Comment on “Determinants of PFOA Serum Half-Life after End of Exposure: A Longitudinal Study on Highly Exposed Subjects in the Veneto Region” – ScienceOpen
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      Comment on “Determinants of PFOA Serum Half-Life after End of Exposure: A Longitudinal Study on Highly Exposed Subjects in the Veneto Region”

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          Abstract

          The paper by Batzella et al. 1 considered 5,860 persons 14–52 years of age exposed to per- and polyfluoroalkyl substances (PFAS). The participants, residents of the Veneto Region in Italy, underwent two rounds of screening in the regional Health Surveillance Plan. The half-life results for perfluorooctanoic acid (PFOA) were similar to those described in the Mid-Ohio Valley (United States) and in Ronneby (Sweden), where exposure was estimated for a smaller number of residents. 2,3 The results pertain to a subset of individuals who underwent the second round of screening and, by definition, exclude all those who did not participate in the surveillance program. The new results are important from a pharmacokinetic perspective. They also indicate that some subpopulations are still being exposed, even after the commendable and timely implementation of double filtration with activated carbon in the aqueducts of the most highly contaminated area (known in the literature as Red Area A). 4 We therefore believe far more research should address pathways of exposure beyond drinking water. The paper presents new knowledge regarding the role of some lifestyle factors (obesity, alcohol consumption, smoking habits) in influencing the serum clearance process of PFOA. However, consumption of drinking water and food was not considered. Further investigation seems appropriate, given that a previous study showed that 50.9% of residents in the affected area consumed vegetables from their own garden, 20.9% consumed their own animal products (mostly eggs and poultry), and 11.6% consumed water from private wells. 4 There is already evidence that food and water consumption is an important source of PFAS exposure in this region: Biomonitoring studies carried out by Istituto Superiore di Sanità (ISS) about 2 years before the start of the first round of Health Surveillance Plan screening also showed higher serum concentrations of PFOA among 257 residents who raised livestock for self-consumption and among 122 farmers and breeders who consumed beef from their own farmsteads. 5,6 In an unpublished scenario analysis conducted by the ISS in 2019, the estimated adult daily intake of PFOA and perfluorooctane sulfonate (PFOS) was about 0.6  ng / kg / day and 1.7  ng / kg / day , respectively, among residents in Red Area A, based on drinking water doubly filtered with activated carbon and eating local food over an extended period. 7 Elevated exposure to PFOA among those consuming vegetables from their own garden was described in the Mid-Ohio Valley. 8 Thus, ongoing exposure to PFOA and PFOS from sources other than tap water among residents in Red Area A cannot be ruled out. Residual excesses in daily intakes might influence the half-life of these congeners in some subgroups of the affected population.

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          Half-lives of PFOS, PFHxS and PFOA after end of exposure to contaminated drinking water

          Background Municipal drinking water contaminated with perfluorinated alkyl acids had been distributed to one-third of households in Ronneby, Sweden. The source was firefighting foam used in a nearby airfield since the mid-1980s. Clean water was provided from 16 December 2013. Objective To determine the rates of decline in serum perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA), and their corresponding half-lives. Methods Up to seven blood samples were collected between June 2014 and September 2016 from 106 participants (age 4–84 years, 53% female). Results Median initial serum concentrations were PFHxS, 277 ng/mL (range 12–1660); PFOS, 345 ng/mL (range 24–1500); and PFOA, 18 ng/mL (range 2.4–92). The covariate-adjusted average rates of decrease in serum were PFHxS, 13% per year (95% CI 12% to 15%); PFOS, 20% per year (95% CI 19% to 22%); and PFOA, 26% per year (95% CI 24% to 28%). The observed data are consistent with a first-order elimination model. The mean estimated half-life was 5.3 years (95% CI 4.6 to 6.0) for PFHxS, 3.4 years (95% CI 3.1 to 3.7) for PFOS and 2.7 years (95% CI 2.5 to 2.9) for PFOA. The interindividual variation of half-life was around threefold when comparing the 5th and 95th percentiles. There was a marked sex difference with more rapid elimination in women for PFHxS and PFOS, but only marginally for PFOA. Conclusions The estimated half-life for PFHxS was considerably longer than for PFOS and PFOA. For PFHxS and PFOS, the average half-life is shorter than the previously published estimates. For PFOA the half-life is in line with the range of published estimates.
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            Rate of Decline in Serum PFOA Concentrations after Granular Activated Carbon Filtration at Two Public Water Systems in Ohio and West Virginia

            Background Drinking water in multiple water districts in the Mid-Ohio Valley has been contaminated with perfluorooctanoic acid (PFOA), which was released by a nearby DuPont chemical plant. Two highly contaminated water districts began granular activated carbon filtration in 2007. Objectives To determine the rate of decline in serum PFOA, and its corresponding half-life, during the first year after filtration. Methods Up to six blood samples were collected from each of 200 participants from May 2007 until August 2008. The primary source of drinking water varied over time for some participants; our analyses were grouped according to water source at baseline in May–June 2007. Results For Lubeck Public Service District customers, the average decrease in serum PFOA concentrations between May–June 2007 and May–August 2008 was 32 ng/mL (26%) for those primarily consuming public water at home (n = 130), and 16 ng/mL (28%) for those primarily consuming bottled water at home (n = 17). For Little Hocking Water Association customers, the average decrease in serum PFOA concentrations between November–December 2007 and May–June 2008 was 39 ng/mL (11%) for consumers of public water (n = 39) and 28 ng/mL (20%) for consumers of bottled water (n = 11). The covariate-adjusted average rate of decrease in serum PFOA concentration after water filtration was 26% per year (95% confidence interval, 25–28% per year). Conclusions The observed data are consistent with first-order elimination and a median serum PFOA half-life of 2.3 years. Ongoing follow-up will lead to improved half-life estimation.
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              Serum Levels of Perfluoroalkyl Substances (PFAS) in Adolescents and Young Adults Exposed to Contaminated Drinking Water in the Veneto Region, Italy: A Cross-Sectional Study Based on a Health Surveillance Program

              Background: In spring 2013, groundwater of a vast area of the Veneto Region (northeastern Italy) was found to be contaminated by perfluoroalkyl substances (PFAS) from a PFAS manufacturing plant active since the late 1960s. Residents were exposed to high concentrations of PFAS, particularly perfluorooctanoic acid (PFOA), through drinking water until autumn 2013. A publicly funded health surveillance program is under way to aid in the prevention, early diagnosis, and treatment of chronic disorders possibly associated with PFAS exposure. Objectives: The objectives of this paper are: a) to describe the organization of the health surveillance program, b) to report serum PFAS concentrations in adolescents and young adults, and c) to identify predictors of serum PFAS concentrations in the studied population. Methods: The health surveillance program offered to residents of municipalities supplied by contaminated waterworks includes a structured interview, routine blood and urine tests, and measurement of 12 PFAS in serum by high-performance liquid chromatography–tandem mass spectrometry. We studied 18,345 participants born between 1978 and 2002, 14–39 years of age at recruitment. Multivariable linear regression was used to identify sociodemographic, lifestyle, dietary, and reproductive predictors of serum PFAS concentrations. Results: The PFAS with the highest serum concentrations were PFOA [median 44.4   ng / mL , interquartile range (IQR) 19.3–84.9], perfluorohexanesulfonic acid (PFHxS) (median 3.9   ng / mL , IQR 1.9–7.4), and perfluorooctanesulfonic acid (PFOS) (median 3.9   ng / mL , IQR 2.6–5.8). The major predictors of serum levels were gender, municipality, duration of residence in the affected area, and number of deliveries. Overall, the regression models explained 37%, 23%, and 43% of the variance of PFOA, PFOS, and PFHxS, respectively. Conclusions: Serum PFOA concentrations were high relative to concentrations in populations with background residential exposures only. Interindividual variation of serum PFAS levels was partially explained by the considered predictors. https://doi.org/10.1289/EHP5337
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                Author and article information

                Journal
                Environ Health Perspect
                Environ Health Perspect
                EHP
                Environmental Health Perspectives
                Environmental Health Perspectives
                0091-6765
                1552-9924
                14 June 2024
                June 2024
                : 132
                : 6
                : 068001
                Affiliations
                [ 1 ]College of Physicians of Vicenza , Vicenza, Italy
                [ 2 ]Professor Emeritus, West Virginia University , Morgantown, West Virginia, USA
                Author notes
                Address correspondence to Armando Olivieri. Email: armando.olivieri54@ 123456gmail.com
                Author information
                https://orcid.org/0009-0004-6216-3611
                Article
                EHP15099
                10.1289/EHP15099
                11218696
                38875023
                a8064a7a-a5a0-4754-bdff-534a11af90c6

                EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.

                History
                : 03 April 2024
                : 31 May 2024
                Categories
                Letter to the Editor

                Public health
                Public health

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