Plasma metabolites associated with exposure to perfluoroalkyl substances and risk of type 2 diabetes – A nested case-control study
Journal article, 2021

Perfluoroalkyl substances (PFAS) are widespread persistent environmental pollutants. There is evidence that PFAS induce metabolic perturbations in humans, but underlying mechanisms are still unknown. In this exploratory study, we investigated PFAS-related plasma metabolites for their associations with type 2 diabetes (T2D) to gain potential mechanistic insight in these perturbations. We used untargeted LC-MS metabolomics to find metabolites related to PFAS exposures in a case-control study on T2D (n = 187 matched pairs) nested within the Västerbotten Intervention Programme cohort. Following principal component analysis (PCA), six PFAS measured in plasma appeared in two groups: 1) perfluorononanoic acid, perfluorodecanoic acid and perfluoroundecanoic acid and 2) perfluorohexane sulfonic acid, perfluorooctane sulfonic acid and perfluorooctanoic acid. Using a random forest algorithm, we discovered metabolite features associated with individual PFAS and PFAS exposure groups which were subsequently investigated for associations with risk of T2D. PFAS levels correlated with 171 metabolite features (0.16 ≤ |r| ≤ 0.37, false discovery rate (FDR) adjusted p < 0.05). Out of these, 35 associated with T2D (p < 0.05), with 7 remaining after multiple testing adjustment (FDR < 0.05). PCA of the 35 PFAS- and T2D-related metabolite features revealed two patterns, dominated by glycerophospholipids and diacylglycerols, with opposite T2D associations. The glycerophospholipids correlated positively with PFAS and associated inversely with risk for T2D (Odds Ratio (OR) per 1 standard deviation (1-SD) increase in metabolite PCA pattern score = 0.2; 95% Confidence Interval (CI) = 0.1–0.4). The diacylglycerols also correlated positively with PFAS, but they associated with increased risk for T2D (OR per 1-SD = 1.9; 95% CI = 1.3–2.7). These results suggest that PFAS associate with two groups of lipid species with opposite relations to T2D risk.

Nested case-control study

Perfluoroalkyl substances


Type 2 Diabetes


Tessa Schillemans

Karolinska Institutet

Lin Shi

Shaanxi Normal University

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

Carolina Donat Vargas

Karolinska Institutet

Universidad Autonoma de Madrid (UAM)

Kati Hanhineva

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

University of Turku

University of Eastern Finland

A. Tornevi

Umeå University

Ingegerd Johansson

Umeå University

Jani Koponen

Finnish Institute for Health and Welfare

Hannu Kiviranta

Finnish Institute for Health and Welfare

Olov Rolandsson

Umeå University

Ingvar A. Bergdahl

Umeå University

Rikard Landberg

Umeå University

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

Agneta Åkesson

Karolinska Institutet

Carl Brunius

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

Environment International

0160-4120 (ISSN) 1873-6750 (eISSN)

Vol. 146 106180

Subject Categories

Endocrinology and Diabetes

Environmental Health and Occupational Health

Nutrition and Dietetics

Driving Forces

Sustainable development





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