Forever chemicals now linked to disease suffered by 35million Americans
Researchers from Mount Sinai looked at the link between polyfluoroalkyl substances (PFAS) - found in everything from non-stick cookware to food packaging to tap water - and the incidence of type 2 diabetes, which affects up to 35 million Americans.
Past research has linked the chemicals, which accumulate in the body over time and are slow to break down, to a range of health problems, including kidney, breast and testicular cancers.
To paint a more comprehensive picture of PFAS and diabetes risk, researchers looked at large population-level datasets to identify patterns of exposure and illness.
Based on available data, the study analyzed 180 people recently diagnosed with type 2 diabetes and compared them to 180 similar individuals without diabetes. All participants were matched based on age, sex, and ancestry.
Researchers used blood samples to analyze PFAS levels and found that higher levels increased the risk of developing type 2 diabetes by almost one third.
Specifically, each increase in range of PFAS exposure was linked to a 31 percent increase in risk.
Dr Vishal Midya, who was the lead author of the study and an assistant professor of environmental medicine at Mount Sinai, said: 'Because they don't break down easily, PFAS accumulate in the environment - and in human bodies.
'Our study is one of the first to examine how these chemicals may disrupt the body's metabolism in ways that increase diabetes risk - particularly in diverse US populations.'
For the study, the researchers used data from BioMe, an electronic health record-linked biobank of more than 65,000 patients seeking primary care at Mount Sinai Hospital in New York since 2007.
From an initial analysis, 180 people recently diagnosed with type 2 diabetes were selected with this group made up of 33 percent African Americans, 33 percent Hispanics, and 33 percent Whites.
These patients were then compared to 180 similar individuals without diabetes. All participants were matched based on age, sex, and ancestry.
Blood plasma samples collected from the individuals before they were diagnosed with diabetes or given the all-clear were used to assess PFAS levels.
The researchers then applied Weighted Quantile Sum (WQS) regression to the samples. This statistical method is used to analyze the effects of mixtures of chemical exposures on a health outcome.
By using WQS, the team were able to see how PFAS levels in the blood were linked to patients developing diabetes.
Metabolic alterations, such as insulin resistance and impaired glucose metabolism, are key contributors to the development of type 2 diabetes.
These changes, often linked to obesity and unhealthy lifestyles, disrupt the body's ability to regulate blood sugar effectively, leading to hyperglycemia.
Hyperglycemia occurs when the level of sugar in your blood gets too high. Chronic or persistent hyperglycemia can lead to diabetes, particularly type 2 diabetes.
Symptoms of hyperglycemia include feeling thirsty, frequent urination, tiredness and breath that smells fruity.
Treatment for type 2 typically involves taking insulin several times a day, either by injection or through a pump.
PFAS exposure can contribute to diabetes development through several mechanisms, including disrupting cells in the pancreas responsible for regulating blood glucose levels, increasing insulin resistance, and potentially increasing body fat.
The researchers say the new findings underscore the importance of regulating PFAS.
Senior author, Dr Damaskini Valvi, said: 'Findings can help us design more effective interventions for the early prevention of type 2 diabetes in the future, taking into account individuals' exposures to environmental chemicals along with other well-known genetic, clinical, and lifestyle factors implicated in diabetes development.
'Mounting research suggests that PFAS are a risk factor for several chronic diseases, such as obesity, liver disease, and diabetes.'
PFAS are microscopic substances that take thousands of years to break down in the environment and human body, earning them the name 'forever chemicals.'
Their main purpose is to repel water and oil, which is what makes non-stick cookware easier to clean and why certain jackets and tents can withstand rain.
The chemicals can seep into the water supply from washing dishes and can enter food if packaging is made to be grease-resistant or if the non-stick coating on pots and pans begins to deteriorate.
PFAS are also common in pesticides used on crops, which produces chemical-rich runoff that can enter the drinking water supply.
There is no level of safe exposure to the chemicals.
Public water systems have four years to implement solutions to reduce PFAS in their water, under orders made by the Environmental Protection Agency (EPA).
Beginning in 2029, the EPA will police levels of six types of PFAS in drinking water - PFOS, PFOA, PFNA, PFHxS, PFHpA, and PFBS - and systems with unacceptable levels, will be required to notify the public.
Last year, the EPA set the maximum contaminant levels for PFAS at 4.0 parts per trillion.
One study found that US counties where drinking water surpassed this level - such as Nassau, Suffolk, and Rockland in New York and Los Angeles, Orange, and Riverside counties in California - had a higher incidence of digestive, endocrine, respiratory, and mouth and throat cancers.
Increases in incidence rates ranged from slightly elevated, at two percent, to 'substantially elevated' at 33 percent.
The Mount Sinai team are now calling for studies involving larger populations, expanding over the life course, in order to better understand the health impacts of PFAS across the lifespan and at vulnerable life periods.
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