Associations of Perfluoroalkyl Substances with Metabolic-Associated Fatty Liver Disease and Non-Alcoholic Fatty Liver Disease: NHANES 2017–2018
Abstract
Objectives This study investigated the potential effects of perfluoroalkyl substance (PFAS) in serum on MAFLD, NAFLD, and liver fibrosis.Methods Our sample included 696 participants (≥ 18 years) from the 2017-2018 NHANES study with available serum PFASs, covariates, and outcomes. Using the first quartile of PFAS as the reference group, we used weighted binary logistic regression and multiple ordered logistic regression used to analyze the relationship between PFAS and MAFLD, NAFLD, and liver fibrosis and multiple ordinal logistic regression to investigate the relationship between PFAS and MAFLD, NAFLD, and liver fibrosis and calculated the odds ratio (OR) and 95% confidence interval for each chemical. Finally, stratified analysis and sensitivity analysis were performed according to gender, age, BMI, and serum cotinine concentration.Results A total of 696 study subjects were included, including 212 NAFLD patients (weighted 27.03%) and 253 MAFLD patients (weighted 32.65%). The quartile 2 of serum PFOA was positively correlated with MAFLD and NAFLD (MAFLD, OR 2.29, 95% CI 1.05-4.98; NAFLD, OR 2.37, 95% CI 1.03-5.47). PFAS were not significantly associated with liver fibrosis after adjusting for potential confounders in MAFLD and NAFLD. Stratified analysis showed that PFOA was strongly associated with MAFLD, NAFLD, and liver fibrosis in males and obese subjects. In women over 60 years old, PFHxS was also correlated with MAFLD, NAFLD, and liver fibrosis.Conclusion The serum PFOA was positively associated with MAFLD and NAFLD in US adults. After stratified analysis, the serum PFHxS was correlated with MFALD, NAFLD, and liver fibrosis.
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These effects contribute to the development of metabolic-associated fatty liver disease (MAFLD) and non-alcoholic fatty liver disease (NAFLD).
“These effects contribute to the development of metabolic-associated fatty liver disease (MAFLD) and non-alcoholic fatty liver disease (NAFLD).”
From Exposure to Per- and Polyfluoroalkyl Substances (PFASs) in Healthcare: Environmental and Clinical Insights (2025) · cites this paper as [77]
Human and animal studies consistently show elevated liver enzymes, hepatic fat accumulation, and disruptions in lipid and bile acid metabolism, even among children without traditional metabolic risk factors.
“Human and animal studies consistently show elevated liver enzymes, hepatic fat accumulation, and disruptions in lipid and bile acid metabolism, even among children without traditional metabolic risk factors [77].”
From Exposure to Per- and Polyfluoroalkyl Substances (PFASs) in Healthcare: Environmental and Clinical Insights (2025) · cites this paper as [77]
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Environmental Pollutants, Occupational Exposures, and Liver Disease
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- Authors
- Zhang, Y., Zhang, M., Jiang, S., Hu, H., Wang, X., Yu, F., Huang, Y., & Liang, Y.
- Affiliations
- Wannan Medical College (CN)
- First Affiliated Hospital of Wannan Medical College (CN)
- Corresponding author
- Huang, Yue’e
- Liang, Yali
- Venue
- Cancer Causes & Control
- Published
- 2024-05-19
- Volume
- 35
- Issue
- 9
- Pages
- 1271-1282
- ISSN
- 0957-5243 (ISSN-L)
- 1573-7225
- OpenAlex
- W4397290553
- Cited by
- 5
- References
- 69
- Citations by year
- 2026: 2 · 2025: 3
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Cancer Causes & Control (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Anhui Province University Collaborative Innovation Project (GXXT-2021-087)
- Anhui Provincial Quality Engineering for Colleges and Universities (2019zyrc063)
- Quality Engineering Project of Wannan Medical College (2019ylzy01)
- Key Projects of Anhui Provincial Department of Education (KJ2021A0836)
- Key scientific research project of Wannan Medical College (grant number WK2020Z07)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Fluorine in Organic Chemistry
- Keywords
- perfluorinated compounds, perfluorooctanoic acid, PFHxS, non-alcoholic fatty liver disease, liver fibrosis, obesity, sex differences, NHANES
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Female, Fluorocarbons, Humans, Liver Cirrhosis, Male, Middle Aged, Nutrition Surveys, United States, Non-alcoholic Fatty Liver Disease
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