Exposure to a class of synthetic chemicals known as per- and polyfluoroalkyl substances (PFAS)—often called "forever chemicals"—may increase the risk of developing type 2 diabetes, according to a new study led by Mount Sinai researchers. The findings were published today in eBioMedicine.
The team conducted a nested case-control study (an observational study that is conducted within a larger cohort study) within BioMe, a large, electronic health record-linked research database comprising records of more than 70,000 study participants who have sought care at The Mount Sinai Hospital in New York City since 2007.
Based on available data, the study analyzed 180 people recently diagnosed with type 2 diabetes (T2D) and compared them to 180 similar individuals without diabetes. All participants were matched based on age, sex, and ancestry.
Researchers used blood samples to analyze PFAS levels—a group of chemicals used in everything from nonstick cookware to stain-resistant furniture to waterproof clothing—and found that higher levels of PFAS were associated with a significantly greater risk of developing T2D in the future. Specifically, each increase in range of PFAS exposure was linked to a 31 percent increase in risk. The team also found that these associations could be due to metabolic irregularities in amino acid biosynthesis and drug metabolism, which may help explain how PFAS affect the body's ability to regulate blood sugar.
"PFAS are synthetic chemicals that resist heat, oil, water, and stains, and are found in countless everyday consumer products," said Vishal Midya, PhD, MStat, corresponding author and Assistant Professor, Environmental Medicine, Icahn School of Medicine at Mount Sinai. "Because they don't break down easily, PFAS accumulate in the environment—and in human bodies. Our study is one of the first to examine how these chemicals may disrupt the body's metabolism in ways that increase diabetes risk—particularly in diverse US populations."
Findings from this study underscore the importance of preventing PFAS exposures to promote public health and of advancing knowledge about potential mechanisms underlying the PFAS impacts on human metabolism.
"This research leverages an exposomics framework to characterize environmental impacts and associated metabolic alterations contributing to the development of type 2 diabetes in vulnerable US populations. Findings can help us design more effective interventions for the early prevention of type 2 diabetes in the future, taking into account individuals' exposures to environmental chemicals along with other well-known genetic, clinical, and lifestyle factors implicated in diabetes development" said Damaskini Valvi, MD, PhD, MPH, senior author on this paper, and Associate Professor, Public Health and Environmental Medicine, Icahn School of Medicine at Mount Sinai. "Mounting research suggests that PFAS are a risk factor for several chronic diseases, such as obesity, liver disease, and diabetes."
The researchers called for further exposome research studies, integrating environmental with genetic data to better understand how environmental exposures interact with human metabolism and contribute to chronic disease. They also call for larger study populations, expanding over the life course, from preconception to elderly, to understand environmental health impacts across the lifespan and at vulnerable life periods.
Read the full study in eBioMedicine. Manuscript reference number: EBIOM-D-24-03733R3. "Exposure to Per- and Poly-Fluoroalkyl substances in association to later occurrence of type 2 diabetes and metabolic pathway dysregulation in a multiethnic US population."
Funding for this study was provided by the National Institute of Environmental Health Sciences (R01ES033688, P30ES023515)
