A recent study has established a connection between certain synthetic compounds known as “forever chemicals” and a heightened risk of liver disease in adolescents. Conducted by the Southern California Superfund Research and Training Program for PFAS Assessment, Remediation and Prevention (ShARP) Center in collaboration with the University of Hawai’i, the research focuses on per- and polyfluoroalkyl substances (PFAS). The findings indicate that exposure to these chemicals may increase the likelihood of developing metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as fatty liver disease, by as much as threefold.
The study was published in the journal Environmental Research and highlights that MASLD affects approximately 10% of children, with rates rising to up to 40% among those with obesity. This chronic condition often lacks evident symptoms, though some affected individuals may experience fatigue, discomfort, and abdominal pain. Left unchecked, MASLD can lead to severe health issues, including type 2 diabetes, heart disease, cirrhosis, and liver cancer.
Dr. Lida Chatzi, a professor at the University of Southern California and director of the ShARP Center, emphasized the gravity of the findings: “When liver fat starts accumulating in adolescence, it may set the stage for a lifetime of metabolic and liver health challenges. If we reduce PFAS exposure early, we may help prevent liver disease later. That’s a powerful public-health opportunity.”
PFAS are synthetic chemicals found in various everyday products such as nonstick cookware, stain- and water-repellent fabrics, food packaging, and certain cleaning agents. They are notorious for their persistence in the environment and their ability to accumulate in human bodies over time. Alarmingly, more than 99% of people in the United States have detectable levels of PFAS in their blood, with at least one PFAS compound present in approximately half of U.S. drinking water supplies.
Dr. Shiwen “Sherlock” Li, the study’s first and corresponding author, pointed out that adolescents face unique vulnerabilities during this critical developmental phase. “In addition to liver disease, PFAS exposure has been associated with a range of adverse health outcomes, including several types of cancer,” he stated.
The research involved an analysis of 284 adolescents and young adults from two longitudinal studies conducted in Southern California. Participants were selected based on their higher metabolic risk, often due to parental history of type 2 diabetes or obesity. Blood tests measured PFAS levels, while magnetic resonance imaging (MRI) assessed liver fat. Results showed that higher blood levels of two prevalent PFAS compounds, perfluorooctanoic acid (PFOA) and perfluoroheptanoic acid (PFHpA), were associated with an increased likelihood of MASLD. Specifically, adolescents with double the amount of PFOA in their blood were nearly three times more likely to develop the condition.
The risk escalated further for those carrying a genetic variant known as PNPLA3 GG, which is known to affect liver fat. Additionally, among young adults, smoking was found to amplify the liver-related impacts of PFAS exposure.
Dr. Max Aung, an assistant professor at the Keck School of Medicine, noted, “These findings suggest that PFAS exposures, genetics, and lifestyle factors work together to influence who has a greater risk of developing MASLD as a function of your life stage.” This research represents a significant advancement in understanding how genetic and environmental factors interact in the context of PFAS exposure.
Moreover, this study is notable for being the first to examine the relationship between PFAS and MASLD in children using established diagnostic criteria. It also explores how genetic and lifestyle factors may interact with PFAS exposure. The rising prevalence of MASLD among adolescents as they mature underscores the notion that puberty and early adulthood may heighten susceptibility to environmental hazards.
The study builds upon previous research from USC, which indicated that a specific PFAS compound, PFHpA, correlates with more severe liver disease in adolescents undergoing bariatric surgery for obesity. Dr. Chatzi remarked, “Taken together, the two studies show that PFAS exposures not only disrupt liver biology but also translate into real liver disease risk in youth. Adolescence seems to be a critical window of susceptibility, suggesting PFAS exposure may matter most when the liver is still developing.”
The study’s co-authors include a diverse group of researchers affiliated with various institutions, including the University of Southern California, Brown University, Emory University, UC Irvine, Johns Hopkins University, and West Virginia University. This collaborative effort received funding from the National Institutes of Health, the U.S. Environmental Protection Agency, and the Hastings Foundation.
As the implications of PFAS exposure become increasingly evident, this research underscores the urgent need for public health initiatives aimed at reducing exposure, particularly among vulnerable populations such as adolescents.
