Associations of single and multiple perfluoroalkyl substances exposure with folate among adolescents in NHANES 2007-2010

Chemosphere. 2022 Nov;307(Pt 3):135995. doi: 10.1016/j.chemosphere.2022.135995. Epub 2022 Aug 15.


Background: The accumulation of perfluoroalkyl substances (PFAS) in human body has raised concerns about the potential health impacts on children and adolescents. However, no study has evaluated the associations of PFAS exposure with folate concentrations among adolescents.

Methods: In the present study, we mainly used three statistical approaches, namely multiple linear regression, Bayesian Kernel Machine Regression (BKMR), and quantile-based g-computation (Q-gcomp) models, to evaluate associations of individual PFAS and their mixtures with serum and red blood cell (RBC) folate concentrations in a sample of 721 adolescents from the NHANES 2007-2010.

Results: In multiple linear regression models, for per unit increase in ln-transformed perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) concentrations, RBC folate concentrations decreased by 72.4 (95% confidence interval (CI): -112.7, -32.2), 58.3 (95% CI: -115.0, -1.6), 60.7 (95% CI: -107.5, -13.8), and 76.5 (95% CI: -119.0, -33.9) nmol/L, respectively. A similar significant inverse association was also observed between ln-transformed PFDA and serum folate. BKMR models further confirmed inverse associations of serum PFOS and PFDA with RBC folate, and serum PFDA with serum folate. However, the inverse associations of PFOA and PFNA with RBC folate shown in multiple linear regression model were not observed or less evident in BKMR analyses. We observed interactions of PFOA with PFOS, PFNA, and PFDA on RBC folate in BKMR models, with the negative slopes for PFOS, PFNA, and PFDA increased when PFOA concentration increased from the 10th percentile to the 90th percentile. Both BKMR and Q-gcomp models suggested that the mixtures of five PFAS showed inverse overall associations with RBC folate concentration.

Conclusions: The present study revealed that adolescent exposure to PFAS might affect serum and RBC folate concentrations.

Keywords: Adolescents; Folate; Multi-pollutant approaches; NHANES; Perfluoroalkyl substances.

MeSH terms

  • Adolescent
  • Alkanesulfonic Acids*
  • Bayes Theorem
  • Caprylates
  • Child
  • Decanoic Acids
  • Environmental Pollutants*
  • Fluorocarbons*
  • Folic Acid
  • Humans
  • Nutrition Surveys


  • Alkanesulfonic Acids
  • Caprylates
  • Decanoic Acids
  • Environmental Pollutants
  • Fluorocarbons
  • perfluorodecanoic acid
  • Folic Acid
  • perfluorooctanoic acid
  • perfluorooctane sulfonic acid