A recent study has established a concerning link between certain synthetic compounds known as per- and polyfluoroalkyl substances (PFAS) and an increased risk of liver disease in adolescents. Co-led by the Southern California Superfund Research and Training Program for PFAS Assessment, Remediation and Prevention (ShARP) and the University of Hawai’i, the research indicates that exposure to these “forever chemicals” could potentially triple the likelihood of developing a liver condition known as metabolic dysfunction-associated steatotic liver disease (MASLD). This finding was detailed in the journal Environmental Research.
MASLD, previously referred to as fatty liver disease, currently affects approximately 10% of children, with rates soaring to 40% among those with obesity. This chronic condition often progresses with minimal symptoms, though some individuals may experience fatigue, discomfort, and abdominal pain. If left unchecked, MASLD can heighten the risk of developing type 2 diabetes, heart disease, advanced liver injury, cirrhosis, and even liver cancer.
According to Lida Chatzi, MD, PhD, a professor and director of the ShARP Center, “MASLD can progress silently for years before causing serious health problems. When liver fat starts accumulating in adolescence, it may set the stage for a lifetime of metabolic and liver health challenges.” Chatzi emphasized the importance of reducing PFAS exposure early in life to mitigate these risks, describing it as a significant public health opportunity.
PFAS are a group of man-made chemicals commonly found in nonstick cookware, stain-resistant fabrics, food packaging, and various cleaning products. They are known for their persistence in the environment and the human body, with more than 99% of the U.S. population having detectable levels of PFAS in their blood. Approximately half of U.S. drinking water supplies contain at least one type of PFAS.
The study’s first author, Shiwen “Sherlock” Li, PhD, an assistant professor at the University of Hawai’i, highlighted the vulnerability of adolescents to PFAS exposure during critical developmental periods. “In addition to liver disease, PFAS exposure has been associated with a range of adverse health outcomes, including several types of cancer,” Li noted.
The research involved 284 adolescents and young adults from two longitudinal studies at the University of Southern California (USC). These participants were already at a higher metabolic risk, as many had parents with type 2 diabetes or were overweight. Blood tests measured PFAS levels, while liver fat was assessed using MRI scans.
The study identified a direct correlation between elevated blood levels of two common PFAS, specifically perfluorooctanoic acid (PFOA) and perfluoroheptanoic acid (PFHpA), and an increased incidence of MASLD. Adolescents with double the amount of PFOA in their bloodstream were nearly three times more likely to be diagnosed with MASLD. The risk was further amplified for individuals carrying a genetic variant known as PNPLA3 GG, which affects liver fat accumulation.
Lifestyle factors also played a role; young adults who smoked exhibited exacerbated liver impacts associated with PFAS exposure. Max Aung, PhD, MPH, an assistant professor at the Keck School of Medicine, stated, “These findings suggest that PFAS exposures, genetics, and lifestyle factors work together to influence who has a greater risk of developing MASLD as a function of your life stage.”
This study marks the first investigation into the relationship between PFAS and MASLD in children using recognized diagnostic criteria and is also the first to examine the interaction between genetic predispositions, lifestyle factors, and PFAS exposure. The prevalence of MASLD increased as participants aged, reinforcing the notion that puberty and early adulthood may heighten susceptibility to environmental factors.
The findings complement previous USC research that indicated a link between PFAS, particularly PFHpA, and severe liver disease among adolescents undergoing bariatric surgery to address obesity. “Taken together, the two studies show that PFAS exposures not only disrupt liver biology but also translate into real liver disease risk in youth,” Chatzi added. “Adolescence seems to be a critical window of susceptibility, suggesting PFAS exposure may matter most when the liver is still developing.”
The study received funding from various sources, including the National Institutes of Health and the U.S. Environmental Protection Agency, underscoring its significance in understanding the health impacts of PFAS.
The collaborative effort involved numerous contributors, including researchers from USC, Brown University, Emory University, UC Irvine, Johns Hopkins University, and West Virginia University, reflecting a broad commitment to addressing public health challenges associated with environmental toxins.
