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Research article - Peer-reviewed, 2022

Demographic, life-style and physiological determinants of serum per- and polyfluoroalkyl substance (PFAS) concentrations in a national cross-sectional survey of Swedish adolescents

Nystrom, Jennifer; Benskin, Jonathan P.; Plassmann, Merle; Sandblom, Oskar; Glynn, Anders; Lampa, Erik; Gyllenhammar, Irina; Moraeus, Lotta; Lignell, Sanna


Per: and polyfluoroalkyl substances (PFAS) may affect adolescent health, yet factors related to PFAS concentrations in serum are poorly understood. We studied demographic, life-style and physiological determinants of serum PFAS concentrations in Swedish adolescents from a nation-wide survey, Riksmaten Adolescents 2016–17 (RMA, age 10–21 years, n = 1098). Serum samples were analyzed for 42 PFAS, using liquid chromatography-tandem mass spectrometry. The cumulative probability model was used to estimate associations between serum PFAS and determinants, using ordinal logistic regression. Legacy linear (lin-) perfluorooctanoic acid (PFOA), perfluorononaoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), lin-perfluorohexanesulfonic acid (PFHxS) and lin-/branched (br-) perfluorooctanesulfonic acid (PFOS) were quantifiable in ≥70% of the samples. The emerging PFAS 9-chlorohexanedecafluoro-3-oxanone-1-sulfonic acid (9Cl-PF3ONS) was quantified in 5.4% of the samples, suggesting initiation of long-range transport far from production sites. Median concentrations of all legacy PFAS were <2 ng/g serum, with a few participants having very high (>100 ng/g serum) lin-PFHxS and lin-/br-PFOS concentrations due to previous high exposure from PFAS-contaminated drinking water. Legacy PFAS exposure was strongly associated with birth country of the participants and their mothers. 2-fold higher estimated adjusted mean (EAM) concentrations were seen among high income country participants with mothers from high income countries than among low/lower-middle income country participants with mothers from the same category. Menstruating females had lower br-PFOS EAM concentrations than those who were not. Iron status (plasma ferritin) among females may be a marker of intensity of menstrual bleeding, but it was not significantly associated with legacy PFAS concentrations among females. Further studies are needed to determine how physiological changes occurring around menstruation affect the toxicokinetics of PFAS in females. In conclusion, PFAS are pollutants of the industrialized world and some of the identified determinants may be overlooked confounders/effect modifiers that should be included in future PFAS/health studies among adolescents.


Riksmaten; Biomonitoring; PFAA; Exposure; Demography; Menstruation

Published in

Environmental Research
2022, volume: 208, article number: 112674

Authors' information

Benskin, Jonathan P.
Stockholm University
Plassmann, Merle
Stockholm University
Sandblom, Oskar
Stockholm University
Lampa, Erik
Uppsala University
Gyllenhammar, Irina
National Food Agency
Moraeus, Lotta
Swedish National Food Agency
Lignell, Sanna
National Food Agency

Sustainable Development Goals

SDG3 Good health and wellbeing

UKÄ Subject classification

Public Health, Global Health, Social Medicine and Epidemiology

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