PFAS & Liver Health

Several studies have been published recently reporting a link between exposure to per- and polyfluoroalkyl substances (PFAS) and metabolic-associated fatty liver disease (MAFLD, a proposed alternative to non-alcoholic fatty liver disease). Notably, MAFLD is growing rapidly, with an estimated prevalence of 100 million people affected in the U.S. alone by 2030, about 1/3 of the adult population, with increases in related conditions such as hepatocellular carcinoma and nonalcoholic steatohepatitis.

Published in Cancer Causes & Control was an analysis of the relationship between serum levels of several PFAS and MAFLD in a sample of nearly 700 adults from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). This study found that one PFAS, perfluorooctanoic acid (PFOA), was associated with an increased risk for MAFLD, with over a 2-fold greater risk comparing the 2nd to 1st quartiles. Additionally, after a stratified analysis, perfluorohexanesulfonic acid (PFHxS) was also correlated with MAFLD and liver fibrosis.

Results of a cross-sectional study published in Ecotoxicology & Environmental Safety found that plasma PFOS, PFHxS, and total PFAS concentrations were each associated with a greater degree of hepatic steatosis and MAFLD, with positive linear associations, among a population of more than 500 patients recently diagnosed with acute coronary syndrome (ACS), with a suggestion that the metabolic harm from PFAS may connect both ACS and MAFLD.

Lastly, a cross-sectional study with nearly 14,000 participants from the 2003-18 NHANES suggested that PFAS may play a role in increasing uric acid levels and the risk for hyperuricemia (itself a key factor in MAFLD). Not only did this study find no safe levels of PFAS exposure, this analysis also indicated that the elevations in uric acid were due to declining renal function, mediated primarily by PFOA.