The moderating role of vitamin E in the association between PFAS exposures and diabetes risk: Evidence from the NHANES 2017–2018

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are widely used in various manufacturing processes due to their exceptional chemical stability and hydrophobic properties. However, these substances tend to bioaccumulate in the environment and human tissues, posing significant health risks, including endocrine disruption, immune system impairment, and an increased risk of diabetes. Vitamin E, a powerful antioxidant, may potentially attenuate the adverse effects of PFAS on glucose metabolism. Therefore, we utilized data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES), which includes measurements of vitamin E content in a subset of participants, to explore the relationship between PFAS exposures, vitamin E levels, and diabetes risk. Our analysis revealed significant variations in PFAS concentrations across different demographic groups, with males and older individuals exhibiting higher PFAS levels. Elevated PFAS concentrations were associated with an increased risk of diabetes, while vitamin E (specifically alpha-tocopherol) exhibited significant interaction effects with PFAS, modulating blood glucose levels. These findings provide compelling evidence linking PFAS exposures to diabetes risk and highlight the potential moderating role of vitamin E in mitigating PFAS-induced metabolic disturbances. Future research should focus on elucidating the underlying biological mechanisms through which PFAS exert their adverse effects and vitamin E exerts its protective actions, as well as conducting longitudinal studies to establish causality and further explore the complex interplay between PFAS exposures, antioxidant status, and metabolic health.