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4238547 
Journal Article 
Perfluoroalkyl substances, bone density, and cardio-metabolic risk factors in obese 8-12 year old children: A pilot study 
Khalil, N; Ebert, JR; Honda, M; Lee, M; Nahhas, RW; Koskela, A; Hangartner, T; Kannan, K 
2018 
Yes 
Environmental Research
ISSN: 0013-9351
EISSN: 1096-0953 
Elsevier 
SAN DIEGO 
160 
Elsevier 
314-321 
English 
BACKGROUND AND OBJECTIVE: Perfluoroalkyl substances (PFASs), including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), have been associated with adverse bone, and metabolic changes in adults. However association of PFASs with bone health in children is understudied. Considering their role as endocrine disruptors, we examined relationships of four PFASs with bone health in children.

METHODS: In a cross sectional pilot study, 48 obese children aged 8-12 years were enrolled from Dayton's Children Hospital, Ohio. Anthropometric, clinical and biochemical assessments of serum were completed. Serum PFASs were measured by UPLC-ESI-MS/MS. In a subset of 23 children, bone health parameters were measured using calcaneal quantitative ultrasound (QUS).

RESULTS: While PFASs exposure was associated with a consistent negative relationship with bone health parameters, among four PFASs tested, only PFNA showed a significant negative relationship with bone parameter (β [95% CI], = - 72.7 [- 126.0, - 19.6], p = .010). PFNA was also associated with raised systolic blood pressure (p = .008), low density lipoprotein cholesterol (LDL-C; p < .001), and total cholesterol (TC; p = .014). In addition, both PFOA and PFOS predicted elevation in LDL-C, and PFOA predicted increased TC, as well. In this analysis, PFASs were not strongly related to thyroid hormones, 25-hydroxy vitamin D, liver enzymes, or glucose homeostasis.

CONCLUSION: PFASs exposure in obese children may play a role in adverse skeletal and cardiovascular risk profiles. 
Children; Perfluoroalkyl substances (PFASs); Perfluorononanoic acid (PFNA); Bone; Metabolic 
IRIS
• Arsenic Susceptibility
     Life Stages Citation Mapping
          25%-30%
PFAS
• Additional PFAS (formerly XAgency)
     Literature Search November 2019
          Other Sources
               Reference list review of included studies
               TEDX
     Screened Studies
          Excluded
               Exclude (TIAB)
• Expanded PFAS SEM (formerly PFAS 430)
     Litsearch: September 2019
          PubMed
          Web of Science
          Other Sources
               PFAS TOX Database
     Screened Studies
          Excluded
               Exclude (TIAB)
     Not prioritized for screening
     Perfluorooctane
• PFAS 150
     Literature Search Update December 2020
          PubMed
          WOS
     Literature Search August 2019
          PubMed
          Web of Science
          Other sources
               Reference list review of included studies
               PFAS TOX Database
     Screened Studies
          Excluded
               Exclude (TIAB)
     Ammonium perfluorooctanoate
     Perfluorinated compounds
     Perfluorohexanesulfonic acid
     Perfluorononanoic acid
     Perfluorooctane
     Perfluorooctanesulfonic acid
     Perfluorooctanoic acid
• PFHxS
     Database searches
          Pubmed
          Toxline
          WOS
          Scopus
          Pelch PFAS SEM
     Inclusion
          TiAb
          Full Text
               Human Study
• PFNA
     Litsearch Update 2017-2018
          PFAS Untag
     Litsearch Addl Synonyms 2018
          Toxline
          WOS
     PFNA Literature Search pre-2019
          WOS
     Literature Search
          Pubmed
          Toxline
          WOS
     PFNA May 2019 Update
          Pubmed
          Toxnet
          Web of Science
     Title and Abstract Screening
          Full Text Screening
               Studies Meeting PECO
                    Human health effects studies
     June 2022 Pelch Database
• PFOA (335-67-1) and PFOS (1763-23-1)
     Literature Search Update (2013-2019)
          PubMed
          WOS
• PFOA and PFOS OW MCLG Approaches
     Cited in White Papers
• Yale PFAS Liver study