A study co-led by researchers at the University of Hawaiʻi at Mānoa has found that exposure to per- and polyfluoroalkyl substances (PFAS)—commonly known as "forever chemicals"—may significantly increase the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) in adolescents. MASLD affects about 10% of children and up to 40% of children with obesity and can increase long-term risk for type 2 diabetes, heart disease and liver cancer.
The findings were published in Environmental Research and is a collaboration with the Southern California Superfund Research and Training Program for PFAS Assessment, Remediation and Prevention Center .
PFAS are synthetic chemicals used in nonstick cookware, stain- and water-repellent fabrics, food packaging and some cleaning products. They persist in the environment and accumulate in the body over time. More than 99% of people in the U.S. have measurable PFAS in their blood, and at least one PFAS is present in roughly half of U.S. drinking water supplies.
"Adolescents are particularly more vulnerable to the health effects of PFAS as it is a critical period of development and growth," said assistant professor Shiwen "Sherlock" Li of UH Mānoa's Department of Public Health Sciences in the Thompson School of Social Work & Public Health , who served as lead and corresponding author. "In addition to liver disease, PFAS exposure has been associated with a range of adverse health outcomes, including several types of cancer." ( Related study )
Linking PFAS, genetics and lifestyle
The research examined 284 adolescents and young adults in Southern California who were already at higher metabolic risk because their parents had type 2 diabetes or were overweight. PFAS levels were measured through blood tests, and liver fat was assessed using MRI.
Adolescents are particularly more vulnerable to the health effects of PFAS as it is a critical period of development and growth.
—Shiwen Li
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. In young adults, smoking further amplified PFAS-related liver impacts.
"MASLD can progress silently for years before causing serious health problems," said Lida Chatzi, professor of population and public health sciences and pediatrics and director of the USC Superfund Center . "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."
Li noted that this is the first study to examine PFAS and MASLD in children using gold-standard diagnostic criteria and to explore how genetic and lifestyle factors may interact with PFAS exposure.
Reducing exposure
Exposure to PFAS can vary by location. Li recommends checking local Consumer Confidence Reports to see whether a water provider tests for PFAS, and using a water filter if PFAS are detected. Avoiding products or packaging made with PFAS may also help reduce exposure. Given rising rates of MASLD in young people worldwide, the researchers call for continued investigation and policies that reduce PFAS use in consumer products.
Other study partners also included the University of California Irvine, West Virginia University, Johns Hopkins University and Children's Hospital Los Angeles.
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