Evidence map›Paper›PMID 31150976›Full record

ArticleEnvironment international2019

Per- and polyfluoroalkyl substances and blood lipid levels in pre-diabetic adults-longitudinal analysis of the diabetes prevention program outcomes study.

Pi-I D Lin, Andres Cardenas, Russ Hauser, Diane R Gold, Ken P Kleinman, Marie-France Hivert, Abby F Fleisch, Antonia M Calafat, Thomas F Webster, Edward S Horton and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Environment international, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
69citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

69 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Determinants of maternal and neonatal PFAS concentrations: a review.Environmental health : a global access science source · 2023
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  20. Adapting existing toxicokinetic models to relate perfluoroalkyl and polyfluoroalkyl intake to biomarkers in humans.Toxicological sciences : an official journal of the Society of Toxicology · 2025
    Article

9 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Pi-I D LinDivision of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Andres CardenasDivision of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
Russ HauserDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Diane R GoldDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Ken P KleinmanDepartment of Biostatistics, School of Public Health and Human Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
Marie-France HivertDivision of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
Abby F FleischPediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.
Antonia M CalafatDivision of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Thomas F WebsterDepartment of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
Edward S HortonJoslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
Emily OkenDivision of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. Electronic address: emily_oken@harvardpilgrim.org.

Funding

Long-term prospective associations of PFAS with musculoskeletal and cardiovascular health among older adultsR01ES024765 · NIEHS · HARVARD PILGRIM HEALTH CARE, INC. · PI Abby Fleisch, Emily Oken · 2015 to 2026
$3.9M
Prospective associations of childhood PFAS with metabolomic profiles, pubertal timing, and bone healthR01ES030101 · NIEHS · MAINEHEALTH · PI Abby Fleisch · 2019 to 2026
$3.6M
Air Pollution Exposure during Pregnancy, Maternal Glycemia, and OffspringGrowthK23ES024803 · NIEHS · MAINEHEALTH · PI FLEISCH, ABBY · 2015 to 2019
$835k
NIEHS NIH HHS K23 ES024803NIEHS NIH HHS R01 ES024765NIEHS NIH HHS R01 ES030101
6 · The paper itself

Abstract

Exposure to per- and polyfluoroalkyl substances (PFASs) may interfere with lipid regulation. However, most previous studies were cross-sectional with the risk of reverse causation, suggesting a need for long-term prospective studies. We examined the relationship of baseline plasma PFAS concentrations with repeated measures of blood lipids. We included 888 prediabetic adults from the Diabetes Prevention Program (DPP) and DPP Outcomes Study, who had measurements of 6 plasma PFAS concentrations at baseline (1996-1999) and repeated measures of blood lipids over 15 years of follow-up, and were initially randomized to placebo or a lifestyle intervention. We used linear regression to examine cross-sectional associations of PFAS concentrations and lipid levels at baseline, and evaluated prospective risks of hypercholesterolemia and hypertriglyceridemia using Cox proportional hazard models, and tested for effect modification by study arm. Participants (65.9% female, 57.0% White, 65.9% aged 40-59 years) had comparable PFAS concentrations [e.g., median (IQR) perfluorooctanoic acid (PFOA) 4.9 ng/mL (3.2)] with the general U.S. population in 1999-2000. We observed higher total cholesterol at baseline per doubling of PFOA (β: 6.1 mg/dL, 95% CI: 3.1, 9.04), perfluorohexane sulfonic acid (PFHxS, β: 2.2 mg/dL, 95% CI: 0.2, 4.3), and perfluorononanoic acid (PFNA, β: 2.9 mg/dL, 95% CI: 0.7, 5.0). Prospectively, baseline concentrations of several PFASs, including PFOA, PFOS, PFHxS and PFNA, predicted higher risks of incident hypercholesterolemia and hypertriglyceridemia, but only in the placebo group and not the lifestyle intervention group. For example, participants in the placebo group with PFOA concentration > median (4.9 ng/mL) were almost twice as likely (HR: 1.90, 95% CI: 1.25, 2.88) to develop hypertriglyceridemia compared to those ≤median. Findings suggest adverse effects of some PFASs on lipid profiles in prediabetic adults. However, the detrimental effect was attenuated with a lifestyle intervention.

Indexed as

AdultCaprylatesCholesterolCross-Sectional StudiesEnvironmental PollutantsFemaleFluorocarbonsFollow-Up StudiesHumansLife StyleLinear ModelsLipidsMaleMiddle AgedPrediabetic StateProspective StudiesCaprylatesCholesterolEnvironmental PollutantsFluorocarbonsLipidsperflexaneperfluorooctanoic acidEnvironmental epidemiologyHyperlipidemiaLifestyle interventionLipid and cholesterolPer- and polyfluoroalkyl substancesProspective assessment

Identifiers

PMID31150976
PMCPMC6570418

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.