regression and Bayesian kernel machine regression (BKMR).
RESULTS: A total of 2984 (male:female = 1:1.3; age range, 19-80 years) adults were enrolled. The prevalence of MetS was 45.6%. Each PFAS and Cmix levels were higher in participants with MetS than in those without MetS. Cmix increased the risk of elevated BP and HbA1c, and eventually MetS (odds ratio [OR] = 2.00, 95% confidence interval [CI] 1.11-3.60 per log10Cmix; OR = 1.57, 95% CI 1.07-2.31 in the highest quartile of Cmix [Q4] vs. the lowest [Q1]). Sex-specific analyses revealed that the impact of Cmix was valid in females but not in males (Cmix Q4 vs. Q1: OR = 1.01, 95% CI 0.57-1.8 in males; OR = 2.30, 95% CI 1.38-3.84 in females). In the BKMR analysis, mixed exposure to PFAS dose-dependently increased the risk of MetS, particularly in females. Among single exposures, PFNA contributed significantly to the cumulative effect.
CONCLUSIONS: Mixed exposure to PFAS was associated with a higher risk of MetS in females. Further studies on potential health concerns associated with PFAS mixtures are warranted.