Greater exposure to PFAS endocrine-disrupting chemicals increases diabetes risk for women
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Middle-aged women exposed to higher levels of the endocrine-disrupting chemical class of perfluoroalkyl and polyfluoroalkyl substances, or PFAS, have an increased risk for developing diabetes, according to study data.
“Given that almost all people are exposed to these known ‘forever chemicals’ as well as innumerable alternatives and substitutes, such as short-chain PFAS, through drinking water, foods, air and consumer products, reduced exposure to PFAS, even before entering midlife, may be a key preventive approach to lowering the risk of diabetes,” Sung Kyun Park, ScD, MPH, associate professor in the departments of epidemiology and environmental health sciences at the University of Michigan School of Public Health, told Healio.
Park and colleagues analyzed data from the Study of Women’s Health Across the Nation (SWAN) Multi-Pollutant Study, which was conducted to evaluate the roles of multiple environmental pollutants in chronic diseases during and after the menopausal transition. Exposure to PFAS was measured through repository serum samples collected from 1,237 women aged 45 to 56 years without prevalent diabetes during the third SWAN follow-up in 1999 and 2000 (median age, 49.4 years; 51.7% white). Participants were grouped into tertiles for exposure to 7 types of PFAS. At subsequent follow-up visits, women were defined as having incident diabetes if they were using a glucose-lowering medication, had fasting glucose of 7 mmol/L (126 mg/dL) or greater on two consecutive visits, or had any two visits with self-reported diabetes and at least one visit with blood glucose of 7 mmol/L or higher.
The findings were published in Diabetologia.
Of the study cohort, 102 women developed diabetes for an incidence rate of 6 per 1,000 person-years. Compared with participants without diabetes, women with incident diabetes had higher concentrations of total perfluorooctane sulfonic acid, n-perfluorooctane sulfonic acid, sum of perfluoromethylheptane sulfonic acid isomers, 2-(N-methyl-perfluorooctane sulfonamido) acetic acid and 2-(N-ethylperfluorooctane sulfonamido) acetic acid.
Women in the highest tertile for linear perfluorooctanoic acid (HR = 1.67; 95% CI, 1.21-2.31; P = .001), perfluorohexane sulfonic acid (HR = 1.58; 95% CI, 1.13-2.21; P = .003), 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (HR = 1.85; 95% CI, 1.28-2.67; P = .0004) and the sum of four common types of PFAS (HR = 1.64; 95% CI, 1.17-2.31; P = .002) had a higher risk for incident diabetes compared with those in the lowest tertile.
The risk for diabetes increased with each doubling of serum concentrations for total perfluorooctane sulfonic acid (HR = 1.22; 95% CI, 1.05-1.43), n-perfluorooctane sulfonic acid (HR = 1.22; 95% CI, 1.04-1.42) and 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (HR = 1.23; 95% CI, 1.07-1.42).
In a quantile-based g-computation evaluating the joint effects of PFAS mixtures, an increase in all PFAS serum concentrations by one tertile increased the risk for developing diabetes (HR = 1.62; 95% CI, 1.06-2.49), and the risk for those in the highest tertile was more than twice as high as the risk for those in the lowest tertile (HR = 2.62; 95% CI, 1.12-6.2).
Park said the amount of PFAS in the environment makes it very difficult for individuals to reduce exposure and that the findings reveal the need for policy changes to lower the number of products featuring PFAS.
“PFAS exposure reduction at the individual level is very limited, so a more important way is to change policies and to limit PFAS in the air, drinking water, foods, etc.,” Park said. “Once released to the environment, the cost to eliminate PFAS is too high. Who should be responsible for the societal cost? We will need to make public consensus and find a good solution to reduce the cost and protect us and the environment.”
For more information:
Sung Kyun Park, ScD, MPH, can be reached at sungkyun@umich.edu.
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