Sex and obesity influence the relationship between perfluoroalkyl substances and lean body mass: NHANES 2011-2018

Abstract

Objective: Polyfluoroalkyl substances (PFAS) are known endocrine disruptors, that have been the subject of limited research regarding their impact on human lean body mass. The aim of this study was to investigate the effects of PFAS exposure on lean body mass.

Methods: We performed a cross-sectional data analysis involving 1022 adolescents and 3274 adults from the National Health and Nutrition Examination Survey (NHANES) 2011-2018, whose lean body mass was measured by dual-energy X-ray absorptiometry. The lean mass index (LMI) was calculated as lean body mass dividing by the square of height. The association between PFAS and LMI was examined through a multivariate-adjusted weighted generalized linear model. Moreover, weighted quantile sum (WQS) regression models were employed to futher examine the relationship between the mixture of PFAS and LMI.

Results: Regression analyses revealed an inverse correlation between PFAS exposure and LMI after adjusting for potential covariates. Adults with higher serum PFAS concentrations manifested a reduction in whole LMI ( β = -0.193, 95 % confidence interval (CI): -0.325 to -0.06). Notably, this correlation was particularly significant in adult females and individuals with obesity, and it was observed across diverse anatomical regions, including lower limbs, right arm, trunk, and whole lean body mass. In adult females, the association between PFAS and whole LMI was statistically significant ( β = -0.294, 95 % CI: -0.495 to -0.094), and a similar trend was found in obese individuals ( β = -0.512, 95 % CI: -0.762 to -0.261). WQS regression analyses supported the results obtained from weighted linear regression analyses.

Conclusions: Our study suggests that exposure to PFAS, whether individually or in combination, is associated with decreased lean body mass in specific body areas, with sex and obesity serving as major influencing factors.

Keywords: Lean body mass; Obesity; Perfluoroalkyl and poly-fluoroalkyl substances; Weighted quantile sum.

Graphical abstract

Fig. 1

Associations of quartiles of PFAS with HLMI, LALMI, LLLMI, RALMI, RLLLMI, ALMI, LLMI, TWWI, WLMI in obesity-age groups in participants of >19 years old in NHANES 2011–2018. Obesity status: adults were defined as “normal” if BMI≤25 kg/m², otherwise adults' status was defined as “obese”. Estimates were adjusted for age (continuous), gender (categorical), race/ethnicity (categorical), education (categorical), BMI category, ratio of family income to poverty (categorical), smoke expose (categorical), Energy (continuous), Protein energy supply ratio(continuous), physically active(categorical). HLMI: Head lean mass index; LALMI: left arm lean mass index; LLLMI: left leg lean mass index; RALMI: right arm lean mass index; RLLMI: right leg lean mass index; TLMI: trunk lean mass index; WLMI: whole lean mass index; CI: confidence interval.