Concentrations and association between exposure to mixed perfluoroalkyl and polyfluoroalkyl substances and glycometabolism among adolescents

Figures & data

Figure 1. Flow chart of study screening.

Table 1. Characteristics of adolescents in the NHANES, 2009–2018.

Characteristics	N (%) or mean ± SD
Age (years)	14.95 ± 1.96
Gender
Male	400 (52.84)
Female	357 (47.16)
Race
Mexican American	176 (23.25)
Other Hispanic	78 (10.30)
Non-Hispanic White	208 (27.48)
Non-Hispanic Black	185 (24.44)
Other race - including multi-racial	110 (14.53)
Number of people in family
≤3	169 (22.32)
4 to 5	388 (51.25)
>5	200 (26.42)
Annual household income
$0 to $24,999	163 (21.53)
$25,000 to $74,999	313 (41.35)
$75,000 and over	247 (32.63)
Refused	34 (4.49)
BMI (kg/m^2)	24.55 ± 5.60
FBG (mmol/L)	5.28 ± 0.68
INS (µlU/mL)	15.83 ± 13.12
GHB (%)	5.27 ± 0.40

Figure 2. Pairwise correlation of five serum PFASs in adolescents. All correlations were statistically significant (p value < .001).

Table 2. Associations between each serum PFAS (ln-transformed) and the glycometabolism outcomes.

PFASs	Model 1^a			Model 2^b
	β	95% CI	p Values	β	95% CI	p Values
FBG
PFDeA	−0.14	(−0.32, 0.03)	.106	−0.16	(−0.33, 0.02)	.086
PFHxS	−0.70	(−0.20, 0.06)	.280	−0.13	(−0.27, 0.01)	.061
Me-PFOSA-AcOH	−0.17	(−0.30, −0.03)	.014	−0.19	(−0.33, −0.06)	.006
PFNA	−0.08	(−0.23, 0.08)	.337	−0.10	(−0.25, 0.06)	.220
PFUA	−0.18	(−0.38, 0.02)	.072	−0.16	(−0.37, 0.05)	.140
INS
PFDeA	−2.82	(−6.18, 0.54)	.100	−1.91	(−5.35, 1.53)	.277
PFHxS	−2.28	(−4.75, 0.18)	.069	−1.95	(−4.58, 0.68)	.147
Me-PFOSA-AcOH	−1.88	(−4.45, 0.69)	.151	−1.08	(−3.74, 1.59)	.428
PFNA	−0.63	(−3.60, 2.33)	.674	0.01	(−2.99, 3.01)	.995
PFUA	−1.65	(−5.51, 2.21)	.402	0.23	(−3.88, 4.35)	.912
HOMA-IR
PFDeA	−0.96	(−1.90, −0.02)	.044	−0.75	(−1.71, 0.20)	.123
PFHxS	−0.75	(−1.44, −0.07)	.031	−0.71	(−1.45, 0.02)	.057
Me-PFOSA-AcOH	−0.66	(−1.37, 0.06)	.072	−0.45	(−1.19, 0.29)	.235
PFNA	−0.31	(−1.13, 0.52)	.464	−0.15	(−0.99, 0.68)	.721
PFUA	−0.66	(−1.73, 0.41)	.228	−0.19	(−1.34, 0.96)	.745
GHB
PFDeA	−0.04	(−0.14, 0.07)	.489	−0.04	(−0.15, 0.06)	.424
PFHxS	−0.02	(−0.10, 0.05)	.557	−0.02	(−0.10, 0.06)	.610
Me-PFOSA-AcOH	−0.03	(−0.11, 0.05)	.496	−0.02	(−0.10, 0.07)	.713
PFNA	0.07	(−0.03, 0.16)	.158	0.05	(−0.04, 0.15)	.244
PFUA	−0.02	(−0.14, 0.10)	.768	−0.08	(−0.20, 0.05)	.236

Note: Cl: confidence interval.

^aUnadjusted model.

^bAdjusted model, adjusted for age, gender, race, the number of people in a family, household income, and BMI.

p Values < 0.05 are bolded. 

Table 3. Associations between the WQS regression index and glycometabolism in NHANES, 2009–2018.

Outcome	Model 1^a			Model 2^b
	β	95% CI	p Values	B	95% CI	p Values
FBG	−0.04	(−0.12, 0.05)	.391	−0.05	(−0.12, 0.02)	.163
INS	−0.93	(−1.92, 0.06)	.066	−0.86	(−1.88, 0.16)	.098
HOMA-IR	−0.41	(−0.83, 0.02)	.060	−0.26	(−0.54, 0.02)	.068
GHB	0	(−0.05, 0.05)	.966	−0.02	(−0.07, 0.04)	.534

Note: Cl: confidence interval.

^aUnadjusted model.

^bAdjusted model, adjusted for age, gender, race, the number of people in a family, household income, and BMI.

Figure 3. The weight of each PFAS in the WQS model. The figure shows the weights of individual PFAS contributing to the overall effect. WQS model regression index weights for FBG: fasting blood glucose (A), INS: insulin (B), HOMA-IR: homeostasis model of assessment for insulin resistance index (C) and GHB: glycosylated haemoglobin (D).

Figure 4. Combined effects of mixed PFAS exposure on FBG: fasting blood glucose (A), INS: insulin (B), HOMA-IR: homeostasis model of assessment for insulin resistance index (C) and GHB: glycosylated haemoglobin (D) levels in the BKMR model. The relationship between PFASs at other percentiles and outcomes of interest was shown in comparison to the situation where all PFASs were kept at median levels.

Data availability statement

The data that support the findings of this study are openly available in NHANES - National Health and Nutrition Examination Survey Homepage at https://www.cdc.gov/nchs/nhanes/.