Exposure to Legacy Per- and Polyfluoroalkyl Substances from Diet and Drinking Water in California Adults, 2018–2020

People are exposed to per- and polyfluoroalkyl substances (PFAS) through multiple sources, with diet historically considered a major source in general populations. This study characterized legacy PFAS in serum from 700 California adults and examined contributions from diet and drinking water. We applied robust regression to estimate associations between nontransformed serum PFAS concentrations, self-reported food consumption, and drinking water PFAS concentrations measured under the USEPA's third Unregulated Contaminant Monitoring Rule (2013-2015). Detectable drinking water concentrations were associated with increased serum perfluorooctanoic acid (PFOA) (0.26 ng/mL; 95% CI: 0.077, 0.43), perfluorohexanesulfonic acid (PFHxS) (0.64 ng/mL; 95% CI: 0.058, 1.23), and perfluorooctanesulfonic acid (PFOS) (0.39 ng/mL; 95% CI: -0.76, 0.86). Seafood consumption was associated with increased perfluorononanoic acid (PFNA) (0.013 ng/mL; 95% CI: 0.0058, 0.021), perfluorodecanoic acid (PFDeA) (0.0059 ng/mL; 95% CI: 0.0026, 0.0092), and perfluoroundecanoic acid (PFUnDA) (0.010 ng/mL; 95% CI: 0.0054, 0.015), while eggs were associated with increased PFDeA (0.0035 ng/mL; 95% CI: 0.00010, 0.0069) and PFNA (0.0073 ng/mL; 95% CI: 0.00017, 0.014). Findings could indicate that dietary contributions may be less than those in earlier studies conducted in other populations, possibly due to shifts in PFAS production over the past 20 years, and that drinking water remains an important source of exposure to PFOA and PFHxS in this population.