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4239224 
Journal Article 
Early life exposure to per- and polyfluoroalkyl substances and mid-childhood lipid and alanine aminotransferase levels 
Mora, AM; Fleisch, AF; Rifas-Shiman, SL; Woo Baidal, JA; Pardo, L; Webster, TF; Calafat, AM; Ye, X; Oken, E; Sagiv, SK 
2018 
Environment International
ISSN: 0160-4120
EISSN: 1873-6750 
111 
1-13 
English 
BACKGROUND: Growing evidence suggests that exposure to per- and polyfluoroalkyl substances (PFASs) may disrupt lipid homeostasis and liver function, but data in children are limited.

OBJECTIVE: We examined the association of prenatal and mid-childhood PFAS exposure with lipids and alanine aminotransferase (ALT) levels in children.

METHODS: We studied 682 mother-child pairs from a Boston-area pre-birth cohort. We quantified PFASs in maternal plasma collected in pregnancy (median 9.7weeks gestation, 1999-2002) and in child plasma collected in mid-childhood (median age 7.7years, 2007-2010). In mid-childhood we also measured fasting total (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and ALT. We then derived low-density lipoprotein cholesterol (LDL-C) from TC, HDL-C, and TG using the Friedewald formula.

RESULTS: Median (interquartile range, IQR) perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorodecanoate (PFDeA) concentrations in child plasma were 6.2 (5.5), 4.3 (3.0), and 0.3 (0.3) ng/mL, respectively. Among girls, higher child PFOS, PFOA, and PFDeA concentrations were associated with detrimental changes in the lipid profile, including higher TC and/or LDL-C [e.g., β per IQR increment in PFOS=4.0mg/dL (95% CI: 0.3, 7.8) for TC and 2.6mg/dL (-0.5, 5.8) for LDL-C]. However, among both boys and girls, higher plasma concentrations of these child PFASs were also associated with higher HDL-C, which predicts better cardiovascular health, and slightly lower ALT, which may indicate better liver function. Prenatal PFAS concentrations were also modestly associated with improved childhood lipid and ALT levels.

CONCLUSIONS: Our data suggest that prenatal and mid-childhood PFAS exposure may be associated with modest, but somewhat conflicting changes in the lipid profile and ALT levels in children. 
Per- and polyfluoroalkyl substances; Lipids; Liver function; Pregnancy; Childhood 
PFAS
• Additional PFAS (formerly XAgency)
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               TEDX
     Screened Studies
          Included
               Include (TIAB)
               Include (Full Text)
• 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
     Potassium perfluorooctanoate
     Sodium perfluorooctanoate
• 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
          Included
               Include (TIAB)
          Excluded
               Exclude (Full Text)
     Ammonium perfluorooctanoate
     Perfluorodecanoic acid
     Perfluorooctane
     Perfluorooctanesulfonic acid
     Perfluorooctanoic acid
• PFDA
     Literature Search
          Pubmed
          WOS
     Literature Search Update 5/2019
          WOS
     Scopus: April 2021
     Title and Abstract Screening
          Full Text Screening
               Studies Meeting PECO
                    Human health effect studies
     June 2022 Pelch Database
     Literature Searches (through April 2023 update and post-public comment/peer review)
          Other
               Published PFAS SEMs
          Title & Abstract Screening
               Tagged as Supplemental
                    Full Text Screening
                         Excluded
                              Not relevant to PECO
• PFHxS
     Database searches
          Pelch PFAS SEM
          Other
     Inclusion
          TiAb
          Full Text
               Human Study
• PFNA
     Litsearch Update 2017-2018
          PFAS Untag
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• 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