Per- and PolyfluoroalkylSubstance Exposure, ObesityPatterns, and Hypertension among Young Men

Abstract Exposure to per- and polyfluoroalkyl substances (PFASs) has been associated with hypertension in some populations, but the associations among young men and underlying mechanisms remain unclear. We measured 16 plasma PFAS and assessed obesity and hypertension (blood pressure ≥130/80 mmHg) among 1283 Chinese young men. In total, 449 (35.0%) men had hypertension. Plasma 6:2 fluorotelomer phosphate diester (6:2 diPAP) concentrations were positively associated with hypertension in a linear dose–response manner (OR = 1.09, 95% CI: 1.01–1.16 per 2.7-fold increase), with an OR of 1.43 (1.07–1.90) for the highest versus lowest exposure tertile. Individual obesity indicators (body mass index [BMI], waist circumference, and waist-to-height ratio [WHtR]) explained 8.6%–19.2% of the association between 6:2 diPAP and hypertension. A machine learning-derived three-level obesity severity spectrum integrating WHtR and BMI (normal, elevated central adiposity alone, and elevated central adiposity with overweight) explained 36.9% of the association. In summary, exposure to 6:2 diPAP was associated with higher odds of hypertension among young men, partly mediated by obesity, with an integrated body shape pattern combining central and general adiposity showing the largest mediating effect.