Assessing the impact of mixed exposure to 18 PFASs on dyslipidemia risk: An epidemiological study in middle-aged and...

Dyslipidemia is a major cardiovascular risk factor, and per- and polyfluoroalkyl substances (PFASs) may disrupt lipid metabolism. This cross-sectional study measured urinary concentrations of 18 PFASs and fasting serum lipids in 214 middle-aged and elderly adults from Guangzhou, China. Associations were assessed using regression models and three mixture approaches: weighted quantile sum regression, quantile g-computation, and Bayesian kernel machine regression, with stratification by sex and age. Twelve PFASs were detected in over 60% of participants, with PFBA and PFPeA showing the highest concentrations. Short-chain PFASs, including PFBA, PFHxA, and PFBS, were positively associated with total cholesterol, triglycerides, and low-density lipoprotein, whereas PFHpA showed inverse associations. 6:2-Cl-PFESA was associated with lower high-density lipoprotein and total cholesterol. Mixture analyses showed no overall association but suggested antagonistic and interactive effects. Associations were stronger in men and adults aged 60-75 years. Prospective studies are needed to clarify causality and mechanisms.