Early-life PFAS exposures and cardiometabolic risk: a comprehensive investigation in Ronneby, Sweden (PFAS-Cardio)

Research problem and specific questions: Cardiometabolic diseases are the leading cause of morbidity and mortality globally and in Sweden.

Recent evidence has linked exposures to perfluoroalkyl substances (PFAS), persistent endocrine-disrupting chemicals, to cardiometabolic risk factors. However, no research has investigated the potential cardiometabolic effects of PFAS in highly-exposed children.

This project will investigate the potential effects of early-life PFAS exposures on cardiometabolic risk factors in children from Blekinge, where contaminated drinking water caused high PFAS exposures in some of the population.

Specifically, this project will estimate associations with childhood obesity (Aim 1), growth trajectories (Aim 2) and biomarkers of cardiometabolic health (Aim 3).

Data and methods: We will evaluate associations between PFAS and childhood obesity and growth trajectories using two large registry-based cohort studies with detailed medical data.

Individual prenatal PFAS exposures will be modeled using measurements from dried blood spots collected at birth, which reduces exposure error compared to previous registry studies and improves the validity of the results.

We will also study the effects of PFAS on childhood growth and cardiometabolic biomarkers in a longitudinal birth cohort, where we will use detailed exposure measurements and mixture methods to further improve the current exposure assessment.

This multi-level design enables us to investigate both population-effects in large datasets as well as underlying mechanisms and subclinical outcomes in biological samples.

Societal relevance and utilization: Evidence regarding the potential cardiometabolic toxicity of early-life PFAS exposure is urgently needed to develop scientifically-sound public health policy. Results from the project will directly inform ongoing and future chemical risk assessments.

If we identify an association between PFAS and cardiometabolic risk, we will work closely with Region Blekinge to develop guidance for medical providers. Early interventions for at-risk children could limit the impact of PFAS exposures and mitigate inequality in health.

Plan for project realization: We are an interdisciplinary team with expertise in environmental epidemiology, biostatistics, environmental medicine and analytical chemistry.

The project will be conducted in close collaboration with regional and national stakeholders to maximize its relevance and impact on public health.