Academic journal article Environmental Health Perspectives

Association of Perfluorooctanoic Acid (PFOA) and Perfluorooctane Sulfonate (PFOS) with Uric Acid among Adults with Elevated Community Exposure to PFOA

Academic journal article Environmental Health Perspectives

Association of Perfluorooctanoic Acid (PFOA) and Perfluorooctane Sulfonate (PFOS) with Uric Acid among Adults with Elevated Community Exposure to PFOA

Article excerpt

BACKGROUND: Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are compounds that do not occur in nature, have been widely used since World War II, and persist indefinitely in most environments. Median serum levels in the United States are 4 ng/mL for PFOA and 21 ng/mL for PFOS. PFOA has been associated with elevated uric acid in two studies of chemical workers. Uric acid is a risk factor for hypertension and possibly other cardiovascular outcomes.

METHODS: We conducted a cross-sectional study of PFOA and PFOS and uric acid among 54,951 adult community residents in Ohio and West Virginia, who lived or worked in six water districts contaminated with PFOA from a chemical plant. Analyses were conducted by linear and logistic regression, adjusted for confounders.

RESULTS: Both PFOA and PFOS were significandy associated with uric acid. An increase of 0.2-0.3 mg/dL uric acid was associated with an increase from the lowest to highest decile of either PFOA or PFOS. Hyperuricemia risk increased modestly with increasing PFOA; the odds ratios by quintile of PFOA were 1.00, 1.33 [95% confidence interval (CI), 1.24-1.43], 1.35 (95% CI, 1.26-1.45), 1.47 (95% CI, 1.37-1.58), and 1.47 (95% CI, 1.37-1.58; test for trend, p < 0.0001). We saw a less steep trend for PFOS. Inclusion of both correlated fluorocarbons in the model indicated PFOA was a more important predictor than was PFOS.

CONCLUSION: Higher serum levels of PFOA were associated with a higher prevalence of hyperuricemia, but the limitations of cross-sectional data and the possibility of noncausal mechanisms prohibit conclusions regarding causality.

KEY WORDS: PFOA, PFOS, uric acid. Environ Health Perspect 118:229-233 (2010). doi:10.1289/ehp.0900940 available via[Online 22 October 2009]


Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are perfluorinated compounds that have been found in the blood of virtually all Americans tested during the last decade (Calafat et al. 2007). They do not occur naturally but were introduced in the environment after World War II.

PFOA is used as a polymerization aid in the manufacture of several types of fluoropolymers, which have been used in a wide variety of industrial and consumer products, such as Teflon and Gore-Tex. PFOA does not break down in most environments. The half-life of PFOA in humans is estimated to be 3.8 years [arithmetic mean; 95% confidence interval (CI), 3.1-4.4 years] (Olsen et al. 2007). The median level in the U.S. population was 4 ng/mL in 2003 (Calafat et al. 2007). The origins of long-chain per-fluorocarbon exposures stem from manufacture or use of industrial products, yet the routes of exposure and specific origins are rarely clear. PFOA is also widespread in the serum of inhabitants of many other countries (Lau et al. 2007).

PFOA has been found to be significantly associated with elevated uric acid in two cross-sectional studies of chemical workers (n = 160 and n = 1,024) (Costa et al. 2009; Sakr et al. 2007a). There is also evidence in the literature for an association of PFOA with cholesterol and diabetes in humans. A positive correlation of PFOA with cholesterol was observed in six occupational studies (Costa et al. 2009; Olsen and Zobel 2007; Olsen et al. 2000, 2003; Sakr et al. 2007a, 2007b), and two community studies (Emmett et al. 2006; Steenland et al. 2009b), although in one community study and two of occupational studies the relationship was not statistically significant. PFOA exposure was observed to be associated with a 2-fold increase in diabetes mortality in one cohort study of highly exposed workers compared with nonexposed workers, although no association was seen in another cross-sectional study of diabetes prevalence (Leonard et al. 2008; MacNeil et al. 2009). In addition, PFOA has been associated with a number of outcomes in animal data, particularly tumors and neonatal loss (Lau et al. …

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