A recent study has established a concerning link between certain synthetic compounds known as per- and polyfluoroalkyl substances (PFAS) and an increased risk of liver disease in adolescents. Co-led by the Southern California Superfund Research and Training Program for PFAS Assessment, Remediation and Prevention (ShARP) Center and the University of Hawai’i, the research indicates that adolescents exposed to PFAS may experience up to a threefold increase in the likelihood of developing metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed fatty liver disease. The findings were published in the journal Environmental Research.
MASLD affects approximately 10% of children and can rise to 40% among children with obesity. This chronic condition may progress with minimal symptoms, although some individuals report fatigue, discomfort, and abdominal pain. Those diagnosed with MASLD face heightened long-term risks for serious health issues, including type 2 diabetes, cardiovascular disease, advanced liver injury, cirrhosis, and liver cancer. Dr. Lida Chatzi, a professor of population and public health sciences and pediatrics at the University of Southern California, emphasized the importance of early intervention: “If we reduce PFAS exposure early, we may help prevent liver disease later. That’s a powerful public-health opportunity.”
PFAS are widely used in products such as nonstick cookware, stain-resistant fabrics, food packaging, and select cleaning agents. These chemicals are highly persistent in the environment and accumulate in the human body over time. Research indicates that over 99% of people in the U.S. have detectable levels of PFAS in their blood, with at least one type present in around half of U.S. drinking water supplies.
The study’s first author, Dr. Shiwen “Sherlock” Li, an assistant professor of public health sciences at the University of Hawai’i, noted that adolescents are particularly susceptible to the harmful health effects of PFAS during this critical growth period. “In addition to liver disease, PFAS exposure has been associated with a range of adverse health outcomes, including several types of cancer,” Li stated.
The research involved 284 adolescents and young adults in Southern California, many of whom were already at heightened metabolic risk due to familial histories of type 2 diabetes or obesity. Researchers measured PFAS levels in participants’ blood and assessed liver fat using MRI technology. The study found that higher blood levels of two PFAS—perfluorooctanoic acid (PFOA) and perfluoroheptanoic acid (PFHpA)—were correlated with an increased likelihood of MASLD. Notably, adolescents with double the level of PFOA in their blood were nearly three times more likely to develop the disease.
The study also identified a genetic variant (PNPLA3 GG) that increases the likelihood of liver fat accumulation, revealing that the risk associated with PFAS exposure was even more pronounced in individuals possessing this variant. Additionally, smoking among young adults was shown to exacerbate liver impacts linked to PFAS.
“This research suggests that PFAS exposures, genetics, and lifestyle factors interact to influence the risk of developing MASLD,” Dr. Max Aung, an assistant professor of population and public health sciences at the Keck School of Medicine, explained. “Understanding gene and environment interactions can help advance precision environmental health for MASLD.”
This study is notable for being the first to apply gold-standard diagnostic criteria to examine the relationship between PFAS and MASLD in children. It also explores how genetic and lifestyle factors may work in conjunction with PFAS exposure. The prevalence of MASLD increased among adolescents as they aged, highlighting that puberty and early adulthood may serve as critical windows for susceptibility to environmental exposures.
The findings build on prior research from USC, which indicated that PFHpA is linked to more severe liver disease outcomes in adolescents undergoing bariatric surgery for obesity. Dr. Chatzi concluded, “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 included contributions from various researchers affiliated with institutions such as USC, Brown University, Emory University, UC Irvine, Johns Hopkins University, and others. Funding was provided by the National Institutes of Health and the U.S. Environmental Protection Agency, among other sources.
The implications of this research are significant, calling for increased awareness of PFAS exposure and its potential health consequences for adolescents, as well as the need for strategies to reduce such exposures in vulnerable populations.
