ArticleEnvironment international2020
Perfluoroalkyl substances and severity of nonalcoholic fatty liver in Children: An untargeted metabolomics approach.
Article in Environment international, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 101 papers, 5 of them syntheses that pooled it.
What it found
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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.
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Who cites it
101 citing papers in PubMed, 5 syntheses or guidelines pooled it, 217 citations in OpenAlex.
- Environmental Endocrine-Disrupting Chemicals and Metabolic Dysfunction-Associated Steatotic Liver Disease.Liver international : official journal of the International Association for the Study of the Liver · 2026Pooled it
- Exposure to Per- and Polyfluoroalkyl Substances and Liver Cancer: A Systematic Review of Animal and Epidemiological Studies.Environmental science & technology · 2026Pooled it
- Metabolic Signatures of Youth Exposure to Mixtures of Per- and Polyfluoroalkyl Substances: A Multi-Cohort Study.Environmental health perspectives · 2023Pooled it
- Human Evidence of Perfluorooctanoic Acid (PFOA) Exposure on Hepatic Disease: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2022Pooled it
- Exposure to per- and Polyfluoroalkyl Substances and Markers of Liver Injury: A Systematic Review and Meta-Analysis.Environmental health perspectives · 2022Pooled it
- A Review on Environmental Occurrence and Toxicity of Perfluorooctanoic Acid and Its Selected Short-Chain Analogs-Perfluorohexanoic Acid and Perfluorobutanoic Acid.International journal of molecular sciences · 2026Review
- Metabolomics of per- and polyfluoroalkyl substances (PFAS) exposure: Advances in LC-MS technology and applications.Journal of food and drug analysis · 2026Review
- Photoperiod perturbations impact perfluorohexane sulfonate (PFHxS) induced developmental toxicity.Journal of hazardous materials · 2026Article
- Forever Chemicals, Finite Defenses: PFAS Burden the Liver, Break Mitochondria, and Outpace Modern Regulation.International journal of molecular sciences · 2026Review
- Per- and Polyfluoroalkyl Substances Induce Cardiotoxicity and Alter Protein Profiles of Extracellular Matrix, Metabolism, and Mitochondrial Function in Human Cardiomyocytes.Chemical research in toxicology · 2026Article
- Associations between per- and polyfluoroalkyl substances and metabolic dysfunction-associated steatotic liver disease in adolescents and young adults: modifying roles of age, lifestyle factors, and PNPLA3 genotype.Environmental research · 2026Article
- PFOS-induced black liver and hepatic aging in mice: A new paradigm in environmental hepatotoxicology.Environment international · 2026Article
- Ubiquitous Environmental Exposures and Risk of Hepatocellular Carcinoma: A Narrative Review.Digestive diseases and sciences · 2026Review
- Endocrine-disrupting chemicals exposure: cardiometabolic health risk in humans.Cardiovascular diabetology · 2025Review
- PFAS Exposure Induces Hearing Loss by Targeting Cochlear Hair Cells, Ribbon Synapses, and Spiral Ganglions.Research square · 2025Article
- Assessing the impact of perfluoroalkyl substances on liver health: a comprehensive study using multi-donor human liver spheroids.Environment international · 2025Article
- Systemic chronic inflammation mediates the effect of per- and polyfluoroalkyl substances exposure on the risk of nonalcoholic fatty liver disease: A cross-sectional study among Chinese government employees.Environmental epidemiology (Philadelphia, Pa.) · 2025Article
- Exposure to per- and poly-fluoroalkyl substances in association to later occurrence of type 2 diabetes and metabolic pathway dysregulation in a multiethnic US population.EBioMedicine · 2025Article
- A subcellular study on reactive oxygen species generation by PFAS in HepG2 cells.Scientific reports · 2025Article
- Environmental Pollutants, Occupational Exposures, and Liver Disease.Seminars in liver disease · 2025Review
41 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundToxicant-associated steatohepatitis has been described in adults but less is known regarding the role of toxicants in liver disease of children. Perfluoroalkyl substances (PFAS) cause hepatic steatosis in rodents, but few previous studies have examined PFAS effects on severity of liver injury in children.
objectivesWe aimed to examine the relationship of PFAS to histologic severity of nonalcoholic fatty liver disease (NAFLD) in children.
methodsSeventy-four children with physician-diagnosed NAFLD were recruited from Children's Healthcare of Atlanta between 2007 and 2015. Biopsy-based liver histological features were scored for steatosis, lobular and portal inflammation, ballooning, and fibrosis. Plasma concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonic acid (PFHxS), and untargeted plasma metabolomic profiling, were determined using liquid chromatography with high-resolution mass spectrometry. A metabolome-wide association study coupled with pathway enrichment analysis was performed to evaluate metabolic dysregulation associated with PFAS. A structural integrated analysis was applied to identify latent clusters of children with more severe form of NAFLD based on their PFAS levels and metabolite pattern.
resultsPatients were 7-19 years old, mostly boys (71%), Hispanic (51%), and obese (85%). The odds of having nonalcoholic steatohepatitis (NASH), compared to children with steatosis alone, was significantly increased with each interquartile range (IQR) increase of PFOS (OR: 3.32, 95% CI: 1.40-7.87) and PFHxS (OR: 4.18, 95% CI: 1.64-10.7). Each IQR increase of PFHxS was associated with increased odds for liver fibrosis (OR: 4.44, 95% CI: 1.34-14.8), lobular inflammation (OR: 2.87, 95% CI: 1.12-7.31), and higher NAFLD activity score (β coefficient 0.46; 95% CI: 0.03, 0.89). A novel integrative analysis identified a cluster of children with NASH, characterized by increased PFAS levels and altered metabolite patterns including higher plasma levels of phosphoethanolamine, tyrosine, phenylalanine, aspartate and creatine, and decreased plasma levels of betaine.
conclusionsΗigher PFAS exposure was associated with more severe disease in children with NAFLD. PFAS may be an important toxicant contributing to NAFLD progression; however larger, longitudinal studies are warranted to confirm these findings.
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