Associations between perfluoroalkyl acids in serum and lead and mercury in whole blood among US children aged 3–11 years

Data for 639 US children aged 3–11 years who participated in the National Health and Nutrition Examination Survey during 2013–2014 were analyzed by fitting regression models with log10-transformed values of blood lead and methyl and total mercury as dependent variables and log10-transformed values of perfluoroalkyl acids (PFAA) as one of the independent variables. PFAAs considered were 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (MPAH), linear isomer of perfluorooctanoic acid (NPFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluorohexane sulfonic acid (PFHxS), linear isomer of perfluorooctane sulfonic acid (NPFOS), and monomethyl branch isomer of perfluorooctane sulfonic acid (MPFOS). Adjusted regression slopes (β) indicating associations between the concentrations of PFAAs with blood lead and mercury were estimated. Statistically significant associations between concentrations of each PFAA and blood lead were observed. For 10% increases in concentrations of MPAH, NPFOA, PFNA, PFDA, PFHxS, NPFOS, and MPFOS, percent increases in the concentrations of blood lead were 0.45%, 1.59%, 0.78%, 0.32%, 0.65%, 1.32%, and 0.89% respectively. For 10% increases in concentrations of MPAH, PFNA, PFDA, and NPFOS, percent increases in the concentrations of total mercury in the blood were 1.62%, 1.44%, and 3.24% respectively. For 10% increases in concentrations of PFDA and NPFOS, percent increases in the concentrations of methyl mercury in the blood were 2.07% and 4.57% respectively. While concentrations of each of the seven PFAAs were positively associated with the concentrations of blood lead, concentrations of only PFDA and NPFOS were positively associated with increases in total and methyl mercury. PFAAs having positive associations with lead and mercury imply co-exposure and/or co-existence of high concentrations of PFAAs and lead/mercury. Since PFAAs as well as lead/mercury are known to be neurotoxic, nephrotoxic, and endocrine disruptors, their co-existence/co-exposure may lead to neurodevelopmental deficits that are additive/synergistic than neurodevelopmental deficits associated with exposures to PFAAs and lead/mercury alone. Future studies are needed to investigate additive/synergistic neurodevelopmental deficits associated with co-exposures to PFAAs and lead/mercury.