Associations Between Serum Per- and Polyfluoroalkyl Substances and Visceral and Subcutaneous Adipose Tissue in United States Adults Using NHANES 2017-2018 Data

Per- and polyfluoroalkyl substances (PFAS), more commonly known as “forever chemicals”, are a large group of man-made chemicals that persist in the environment and human body. Due to their resistance to breakdown, there is growing concern about their potential health effects, including obesity. While PFAS exposure has been linked to general obesity measures like BMI, few studies have examined associations with more precise body fat indicators such as visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), particularly in adult populations. This study used data from the 2017–2018 NHANES cycle to assess associations between serum concentrations of ten individual PFAS compounds and DXA-derived VAT and SAT volumes in U.S. adults aged 18–59 years. Sex stratified linear regression models were run using three approaches including an age-adjusted model, a fully adjusted model, and a fully adjusted model that additionally controlled for the alternate adipose tissue. Most PFAS compounds showed small, negative associations with VAT and SAT volumes in both sexes, although few reached significance. In females (n = 388), five PFAS (PFDeA, PFNA, PFUA, n-PFOA, and n-PFOS) were significantly associated with lower SAT across models. For VAT in females, fewer PFAS showed significant associations, and none remained significant after adjusting for SAT. In males (n = 452), three PFAS (PFDeA, Me-PFOSA-AcOH, and Sb-PFOA) were significantly associated with lower VAT and SAT volumes, but these associations became non-significant when adjusted for the alternate adipose tissue. These findings suggest limited evidence for an association between PFAS exposure and VAT or SAT, as most effect estimates were small and close to the null. Further longitudinal research in larger, more diverse populations is needed to clarify the direction, underlying mechanisms, and potential implications for obesity.