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HOME > Ann Occup Environ Med > Volume 38; 2026 > Article
Original Article Association between seafood consumption and serum polyfluoroalkyl substance concentrations among Korean adolescents: the Korean National Environmental Health Survey (KoNEHS) cycle 5, 2021–2023
Hyun Joong Kim1orcid, Yongjin Kim1orcid, Dong-Jae Seo1orcid, Jaewon Mun1orcid, Sunwoo Jung1orcid, Shin-Goo Park1,2orcid, Yangwoo Kim1,2orcid, Hwan-Cheol Kim1,2,*orcid
Annals of Occupational and Environmental Medicine 2026;38:e38.
DOI: https://doi.org/10.35371/aoem.2026.38.e38
Published online: August 20, 2026

1Department of Occupational and Environmental Medicine, Inha University Hospital, Incheon, Korea

2Department of Social and Preventive Medicine, Inha University College of Medicine, Incheon, Korea

*Corresponding author Hwan-Cheol Kim Department of Occupational and Environmental Medicine, Inha University Hospital, Inha University College of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea E-mail: carpediem@inha.ac.kr
• Received: June 23, 2026   • Revised: August 12, 2026   • Accepted: August 12, 2026

© 2026 Korean Society of Occupational & Environmental Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background
    Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants commonly found in seafood; however, evidence of dietary ingestion among adolescents remains limited. We aimed to evaluate the association between seafood consumption and serum PFAS concentrations among Korean adolescents.
  • Methods
    This cross-sectional study used data from the fifth Korean National Environmental Health Survey (KoNEHS, 2021–2023). We included 827 adolescents aged 12–18 years. Serum concentrations of five PFAS compounds (perfluorooctanoic acid [PFOA], perfluorooctane sulfonic acid [PFOS], perfluorohexane sulfonic acid, perfluorononanoic acid [PFNA], and perfluorodecanoic acid [PFDeA]) were measured. Seafood consumption was assessed using a questionnaire and categorized as rarely consumed, monthly consumption, or weekly consumption. Complex sample general linear models were performed using log-transformed PFAS concentrations.
  • Results
    Compared with the rarely consumed, weekly fish consumption was significantly associated with higher serum concentrations of PFOA (B = 1.15; 95% confidence interval [CI]: 0.46–1.83; p = 0.001), PFOS (B = 2.14; 95% CI: 1.23–3.05; p < 0.001), PFNA (B = 0.28; 95% CI: 0.14–0.42; p < 0.001), and PFDeA (B=0.14; 95% CI: 0.05–0.23; p = 0.004), whereas monthly fish consumption was associated with higher PFOS and PFNA. Crustacean consumption showed positive associations with PFOA (B = 1.10; 95% CI: 0.57–1.63; p < 0.001), PFOS (B = 0.93; 95% CI: 0.24–1.61; p = 0.009), PFNA (B = 0.18; 95% CI: 0.08–0.28; p < 0.001), and PFDeA (B = 0.11; 95% CI: 0.05–0.16; p < 0.001) in the monthly group, whereas associations were attenuated in the weekly group. No significant associations were observed for large fish and tuna, seaweed, shellfish, or other seafood.
  • Conclusions
    Fish and crustacean consumption were associated with serum PFAS concentrations among Korean adolescents, whereas other seafood types showed no significant associations. Future prospective studies with more detailed dietary assessments are warranted to clarify causal relationships.
  • Keywords: PFAS; Seafood consumption; Adolescent; Dietary exposure
Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals with high thermal and chemical stability owing to their strong carbon–fluorine bonds.1 Owing to these properties, PFAS are extensively used in various industrial and consumer products requiring water- and oil-repellent properties. Because PFAS are highly resistant to environmental degradation, they are commonly referred to as “forever chemicals,” reflecting their persistence in soil, water, and biological systems.2
Accumulated PFAS in the human body have been associated with various adverse health outcomes, including elevated total cholesterol and triglyceride levels,3 disruption of lipid metabolism, and an increased risk of metabolic syndrome.4 In 2023, the International Agency for Research on Cancer classified perfluorooctanoic acid (PFOA) as carcinogenic to humans (group 1) and perfluorooctanesulfonic acid (PFOS) as possibly carcinogenic to humans (group 2B), further highlighting concerns regarding the potential health effects of PFAS exposure.5 Relatively high PFAS concentrations have been linked to elevated liver function markers, such as alanine aminotransferase and gamma-glutamyl transferase,6,7 and an increased risk of non-alcoholic fatty liver disease,8 as well as immunotoxic9 and endocrine-disrupting effects.10 Although the health effects of PFAS exposure are well documented in adults, adolescents may be particularly vulnerable as this life stage involves rapid growth, hormonal changes, and physiological development.11 Early-life PFAS exposure has raised concerns regarding potential effects on endocrine function and developmental processes; recent epidemiological evidence has reported associations between PFAS exposure and metabolic alterations among children and adolescents.12
Ingestion of contaminated water and food is the primary human exposure pathway for PFAS.13 In aquatic environments, PFAS can be biomagnified through the food chain, accumulating in fish and seafood and subsequently leading to human exposure via dietary intake.14 Studies from various countries have reported associations between fish and seafood consumption and elevated serum PFAS concentrations,15 with a positive exposure-response trend with increasing seafood intake frequency.16 In Korea, PFAS exposure levels have been continuously monitored; recent surveys report high detection rates of major PFAS compounds among the general population.17 However, Korean research to date has focused primarily on PFAS exposure levels and health effects in adults.18 Adolescence is considered a sensitive development period for environmental toxicants because multiple organ systems, including the reproductive, immune, skeletal, and central nervous systems, undergo rapid maturation during this stage. Physiological changes in body composition and metabolic capacity during adolescence may further influence the toxicokinetics and effects of environmental contaminants.19
In the fifth Korean National Environmental Health Survey (KoNEHS, 2021–2023), PFAS concentrations were measured among Korean adolescents, offering a valuable opportunity to investigate the association between serum PFAS levels and seafood consumption. However, studies on the health effects of environmental exposures during adolescence remain limited in Korea.
We aimed to investigate the association between seafood consumption and serum PFAS concentrations among Korean adolescents using data from the fifth KoNEHS (2021–2023), thereby contributing to a deeper understanding of environmental determinants, including major PFAS exposure pathways, in adolescents and providing foundational data for the development of future environmental health policies.
Study population and data source
We used data from the fifth KoNEHS, which was conducted by the National Institute of Environmental Research (NIER) between 2021 and 2023. The KoNEHS is a nationwide survey designed to assess Korean population exposure to environmental contaminants and associated health effects. Information on demographic characteristics, lifestyle factors, dietary habits, and the concentrations of environmental contaminants in biological samples was collected. Data on serum PFAS concentrations, anthropometric measurements, and dietary habits were obtained through physical examinations, blood sampling, and questionnaires. The initial sample comprised 901 Korean middle and high school students aged 12–18 years. Among these, we excluded 15 participants with missing serum PFAS measurements and 59 participants who responded “don’t know” to the household income questionnaire item. The final analytic sample was 827 participants.
Analysis of serum perfluoroalkyl substances
Serum concentrations of five PFAS substances (PFOA, PFOS, perfluorohexane sulfonic acid [PFHxS], perfluorononanoic acid [PFNA], and perfluorodecanoic acid [PFDeA]) were determined according to the NIER analytical protocol for biological samples in the fifth KoNEHS. Serum samples were pretreated using protein precipitation and subsequently quantified via liquid chromatography–tandem mass spectrometry. The reporting limits for each analyte were 0.054, 0.061, 0.071, 0.025, and 0.022 µg/L for PFOA, PFOS, PFHxS, PFNA, and PFDeA, respectively. All analytical procedures were conducted under strict internal quality control, with calibration curves showing coefficients of determination (R²) ≥ 0.995. Values below the limit of detection were not additionally imputed or transformed in this analysis as the dataset provided by KoNEHS was used as received from the data provider.
Definition and classification of variables
The variables used in this study were selected and classified based on the KoNEHS guidelines for the use of raw data. Seafood consumption, which was considered a potential contributor to PFAS exposure, was the primary exposure variable; six food groups were included: large fish and tuna, fish, crustaceans, seaweed, shellfish, and other seafood (e.g., squid and sea cucumber). The dietary intake frequency variables were originally assessed using a 9-point scale ranging from “rarely consumed” to “consume three times per day.” For analytical purposes, these variables were reclassified into three categories to improve interpretability and ensure an adequate sample size within each group. The reclassification was performed as follows: (1) rarely consumed, (2) monthly consumption (one to three times per month), and (3) weekly consumption (≥one time per week, including weekly, two to three times per week, four to six times per week, once daily, twice daily, and three times daily). The rarely consumed group was used as the reference category in all regression analyses. Covariates, including sociodemographic characteristics such as sex, age, household income, smoking status, alcohol consumption, and body mass index (BMI), as well as other potential confounders associated with seafood consumption, including coated frying pan usage, coated pot usage, and indoor and outdoor drinking water sources, were selected and adjusted in the analyses. Variables related to potential non-dietary PFAS exposure sources, including coated frying pan usage, coated pot usage, and drinking water sources, were considered potential sources or determinants of PFAS exposure. Therefore, they were included as covariates.14,20 Age was treated as a continuous variable. It is presented as the mean ± standard error. Household income was categorized into quartiles based on questionnaire data from the KoNEHS. BMI was calculated as weight (kg) divided by height squared (m²) and categorized as <25 kg/m² or ≥25 kg/m² for descriptive analyses.
Statistical analysis
The general characteristics of the study participants are presented as n (unweighted) and percentages (weighted) for categorical variables, and as the mean ± standard error for continuous variables. All analyses accounted for the complex survey design of the fifth KoNEHS by incorporating the sampling weights, stratification variables, and clustering variables provided by KoNEHS. Each PFAS was categorized into low- and high-exposure groups based on the geometric mean reported in the fifth KoNEHS, with values below and above the geometric mean defined as the low- and high-exposure groups, respectively. For comparisons of continuous variables, complex sample general linear models (GLMs) were used; categorical variables were compared using the Rao-Scott chi-square test. Complex sample GLMs were conducted to assess the association between seafood consumption and serum PFAS concentrations. Serum PFAS concentrations were right-skewed, as commonly observed for environmental exposure biomarkers. Therefore, the dependent variable was natural log–transformed to approximate normality, reduce the influence of extreme values, and satisfy the assumptions of linear regression models. The log-transformed PFAS concentrations were used as dependent variables in all regression analyses. Regression analyses were performed using unadjusted and adjusted models. The adjusted model included sex, age, household income, smoking status, alcohol consumption, BMI, coated frying pan usage, coated pot usage, and indoor and outdoor drinking water sources as covariates. The results are presented as unstandardized regression coefficients (B), 95% confidence intervals (95% CIs), and p-values. All statistical analyses were performed using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA); a p-value < 0.05 was considered statistically significant.
Ethics statement
The present study protocol was reviewed and approved by the Institutional Review Board (IRB) of Inha University Hospital (IRB No. 2026-06-020). All participants of the KoNEHS cycle 5 (2021–2023) included in this study provided written informed consent.
General characteristics of the study participants
Tables 1–3 present the general characteristics of the study participants and their distribution across serum PFAS concentration levels. The study included 827 participants, of whom 385 were males and 442 were females, corresponding to weighted proportions of 52.4% and 47.6%, respectively. The mean age of the participants was 14.47 ± 0.20 years; 158 participants had a BMI ≥ 25 kg/m², corresponding to a weighted proportion of 20.3%. The mean serum PFAS concentrations (presented as mean ± standard error) were 4.49 ± 0.12 µg/L for PFOA, 6.84 ± 0.18 µg/L for PFOS, 2.67 ± 0.17 µg/L for PFHxS, 1.00 ± 0.02 µg/L for PFNA, and 0.48 ± 0.02 µg/L for PFDeA. Significant differences in sex distribution were observed across PFAS concentration levels for PFOA, PFOS, PFHxS, and PFNA (p < 0.05), with males prevalent in the high-exposure groups. Most PFAS exposures also differed significantly by seafood consumption frequency, with the proportion of participants in the high-exposure group increasing alongside fish and crustacean intake. In contrast, no significant associations were observed between age, smoking status, alcohol consumption, BMI, and PFAS concentration levels for most analytes. The distribution of seafood consumption frequency among Korean adolescents is presented in Supplementary Table 1.
Association between seafood consumption and serum PFAS concentrations
Tables 4–6 present the results of complex sample GLMs assessing the association between dietary habits and serum PFAS concentrations. In multivariable models adjusted for sex, age, BMI, household income, smoking status, alcohol consumption, coated frying pan usage, coated pot usage, and drinking water sources, fish consumption was significantly positively associated with serum PFOA, PFOS, PFNA, and PFDeA concentrations. Compared with the rarely consumed group, participants who consumed fish at least once per week had significantly higher serum PFOA (B = 1.15; 95% CI: 0.46–1.83; p = 0.001), PFOS (B = 2.14; 95% CI: 1.23–3.05; p < 0.001), PFNA (B = 0.28; 95% CI: 0.14–0.42; p < 0.001), and PFDeA (B = 0.14; 95% CI: 0.05–0.23; p = 0.004) concentrations. Moreover, significant positive associations were observed for PFOS and PFNA in the monthly consumption group.
Crustacean consumption was also significantly associated with some serum PFAS concentrations. Compared with rarely consumed, participants who consumed crustaceans at least once per month had significantly higher serum PFOA (B = 1.10; 95% CI: 0.57–1.63; p < 0.001), PFOS (B = 0.93; 95% CI: 0.24–1.61; p = 0.009), PFNA (B = 0.18; 95% CI: 0.08–0.28; p < 0.001), and PFDeA (B = 0.11; 95% CI: 0.05–0.16; p < 0.001) concentrations. However, no significant associations were observed among participants who consumed it at least once per week.
No significant associations were observed between the PFAS compounds and consumption of large fish and tuna, seaweed, shellfish, and other seafood. Overall, fish consumption showed consistent positive associations with serum concentrations of PFOA, PFOS, PFNA, and PFDeA, whereas crustacean consumption was associated with several PFAS compounds.
We evaluated the association between seafood consumption and serum PFAS concentrations among Korean adolescents using data from the fifth KoNEHS. Fish consumption frequency was significantly and positively associated with serum PFOA, PFOS, PFNA, and PFDeA concentrations; these associations remained significant after adjusting for sex, age, BMI, household income, smoking status, alcohol consumption, coated frying pan usage, coated pot usage, and drinking water sources. Crustacean consumption was significantly associated with several serum PFAS concentrations, whereas no significant associations were observed for large fish and tuna, seaweed, shellfish, or other seafood.
The most notable finding was that fish consumption showed the most consistent associations across multiple PFAS compounds. In aquatic environments, PFAS exhibit high affinity for proteins21 and can accumulate in the blood, liver, and muscle tissues of aquatic organisms.22 Following dietary exposure, PFAS can be absorbed through the gastrointestinal tract and distributed via the bloodstream. Owing to their chemical stability and limited metabolic degradation, PFAS can persist in the human body and contribute to measurable serum concentrations after repeated exposure.23 Unlike traditional persistent organic pollutants, PFAS have a distinct retention mechanism, preferentially binding to proteins rather than accumulating in adipose tissue.24,25 The affinity of PFAS for proteins increases with carbon chain length; therefore, long-chain PFAS exhibit clear biomagnification, with increasing concentrations observed at relatively high trophic levels in marine ecosystems.26 Therefore, populations that rely on seafood as a major dietary protein source may face increased PFAS exposure through this biomagnification pathway.27 Studies from countries such as the United States and Sweden have identified fish consumption as a major determinant of serum PFAS levels.28,29 The findings of this study are consistent with those found in previous research, suggesting that seafood consumption plays an important role in PFAS exposure among Korean adolescents.
General fish consumption showed more consistent associations than large fish and tuna consumption. As apex predators, large fish may accumulate relatively high PFAS concentrations through food chain biomagnification. However, because the KoNEHS assessed only consumption frequency rather than quantity, regularly consumed fish may have contributed more to cumulative exposure than large fish, which are consumed less frequently. Consistent with this explanation, fish consumption was more frequent than large fish and tuna consumption among participants in the present study. Previous studies have suggested that the relationship between fish consumption and PFAS exposure differs by fish species. Omega-3-rich fish, such as salmon and tuna, have been inversely associated with some PFAS concentrations, potentially reflecting differences in contamination profiles or dietary patterns.30 Thus, the stronger associations observed for general fish, compared with those for large fish and tuna, may also reflect species-specific differences in PFAS accumulation. This finding highlights the need to consider the contamination levels of specific foods and information on consumption frequency, quantity, and species-specific characteristics.
Crustacean consumption was also significantly associated with serum PFAS concentrations. Like fish, crustaceans inhabit aquatic environments; as benthic organisms in close contact with bottom sediments, they are continuously exposed to sediment-accumulated PFAS,31 which can be transferred to humans through dietary intake.32 However, the association between crustacean consumption frequency and serum PFAS concentrations was less consistent than that observed for fish consumption in this study. In particular, significant associations were observed in the monthly consumption of some PFAS, whereas these associations were attenuated or disappeared in the weekly consumption group. This finding may be attributable to a limited sample size in the high-frequency consumption group, heterogeneity in crustacean species, and the lack of information on actual consumption amounts.
East Asian countries, including Korea, have higher seafood consumption than Western countries; accordingly, seafood is a major PFAS exposure pathway in this region.33 Given the high level of seafood consumption in Korea, dietary exposure to PFAS could be of considerable importance. However, the relationship between seafood consumption and PFAS exposure may vary according to fish species, habitat, processing, and cooking methods.30 This condition highlights the need to consider contamination levels across the food supply chain, as well as cooking-related factors, in a comprehensive manner.
Serum PFAS concentrations among Korean adolescents were generally comparable between the fourth (2018–2020) and fifth (2021–2023) KoNEHS cycles. The geometric mean concentrations of PFOA, PFOS, PFHxS, PFDeA, and PFNA were 3.93, 6.13, 2.22, 0.419, and 0.895 µg/L in the fifth cycle, respectively, compared with 3.66, 7.97, 2.52, 0.45, and 0.92 µg/L in the fourth cycle, respectively. These comparable concentrations suggest that PFAS exposure levels among Korean adolescents have remained relatively consistent over time. Furthermore, serum PFOA and PFOS concentrations among Korean adolescents exceeded the human biomonitoring (HBM)-I values established by the German Human Biomonitoring Commission (2 and 5 µg/L, respectively),34 which represent levels without expected adverse health effects in the general population, but remained below the HBM-II values (10 and 20 µg/L, respectively), above which health risks cannot be excluded.35 Collectively, these findings underscore the need for continued monitoring of PFAS exposure among Korean adolescents.
Sex differences in serum PFAS concentrations were also observed, with males generally showing higher concentrations than females across several compounds. Sex differences in serum PFAS concentrations may partly reflect differences in elimination pathways. Menstruation has been suggested as one possible factor contributing to enhanced PFAS elimination among women.36 As most female adolescents in this age group have likely experienced menarche, menstruation-related elimination may partly explain the relatively low serum PFAS concentrations observed among these females.
Collectively, these findings highlight the need for continuous management of PFAS exposure pathways through environmental media and dietary sources to protect adolescents. Seafood is an important component of the Korean diet and may represent an important dietary pathway for PFAS exposure; therefore, management strategies should be based on PFAS concentrations in food and exposure characteristics rather than on simple recommendations to restrict seafood consumption. Previous studies in Korea have suggested various approaches to reduce PFAS concentrations in seafood, reporting that washing, soaking, and cooking methods may influence PFAS levels in fish.37 Additionally, studies comparing PFAS concentrations among different fish tissues have shown higher concentrations in the liver and gut than in muscle, suggesting that the consumed parts of seafood should also be considered in future dietary exposure assessments.38 Therefore, establishing regional- and species-specific PFAS concentration databases, conducting quantitative dietary assessments incorporating actual consumption amounts, and evaluating the effects of food preparation and processing methods are needed for a more comprehensive characterization of dietary PFAS exposure. Based on such information, evidence-based dietary management strategies should be developed to minimize PFAS exposure among vulnerable populations, such as adolescents, while maintaining the nutritional benefits of seafood consumption.
The main contribution of this study lies in its evaluation of the association between seafood consumption and serum PFAS concentrations among Korean adolescents. Unlike previous studies conducted primarily in adults or using foreign datasets, this study evaluated PFAS exposure characteristics among Korean adolescents using nationally representative data. Moreover, the simultaneous analysis of various seafood consumption items, including large fish and tuna, fish, crustaceans, shellfish, seaweed, and other seafood, allowed for a more comprehensive assessment of dietary exposure characteristics among adolescents.
However, this study has some limitations. First, the cross-sectional design precludes causal inference regarding the relationship between seafood consumption and PFAS exposure. Second, dietary intake data were collected through self-reported questionnaires, which may be subject to recall bias. Third, information on seafood type, origin, and actual consumption amounts was limited, which may have compromised the accuracy of PFAS exposure assessment. Finally, other potential PFAS exposure sources, such as regional differences and industrial activities, could not be fully assessed owing to limitations of the available data.
Despite these limitations, this study makes a meaningful contribution by assessing the association between seafood consumption and serum PFAS concentrations among Korean adolescents using nationally representative environmental health survey data.
In this study, fish consumption was significantly associated with elevated serum PFOA, PFOS, PFNA, and PFDeA concentrations among Korean adolescents, whereas crustacean consumption was positively associated with some PFAS compounds. No significant associations were observed between the consumption of large fish and tuna, seaweed, shellfish, or other seafood and serum PFAS concentrations. These findings suggest that general fish consumption contributes to PFAS exposure among adolescents, highlighting the need for national-level strategies to continuously monitor environmental contaminant exposure. Future prospective studies are needed to clarify the causal relationship between seafood consumption and PFAS exposure and develop dietary exposure management strategies to reduce environmental contaminant exposure among adolescents.

BMI

body mass index

CI

confidence interval

GLM

general linear model

HBM

human biomonitoring

KoNEHS

Korean National Environmental Health Survey

NIER

National Institute of Environmental Research

PFAS

per- and polyfluoroalkyl substances

PFDeA

perfluorodecanoic acid

PFHxS

perfluorohexane sulfonic acid

PFNA

perfluorononanoic acid

PFOA

perfluorooctanoic acid

PFOS

perfluorooctane sulfonic acid

SE

standard error

Competing interests

Hwan-Cheol Kim, a contributing editor of the Annals of Occupational and Environmental Medicine, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest.

Author contributions

Conceptualization: Kim HJ, Kim HC. Data curation: Kim HC. Methodology/formal analysis: Kim HJ, Kim HC. Validation: KIM HJ, KIM HC, KIM Y (Yongjin Kim), Seo DJ, Mun J, Jung S. Project administration: Kim HC. Supervision: Kim HC, Park SG, Kim Y (Yangwoo Kim). Writing - original draft: Kim HJ. Writing - review & editing: Kim Y (Yongjin Kim), Seo DJ, Mun J, Jung S, Park SG, Kim HC, Kim Y (Yangwoo Kim).

Supplementary Table 1.
Seafood consumption frequency among Korean adolescents.
aoem-2026-38-e38_Supplementary-Table-1.pdf
Table 1.
General characteristics and PFOA and PFOS levels (µg/L) of the study population
Characteristic Total PFOA PFOA p-valuea p-valueb PFOS PFOS p-valuea p-valueb
Low High Low High
Total 827 (100) 4.49 ± 0.12 438 (52.7) 389 (47.3) 6.84 ± 0.18 412 (49.6) 415 (50.4)
Sex
 Male 385 (52.4) 4.76 ± 0.19 187 (47.5) 198 (57.8) 0.010 0.002 7.33 ± 0.29 171 (46.8) 214 (57.9) 0.002 0.016
 Female 442 (47.6) 4.19 ± 0.13 251 (52.5) 191 (42.2) 6.30 ± 0.18 241 (53.2) 201 (42.1)
Mean age (years) 14.47 ± 0.20 - 14.49 ± 0.22 14.45 ± 0.22 0.821 - - 14.46 ± 0.22 14.49 ± 0.22 0.835 -
Household income
 1st quartile 135 (15.7) 4.45 ± 0.28 80 (17.3) 55 (14.0) 0.938 0.548 6.49 ± 0.40 83 (20.0) 52 (11.5) 0.080 <0.001
 2nd quartile 218 (25.9) 4.44 ± 0.26 107 (23.7) 111 (28.3) 6.68 ± 0.23 110 (26.2) 108 (25.6)
 3rd quartile 247 (29.3) 4.60 ± 0.23 129 (29.7) 118 (28.9) 6.63 ± 0.27 128 (31.4) 119 (27.3)
 4th quartile 227 (29.1) 4.43 ± 0.22 122 (29.3) 105 (28.8) 7.39 ± 0.30 91 (22.4) 136 (35.6)
Smoking
 Non-smoker 813 (98.3) 4.49 ± 0.13 429 (98.1) 384 (98.6) 0.937 0.373 6.82 ± 0.18 404 (98.1) 409 (98.5) 0.455 0.592
 Current smoker 14 (1.7) 4.44 ± 0.55 9 (1.9) 5 (1.4) 8.24 ± 1.87 8 (1.9) 6 (1.5)
Alcohol
 Never drinking 657 (79.6) 4.48 ± 0.13 352 (80.5) 305 (78.6) 0.873 0.528 6.77 ± 0.20 320 (78.5) 337 (80.7) 0.378 0.440
 Ever once 170 (20.4) 4.52 ± 0.22 86 (19.5) 84 (21.4) 7.11 ± 0.36 92 (21.5) 78 (19.3)
BMI (kg/m2)
 <25 669 (79.7) 4.45 ± 0.11 360 (81.2) 309 (78.1) 0.484 0.324 6.82 ± 0.20 336 (80.1) 333 (79.4) 0.827 0.855
 ≥25 158 (20.3) 4.65 ± 0.30 78 (18.8) 80 (21.9) 6.90 ± 0.31 76 (19.9) 82 (20.6)
Large fish and tuna
 Rarely 382 (44.9) 4.28 ± 0.19 221 (50.2) 161 (39.1) 0.228 0.006 6.40 ± 0.24 223 (51.7) 159 (38.3) 0.009 <0.001
 ≥Once per month 306 (36.8) 4.64 ± 0.17 146 (32.5) 160 (41.5) 7.06 ± 0.22 130 (31.8) 176 (41.6)
 ≥Once per week 139 (18.3) 4.68 ± 0.22 71 (17.3) 68 (19.4) 7.48 ± 0.34 59 (16.5) 80 (20.1)
Fish
 Rarely 160 (19.0) 3.42 ± 0.19 115 (26.3) 45 (11.0) <0.001 <0.001 5.30 ± 0.20 117 (28.0) 43 (10.2) <0.001 <0.001
 ≥Once per month 427 (52.2) 4.41 ± 0.18 228 (51.6) 199 (52.8) 6.73 ± 0.21 217 (52.3) 210 (52.0)
 ≥Once per week 240 (28.8) 5.33 ± 0.20 95 (22.2) 145 (36.2) 8.05 ± 0.32 78 (19.7) 162 (37.8)
Crustaceans
 Rarely 301 (37.3) 3.60 ± 0.15 210 (49.1) 91 (24.2) <0.001 <0.001 5.93 ± 0.18 175 (43.2) 126 (31.5) <0.001 0.013
 ≥Once per month 435 (51.3) 5.04 ± 0.19 190 (41.7) 245 (61.8) 7.46 ± 0.25 196 (45.8) 239 (56.6)
 ≥Once per week 91 (11.4) 4.92 ± 0.27 38 (9.1) 53 (14.0) 7.01 ± 0.39 41 (11.0) 50 (11.8)
Seaweeds
 Rarely 69 (8.7) 3.53 ± 0.25 49 (11.7) 20 (5.4) <0.001 <0.001 6.21 ± 0.44 41 (10.4) 28 (7.0) 0.002 <0.001
 ≥Once per month 332 (39.5) 4.25 ± 0.14 192 (43.1) 140 (35.4) 6.42 ± 0.22 188 (45.0) 144 (34.0)
 ≥Once per week 426 (51.8) 4.83 ± 0.15 197 (45.2) 229 (59.2) 7.26 ± 0.23 183 (44.5) 243 (59.0)
Shellfish
 Rarely 401 (48.7) 4.02 ± 0.15 253 (57.9) 148 (38.5) <0.001 <0.001 6.29 ± 0.19 231 (55.0) 170 (42.5) <0.001 0.002
 ≥Once per month 362 (43.6) 4.82 ± 0.15 161 (36.5) 201 (51.5) 7.40 ± 0.24 153 (37.4) 209 (49.7)
 ≥Once per week 64 (7.7) 5.55 ± 0.47 24 (5.6) 40 (10.0) 7.12 ± 0.41 28 (7.6) 36 (7.8)
Other seafood
 Rarely 262 (32.5) 3.73 ± 0.18 180 (42.5) 82 (21.4) <0.001 <0.001 6.09 ± 0.25 159 (38.9) 103 (26.3) <0.001 0.001
 ≥Once per month 424 (50.8) 4.75 ± 0.16 201 (44.7) 223 (57.6) 7.07 ± 0.22 199 (47.3) 225 (54.3)
 ≥Once per week 141 (16.7) 5.15 ± 0.28 57 (12.8) 84 (21.0) 7.60 ± 0.36 54 (13.9) 87 (19.5)
Coated frying pan usage
 ≤Once per week 83 (9.6) 3.92 ± 0.20 49 (10.8) 34 (8.1) 0.008 0.291 6.37 ± 0.42 49 (11.0) 34 (8.2) 0.217 0.178
 >Once per week 744 (90.4) 4.55 ± 0.13 389 (89.2) 355 (91.9) 6.89 ± 0.18 363 (89.0) 381 (91.8)
Coated pot usage
 ≤Once per week 279 (34.0) 4.58 ± 0.19 143 (33.6) 136 (34.5) 0.547 0.815 7.09 ± 0.24 131 (31.2) 148 (36.8) 0.166 0.108
 >Once per week 548 (66.0) 4.44 ± 0.14 295 (66.4) 253 (65.5) 6.71 ± 0.21 281 (68.8) 267 (63.2)
Type of water drinking indoor
 Purified/bottled water 712 (86.3) 4.48 ± 0.13 375 (85.5) 337 (87.2) 0.869 0.564 6.86 ± 0.20 357 (86.3) 355 (86.4) 0.711 0.945
 Ground/tap water 115 (13.7) 4.54 ± 0.35 63 (14.5) 52 (12.8) 6.74 ± 0.27 55 (13.7) 60 (13.6)
Type of water drinking outdoor
 Purified/bottled water 767 (93.1) 4.50 ± 0.13 406(92.4) 361 (93.8) 0.668 0.464 6.85 ± 0.19 384 (93.2) 383 (92.9) 0.607 0.889
 Ground/tap water 60 (6.9) 4.26 ± 0.54 32(7.6) 28 (6.2) 6.66 ± 0.34 28 (6.8) 32 (7.1)

Values are presented as mean ± SE for continuous variables and n (unweighted) and % (weighted) for categorical variables.

PFOA: perfluorooctanoic acid; PFOS: perfluorooctane sulfonic acid; BMI: body mass index; SE, standard error.

ap-values were calculated using complex sample general linear models;

bp-values were calculated using the Rao-Scott chi-square test.

Table 2.
General characteristics and PFHxS and PFNA levels (µg/L) of the study population
Characteristic Total PFHxS PFHxS p-valuea p-valueb PFNA PFNA p-valuea p-valueb
Low High Low High
Total 827 (100) 2.67 ± 0.17 455 (50.6) 372 (49.4) 1.00 ± 0.02 411 (48.7) 416 (51.3)
Sex
 Male 385 (52.4) 2.98 ± 0.22 185 (41.8) 200 (63.2) 0.002 <0.001 1.08 ± 0.04 157 (43.0) 228 (61.3) <0.001 <0.001
 Female 442 (47.6) 2.33 ± 0.16 270 (58.2) 172 (36.8) 0.90 ± 0.02 254 (57.0) 188 (38.7)
Mean age (years) 14.47 ± 0.20 - 14.41 ± 0.23 14.54 ± 0.24 0.573 - - 14.45 ± 0.21 14.49 ± 0.22 0.770 -
Household income
 1st quartile 135 (15.7) 2.57 ± 0.18 81 (16.6) 54 (14.9) 0.755 0.814 0.96 ± 0.05 74 (17.4) 61 (14.2) 0.649 0.685
 2nd quartile 218 (25.9) 2.60 ± 0.18 122 (26.3) 96 (25.5) 0.97 ± 0.04 104 (25.0) 114 (26.8)
 3rd quartile 247 (29.3) 2.67 ± 0.18 137 (29.7) 110 (28.9) 1.03 ± 0.05 117 (28.2) 130 (30.4)
 4th quartile 227 (29.1) 2.79 ± 0.26 115 (27.4) 112 (30.7) 1.00 ± 0.04 116 (29.5) 111 (28.7)
Smoking
 Non-smoker 813 (98.3) 2.66 ± 0.16 444 (97.6) 369 (99.0) 0.454 0.145 1.00 ± 0.03 403 (98.2) 410 (98.4) 0.470 0.681
 Current smoker 14 (1.7) 3.43 ± 1.11 11 (2.4) 3 (1.0) 0.94 ± 0.07 8 (1.8) 6 (1.6)
Alcohol
 Never drinking 657 (79.6) 2.64 ± 0.14 366 (80.6) 291 (78.7) 0.561 0.575 0.98 ± 0.03 339 (83.4) 318 (76.1) 0.054 0.017
 Ever once 170 (20.4) 2.81 ± 0.36 89 (19.4) 81 (21.3) 1.07 ± 0.04 72 (16.6) 98 (23.9)
BMI (kg/m2)
 <25 669 (79.7) 2.59 ± 0.15 373 (81.8) 296 (77.6) 0.096 0.218 0.99 ± 0.03 338 (80.7) 331 (78.8) 0.701 0.556
 ≥25 158 (20.3) 2.98 ± 0.31 82 (18.2) 76 (22.4) 1.01 ± 0.05 73 (19.3) 85 (21.2)
Large fish and tuna
 Rarely 382 (44.9) 2.52 ± 0.16 218 (47.5) 164 (42.3) 0.092 0.282 0.92 ± 0.03 213 (50.6) 169 (39.6) 0.005 0.021
 ≥Once per month 306 (36.8) 2.80 ± 0.21 163 (35.1) 143 (38.4) 1.05 ± 0.03 135 (31.9) 171 (41.4)
 ≥Once per week 139 (18.3) 2.77 ± 0.21 74 (17.4) 65 (19.2) 1.07 ± 0.05 63 (17.6) 76 (19.0)
Fish
 Rarely 160 (19.0) 2.31 ± 0.28 110 (25.1) 50 (12.8) 0.206 <0.001 0.75 ± 0.04 113 (26.9) 47 (11.5) <0.001 <0.001
 ≥Once per month 427 (52.2) 2.63 ± 0.11 224 (49.0) 203 (55.4) 0.98 ± 0.03 216 (53.2) 211 (51.1)
 ≥Once per week 240 (28.8) 2.98 ± 0.32 121 (26.0) 119 (31.8) 1.20 ± 0.04 82 (19.9) 158 (37.3)
Crustaceans
 Rarely 301 (37.3) 2.43 ± 0.17 183 (40.9) 118 (33.6) 0.126 0.034 0.82 ± 0.03 193 (48.7) 108 (26.6) <0.001 <0.001
 ≥Once per month 435 (51.3) 2.85 ± 0.21 219 (46.4) 216 (56.3) 1.09 ± 0.03 183 (42.4) 252 (59.7)
 ≥Once per week 91 (11.4) 2.64 ± 0.22 53 (12.7) 38 (10.1) 1.14 ± 0.06 35 (8.9) 56 (13.8)
Seaweeds
 Rarely 69 (8.7) 2.47 ± 0.27 42 (9.6) 27 (7.8) 0.418 0.615 0.81 ± 0.06 46 (11.8) 23 (5.8) <0.001 <0.001
 ≥Once per month 332 (39.5) 2.58 ± 0.13 177 (38.4) 155 (40.6) 0.96 ± 0.03 185 (43.6) 147 (35.6)
 ≥Once per week 426 (51.8) 2.77 ± 0.23 236 (52.0) 190 (51.6) 1.06 ± 0.03 180 (44.7) 246 (58.5)
Shellfish
 Rarely 401 (48.7) 2.52 ± 0.18 235 (51.7) 166 (45.6) 0.244 0.242 0.89 ± 0.03 247 (60.9) 154 (37.2) <0.001 <0.001
 ≥Once per month 362 (43.6) 2.76 ± 0.15 184 (40.5) 178 (46.7) 1.09 ± 0.03 148 (34.9) 214 (51.8)
 ≥Once per week 64 (7.7) 3.11 ± 0.64 36 (7.8) 28 (7.6) 1.15 ± 0.06 16 (4.1) 48 (11.1)
Other seafood
 Rarely 262 (32.5) 2.39 ± 0.17 169 (38.4) 93 (26.5) 0.029 0.008 0.84 ± 0.03 172 (43.8) 90 (21.8) <0.001 <0.001
 ≥Once per month 424 (50.8) 2.73 ± 0.15 214 (45.6) 210 (56.1) 1.05 ± 0.03 188 (43.6) 236 (57.6)
 ≥Once per week 141 (16.7) 3.03 ± 0.38 72 (16.0) 69 (17.4) 1.14 ± 0.04 51 (12.6) 90 (20.6)
Coated frying pan usage
 ≤Once per week 83 (9.6) 2.52 ± 0.22 49 (10.1) 34 (9.0) 0.449 0.579 0.96 ± 0.07 42 (9.7) 41 (9.4) 0.564 0.922
 >Once per week 744 (90.4) 2.69 ± 0.18 406 (89.9) 338 (91.0) 1.00 ± 0.02 369 (90.3) 375 (90.6)
Coated pot usage
 ≤Once per week 279 (34.0) 2.57 ± 0.15 153 (34.1) 126 (34.0) 0.521 0.963 1.04 ± 0.04 130 (32.0) 149 (36.0) 0.140 0.238
 >Once per week 548 (66.0) 2.72 ± 0.22 302 (65.9) 246 (66.0) 0.97 ± 0.03 281 (68.0) 267 (64.0)
Type of water drinking indoor
 Purified/bottled water 712 (86.3) 2.70 ± 0.18 393 (86.8) 319 (85.9) 0.301 0.701 0.99 ± 0.02 355 (86.3) 357 (86.4) 0.706 0.951
 Ground/tap water 115 (13.7) 2.50 ± 0.15 62 (13.2) 53 (14.1) 1.01 ± 0.06 56 (13.7) 59 (13.6)
Type of water drinking outdoor
 Purified/bottled water 767 (93.1) 2.62 ± 0.13 426 (93.9) 341 (92.3) 0.453 0.497 1.00 ± 0.03 380 (91.9) 387 (94.2) 0.086 0.249
 Ground/tap water 60 (6.9) 3.31 ± 0.97 29 (6.1) 31 (7.7) 0.91 ± 0.04 31 (8.1) 29 (5.8)

Values are presented as mean ± SE for continuous variables and n (unweighted) and % (weighted) for categorical variables.

PFHxS: perfluorohexane sulfonic acid; PFNA: perfluorononanoic acid; BMI: body mass index; SE, standard error.

ap-values were calculated using complex sample general linear models;

bp-values were calculated using the Rao-Scott chi-square test.

Table 3.
General characteristics and PFDeA levels (µg/L) of the study population
Characteristic Total PFDeA PFDeA p-valuea p-valueb
Low High
Total 827 (100) 0.48 ± 0.02 392 (47.0) 435 (53.0)
Sex
 Male 385 (52.4) 0.51 ± 0.03 173 (49.2) 212 (55.3) 0.103 0.179
 Female 442 (47.6) 0.45 ± 0.02 219 (50.8) 223 (44.7)
Mean age (years) 14.47 ± 0.20 - 14.41 ± 0.23 14.53 ± 0.22 0.518 -
Household income
 1st quartile 135 (15.7) 0.49 ± 0.05 69 (16.9) 66 (14.7) 0.513 0.575
 2nd quartile 218 (25.9) 0.46 ± 0.02 106 (27.4) 112 (24.6)
 3rd quartile 247 (29.3) 0.49 ± 0.02 112 (27.8) 135 (30.7)
 4th quartile 227 (29.1) 0.49 ± 0.02 105 (27.9) 122 (30.0)
Smoking
 Non-smoker 813 (98.3) 0.48 ± 0.02 383 (97.9) 430 (98.7) 0.792 0.254
 Current smoker 14 (1.7) 0.47 ± 0.06 9 (2.1) 5 (1.3)
Alcohol
 Never drinking 657 (79.6) 0.48 ± 0.02 315 (80.8) 342 (78.6) 0.252 0.475
 Ever once 170 (20.4) 0.51 ± 0.02 77 (19.2) 93 (21.4)
BMI (kg/m2)
 <25 669 (79.7) 0.50 ± 0.02 315 (79.0) 354 (80.4) 0.037 0.662
 ≥25 158 (20.3) 0.44 ± 0.02 77 (21.0) 81 (19.6)
Large fish and tuna
 Rarely 382 (44.9) 0.45 ± 0.03 210 (51.8) 172 (38.9) 0.167 0.001
 ≥Once per month 306 (36.8) 0.51 ± 0.02 131 (33.6) 175 (39.6)
 ≥Once per week 139 (18.3) 0.51 ± 0.02 51 (14.6) 88 (21.6)
Fish
 Rarely 160 (19.0) 0.38 ± 0.02 111 (27.6) 49 (11.5) <0.001 <0.001
 ≥Once per month 427 (52.2) 0.47 ± 0.02 206 (52.5) 221 (51.8)
 ≥Once per week 240 (28.8) 0.57 ± 0.03 75 (20.0) 165 (36.7)
Crustaceans
 Rarely 301 (37.3) 0.40 ± 0.02 191 (50.0) 110 (26.1) <0.001 <0.001
 ≥Once per month 435 (51.3) 0.54 ± 0.02 170 (41.5) 265 (59.9)
 ≥Once per week 91 (11.4) 0.54 ± 0.03 31 (8.5) 60 (14.0)
Seaweeds
 Rarely 69 (8.7) 0.40 ± 0.04 45 (11.8) 24 (6.0) 0.002 0.002
 ≥Once per month 332 (39.5) 0.47 ± 0.02 174 (42.7) 158 (36.6)
 ≥Once per week 426 (51.8) 0.51 ± 0.02 173 (45.5) 253 (57.4)
Shellfish
 Rarely 401 (48.7) 0.44 ± 0.02 231 (59.3) 170 (39.3) 0.001 <0.001
 ≥Once per month 362 (43.6) 0.53 ± 0.02 143 (35.7) 219 (50.6)
 ≥Once per week 64 (7.7) 0.54 ± 0.04 18 (5.1) 46 (10.1)
Other seafood
 Rarely 262 (32.5) 0.42 ± 0.03 167 (43.2) 95 (23.0) 0.003 <0.001
 ≥Once per month 424 (50.8) 0.50 ± 0.02 185 (45.5) 239 (55.5)
 ≥Once per week 141 (16.7) 0.56 ± 0.03 40 (11.3) 101 (21.5)
Coated frying pan usage
 ≤Once per week 83 (9.6) 0.46 ± 0.03 41 (10.0) 42 (9.2) 0.430 0.746
 >Once per week 744 (90.4) 0.49 ± 0.02 351 (90.0) 393 (90.8)
Coated pot usage
 ≤Once per week 279 (34.0) 0.52 ± 0.03 130 (33.5) 149 (34.5) 0.141 0.770
 >Once per week 548 (66.0) 0.47 ± 0.02 262 (66.5) 286 (65.5)
Type of water drinking indoor
 Purified/bottled water 712 (86.3) 0.48 ± 0.02 344 (87.6) 368 (85.2) 0.537 0.387
 Ground/tap water 115 (13.7) 0.50 ± 0.03 48 (12.4) 67 (14.8)
Type of water drinking outdoor
 Purified/bottled water 767 (93.1) 0.48 ± 0.02 368 (93.6) 399 (92.6) 0.828 0.651
 Ground/tap water 60 (6.9) 0.48 ± 0.03 24 (6.4) 36 (7.4)

Values are presented as mean ± SE for continuous variables and n (unweighted) and % (weighted) for categorical variables.

PFDeA: perfluorodecanoic acid; BMI: body mass index; SE, standard error.

ap-values were calculated using complex sample general linear models;

bp-values were calculated using the Rao-Scott chi-square test.

Table 4.
Associations between dietary habits and blood PFOA and PFOS concentrations
Category PFOA PFOS
Unadjusted model Adjusted modela Unadjusted model Adjusted modela
Estimate (95% CI) p-value Estimate (95% CI) p-value Estimate (95% CI) p-value Estimate (95% CI) p-value
Large fish and tuna
 N Ref. Ref. Ref. Ref.
 ≥Once per month –0.17 (–0.70 to 0.36) 0.526 –0.19 (–0.73 to 0.34) 0.477 0.07 (–0.55 to 0.69) 0.830 0.05 (–0.57 to 0.67) 0.883
 ≥Once per week –0.31 (–0.88 to 0.25) 0.272 –0.35 (–0.90 to 0.20) 0.206 0.31 (–0.50 to 1.11) 0.451 0.21 (–0.51 to 0.93) 0.561
Fish
 N Ref. Ref. Ref. Ref.
 ≥Once per month 0.52 (–0.08 to 1.11) 0.086 0.46 (–0.13 to 1.06) 0.126 1.09 (0.42 to 1.75) 0.002 0.98 (0.24 to 1.72) 0.011
 ≥Once per week 1.27 (0.60 to 1.95) <0.001 1.15 (0.46 to 1.83) 0.001 2.37 (1.49 to 3.24) <0.001 2.14 (1.23 to 3.05) <0.001
Crustaceans
 N Ref. Ref. Ref. Ref.
 ≥Once per month 1.00 (0.48 to 1.51) <0.001 1.10 (0.57 to 1.63) <0.001 0.81 (0.16 to 1.47) 0.016 0.93 (0.24 to 1.61) 0.009
 ≥Once per week 0.26 (–0.47 to 0.99) 0.480 0.30 (–0.46 to 1.06) 0.429 –0.42 (–1.44 to 0.60) 0.414 –0.37 (–1.28 to 0.55) 0.428
Seaweeds
 N Ref. Ref. Ref. Ref.
 ≥Once per month 0.10 (–0.43 to 0.62) 0.716 0.11 (–0.37 to 0.60) 0.639 –0.73 (–1.65 to 0.19) 0.119 –0.69 (–1.63 to 0.26) 0.151
 ≥Once per week 0.36 (–0.25 to 0.97) 0.242 0.42 (–0.15 to 0.99) 0.145 –0.33 (–1.33 to 0.66) 0.508 –0.19 (–1.19 to 0.81) 0.709
Shellfish
 N Ref. Ref. Ref. Ref.
 ≥Once per month 0.02 (–0.42 to 0.46) 0.931 0.00 (–0.44 to 0.45) 0.990 0.26 (–0.27 to 0.78) 0.329 0.24 (–0.30 to 0.77) 0.386
 ≥Once per week 0.72 (–0.42 to 1.87) 0.210 0.81 (–0.31 to 1.93) 0.154 –0.47 (–1.77 to 0.82) 0.469 –0.25 (–1.48 to 0.98) 0.685
Other seafood
 N Ref. Ref. Ref. Ref.
 ≥Once per month 0.31 (–0.23 to 0.85) 0.257 0.34 (–0.17 to 0.85) 0.182 0.11 (–0.59 to 0.80) 0.760 0.09 (–0.56 to 0.75) 0.778
 ≥Once per week 0.18 (–0.53 to 0.88) 0.616 0.13 (–0.58 to 0.83) 0.723 0.47 (–0.67 to 1.60) 0.413 0.27 (–0.91 to 1.44) 0.653

PFOA: perfluorooctanoic acid; PFOS: perfluorooctane sulfonic acid; CI: confidence interval; N: rarely consumed.

aAdjusted model was adjusted for sex, age, body mass index, household income, smoking status, alcohol consumption, coated frying pan usage, coated pot usage, and indoor and outdoor drinking water sources.

Table 5.
Associations between dietary habits and blood PFHxS and PFNA concentrations
Category PFHxS PFNA
Unadjusted model Adjusted modela Unadjusted model Adjusted modela
Estimate (95% CI) p-value Estimate (95% CI) p-value Estimate (95% CI) p-value Estimate (95% CI) p-value
Large fish and tuna
 N Ref. Ref. Ref. Ref.
 ≥Once per month 0.14 (–0.19 to 0.47) 0.394 0.12 (–0.20 to 0.45) 0.452 0.01 (–0.07 to 0.10) 0.784 0.00 (–0.08 to 0.09) 0.933
 ≥Once per week 0.06 (–0.28 to 0.40) 0.711 –0.10 (–0.45 to 0.25) 0.576 –0.01 (–0.09 to 0.08) 0.857 –0.02 (–0.11 to 0.06) 0.597
Fish
 N Ref. Ref. Ref. Ref.
 ≥Once per month 0.19 (–0.33 to 0.71) 0.474 0.05 (–0.50 to 0.61) 0.845 0.13 (0.04 to 0.23) 0.007 0.12 (0.02 to 0.22) 0.022
 ≥Once per week 0.52 (0.07 to 0.98) 0.025 0.39 (–0.04 to 0.81) 0.072 0.32 (0.18 to 0.46) <0.001 0.28 (0.14 to 0.42) <0.001
Crustaceans
 N Ref. Ref. Ref. Ref.
 ≥Once per month 0.18 (–0.11 to 0.46) 0.217 0.27 (–0.02 to 0.56) 0.072 0.15 (0.05 to 0.25) 0.003 0.18 (0.08 to 0.28) <0.001
 ≥Once per week –0.38 (–1.51 to 0.75) 0.506 –0.31 (–1.38 to 0.76) 0.568 0.09 (–0.04 to 0.22) 0.173 0.11 (–0.03 to 0.24) 0.119
Seaweeds
 N Ref. Ref. Ref. Ref.
 ≥Once per month –0.16 (–0.66 to 0.34) 0.534 –0.10 (–0.54 to 0.34) 0.647 0.01 (–0.11 to 0.12) 0.919 0.01 (–0.09 to 0.12) 0.787
 ≥Once per week –0.11 (–0.49 to 0.27) 0.565 –0.02 (–0.38 to 0.34) 0.918 0.02 (–0.10 to 0.14) 0.687 0.05 (–0.07 to 0.16) 0.431
Shellfish
 N Ref. Ref. Ref. Ref.
 ≥Once per month –0.04 (–0.37 to 0.29) 0.813 –0.03 (–0.32 to 0.26) 0.826 0.05 (–0.03 to 0.13) 0.236 0.03 (–0.04 to 0.11) 0.411
 ≥Once per week 0.29 (–0.97 to 1.55) 0.646 0.35 (–0.99 to 1.68) 0.605 0.04 (–0.15 to 0.22) 0.704 0.05 (–0.13 to 0.23) 0.587
Other seafood
 N Ref. Ref. Ref. Ref.
 ≥Once per month 0.19 (–0.12 to 0.51) 0.228 0.18 (–0.14 to 0.50) 0.257 0.04 (–0.06 to 0.15) 0.403 0.05 (–0.05 to 0.15) 0.323
 ≥Once per week 0.37 (–0.11 to 0.84) 0.125 0.28 (–0.20 to 0.75) 0.249 0.06 (–0.09 to 0.20) 0.427 0.04 (–0.10 to 0.18) 0.589

PFHxS: perfluorohexane sulfonic acid; PFNA: perfluorononanoic acid; CI: confidence interval; N: rarely consumed.

aAdjusted model was adjusted for sex, age, body mass index, household income, smoking status, alcohol consumption, coated frying pan usage, coated pot usage, and indoor and outdoor drinking water sources.

Table 6.
Associations between dietary habits and blood PFDeA concentrations
Category PFDeA
Unadjusted model Adjusted modela
Estimate (95% CI) p-value Estimate (95% CI) p-value
Large fish and tuna
 N Ref. Ref.
 ≥Once per month 0.00 (–0.08 to 0.08) 0.955 0.00 (–0.08 to 0.08) 0.978
 ≥Once per week –0.02 (–0.09 to 0.06) 0.649 –0.02 (–0.09 to 0.06) 0.608
Fish
 N Ref. Ref.
 ≥Once per month 0.05 (–0.03 to 0.13) 0.194 0.05 (–0.03 to 0.13) 0.187
 ≥Once per week 0.15 (0.05 to 0.25) 0.006 0.14 (0.05 to 0.23) 0.004
Crustaceans
 N Ref. Ref.
 ≥Once per month 0.10 (0.04 to 0.15) <0.001 0.11 (0.05 to 0.16) <0.001
 ≥Once per week 0.05 (–0.04 to 0.13) 0.284 0.05 (–0.04 to 0.13) 0.257
Seaweeds
 N Ref. Ref.
 ≥Once per month 0.01 (–0.07 to 0.09) 0.841 0.01 (–0.07 to 0.09) 0.866
 ≥Once per week 0.01 (–0.07 to 0.09) 0.794 0.02 (–0.06 to 0.10) 0.630
Shellfish
 N Ref. Ref.
 ≥Once per month 0.02 (–0.02 to 0.06) 0.309 0.01 (–0.02 to 0.05) 0.445
 ≥Once per week –0.01 (–0.12 to 0.09) 0.778 0.00 (–0.10 to 0.11) 0.955
Other seafood
 N Ref. Ref.
 ≥Once per month –0.01 (–0.09 to 0.07) 0.779 –0.01 (–0.08 to 0.06) 0.802
 ≥Once per week 0.03 (–0.07 to 0.14) 0.529 0.02 (–0.08 to 0.12) 0.645

PFDeA: perfluorodecanoic acid; CI: confidence interval; N: rarely consumed.

aAdjusted model was adjusted for sex, age, body mass index, household income, smoking status, alcohol consumption, coated frying pan usage, coated pot usage, and indoor and outdoor drinking water sources.

  • 1. Buck RC, Franklin J, Berger U, Conder JM, Cousins IT, de Voogt P, et al. Perfluoroalkyl and polyfluoroalkyl substances in the environment: terminology, classification, and origins. Integr Environ Assess Manag 2011;7(4):513–41.ArticlePubMedPMCPDF
  • 2. Brunn H, Arnold G, Korner W, Rippen G, Steinhauser KG, Valentin I. PFAS: forever chemicals—persistent, bio accumulative and mobile. Reviewing the status and the need for their phase out and remediation of contaminated sites. Environ Sci Eur 2023;35(1):20.ArticlePDF
  • 3. Dunder L, Lind PM, Salihovic S, Stubleski J, Karrman A, Lind L. Changes in plasma levels of per- and polyfluoroalkyl substances (PFAS) are associated with changes in plasma lipids: a longitudinal study over 10 years. Environ Res 2022;211:112903.ArticlePubMed
  • 4. Hall AM, Braun JM. Per- and polyfluoroalkyl substances and outcomes related to metabolic syndrome: a review of the literature and current recommendations for clinicians. Am J Lifestyle Med 2025;19(2):211–29.ArticlePubMedPMCPDF
  • 5. Zahm S, Bonde JP, Chiu WA, Hoppin J, Kanno J, Abdallah M, et al. Carcinogenicity of perfluorooctanoic acid and perfluorooctanesulfonic acid. Lancet Oncol 2024;25(1):16–7.ArticlePubMed
  • 6. Costello E, Rock S, Stratakis N, Eckel SP, Walker DI, Valvi D, et al. Exposure to per- and polyfluoroalkyl substances and markers of liver injury: a systematic review and meta-analysis. Environ Health Perspect 2022;130(4):46001.ArticlePubMedPMC
  • 7. Zhang X, Zhao L, Ducatman A, Deng C, von Stackelberg KE, Danford CJ, et al. Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults. JHEP Rep 2023;5(5):100694.ArticlePubMedPMC
  • 8. Yun J, Min YS. Association between perfluoroalkyl substance (PFAS) exposure and nonalcoholic fatty liver disease in Korean adults: results from the KoNEHS 2018-2020: a cross-sectional study. Am J Ind Med 2025;68(7):588–97.ArticlePubMed
  • 9. Ehrlich V, Bil W, Vandebriel R, Granum B, Luijten M, Lindeman B, et al. Consideration of pathways for immunotoxicity of per- and polyfluoroalkyl substances (PFAS). Environ Health 2023;22(1):19.ArticlePubMedPMCPDF
  • 10. Fenton SE, Ducatman A, Boobis A, DeWitt JC, Lau C, Ng C, et al. Per- and polyfluoroalkyl substance toxicity and human health review: current state of knowledge and strategies for informing future research. Environ Toxicol Chem 2021;40(3):606–30.ArticlePubMedPMCPDF
  • 11. Winkens K, Vestergren R, Berger U, Cousins IT. Early life exposure to per- and polyfluoroalkyl substances (PFASs): a critical review. Emerg Contam 2017;3(2):55–68.Article
  • 12. Zheng Q, Yan W, Gao S, Li X. The effect of PFAS exposure on glucolipid metabolism in children and adolescents: a meta-analysis. Front Endocrinol (Lausanne) 2024;15:1261008.ArticlePubMedPMC
  • 13. Roth K, Imran Z, Liu W, Petriello MC. Diet as an exposure source and mediator of per- and polyfluoroalkyl substance (PFAS) toxicity. Front Toxicol 2020;2:601149.ArticlePubMedPMC
  • 14. Sunderland EM, Hu XC, Dassuncao C, Tokranov AK, Wagner CC, Allen JG. A review of the pathways of human exposure to poly- and perfluoroalkyl substances (PFASs) and present understanding of health effects. J Expo Sci Environ Epidemiol 2019;29(2):131–47.ArticlePubMedPMCPDF
  • 15. Chen K, Beglarian E, Kauffman D, Tang IW, Saephan F, Park JS, et al. Associations between seafood consumption and serum PFAS levels among Asian/Pacific islanders in the San Francisco Bay Area, California. Expo Health 2026;18(2):14.ArticlePubMedPMCPDF
  • 16. Domingo JL, Nadal M. Per- and polyfluoroalkyl substances (PFASs) in food and human dietary intake: a review of the recent scientific literature. J Agric Food Chem 2017;65(3):533–43.ArticlePubMed
  • 17. Hong S, Kim OJ, Jung SK, Jeon HL, Kim S, Kil J. The exposure status of environmental chemicals in South Korea: the Korean National Environmental Health Survey 2018-2020. Toxics 2024;12(11):829.ArticlePubMedPMC
  • 18. Cho YM, Han D, Jeong J, Kim MJ, Choi KH, Kim WJ, et al. Reference values of per- and poly- fluoroalkyl substances concentration in serum and related factors in Korean adults: Korean National Environmental Health Survey. Environ Anal Health Toxicol 2025;40(3):e2025021-0.ArticlePubMedPMCPDF
  • 19. Golub MS. Adolescent health and the environment. Environ Health Perspect 2000;108(4):355–62.ArticlePubMedPMC
  • 20. Gluge J, Scheringer M, Cousins IT, DeWitt JC, Goldenman G, Herzke D, et al. An overview of the uses of per- and polyfluoroalkyl substances (PFAS). Environ Sci Process Impacts 2020;22(12):2345–73.ArticlePubMedPMCPDF
  • 21. Hu XC, Dassuncao C, Zhang X, Grandjean P, Weihe P, Webster GM, et al. Can profiles of poly- and perfluoroalkyl substances (PFASs) in human serum provide information on major exposure sources? Environ Health 2018;17(1):11.ArticlePubMedPMCPDF
  • 22. Barbo N, Stoiber T, Naidenko OV, Andrews DQ. Locally caught freshwater fish across the United States are likely a significant source of exposure to PFOS and other perfluorinated compounds. Environ Res 2023;220:115165.ArticlePubMed
  • 23. Cao Y, Huang Y, Ma Y, Nie J, Hu C, Chen Y, et al. Environmental occurrence, human exposure, and metabolism of per- and polyfluoroalkyl substance: a review. Environ Res Commun 2025;7(5):052001.ArticlePDF
  • 24. Liu W, Wu J, He W, Xu F. A review on perfluoroalkyl acids studies: environmental behaviors, toxic effects, and ecological and health risks. Ecosyst Health Sustain 2019;5(1):1–19.ArticlePDF
  • 25. Ankley GT, Cureton P, Hoke RA, Houde M, Kumar A, Kurias J, et al. Assessing the ecological risks of per- and polyfluoroalkyl substances: current state-of-the science and a proposed path forward. Environ Toxicol Chem 2021;40(3):564–605.ArticlePubMedPMCPDF
  • 26. Ali AM, Langberg HA, Hale SE, Kallenborn R, Hartz WF, Mortensen AK, et al. The fate of poly- and perfluoroalkyl substances in a marine food web influenced by land-based sources in the Norwegian Arctic. Environ Sci Process Impacts 2021;23(4):588–604.ArticlePubMed
  • 27. Chen WL, Bai FY, Chang YC, Chen PC, Chen CY. Concentrations of perfluoroalkyl substances in foods and the dietary exposure among Taiwan general population and pregnant women. J Food Drug Anal 2018;26(3):994–1004.ArticlePubMedPMC
  • 28. Nystrom J, Benskin JP, Plassmann M, Sandblom O, Glynn A, Lampa E, et al. Healthy eating index and diet diversity score as determinants of serum perfluoroalkyl acid (PFAA) concentrations in a national survey of Swedish adolescents. Environ Res 2022;212(Pt A):113170.ArticlePubMed
  • 29. McAdam J, Jones LE, Romeiko XX, Bell EM. Exogenous factors associated with legacy PFAS concentrations in the general U.S. population: NHANES 1999-2018. Water Emerg Contam Nanoplastics 2024;3:15.Article
  • 30. Lin PI, Cardenas A, Hauser R, Gold DR, Kleinman KP, Hivert MF, et al. Dietary characteristics associated with plasma concentrations of per- and polyfluoroalkyl substances among adults with pre-diabetes: cross-sectional results from the Diabetes Prevention Program Trial. Environ Int 2020;137:105217.ArticlePubMedPMC
  • 31. Wang XF, Mo MS, Chen HG, Wang Q, Yang JL, Zhao DH. Distribution and exposure risk assessment of perfluorinated alkyl substances in aquatic products along the coastal region of the South China Sea. Expos Health 2021;13:505–15.ArticlePDF
  • 32. Huh SW, Cho SY, Yoon S, Kim D, Park HW, Kang J, et al. Relationship between crustacean consumption and serum perfluoroalkyl substances (PFAS): the Korean National Environmental Health Survey (KoNEHS) cycle 4. Ann Occup Environ Med 2024;36:e12.ArticlePubMedPMCPDF
  • 33. Fujii Y, Harada KH. A review of human exposure to PFAS: substantial contribution from seafood. Environ Health Prev Med 2025;30:73.ArticlePubMedPMC
  • 34. Umweltbundesamt. HBM-I values for perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) in blood plasma: Statement of the German Human Biomonitoring Commission (HBM Commission). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018;61(4):474–87.ArticlePubMed
  • 35. Umweltbundesamt. HBM-II-Werte für Perfluoroctansäure (PFOA) und Perfluoroctansulfonsäure (PFOS) in Blutplasma – Stellungnahme der Kommission Human-Biomonitoring des. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63(3):356–60.ArticlePubMedPDF
  • 36. Wong F, MacLeod M, Mueller JF, Cousins IT. Enhanced elimination of perfluorooctane sulfonic acid by menstruating women: evidence from population-based pharmacokinetic modeling. Environ Sci Technol 2014;48(15):8807–14.ArticlePubMedPMC
  • 37. Kim MJ, Park J, Luo L, Min J, Kim JH, Yang HD, et al. Effect of washing, soaking, and cooking methods on perfluorinated compounds in mackerel (Scomber japonicus). Food Sci Nutr 2020;8(8):4399–408.ArticlePubMedPMCPDF
  • 38. Heo JJ, Lee JW, Kim SK, Oh JE. Monitoring and development of pretreatment method for perfluorinated compounds in fish samples. J Korean Soc Environ Eng 2013;35(7):485–94.Article

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        Association between seafood consumption and serum polyfluoroalkyl substance concentrations among Korean adolescents: the Korean National Environmental Health Survey (KoNEHS) cycle 5, 2021–2023
        Ann Occup Environ Med. 2026;38:e38  Published online August 20, 2026
        DOI: https://doi.org/10.35371/aoem.2026.38.e38
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      Association between seafood consumption and serum polyfluoroalkyl substance concentrations among Korean adolescents: the Korean National Environmental Health Survey (KoNEHS) cycle 5, 2021–2023
      Association between seafood consumption and serum polyfluoroalkyl substance concentrations among Korean adolescents: the Korean National Environmental Health Survey (KoNEHS) cycle 5, 2021–2023
      Characteristic Total PFOA PFOA p-valuea p-valueb PFOS PFOS p-valuea p-valueb
      Low High Low High
      Total 827 (100) 4.49 ± 0.12 438 (52.7) 389 (47.3) 6.84 ± 0.18 412 (49.6) 415 (50.4)
      Sex
       Male 385 (52.4) 4.76 ± 0.19 187 (47.5) 198 (57.8) 0.010 0.002 7.33 ± 0.29 171 (46.8) 214 (57.9) 0.002 0.016
       Female 442 (47.6) 4.19 ± 0.13 251 (52.5) 191 (42.2) 6.30 ± 0.18 241 (53.2) 201 (42.1)
      Mean age (years) 14.47 ± 0.20 - 14.49 ± 0.22 14.45 ± 0.22 0.821 - - 14.46 ± 0.22 14.49 ± 0.22 0.835 -
      Household income
       1st quartile 135 (15.7) 4.45 ± 0.28 80 (17.3) 55 (14.0) 0.938 0.548 6.49 ± 0.40 83 (20.0) 52 (11.5) 0.080 <0.001
       2nd quartile 218 (25.9) 4.44 ± 0.26 107 (23.7) 111 (28.3) 6.68 ± 0.23 110 (26.2) 108 (25.6)
       3rd quartile 247 (29.3) 4.60 ± 0.23 129 (29.7) 118 (28.9) 6.63 ± 0.27 128 (31.4) 119 (27.3)
       4th quartile 227 (29.1) 4.43 ± 0.22 122 (29.3) 105 (28.8) 7.39 ± 0.30 91 (22.4) 136 (35.6)
      Smoking
       Non-smoker 813 (98.3) 4.49 ± 0.13 429 (98.1) 384 (98.6) 0.937 0.373 6.82 ± 0.18 404 (98.1) 409 (98.5) 0.455 0.592
       Current smoker 14 (1.7) 4.44 ± 0.55 9 (1.9) 5 (1.4) 8.24 ± 1.87 8 (1.9) 6 (1.5)
      Alcohol
       Never drinking 657 (79.6) 4.48 ± 0.13 352 (80.5) 305 (78.6) 0.873 0.528 6.77 ± 0.20 320 (78.5) 337 (80.7) 0.378 0.440
       Ever once 170 (20.4) 4.52 ± 0.22 86 (19.5) 84 (21.4) 7.11 ± 0.36 92 (21.5) 78 (19.3)
      BMI (kg/m2)
       <25 669 (79.7) 4.45 ± 0.11 360 (81.2) 309 (78.1) 0.484 0.324 6.82 ± 0.20 336 (80.1) 333 (79.4) 0.827 0.855
       ≥25 158 (20.3) 4.65 ± 0.30 78 (18.8) 80 (21.9) 6.90 ± 0.31 76 (19.9) 82 (20.6)
      Large fish and tuna
       Rarely 382 (44.9) 4.28 ± 0.19 221 (50.2) 161 (39.1) 0.228 0.006 6.40 ± 0.24 223 (51.7) 159 (38.3) 0.009 <0.001
       ≥Once per month 306 (36.8) 4.64 ± 0.17 146 (32.5) 160 (41.5) 7.06 ± 0.22 130 (31.8) 176 (41.6)
       ≥Once per week 139 (18.3) 4.68 ± 0.22 71 (17.3) 68 (19.4) 7.48 ± 0.34 59 (16.5) 80 (20.1)
      Fish
       Rarely 160 (19.0) 3.42 ± 0.19 115 (26.3) 45 (11.0) <0.001 <0.001 5.30 ± 0.20 117 (28.0) 43 (10.2) <0.001 <0.001
       ≥Once per month 427 (52.2) 4.41 ± 0.18 228 (51.6) 199 (52.8) 6.73 ± 0.21 217 (52.3) 210 (52.0)
       ≥Once per week 240 (28.8) 5.33 ± 0.20 95 (22.2) 145 (36.2) 8.05 ± 0.32 78 (19.7) 162 (37.8)
      Crustaceans
       Rarely 301 (37.3) 3.60 ± 0.15 210 (49.1) 91 (24.2) <0.001 <0.001 5.93 ± 0.18 175 (43.2) 126 (31.5) <0.001 0.013
       ≥Once per month 435 (51.3) 5.04 ± 0.19 190 (41.7) 245 (61.8) 7.46 ± 0.25 196 (45.8) 239 (56.6)
       ≥Once per week 91 (11.4) 4.92 ± 0.27 38 (9.1) 53 (14.0) 7.01 ± 0.39 41 (11.0) 50 (11.8)
      Seaweeds
       Rarely 69 (8.7) 3.53 ± 0.25 49 (11.7) 20 (5.4) <0.001 <0.001 6.21 ± 0.44 41 (10.4) 28 (7.0) 0.002 <0.001
       ≥Once per month 332 (39.5) 4.25 ± 0.14 192 (43.1) 140 (35.4) 6.42 ± 0.22 188 (45.0) 144 (34.0)
       ≥Once per week 426 (51.8) 4.83 ± 0.15 197 (45.2) 229 (59.2) 7.26 ± 0.23 183 (44.5) 243 (59.0)
      Shellfish
       Rarely 401 (48.7) 4.02 ± 0.15 253 (57.9) 148 (38.5) <0.001 <0.001 6.29 ± 0.19 231 (55.0) 170 (42.5) <0.001 0.002
       ≥Once per month 362 (43.6) 4.82 ± 0.15 161 (36.5) 201 (51.5) 7.40 ± 0.24 153 (37.4) 209 (49.7)
       ≥Once per week 64 (7.7) 5.55 ± 0.47 24 (5.6) 40 (10.0) 7.12 ± 0.41 28 (7.6) 36 (7.8)
      Other seafood
       Rarely 262 (32.5) 3.73 ± 0.18 180 (42.5) 82 (21.4) <0.001 <0.001 6.09 ± 0.25 159 (38.9) 103 (26.3) <0.001 0.001
       ≥Once per month 424 (50.8) 4.75 ± 0.16 201 (44.7) 223 (57.6) 7.07 ± 0.22 199 (47.3) 225 (54.3)
       ≥Once per week 141 (16.7) 5.15 ± 0.28 57 (12.8) 84 (21.0) 7.60 ± 0.36 54 (13.9) 87 (19.5)
      Coated frying pan usage
       ≤Once per week 83 (9.6) 3.92 ± 0.20 49 (10.8) 34 (8.1) 0.008 0.291 6.37 ± 0.42 49 (11.0) 34 (8.2) 0.217 0.178
       >Once per week 744 (90.4) 4.55 ± 0.13 389 (89.2) 355 (91.9) 6.89 ± 0.18 363 (89.0) 381 (91.8)
      Coated pot usage
       ≤Once per week 279 (34.0) 4.58 ± 0.19 143 (33.6) 136 (34.5) 0.547 0.815 7.09 ± 0.24 131 (31.2) 148 (36.8) 0.166 0.108
       >Once per week 548 (66.0) 4.44 ± 0.14 295 (66.4) 253 (65.5) 6.71 ± 0.21 281 (68.8) 267 (63.2)
      Type of water drinking indoor
       Purified/bottled water 712 (86.3) 4.48 ± 0.13 375 (85.5) 337 (87.2) 0.869 0.564 6.86 ± 0.20 357 (86.3) 355 (86.4) 0.711 0.945
       Ground/tap water 115 (13.7) 4.54 ± 0.35 63 (14.5) 52 (12.8) 6.74 ± 0.27 55 (13.7) 60 (13.6)
      Type of water drinking outdoor
       Purified/bottled water 767 (93.1) 4.50 ± 0.13 406(92.4) 361 (93.8) 0.668 0.464 6.85 ± 0.19 384 (93.2) 383 (92.9) 0.607 0.889
       Ground/tap water 60 (6.9) 4.26 ± 0.54 32(7.6) 28 (6.2) 6.66 ± 0.34 28 (6.8) 32 (7.1)
      Characteristic Total PFHxS PFHxS p-valuea p-valueb PFNA PFNA p-valuea p-valueb
      Low High Low High
      Total 827 (100) 2.67 ± 0.17 455 (50.6) 372 (49.4) 1.00 ± 0.02 411 (48.7) 416 (51.3)
      Sex
       Male 385 (52.4) 2.98 ± 0.22 185 (41.8) 200 (63.2) 0.002 <0.001 1.08 ± 0.04 157 (43.0) 228 (61.3) <0.001 <0.001
       Female 442 (47.6) 2.33 ± 0.16 270 (58.2) 172 (36.8) 0.90 ± 0.02 254 (57.0) 188 (38.7)
      Mean age (years) 14.47 ± 0.20 - 14.41 ± 0.23 14.54 ± 0.24 0.573 - - 14.45 ± 0.21 14.49 ± 0.22 0.770 -
      Household income
       1st quartile 135 (15.7) 2.57 ± 0.18 81 (16.6) 54 (14.9) 0.755 0.814 0.96 ± 0.05 74 (17.4) 61 (14.2) 0.649 0.685
       2nd quartile 218 (25.9) 2.60 ± 0.18 122 (26.3) 96 (25.5) 0.97 ± 0.04 104 (25.0) 114 (26.8)
       3rd quartile 247 (29.3) 2.67 ± 0.18 137 (29.7) 110 (28.9) 1.03 ± 0.05 117 (28.2) 130 (30.4)
       4th quartile 227 (29.1) 2.79 ± 0.26 115 (27.4) 112 (30.7) 1.00 ± 0.04 116 (29.5) 111 (28.7)
      Smoking
       Non-smoker 813 (98.3) 2.66 ± 0.16 444 (97.6) 369 (99.0) 0.454 0.145 1.00 ± 0.03 403 (98.2) 410 (98.4) 0.470 0.681
       Current smoker 14 (1.7) 3.43 ± 1.11 11 (2.4) 3 (1.0) 0.94 ± 0.07 8 (1.8) 6 (1.6)
      Alcohol
       Never drinking 657 (79.6) 2.64 ± 0.14 366 (80.6) 291 (78.7) 0.561 0.575 0.98 ± 0.03 339 (83.4) 318 (76.1) 0.054 0.017
       Ever once 170 (20.4) 2.81 ± 0.36 89 (19.4) 81 (21.3) 1.07 ± 0.04 72 (16.6) 98 (23.9)
      BMI (kg/m2)
       <25 669 (79.7) 2.59 ± 0.15 373 (81.8) 296 (77.6) 0.096 0.218 0.99 ± 0.03 338 (80.7) 331 (78.8) 0.701 0.556
       ≥25 158 (20.3) 2.98 ± 0.31 82 (18.2) 76 (22.4) 1.01 ± 0.05 73 (19.3) 85 (21.2)
      Large fish and tuna
       Rarely 382 (44.9) 2.52 ± 0.16 218 (47.5) 164 (42.3) 0.092 0.282 0.92 ± 0.03 213 (50.6) 169 (39.6) 0.005 0.021
       ≥Once per month 306 (36.8) 2.80 ± 0.21 163 (35.1) 143 (38.4) 1.05 ± 0.03 135 (31.9) 171 (41.4)
       ≥Once per week 139 (18.3) 2.77 ± 0.21 74 (17.4) 65 (19.2) 1.07 ± 0.05 63 (17.6) 76 (19.0)
      Fish
       Rarely 160 (19.0) 2.31 ± 0.28 110 (25.1) 50 (12.8) 0.206 <0.001 0.75 ± 0.04 113 (26.9) 47 (11.5) <0.001 <0.001
       ≥Once per month 427 (52.2) 2.63 ± 0.11 224 (49.0) 203 (55.4) 0.98 ± 0.03 216 (53.2) 211 (51.1)
       ≥Once per week 240 (28.8) 2.98 ± 0.32 121 (26.0) 119 (31.8) 1.20 ± 0.04 82 (19.9) 158 (37.3)
      Crustaceans
       Rarely 301 (37.3) 2.43 ± 0.17 183 (40.9) 118 (33.6) 0.126 0.034 0.82 ± 0.03 193 (48.7) 108 (26.6) <0.001 <0.001
       ≥Once per month 435 (51.3) 2.85 ± 0.21 219 (46.4) 216 (56.3) 1.09 ± 0.03 183 (42.4) 252 (59.7)
       ≥Once per week 91 (11.4) 2.64 ± 0.22 53 (12.7) 38 (10.1) 1.14 ± 0.06 35 (8.9) 56 (13.8)
      Seaweeds
       Rarely 69 (8.7) 2.47 ± 0.27 42 (9.6) 27 (7.8) 0.418 0.615 0.81 ± 0.06 46 (11.8) 23 (5.8) <0.001 <0.001
       ≥Once per month 332 (39.5) 2.58 ± 0.13 177 (38.4) 155 (40.6) 0.96 ± 0.03 185 (43.6) 147 (35.6)
       ≥Once per week 426 (51.8) 2.77 ± 0.23 236 (52.0) 190 (51.6) 1.06 ± 0.03 180 (44.7) 246 (58.5)
      Shellfish
       Rarely 401 (48.7) 2.52 ± 0.18 235 (51.7) 166 (45.6) 0.244 0.242 0.89 ± 0.03 247 (60.9) 154 (37.2) <0.001 <0.001
       ≥Once per month 362 (43.6) 2.76 ± 0.15 184 (40.5) 178 (46.7) 1.09 ± 0.03 148 (34.9) 214 (51.8)
       ≥Once per week 64 (7.7) 3.11 ± 0.64 36 (7.8) 28 (7.6) 1.15 ± 0.06 16 (4.1) 48 (11.1)
      Other seafood
       Rarely 262 (32.5) 2.39 ± 0.17 169 (38.4) 93 (26.5) 0.029 0.008 0.84 ± 0.03 172 (43.8) 90 (21.8) <0.001 <0.001
       ≥Once per month 424 (50.8) 2.73 ± 0.15 214 (45.6) 210 (56.1) 1.05 ± 0.03 188 (43.6) 236 (57.6)
       ≥Once per week 141 (16.7) 3.03 ± 0.38 72 (16.0) 69 (17.4) 1.14 ± 0.04 51 (12.6) 90 (20.6)
      Coated frying pan usage
       ≤Once per week 83 (9.6) 2.52 ± 0.22 49 (10.1) 34 (9.0) 0.449 0.579 0.96 ± 0.07 42 (9.7) 41 (9.4) 0.564 0.922
       >Once per week 744 (90.4) 2.69 ± 0.18 406 (89.9) 338 (91.0) 1.00 ± 0.02 369 (90.3) 375 (90.6)
      Coated pot usage
       ≤Once per week 279 (34.0) 2.57 ± 0.15 153 (34.1) 126 (34.0) 0.521 0.963 1.04 ± 0.04 130 (32.0) 149 (36.0) 0.140 0.238
       >Once per week 548 (66.0) 2.72 ± 0.22 302 (65.9) 246 (66.0) 0.97 ± 0.03 281 (68.0) 267 (64.0)
      Type of water drinking indoor
       Purified/bottled water 712 (86.3) 2.70 ± 0.18 393 (86.8) 319 (85.9) 0.301 0.701 0.99 ± 0.02 355 (86.3) 357 (86.4) 0.706 0.951
       Ground/tap water 115 (13.7) 2.50 ± 0.15 62 (13.2) 53 (14.1) 1.01 ± 0.06 56 (13.7) 59 (13.6)
      Type of water drinking outdoor
       Purified/bottled water 767 (93.1) 2.62 ± 0.13 426 (93.9) 341 (92.3) 0.453 0.497 1.00 ± 0.03 380 (91.9) 387 (94.2) 0.086 0.249
       Ground/tap water 60 (6.9) 3.31 ± 0.97 29 (6.1) 31 (7.7) 0.91 ± 0.04 31 (8.1) 29 (5.8)
      Characteristic Total PFDeA PFDeA p-valuea p-valueb
      Low High
      Total 827 (100) 0.48 ± 0.02 392 (47.0) 435 (53.0)
      Sex
       Male 385 (52.4) 0.51 ± 0.03 173 (49.2) 212 (55.3) 0.103 0.179
       Female 442 (47.6) 0.45 ± 0.02 219 (50.8) 223 (44.7)
      Mean age (years) 14.47 ± 0.20 - 14.41 ± 0.23 14.53 ± 0.22 0.518 -
      Household income
       1st quartile 135 (15.7) 0.49 ± 0.05 69 (16.9) 66 (14.7) 0.513 0.575
       2nd quartile 218 (25.9) 0.46 ± 0.02 106 (27.4) 112 (24.6)
       3rd quartile 247 (29.3) 0.49 ± 0.02 112 (27.8) 135 (30.7)
       4th quartile 227 (29.1) 0.49 ± 0.02 105 (27.9) 122 (30.0)
      Smoking
       Non-smoker 813 (98.3) 0.48 ± 0.02 383 (97.9) 430 (98.7) 0.792 0.254
       Current smoker 14 (1.7) 0.47 ± 0.06 9 (2.1) 5 (1.3)
      Alcohol
       Never drinking 657 (79.6) 0.48 ± 0.02 315 (80.8) 342 (78.6) 0.252 0.475
       Ever once 170 (20.4) 0.51 ± 0.02 77 (19.2) 93 (21.4)
      BMI (kg/m2)
       <25 669 (79.7) 0.50 ± 0.02 315 (79.0) 354 (80.4) 0.037 0.662
       ≥25 158 (20.3) 0.44 ± 0.02 77 (21.0) 81 (19.6)
      Large fish and tuna
       Rarely 382 (44.9) 0.45 ± 0.03 210 (51.8) 172 (38.9) 0.167 0.001
       ≥Once per month 306 (36.8) 0.51 ± 0.02 131 (33.6) 175 (39.6)
       ≥Once per week 139 (18.3) 0.51 ± 0.02 51 (14.6) 88 (21.6)
      Fish
       Rarely 160 (19.0) 0.38 ± 0.02 111 (27.6) 49 (11.5) <0.001 <0.001
       ≥Once per month 427 (52.2) 0.47 ± 0.02 206 (52.5) 221 (51.8)
       ≥Once per week 240 (28.8) 0.57 ± 0.03 75 (20.0) 165 (36.7)
      Crustaceans
       Rarely 301 (37.3) 0.40 ± 0.02 191 (50.0) 110 (26.1) <0.001 <0.001
       ≥Once per month 435 (51.3) 0.54 ± 0.02 170 (41.5) 265 (59.9)
       ≥Once per week 91 (11.4) 0.54 ± 0.03 31 (8.5) 60 (14.0)
      Seaweeds
       Rarely 69 (8.7) 0.40 ± 0.04 45 (11.8) 24 (6.0) 0.002 0.002
       ≥Once per month 332 (39.5) 0.47 ± 0.02 174 (42.7) 158 (36.6)
       ≥Once per week 426 (51.8) 0.51 ± 0.02 173 (45.5) 253 (57.4)
      Shellfish
       Rarely 401 (48.7) 0.44 ± 0.02 231 (59.3) 170 (39.3) 0.001 <0.001
       ≥Once per month 362 (43.6) 0.53 ± 0.02 143 (35.7) 219 (50.6)
       ≥Once per week 64 (7.7) 0.54 ± 0.04 18 (5.1) 46 (10.1)
      Other seafood
       Rarely 262 (32.5) 0.42 ± 0.03 167 (43.2) 95 (23.0) 0.003 <0.001
       ≥Once per month 424 (50.8) 0.50 ± 0.02 185 (45.5) 239 (55.5)
       ≥Once per week 141 (16.7) 0.56 ± 0.03 40 (11.3) 101 (21.5)
      Coated frying pan usage
       ≤Once per week 83 (9.6) 0.46 ± 0.03 41 (10.0) 42 (9.2) 0.430 0.746
       >Once per week 744 (90.4) 0.49 ± 0.02 351 (90.0) 393 (90.8)
      Coated pot usage
       ≤Once per week 279 (34.0) 0.52 ± 0.03 130 (33.5) 149 (34.5) 0.141 0.770
       >Once per week 548 (66.0) 0.47 ± 0.02 262 (66.5) 286 (65.5)
      Type of water drinking indoor
       Purified/bottled water 712 (86.3) 0.48 ± 0.02 344 (87.6) 368 (85.2) 0.537 0.387
       Ground/tap water 115 (13.7) 0.50 ± 0.03 48 (12.4) 67 (14.8)
      Type of water drinking outdoor
       Purified/bottled water 767 (93.1) 0.48 ± 0.02 368 (93.6) 399 (92.6) 0.828 0.651
       Ground/tap water 60 (6.9) 0.48 ± 0.03 24 (6.4) 36 (7.4)
      Category PFOA PFOS
      Unadjusted model Adjusted modela Unadjusted model Adjusted modela
      Estimate (95% CI) p-value Estimate (95% CI) p-value Estimate (95% CI) p-value Estimate (95% CI) p-value
      Large fish and tuna
       N Ref. Ref. Ref. Ref.
       ≥Once per month –0.17 (–0.70 to 0.36) 0.526 –0.19 (–0.73 to 0.34) 0.477 0.07 (–0.55 to 0.69) 0.830 0.05 (–0.57 to 0.67) 0.883
       ≥Once per week –0.31 (–0.88 to 0.25) 0.272 –0.35 (–0.90 to 0.20) 0.206 0.31 (–0.50 to 1.11) 0.451 0.21 (–0.51 to 0.93) 0.561
      Fish
       N Ref. Ref. Ref. Ref.
       ≥Once per month 0.52 (–0.08 to 1.11) 0.086 0.46 (–0.13 to 1.06) 0.126 1.09 (0.42 to 1.75) 0.002 0.98 (0.24 to 1.72) 0.011
       ≥Once per week 1.27 (0.60 to 1.95) <0.001 1.15 (0.46 to 1.83) 0.001 2.37 (1.49 to 3.24) <0.001 2.14 (1.23 to 3.05) <0.001
      Crustaceans
       N Ref. Ref. Ref. Ref.
       ≥Once per month 1.00 (0.48 to 1.51) <0.001 1.10 (0.57 to 1.63) <0.001 0.81 (0.16 to 1.47) 0.016 0.93 (0.24 to 1.61) 0.009
       ≥Once per week 0.26 (–0.47 to 0.99) 0.480 0.30 (–0.46 to 1.06) 0.429 –0.42 (–1.44 to 0.60) 0.414 –0.37 (–1.28 to 0.55) 0.428
      Seaweeds
       N Ref. Ref. Ref. Ref.
       ≥Once per month 0.10 (–0.43 to 0.62) 0.716 0.11 (–0.37 to 0.60) 0.639 –0.73 (–1.65 to 0.19) 0.119 –0.69 (–1.63 to 0.26) 0.151
       ≥Once per week 0.36 (–0.25 to 0.97) 0.242 0.42 (–0.15 to 0.99) 0.145 –0.33 (–1.33 to 0.66) 0.508 –0.19 (–1.19 to 0.81) 0.709
      Shellfish
       N Ref. Ref. Ref. Ref.
       ≥Once per month 0.02 (–0.42 to 0.46) 0.931 0.00 (–0.44 to 0.45) 0.990 0.26 (–0.27 to 0.78) 0.329 0.24 (–0.30 to 0.77) 0.386
       ≥Once per week 0.72 (–0.42 to 1.87) 0.210 0.81 (–0.31 to 1.93) 0.154 –0.47 (–1.77 to 0.82) 0.469 –0.25 (–1.48 to 0.98) 0.685
      Other seafood
       N Ref. Ref. Ref. Ref.
       ≥Once per month 0.31 (–0.23 to 0.85) 0.257 0.34 (–0.17 to 0.85) 0.182 0.11 (–0.59 to 0.80) 0.760 0.09 (–0.56 to 0.75) 0.778
       ≥Once per week 0.18 (–0.53 to 0.88) 0.616 0.13 (–0.58 to 0.83) 0.723 0.47 (–0.67 to 1.60) 0.413 0.27 (–0.91 to 1.44) 0.653
      Category PFHxS PFNA
      Unadjusted model Adjusted modela Unadjusted model Adjusted modela
      Estimate (95% CI) p-value Estimate (95% CI) p-value Estimate (95% CI) p-value Estimate (95% CI) p-value
      Large fish and tuna
       N Ref. Ref. Ref. Ref.
       ≥Once per month 0.14 (–0.19 to 0.47) 0.394 0.12 (–0.20 to 0.45) 0.452 0.01 (–0.07 to 0.10) 0.784 0.00 (–0.08 to 0.09) 0.933
       ≥Once per week 0.06 (–0.28 to 0.40) 0.711 –0.10 (–0.45 to 0.25) 0.576 –0.01 (–0.09 to 0.08) 0.857 –0.02 (–0.11 to 0.06) 0.597
      Fish
       N Ref. Ref. Ref. Ref.
       ≥Once per month 0.19 (–0.33 to 0.71) 0.474 0.05 (–0.50 to 0.61) 0.845 0.13 (0.04 to 0.23) 0.007 0.12 (0.02 to 0.22) 0.022
       ≥Once per week 0.52 (0.07 to 0.98) 0.025 0.39 (–0.04 to 0.81) 0.072 0.32 (0.18 to 0.46) <0.001 0.28 (0.14 to 0.42) <0.001
      Crustaceans
       N Ref. Ref. Ref. Ref.
       ≥Once per month 0.18 (–0.11 to 0.46) 0.217 0.27 (–0.02 to 0.56) 0.072 0.15 (0.05 to 0.25) 0.003 0.18 (0.08 to 0.28) <0.001
       ≥Once per week –0.38 (–1.51 to 0.75) 0.506 –0.31 (–1.38 to 0.76) 0.568 0.09 (–0.04 to 0.22) 0.173 0.11 (–0.03 to 0.24) 0.119
      Seaweeds
       N Ref. Ref. Ref. Ref.
       ≥Once per month –0.16 (–0.66 to 0.34) 0.534 –0.10 (–0.54 to 0.34) 0.647 0.01 (–0.11 to 0.12) 0.919 0.01 (–0.09 to 0.12) 0.787
       ≥Once per week –0.11 (–0.49 to 0.27) 0.565 –0.02 (–0.38 to 0.34) 0.918 0.02 (–0.10 to 0.14) 0.687 0.05 (–0.07 to 0.16) 0.431
      Shellfish
       N Ref. Ref. Ref. Ref.
       ≥Once per month –0.04 (–0.37 to 0.29) 0.813 –0.03 (–0.32 to 0.26) 0.826 0.05 (–0.03 to 0.13) 0.236 0.03 (–0.04 to 0.11) 0.411
       ≥Once per week 0.29 (–0.97 to 1.55) 0.646 0.35 (–0.99 to 1.68) 0.605 0.04 (–0.15 to 0.22) 0.704 0.05 (–0.13 to 0.23) 0.587
      Other seafood
       N Ref. Ref. Ref. Ref.
       ≥Once per month 0.19 (–0.12 to 0.51) 0.228 0.18 (–0.14 to 0.50) 0.257 0.04 (–0.06 to 0.15) 0.403 0.05 (–0.05 to 0.15) 0.323
       ≥Once per week 0.37 (–0.11 to 0.84) 0.125 0.28 (–0.20 to 0.75) 0.249 0.06 (–0.09 to 0.20) 0.427 0.04 (–0.10 to 0.18) 0.589
      Category PFDeA
      Unadjusted model Adjusted modela
      Estimate (95% CI) p-value Estimate (95% CI) p-value
      Large fish and tuna
       N Ref. Ref.
       ≥Once per month 0.00 (–0.08 to 0.08) 0.955 0.00 (–0.08 to 0.08) 0.978
       ≥Once per week –0.02 (–0.09 to 0.06) 0.649 –0.02 (–0.09 to 0.06) 0.608
      Fish
       N Ref. Ref.
       ≥Once per month 0.05 (–0.03 to 0.13) 0.194 0.05 (–0.03 to 0.13) 0.187
       ≥Once per week 0.15 (0.05 to 0.25) 0.006 0.14 (0.05 to 0.23) 0.004
      Crustaceans
       N Ref. Ref.
       ≥Once per month 0.10 (0.04 to 0.15) <0.001 0.11 (0.05 to 0.16) <0.001
       ≥Once per week 0.05 (–0.04 to 0.13) 0.284 0.05 (–0.04 to 0.13) 0.257
      Seaweeds
       N Ref. Ref.
       ≥Once per month 0.01 (–0.07 to 0.09) 0.841 0.01 (–0.07 to 0.09) 0.866
       ≥Once per week 0.01 (–0.07 to 0.09) 0.794 0.02 (–0.06 to 0.10) 0.630
      Shellfish
       N Ref. Ref.
       ≥Once per month 0.02 (–0.02 to 0.06) 0.309 0.01 (–0.02 to 0.05) 0.445
       ≥Once per week –0.01 (–0.12 to 0.09) 0.778 0.00 (–0.10 to 0.11) 0.955
      Other seafood
       N Ref. Ref.
       ≥Once per month –0.01 (–0.09 to 0.07) 0.779 –0.01 (–0.08 to 0.06) 0.802
       ≥Once per week 0.03 (–0.07 to 0.14) 0.529 0.02 (–0.08 to 0.12) 0.645
      Table 1. General characteristics and PFOA and PFOS levels (µg/L) of the study population

      Values are presented as mean ± SE for continuous variables and n (unweighted) and % (weighted) for categorical variables.

      PFOA: perfluorooctanoic acid; PFOS: perfluorooctane sulfonic acid; BMI: body mass index; SE, standard error.

      p-values were calculated using complex sample general linear models;

      p-values were calculated using the Rao-Scott chi-square test.

      Table 2. General characteristics and PFHxS and PFNA levels (µg/L) of the study population

      Values are presented as mean ± SE for continuous variables and n (unweighted) and % (weighted) for categorical variables.

      PFHxS: perfluorohexane sulfonic acid; PFNA: perfluorononanoic acid; BMI: body mass index; SE, standard error.

      p-values were calculated using complex sample general linear models;

      p-values were calculated using the Rao-Scott chi-square test.

      Table 3. General characteristics and PFDeA levels (µg/L) of the study population

      Values are presented as mean ± SE for continuous variables and n (unweighted) and % (weighted) for categorical variables.

      PFDeA: perfluorodecanoic acid; BMI: body mass index; SE, standard error.

      p-values were calculated using complex sample general linear models;

      p-values were calculated using the Rao-Scott chi-square test.

      Table 4. Associations between dietary habits and blood PFOA and PFOS concentrations

      PFOA: perfluorooctanoic acid; PFOS: perfluorooctane sulfonic acid; CI: confidence interval; N: rarely consumed.

      Adjusted model was adjusted for sex, age, body mass index, household income, smoking status, alcohol consumption, coated frying pan usage, coated pot usage, and indoor and outdoor drinking water sources.

      Table 5. Associations between dietary habits and blood PFHxS and PFNA concentrations

      PFHxS: perfluorohexane sulfonic acid; PFNA: perfluorononanoic acid; CI: confidence interval; N: rarely consumed.

      Adjusted model was adjusted for sex, age, body mass index, household income, smoking status, alcohol consumption, coated frying pan usage, coated pot usage, and indoor and outdoor drinking water sources.

      Table 6. Associations between dietary habits and blood PFDeA concentrations

      PFDeA: perfluorodecanoic acid; CI: confidence interval; N: rarely consumed.

      Adjusted model was adjusted for sex, age, body mass index, household income, smoking status, alcohol consumption, coated frying pan usage, coated pot usage, and indoor and outdoor drinking water sources.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

      Table 5.

      Table 6.

      Ann Occup Environ Med : Annals of Occupational and Environmental Medicine
      © Korean Society of Occupational & Environmental Medicine.
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