Two teflon coated pans stacked on stovetop
A groundbreaking study co-led by researchers at the University of Hawaiʻi at Mānoa has revealed that exposure to per- and polyfluoroalkyl substances (PFAS), often referred to as “forever chemicals,” may significantly elevate the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) in adolescents. This condition, which affects approximately 10% of children and up to 40% of those with obesity, is a precursor to more severe health issues such as type 2 diabetes, heart disease, and liver cancer.
The findings, published in the journal Environmental Research, are the result of a collaboration with the Southern California Superfund Research and Training Program for PFAS Assessment, Remediation, and Prevention Center. PFAS are synthetic chemicals prevalent in various consumer products, including nonstick cookware, stain- and water-repellent fabrics, food packaging, and some cleaning products. These chemicals are notorious for their persistence in the environment and their tendency to accumulate in the human body over time. Alarmingly, over 99% of the U.S. population has detectable levels of PFAS in their blood, and at least one PFAS is found in about half of the country’s drinking water supplies.
Understanding the Impact on Adolescents
“Adolescents are particularly more vulnerable to the health effects of PFAS as it is a critical period of development and growth,” stated Shiwen “Sherlock” Li, an assistant professor at UH Mānoa’s Department of Public Health Sciences in the Thompson School of Social Work & Public Health, who served as the lead and corresponding author of the study. “In addition to liver disease, PFAS exposure has been associated with a range of adverse health outcomes, including several types of cancer.”
The research focused on 284 adolescents and young adults in Southern California who were already at a higher metabolic risk due to parental history of type 2 diabetes or obesity. PFAS levels were determined through blood tests, while liver fat was assessed using MRI technology. The study found that higher blood levels of two common PFAS chemicals—perfluorooctanoic acid (PFOA) and perfluoroheptanoic acid (PFHpA)—were linked to a greater likelihood of MASLD.
“Adolescents with twice as much PFOA in their blood were nearly three times more likely to have MASLD. The risk was even higher for those with a genetic variant (PNPLA3 GG) known to influence liver fat.” — Shiwen Li
Exploring Genetic and Lifestyle Interactions
Li emphasized that this is the first study to examine the relationship between PFAS and MASLD in children using gold-standard diagnostic criteria, while also exploring how genetic and lifestyle factors may interact with PFAS exposure. For instance, in young adults, smoking was found to further amplify the liver impacts associated with PFAS.
Lida Chatzi, a professor of population and public health sciences and pediatrics and director of the USC Superfund Center, highlighted the long-term implications: “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. If we reduce PFAS exposure early, we may help prevent liver disease later.”
Strategies for Reducing PFAS Exposure
Exposure to PFAS can vary significantly by location. Li recommends that individuals check local Consumer Confidence Reports to determine whether their water provider tests for PFAS, and to use a water filter if these chemicals are detected. Avoiding products or packaging made with PFAS can also help reduce exposure. Given the rising rates of MASLD among young people globally, researchers are calling for continued investigation and the implementation of policies aimed at reducing PFAS use in consumer products.
The study also involved contributions from the University of California Irvine, West Virginia University, Johns Hopkins University, and Children’s Hospital Los Angeles, underscoring the collaborative effort to address this pressing public health issue.
This development follows growing concerns over the widespread presence of PFAS in the environment and its potential health impacts, particularly among vulnerable populations such as adolescents. As research continues, the emphasis on reducing PFAS exposure and understanding its broader implications remains a critical focus for public health experts.
