Exposure to PFAS Increases Risk of Diabetes During Midlife in Women

Sung Kyun Park, ScD, MPH

New research from investigators at the University of Michigan suggests exposure to per- and polyfluoroalkyl substances (PFAS) was associated with an increased risk of developing diabetes in midlife among women.

An analysis of data from more than 1200 women in the Study of Women’s Health Across the Nation Multi-Pollutant Study (SWAN-MPS), results provide evidence demonstrating women in the highest tertile of PFAS exposure were at a more than 2-fold increase in risk of developing incident diabetes compared to their counterparts in the lowest tertile of exposure.

“Higher serum concentrations of certain PFAS were associated with higher risk of incident diabetes in midlife women,” wrote investigators. “The joint effects of PFAS mixtures were greater than those for individual PFAS, suggesting a potential additive or synergistic effect of multiple PFAS on diabetes risk”.

In recent years, the interest in the long-term impact of exposure to PFAS has grown. A group of more than 4700 synthetic chemicals found in a wide range of consumer products, including cookware and cosmetic products, recent studies suggest exposure to these chemicals were associated with a negative impact on cardiometabolic health profiles. As such, Sung Kyun Park, ScD, MPH, and a team of colleagues from the Department of Epidemiology at University of Michigan School of Public Health designed the current study with an interest in assessing the impact of PFAS exposure on risk of incident diabetes.

With this in mind, investigators designed their study to assess potential associations between serum PFAS concentrations and incident diabetes using data from SWAN-MPS. A substudy of the multicenter, community-based, prospective SWAN study, SWAN-MPS was launch in 2016 to evaluate the roles of environmental pollutants in chronic diseases during and after the menopausal transition. From the study, investigators obtained data from 1400 women with stored blood and urine samples from the 3302-woman cohort included in the original study.

After exclusion of those with diabetes at baseline and those with insufficient data for analysis, investigators had identified a cohort of 1237 women for inclusion in their analyses. This cohort had a median age of 49.4 years, 17,005 person-years of follow-up, and 102 women who developed incident diabetes during the follow-up.

For the purpose of analysis, investigators assessed associations of incident diabetes with serum concentrations of 7 PFAS with high detection rates, which was defined as greater than 96% detection rate, in Cox proportional hazards models adjusted for race/ethnicity, site, education, smoking status, alcohol consumption, total energy intake, physical activity, menopausal status and BMI. The 7 PFAS of interest were n-PFOA, PFNA, PFHxS, n-PFOS, Sm-PFOS, MeFOSAA, and EtFOSAA.

Upon analysis, results indicated an increased risk of incident diabetes was observed for those in the highest tertile of for n-PFOA (HR, 1.67 [95% CI, 1.21-2.31]; P=.001), for PFHxS (HR, 1.58 [95% CI, 1.13-2.21]; P=.003), for Sm-PFOS (HR, 1.36 [95% CI, 0.97-1.90]; P=.05), for MeFOSAA (HR, 1.85 [95% CI, 1.28-2.67]; P=.0004), and for the sum of 4 common PFAS (HR, 1.64 [95% CI, 1.17-2.31]; P=.002) compared to those in the lowest tertiles for each category. When assessing exposure to the 7 PFAS of interest as mixtures, those in the highest tertile of exposure were at a more than 2-fold greater risk of developing incident diabetes compared to those in the lowest tertile of exposure (HR, 2.62 [95% CI, 1.12-6.20]).

“Reduced exposure to these ‘forever and everywhere chemicals’ even before entering midlife may be a key preventative approach to lowering the risk of diabetes. Policy changes around drinking water and consumer products could prevent population-wide exposure,” investigators added.

This study, “Per- and polyfluoroalkyl substances and incident diabetes in midlife women: the Study of Women’s Health Across the Nation (SWAN),” was published in Diabetologia.