Per- and polyfluoroalkyl substances and bone mineral content in early adolescence: Modification by diet and physical activity

Jessie P. Buckley, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: Jessie.Buckley@unc.edu.
Junyi Zhou, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Katherine M. Marquess, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Bruce P. Lanphear, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
Kim M. Cecil, Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA.
Aimin Chen, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
Clara G. Sears, Christina Lee Brown Envirome Institute, Department of Medicine, Division of Environmental Medicine, University of Louisville, KY, USA.
Yingying Xu, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA.
Kimberly Yolton, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA.
Heidi J. Kalkwarf, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA.
Joseph M. Braun, Department of Epidemiology, Brown University, Providence, USA.
Jordan R. Kuiper, Department of Environmental and Occupational Health, The George Washington University Milken Institute School of Public Health, Washington, D.C., USA.

Document Type

Journal Article

Publication Date

4-3-2024

Journal

Environmental research

Volume

252

Issue

Pt 1

DOI

10.1016/j.envres.2024.118872

Keywords

Adolescent health; Bone mineral content; Calcium; Diet; Perfluoroalkyl substances; Physical activity

Abstract

BACKGROUND: Per- and polyfluoroalkyl substance (PFAS) exposures may negatively impact bone mineral accrual, but little is known about potential mitigators of this relation. We assessed whether associations of PFAS and their mixture with bone mineral content (BMC) in adolescence were modified by diet and physical activity. METHODS: We included 197 adolescents enrolled in a prospective pregnancy and birth cohort in Cincinnati, Ohio (2003-2006). At age 12 years, we collected serum for PFAS measurements and used dual-energy x-ray absorptiometry to measure BMC. We calculated dietary calcium intake and Health Eating Index (HEI) scores from repeated 24-h dietary recalls, physical activity scores using the Physical Activity Questionnaire for Older Children (PAQ-C), and average moderate to vigorous physical activity (MVPA) based on accelerometry. We estimated covariate-adjusted differences in BMC z-scores per interquartile range (IQR) increase of individual PFAS concentrations using linear regression and per simultaneous IQR increase in all four PFAS using g-computation. We evaluated effect measure modification (EMM) using interaction terms between each modifier and PFAS. RESULTS: Higher serum perfluorooctanoic acid, perfluorooctanesulfonic acid, and perfluorononanoic acid concentrations and the PFAS mixture were associated with lower BMC z-scores. An IQR increase in all PFAS was associated with a 0.27 (-0.54, 0.01) lower distal radius BMC z-score. Associations with lower BMC were generally stronger among adolescents classified as < median for calcium intake, HEI scores, or MVPA compared to those ≥ median. The difference in distal radius BMC z-score per IQR increase in all PFAS was -0.38 (-0.72, -0.04) for those with

Department

Environmental and Occupational Health

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