Evaluating health impacts of exposure to PFAS mixtures: a systematic review of epidemiological studies using mixture methods.

IF 4.1 2区 医学 Q1 TOXICOLOGY
Critical Reviews in Toxicology Pub Date : 2025-01-01 Epub Date: 2025-09-16 DOI:10.1080/10408444.2025.2546427
Megan J Kemp, Krishanth Thoppe, Kylie Jones, Meghan Maltby, Kristen Ball, Christy A Barlow
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Abstract

Per- and polyfluoroalkyl substances (PFAS) continue to be an emerging chemical class of concern due to their long half-lives in nature and in the human body. There have been many epidemiology studies published in the scientific literature on PFAS and various health effects. Until recently, these studies have focused on assessing exposure to individual PFAS rather than exposure to mixtures of PFAS. Over the past two decades, mixture methods-statistical methods for investigating the association of mixtures-have been developed, making it possible to more accurately assess the risk of adverse health effects associated with exposure to PFAS. To help provide a resource for the overall evaluation of potential health effects of PFAS mixtures, we applied a consistent set of examination methods and criteria for all epidemiology studies that examined the potential relationship between exposure to PFAS mixtures and various types of health outcomes. We identified 233 cohort studies, 39 case-control studies, and 89 cross-sectional studies that evaluated general background-level exposures, exposure from contaminated sites, and occupational exposure to PFAS mixtures and health outcomes including metabolic, cardiovascular, and immune system effects, fetal development, pregnancy outcomes, reproductive effects, liver function, and respiratory effects. We extracted study characteristics and results in a systematic manner and performed a formal study quality evaluation and classified studies into tiers based on their methodological strengths and weaknesses. We found 42 prospective cohort studies, five nested case-control studies, and one traditional case-control study that qualified for inclusion in the highest tier of quality (Tier I). Overall, the weight of evidence from this systematic review indicates that the available epidemiology studies currently support an association between exposure to PFAS mixtures and adiposity, increased total cholesterol, and hypertension, while the evidence for all other health outcomes is suggestive or limited.

评估接触PFAS混合物对健康的影响:使用混合方法的流行病学研究的系统综述。
全氟烷基和多氟烷基物质(PFAS)由于其在自然界和人体内的半衰期长,继续成为令人关注的一类新兴化学物质。科学文献中已经发表了许多关于PFAS及其各种健康影响的流行病学研究。直到最近,这些研究都集中在评估对单个PFAS的暴露,而不是对PFAS混合物的暴露。在过去的二十年里,混合方法——用于调查混合物关联的统计方法——已经发展起来,使得更准确地评估与接触PFAS相关的不良健康影响的风险成为可能。为了帮助提供全面评估PFAS混合物潜在健康影响的资源,我们对所有检查PFAS混合物暴露与各种健康结果之间潜在关系的流行病学研究应用了一套一致的检查方法和标准。我们确定了233项队列研究、39项病例对照研究和89项横断面研究,这些研究评估了一般背景水平暴露、污染地点暴露和PFAS混合物的职业暴露,以及健康结果,包括代谢、心血管和免疫系统影响、胎儿发育、妊娠结局、生殖影响、肝功能和呼吸影响。我们以系统的方式提取研究特征和结果,并进行正式的研究质量评估,并根据研究方法的优缺点将研究分类。我们发现42项前瞻性队列研究、5项嵌套病例对照研究和1项传统病例对照研究符合最高质量等级(第一级)。总体而言,本系统综述的证据权重表明,现有的流行病学研究目前支持PFAS混合物暴露与肥胖、总胆固醇升高和高血压之间的关联,而所有其他健康结果的证据都是提示性的或有限的。
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来源期刊
CiteScore
9.50
自引率
1.70%
发文量
29
期刊介绍: Critical Reviews in Toxicology provides up-to-date, objective analyses of topics related to the mechanisms of action, responses, and assessment of health risks due to toxicant exposure. The journal publishes critical, comprehensive reviews of research findings in toxicology and the application of toxicological information in assessing human health hazards and risks. Toxicants of concern include commodity and specialty chemicals such as formaldehyde, acrylonitrile, and pesticides; pharmaceutical agents of all types; consumer products such as macronutrients and food additives; environmental agents such as ambient ozone; and occupational exposures such as asbestos and benzene.
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