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HOME > Ann Occup Environ Med > Volume 36; 2024 > Article
Original Article Relationship between crustacean consumption and serum perfluoroalkyl substances (PFAS): the Korean National Environmental Health Survey (KoNEHS) cycle 4
Sung Woo Huhorcid, Seong-yong Choorcid, Seongyong Yoonorcid, Daehwan Kimorcid, Hyun Woo Parkorcid, Jisoo Kangorcid, Keon Woo Kimorcid
Annals of Occupational and Environmental Medicine 2024;36:e12.
DOI: https://doi.org/10.35371/aoem.2024.36.e12
Published online: April 19, 2024

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Correspondence: Seong-yong Cho. Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, 179 1gongdan-ro, Gumi 39371, Korea. 97blueciel@naver.com
• Received: January 10, 2024   • Revised: April 3, 2024   • Accepted: April 17, 2024

© 2024 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
    Perfluoroalkyl substances (PFASs) are non-aromatic organic compounds, whose hydrogen atoms in the carbon chain substituted by fluorine atoms. PFASs exhibit developmental toxicity, carcinogenicity, hepatotoxicity, reproductive toxicity, immunotoxicity, and hormone toxicity. PFASs are used in the production of disposable food packages, aircraft and automobile devices, cooking utensils, outdoor gear, furniture and carpets, aqueous film forming foam (AFFF), cables and wires, electronics, and semiconductors. This study aimed to determine the association between crustacean consumption and serum PFASs.
  • Methods
    Adult participants (2,993) aged ≥ 19 years were extracted from the 4th cycle data of the Korean National Environmental Health Survey (KoNEHS). Based on the 50th percentile concentrations of serum PFASs, participants were divided into the low-concentration group (LC) and the high-concentration group (HC). General characteristics, dietary factors, coated product usage, and personal care product usage, an independent t-test and χ2 test were analyzed. The odds ratio (OR) of serum PFAS concentration against crustacean consumption was estimated via logistic regression analysis adjusting for general characteristics, dietary factors, coated product usage, and personal care product usage.
  • Results
    The OR for the HC of serum PFASs was higher in individuals with ≥once a week crustacean consumption than in those with < once a week crustacean consumption. Estimated ORs were perfluorohexanesulfonic acid 2.15 (95% confidence interval [CI]: 1.53–3.02), perfluorononanoic acid (PFNA) 1.23 (95% CI: 1.07–1.41), and perfluorodecanoic acid (PFDeA) 1.42 (95% CI: 1.17–1.74) in males, and perfluorooctanoic acid 1.48 (95% CI: 1.19–1.84), perfluorooctanesulfonic acid 1.39 (95% CI: 1.27–1.52), PFNA 1.70 (95% CI: 1.29–2.26) and PFDeA 1.43 (95% CI: 1.32–1.54) in females.
  • Conclusions
    This study revealed the association between the crustacean consumption and concentrations of serum PFASs in general Korean population.
  • Keywords: Crustacean; PFAS; Korean National Environmental Health Survey
Perfluoroalkyl substances (PFASs) are non-aromatic organic chemical compounds, in which hydrogen atoms within the carbon chain are substituted by fluorine atoms.1 PFASs are highly stable based on the strong binding between carbon and fluorine, and their non-stick and surface tension-lowering properties allow application in many fields.1,2 The main uses include disposable food packages, aircraft and automobile devices, cooking utensils, outdoor gear, furniture and carpets, aqueous film forming foam (AFFF), cables and wires, electronics, and semiconductors.3 The high stability of PFASs prevents degradation, continuously affecting the marine environment.4
Crustaceans include shrimps, crayfish, crabs, krill, and etc., and they feed on seaweeds, plankton, small fish, and organic matter in sediments.5,6,7 High concentrations of PFASs are detected in crustaceans due to high PFAS exposure from food and habitat conditions.8 Crustaceans are abundantly found in the marine environment and can be used to quantitatively assess the level of marine pollution, so they are used as biomonitors for PFAS contamination.9,10
The PFAS exposure pathways in the human body include oral intake, dust inhalation, and skin contact, while the main pathway is through food intake.11 The elimination half-life of PFASs in the human body is 2.7 years for perfluorooctanoic acid (PFOA), 3.4 years for perfluorooctanesulfonic acid (PFOS), and 5.3 years for perfluorohexanesulfonic acid (PFHxS), which is considerably long.12 Various symptoms may be induced with long-term persistence of PFASs in the body, from developmental toxicity to carcinogenicity, hepatotoxicity, reproductive toxicity, immunotoxicity, and hormone toxicity.13,14
South Korea’s seafood consumption is one of the highest in Asia, and like ganjang-gejang (soy sauce marinated crab), there is a recipe for eating the intestines of crustaceans.15,16 So far, few large-scale studies in South Korea have investigated the association between crustacean consumption and serum PFAS. Thus, this study aimed to determine the association between crustacean consumption and serum concentrations of PFASs in the Korean population using the 4th cycle data (2018–2020) of the Korean National Environmental Health Survey (KoNEHS).
Study participants
This study used the KoNEHS data collected between 2018 and 2020. 4,239 participants, who were aged ≥ 19 years were selected. The KoNEHS is a national monitoring program that has been conducted by the Ministry of Environment and the National Institute of Environmental Research in 3-year intervals since 2009.17 Those with missing values on the main variables of this study were excluded. After excluding 1,246 participants, 2,993 individuals were included in the analysis (Fig. 1).
Fig. 1

Flow chart of the selection of study participants.

KoNEHS: Korean National Environmental Health Survey; PFAS: perfluoroalkyl substance.
aoem-36-e12-g001.jpg
Serum PFAS concentration
Investigated in KoNEHS data were 5 PFAS types: PFOA, PFOS, PFHxS, perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDeA). Blood samples were collected in a container and stored in a −70°C freezer.17 After protein precipitation via centrifugation and removal of, and using the Q-sight Triple Quad High-Performance Liquid Chromatography/Mass Spectrometer (PerkinElmer, Waltham, MA, USA), serum PFASs were isolated and quantitatively analyzed.17 The limit of detection (LOD) in this study was as follows: PFOA 0.071 μg/L, PFOS 0.056 μg/L, PFHxS 0.071 μg/L, PFNA 0.019 μg/L, and PFDeA 0.017 μg/L.17 In this way, serum PFAS concentration was divided into quartiles, and participants were divided into the low-concentration group (LC) and the high-concentration group (HC) based on the 50th percentile concentration.18
Consumption of crustaceans
The question on crustacean consumption in the KoNEHS is on the following frequency scale: rarely, once a month, 2 to 3 times a month, once a week, 2 to 3 times a week, 4 to 6 times a week, once a day, twice a day, and 3 times a day. The survey about crustacean consumption was conducted from year 2018 to 2020.17 In this study, responses of rarely, once a month, and 2 to 3 times a month were grouped as < once a week consumption, and those of once a week, 2 to 3 times a week, four to 6 times a week, once a day, twice a day, and 3 times a day were grouped as ≥ once a week consumption.19
Potential confounders
The confounders in this study were set as follows: general characteristics, including age, body mass index (BMI), marital status, smoking, the usage of products containing PFASs, food and water intake, and ventilation time. To exclude additional PFAS exposure other than crustacean consumption, the usage of products known to contain PFASs for waterproofing or anti-stick purposes, which leads to exposure via oral or dermal was included.11,20 Those are, coated frying pans, coated pots, coated electric cookers, coated containers, hiking suits, hiking boots and sneakers, disposable paper cups, hair products, make-up products, and ultraviolet (UV) block sunscreen.2,11,20,21 The food and water intake items included seafood, the type of indoor or outdoor water drinking, and the average ventilation time per day. 2,11 Consumption of grilled meat and grilled fish was included because frying or grilling can increase the total PFAS, while popcorn and hamburger-pizza-chicken consumption was included because PFAS is used in packages.22,23
Statistical analysis
Since previous studies recommended separating the analysis of males and females, we stratified the analysis according to the sex of the participants.24 An independent t-test and χ2 test were employed to compare serum PFAS concentrations, general characteristics, dietary factors, coated product usage, and personal care product usage. The odds ratio (OR) of serum PFAS concentration against crustacean consumption was estimated via logistic regression analysis after adjustments for general characteristics, dietary factors, coated product usage, and personal care product usage. In this study, a complex sample analysis was performed, including stratification, clustering, and weighting.17 In all analyses, IBM SPSS version 28 for Windows (IBM Corp., Armonk, NY, USA) was used, and statistical significance was set at p < 0.05.
Ethics statement
This study received approval from the Institutional Review Board of Soonchunhyang University Gumi Hospital (IRB No.2023-12-02).
Table 1 describes the general characteristics of the study participants. Among 2,993 participants, 1,298 (43%) were males, and 1,695 (57%) were females. The mean concentrations of PFOA, PFOS, PFHxS, PFNA, and PFDeA were consistently higher in males than in females. Males exhibited higher consumption of large fish and tuna, fish, and seaweeds, and disposable paper cups. Conversely, females showed higher usage frequency of hair products, make-up products, and UV block sunscreen.
Table 1

Baseline characteristics of the participants

Category Total (n = 2,993)a Men (n = 1,298) Women (n = 1,695) p-value
PFAS
PFOA 7.66 (7.33–8.00) 7.99 (7.53–8.45) 7.34 (7.13–7.55) < 0.001b
PFOS 18.87 (18.64–19.10) 20.26 (19.53–20.98) 17.48 (17.02–17.94) < 0.001
PFHxS 5.76 (5.39–6.12) 6.42 (6.11–6.74) 5.09 (4.68–5.50) < 0.001
PFNA 2.54 (2.52–2.57) 2.73 (2.71–2.75) 2.35 (2.32–2.39) < 0.001
PFDeA 1.08 (1.06–1.10) 1.15 (1.13–1.17) 1.01 (1.00–1.03) < 0.001
Age 47.4 ± 0.13 46.4 ± 0.18 48.5 ± 0.10 < 0.001
BMI group 0.003c
≤ 25 kg/m2 1,577 (53.4) 595 (46.1) 982 (60.7)
> 25 kg/m2 1,416 (46.6) 703 (53.9) 713 (39.3)
Marital status 0.001
Single 354 (22.8) 176 (26.5) 178 (19.2)
Married 2,286 (67.8) 1,035 (69.0) 1,251 (66.6)
Others 353 (9.4) 87 (4.5) 266 (14.2)
Smoking < 0.001
None or ex-smoker 2,527 (80.9) 879 (64.7) 1,648 (97.0)
Current smoker 466 (19.1) 419 (35.3) 47 (3.0)
Coated frying pans usage < 0.001
< Once a week 199 (5.5) 96 (6.0) 103 (5.0)
≥ Once a week 2,794 (94.5) 1,202 (94.0) 1,592 (95.0)
Coated pot usage 0.046
< Once a week 1,250 (41.1) 543 (39.7) 707 (42.4)
≥ Once a week 1,743 (58.9) 755 (60.3) 988 (57.6)
Coated electric cookers usage 0.770
< Once a week 411 (14.1) 173 (14.1) 238 (14.1)
≥ Once a week 2,582 (85.9) 1,125 (85.9) 1,457 (85.9)
Coated containers usage 0.047
< Once a week 2,594 (86.4) 1,126 (86.1) 1,468 (86.7)
≥ Once a week 399 (13.6) 172 (13.9) 227 (13.3)
Hiking suit usage 0.002
< Once a week 1,869 (62.4) 697 (54.6) 1,172 (70.0)
≥ Once a week 1,124 (37.6) 601 (45.4) 523 (30.0)
Hiking boots and sneakers usage < 0.001
< Once a week 1,872 (61.1) 708 (52.9) 1,164 (69.3)
≥ Once a week 1,121 (38.9) 590 (47.1) 531 (30.7)
Disposable paper cups usage < 0.001
< Once a week 1,286 (41.3) 419 (30.8) 867 (51.6)
≥ Once a week 1,707 (58.7) 879 (69.2) 828 (48.4)
Coated agent or polish usage 0.006
< Once a week 2,969 (99.2) 1,279 (98.7) 1,690 (99.7)
≥ Once a week 24 (0.8) 19 (1.3) 5 (0.3)
Consumption of grilled meat 0.001
< Once a week 1,813 (53.6) 730 (47.2) 1,083 (59.9)
≥ Once a week 1,180 (46.4) 568 (52.8) 612 (40.1)
Consumption of grilled fish 0.001
< Once a week 2,377 (79.3) 1,019 (77.3) 1,358 (81.3)
≥ Once a week 616 (20.7) 279 (22.7) 337 (18.7)
Consumption of popcorn 0.405
< Once a week 2,976 (99.1) 1,291 (98.9) 1,685 (99.3)
≥ Once a week 17 (0.9) 7 (1.1) 10 (0.7)
Consumption of hamburger-pizza-fried chicken < 0.001
< Once a week 2,558 (78.1) 1,084 (72.7) 1,474 (83.4)
≥ Once a week 435 (21.9) 214 (27.3) 221 (16.6)
Consumption of large fish and tuna 0.002
< Once a week 2,700 (88.0) 1,148 (84.5) 1,552 (91.5)
≥ Once a week 293 (12.0) 150 (15.5) 143 (8.5)
Consumption of fish 0.001
< Once a week 1,349 (48.9) 552 (46.8) 797 (50.9)
≥ Once a week 1,644 (51.1) 746 (53.2) 898 (49.1)
Consumption of crustacean 0.076
< Once a week 2,753 (91.8) 1,189 (91.6) 1,564 (92.1)
≥ Once a week 240 (8.2) 109 (8.4) 131 (7.9)
Consumption of seaweed 0.136
< Once a week 700 (23.6) 287 (22.8) 413 (24.4)
≥ Once a week 2,293 (76.4) 1,011 (77.2) 1,282 (75.6)
Consumption of shellfish 0.001
< Once a week 2,600 (85.4) 1,121 (84.2) 1,479 (86.5)
≥ Once a week 393 (14.6) 177 (15.8) 216 (13.5)
Consumption of other seafood items 0.004
< Once a week 2,634 (87.4) 1,125 (85.3) 1,509 (89.4)
≥ Once a week 359 (12.6) 173 (14.7) 186 (10.6)
Type of water drinking indoor 0.001
Water purifier, bottled water, etc. 2,047 (71.4) 896 (73.5) 1,151 (69.4)
Underground water, small-scale water-supply system, tap water 946 (28.6) 402 (26.5) 544 (30.6)
Type of water drinking outdoor < 0.001
Water purifier, bottled water, etc. 2,747 (93.3) 1,207 (95.1) 1,540 (91.4)
Underground water, small-scale water-supply system, tap water 246 (6.7) 91 (4.9) 155 (8.6)
Average ventilation time per day 0.043
< 30 min 354 (10.5) 174 (11.3) 180 (9.7)
≥ 30 min, < 60 min 371 (11.1) 156 (10.6) 215 (11.4)
≥ 60 min, < 600 min 1,112 (36.6) 488 (37.7) 624 (35.6)
≥ 600 min 1,156 (41.8) 480 (40.4) 676 (43.3)
Usage of hair products < 0.001
< Once a week 2,019 (67.6) 1,102 (81.2) 917 (54.1)
≥ Once a week 974 (32.4) 196 (18.8) 778 (45.9)
Usage of make-up products < 0.001
< Once a week 1,399 (50.7) 1,139 (87.3) 260 (14.4)
≥ Once a week 1,594 (49.3) 159 (12.7) 1,435 (85.6)
Usage of ultraviolet block sunscreens < 0.001
< Once a week 1,405 (49.2) 1,086 (82.2) 319 (16.4)
≥ Once a week 1,588 (50.8) 212 (17.8) 1,376 (83.6)
Data are presented as mean (95% confidence interval), number (%) for categorical variables and as mean ± standard error for continuous variables.
PFAS: perfluoroalkyl substances; PFOA: perfluorooctanoic acid; PFOS: perfluorooctanesulfonic acid; PFHxS: perfluorohexanesulfonic acid; PFNA: perfluorononanoic acid; PFDeA: perfluorodecanoic acid; BMI: body mass index.
aUnweighted count; bp-value by t-test; cp-value by χ2 test.
Tables 2 and 3 show the distribution of serum PFASs according to the tested variables, with the participants divided into the HC and LC based on the 50th percentile concentrations of serum PFOA, PFOS, PFHxS, PFNA, and PFDeA. For all PFASs; PFOA, PFOS, PFHxS, PFNA, and PFDeA, the average age of males was higher in the HC. Males in the HC had higher percentages when frequently using a coated frying pan or with ≥ once a week crustaceans, shellfish, or seaweed consumption than those with < once a week consumption. Females in the HC had higher percentages when using a coated agent or polish or hiking suit or boots once or more in 1 week and those with ≥ once a week consumption of fish, shellfish, or seaweeds. In both males and females, HC percentages were higher for those consuming groundwater or tap water for drinking compared to those drinking purified or mineral water.
Table 2

Baseline characteristics of the men according to serum perfluoroalkyl substances: PFOA, PFOS, PFHxS, PFNA, PFDeA

Variable PFOA PFOS PFHxS PFNA PFDeA
Low (n = 649)a High (n = 649) p-value Low (n = 649) High (n = 649) p-value Low (n = 649)a High (n = 649) p-value Low (n = 649) High (n = 649) p-value Low (n = 649) High (n = 649) p-value
Age 40.5 ± 0.27 54.4 ± 0.33 < 0.001b 39.4 ± 0.27 56.9 ± 0.23 < 0.001 40.8 ± 0.25 52.9 ± 0.35 < 0.001b 39.4 ± 0.32 57.0 ± 0.08 < 0.001 39.2 ± 0.29 58.0 ± 0.11 < 0.001
BMI group 0.013c 0.489 0.737c 0.737 0.044
≤ 25 kg/m2 321 (59.9) 274 (40.1) 301 (60.3) 294 (39.7) 303 (54.0) 292 (46.0) 315 (60.6) 280 (39.4) 294 (59.8) 301 (40.2)
> 25 kg/m2 328 (55.9) 375 (44.1) 348 (60.6) 355 (39.4) 346 (54.3) 357 (45.7) 334 (60.3) 369 (39.7) 355 (63.8) 348 (36.2)
Marital status < 0.001 < 0.001 0.001 0.001 0.001
Single 145 (88.5) 31 (11.5) 153 (90.5) 23 (9.5) 135 (80.8) 41 (19.2) 159 (96.5) 17 (3.5) 162 (97.0) 14 (3.0)
Married 452 (45.4) 583 (54.6) 452 (49.2) 583 (50.8) 477 (44.7) 558 (55.3) 445 (46.7) 590 (53.3) 442 (49.0) 593 (51.0)
Others 52 (65.0) 35 (35.0) 44 (56.1) 43 (43.9) 37 (40.9) 50 (59.1) 45 (59.2) 42 (40.8) 45 (54.1) 42 (45.9)
Smoking 0.190 < 0.001 0.675 0.007 0.004
None or ex-smoker 422 (56.9) 457 (43.1) 400 (57.7) 479 (42.3) 438 (54.4) 441 (45.6) 412 (58.9) 467 (41.1) 405 (59.4) 474 (40.6)
Current smoker 227 (59.3) 192 (40.7) 249 (65.4) 170 (34.6) 211 (53.6) 208 (46.4) 237 (63.3) 182 (36.7) 244 (66.7) 175 (33.3)
Coated frying pans usage 0.004 < 0.001 0.002 0.001 < 0.001
< Once a week 54 (76.0) 42 (24.0) 49 (75.6) 47 (24.4) 53 (72.6) 43 (27.4) 46 (64.7) 50 (35.3) 48 (73.3) 48 (26.7)
≥ Once a week 595 (56.6) 607 (43.4) 600 (59.5) 602 (40.5) 596 (53.0) 606 (47.0) 603 (60.2) 599 (39.8) 601 (61.3) 601 (38.7)
Coated pot usage 0.374 0.018 0.123 0.304 0.485
< Once a week 258 (56.9) 285 (43.1) 252 (57.3) 291 (42.7) 274 (56.0) 269 (44.0) 267 (59.5) 276 (40.5) 265 (61.5) 278 (38.5)
≥ Once a week 391 (58.3) 364 (41.7) 397 (62.5) 358 (37.5) 375 (52.9) 380 (47.1) 382 (61.1) 373 (38.9) 384 (62.3) 371 (37.7)
Coated electric cookers usage 0.807 0.311 0.020 0.081 0.340
< Once a week 84 (57.9) 89 (42.1) 83 (61.4) 90 (38.6) 88 (52.0) 85 (48.0) 82 (58.2) 91 (41.8) 83 (63.2) 90 (36.8)
≥ Once a week 565 (57.7) 560 (42.3) 566 (60.3) 559 (39.7) 561 (54.5) 564 (45.5) 567 (60.8) 558 (39.2) 566 (61.8) 559 (38.2)
Coated containers usage < 0.001 0.002 0.249 < 0.001 0.005
< Once a week 555 (56.3) 571 (43.7) 544 (58.7) 582 (41.3) 570 (53.8) 556 (46.2) 546 (58.9) 580 (41.1) 543 (60.1) 583 (39.9)
≥ Once a week 94 (66.6) 78 (33.4) 105 (71.0) 67 (29.0) 79 (56.6) 93 (43.4) 103 (69.9) 69 (30.1) 106 (73.4) 66 (26.6)
Hiking suit usage 0.021 0.477 0.136 0.055 0.174
< Once a week 378 (61.7) 319 (38.3) 349 (61.0) 348 (39.0) 347 (55.3) 350 (44.7) 370 (62.8) 327 (37.2) 371 (62.7) 326 (37.3)
≥ Once a week 271 (52.9) 330 (47.1) 300 (59.8) 301 (40.2) 302 (52.8) 299 (47.2) 279 (57.6) 322 (42.4) 278 (61.1) 323 (38.9)
Hiking boots and sneakers usage 0.006 0.156 < 0.001 0.053 0.103
< Once a week 372 (59.5) 336 (40.5) 357 (60.1) 351 (39.9) 365 (56.7) 343 (43.3) 365 (59.6) 343 (40.4) 365 (60.9) 343 (39.1)
≥ Once a week 277 (55.8) 313 (44.2) 292 (60.9) 298 (39.1) 284 (51.3) 306 (48.7) 284 (61.3) 306 (38.7) 284 (63.2) 306 (36.8)
Disposable paper cups usage 0.090 0.005 0.002 0.215 < 0.001
< Once a week 214 (58.7) 205 (41.3) 192 (55.0) 227 (45.0) 204 (50.5) 215 (49.5) 209 (60.8) 210 (39.2) 210 (58.9) 209 (41.1)
≥ Once a week 435 (57.3) 444 (42.7) 457 (62.9) 422 (37.1) 445 (55.8) 434 (44.2) 440 (60.3) 439 (39.7) 439 (63.3) 440 (36.7)
Coated agent or polish usage 0.043 0.076 0.042 0.011 0.007
< Once a week 641 (57.8) 638 (42.2) 640 (60.4) 639 (39.6) 641 (54.3) 638 (45.7) 641 (60.5) 638 (39.5) 641 (62.1) 638 (37.9)
≥ Once a week 8 (49.6) 11 (50.4) 9 (60.8) 10 (39.2) 8 (40.0) 11 (60.0) 8 (56.3) 11 (43.7) 8 (55.1) 11 (44.9)
Consumption of grilled meat 0.165 0.004 0.060 0.494 0.029
< Once a week 358 (57.0) 372 (73.0) 317 (53.2) 413 (46.8) 362 (52.2) 368 (47.8) 345 (60.0) 385 (40.0) 337 (58.8) 393 (41.2)
≥ Once a week 291 (58.4) 277 (41.6) 332 (66.9) 236 (33.1) 287 (55.9) 281 (44.1) 304 (60.8) 264 (39.2) 312 (64.8) 256 (35.2)
Consumption of grilled fish < 0.001 0.649 0.012 0.073 0.034
< Once a week 526 (58.3) 493 (41.7) 530 (60.5) 489 (39.5) 508 (53.0) 511 (47.0) 532 (61.1) 487 (38.9) 537 (63.0) 482 (37.0)
≥ Once a week 123 (55.9) 156 (44.1) 119 (60.3) 160 (39.7) 141 (58.2) 138 (41.8) 117 (58.3) 162 (41.7) 112 (58.7) 167 (41.3)
Consumption of popcorn 0.002 < 0.001 < 0.001 < 0.001 < 0.001
< Once a week 645 (57.5) 646 (42.5) 644 (60.1) 647 (39.9) 644 (53.8) 647 (46.2) 645 (60.3) 646 (39.7) 644 (61.7) 647 (38.3)
≥ Once a week 4 (74.5) 3 (25.5) 5 (87.4) 2 (12.6) 5 (87.4) 2 (12.6) 4 (74.5) 3 (25.5) 5 (87.4) 2 (12.6)
Consumption of hamburger-pizza-fried chicken < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
< Once a week 492 (50.3) 592 (49.7) 476 (51.9) 608 (48.1) 514 (48.1) 570 (51.9) 479 (52.5) 605 (47.5) 472 (53.6) 612 (46.4)
≥ Once a week 157 (77.6) 57 (22.4) 173 (83.2) 41 (16.8) 135 (70.2) 79 (29.8) 170 (81.7) 44 (18.3) 177 (84.5) 37 (15.5)
Consumption of large fish and tuna < 0.001 < 0.001 0.002 0.002 0.002
< Once a week 553 (55.5) 595 (44.5) 547 (58.0) 601 (42.0) 562 (52.2) 586 (47.8) 544 (57.8) 604 (42.2) 544 (58.7) 604 (41.3)
≥ Once a week 96 (70.1) 54 (29.9) 102 (73.8) 48 (26.2) 87 (64.9) 63 (35.1) 105 (75.1) 45 (24.9) 105 (79.9) 45 (20.1)
Consumption of fish < 0.001 0.002 < 0.001 0.002 0.004
< Once a week 339 (69.9) 213 (30.1) 336 (69.9) 216 (30.1) 302 (59.9) 250 (40.1) 340 (72.2) 212 (27.8) 348 (73.3) 204 (26.7)
≥ Once a week 310 (47.0) 436 (53.0) 313 (52.1) 433 (47.9) 347 (49.1) 399 (50.9) 309 (50.1) 437 (49.9) 301 (52.0) 445 (48.0)
Consumption of crustacean 0.005 0.008 < 0.001 < 0.001 < 0.001
< Once a week 602 (59.5) 587 (40.5) 590 (61.2) 599 (38.8) 606 (55.8) 583 (44.2) 594 (62.0) 595 (38.0) 592 (63.5) 597 (36.5)
≥ Once a week 47 (38.1) 62 (61.9) 59 (52.4) 50 (47.6) 43 (35.9) 66 (64.1) 55 (43.9) 54 (56.1) 57 (45.8) 52 (54.2)
Consumption of seaweed 0.008 < 0.001 0.450 0.004 0.007
< Once a week 164 (66.5) 123 (33.5) 157 (65.6) 130 (34.4) 148 (54.4) 139 (45.6) 162 (71.7) 125 (28.3) 161 (70.6) 126 (29.4)
≥ Once a week 485 (55.1) 526 (44.9) 492 (58.9) 519 (41.1) 501 (54.1) 510 (45.9) 487 (57.1) 524 (42.9) 488 (59.4) 523 (40.6)
Consumption of shellfish < 0.001 < 0.001 < 0.001 0.003 0.004
< Once a week 588 (61.1) 533 (38.9) 574 (62.7) 547 (37.3) 582 (55.8) 539 (44.2) 580 (63.3) 541 (36.7) 576 (64.0) 545 (36.0)
≥ Once a week 61 (39.9) 116 (60.1) 75 (48.4) 102 (51.6) 67 (45.1) 110 (54.9) 69 (45.1) 108 (54.9) 73 (51.1) 104 (48.9)
Consumption of other seafood items 0.005 0.011 0.003 0.040 0.286
< Once a week 564 (58.1) 561 (41.9) 554 (59.7) 571 (40.3) 556 (52.8) 569 (47.2) 560 (60.7) 565 (39.3) 560 (61.8) 565 (38.2)
≥ Once a week 85 (55.6) 88 (44.4) 95 (64.6) 78 (35.4) 93 (62.0) 80 (38.0) 89 (59.1) 84 (40.9) 89 (63.1) 84 (36.9)
Type of water drinking indoor 0.008 0.002 0.033 0.001 < 0.001
Water purifier, bottled water, etc. 466 (60.6) 430 (39.4) 488 (65.6) 408 (34.4) 452 (56.4) 444 (43.6) 481 (65.1) 415 (34.9) 489 (67.0) 407 (33.0)
Underground water, small-scale water-supply system, tap water 183 (49.6) 219 (50.4) 161 (46.1) 241 (53.9) 197 (48.0) 205 (52.0) 168 (47.6) 234 (52.4) 160 (48.1) 242 (51.9)
Type of water drinking outdoor < 0.001 0.005 0.001 0.003 0.002
Water purifier, bottled water, etc. 611 (58.7) 596 (41.3) 617 (61.4) 590 (38.6) 604 (55.1) 603 (44.9) 615 (61.5) 592 (38.5) 620 (63.3) 587 (36.7)
Underground water, small-scale water-supply system, tap water 38 (38.9) 53 (61.1) 32 (41.9) 59 (58.1) 45 (35.7) 46 (64.3) 34 (40.0) 57 (60.0) 29 (36.8) 62 (63.2)
Average ventilation time per day < 0.001 0.039 0.001 0.019 0.012
< 30 min 72 (46.2) 102 (53.8) 78 (55.4) 96 (44.6) 76 (43.4) 98 (56.6) 72 (53.6) 102 (46.4) 76 (51.6) 98 (48.4)
≥ 30 min, < 60 min 81 (66.8) 75 (33.2) 78 (67.7) 78 (32.3) 77 (57.8) 79 (42.2) 80 (66.2) 76 (33.8) 76 (63.7) 80 (36.3)
≥ 60 min, < 600 min 240 (53.0) 248 (47.0) 240 (57.9) 248 (42.1) 242 (51.4) 246 (48.6) 239 (57.2) 249 (42.8) 234 (59.0) 254 (41.0)
≥ 600 min 256 (63.0) 224 (37.0) 253 (62.3) 227 (33.7) 254 (58.8) 226 (41.2) 258 (63.8) 222 (36.2) 263 (67.2) 217 (32.8)
Usage of hair products < 0.001 0.004 0.002 0.002 0.003
< Once a week 540 (55.6) 562 (44.4) 527 (57.1) 575 (42.9) 545 (52.8) 557 (47.2) 538 (58.0) 564 (42.0) 533 (59.0) 569 (41.0)
≥ Once a week 109 (67.1) 87 (32.9) 122 (74.7) 74 (25.3) 104 (60.0) 92 (40.0) 111 (71.0) 85 (29.0) 116 (74.7) 80 (25.3)
Usage of make-up products 0.002 0.001 0.058 0.002 0.002
< Once a week 559 (55.7) 580 (44.3) 564 (59.3) 575 (40.7) 571 (53.7) 568 (46.3) 558 (58.6) 581 (41.4) 565 (60.1) 574 (39.9)
≥ Once a week 90 (71.6) 69 (28.4) 85 (68.0) 74 (32.0) 78 (57.2) 81 (42.8) 91 (73.4) 68 (26.6) 84 (75.0) 75 (25.0)
Usage of ultraviolet block sunscreens 0.007 0.009 0.008 0.011 0.001
< Once a week 536 (55.6) 550 (44.4) 541 (58.9) 545 (41.1) 538 (52.6) 548 (47.4) 537 (59.1) 549 (40.9) 541 (59.7) 545 (40.3)
≥ Once a week 113 (67.5) 99 (32.5) 108 (67.7) 104 (32.3) 111 (61.3) 101 (38.7) 112 (66.9) 100 (33.1) 108 (72.5) 104 (27.5)
Data are presented as number (%) for categorical variables and as mean ± standard error for continuous variables
PFOA: perfluorooctanoic acid; PFOS: perfluorooctanesulfonic acid; PFHxS: perfluorohexanesulfonic acid; PFNA: perfluorononanoic acid; PFDeA: perfluorodecanoic acid; BMI: body mass index
aUnweighted count; bp-value by t-test; cp-value by χ2 test.
Table 3

Baseline characteristics of the women according to serum perfluoroalkyl substances: PFOA, PFOS, PFHxS, PFNA, PFDeA

Variable PFOA PFOS PFHxS PFNA PFDeA
Low (n = 848)a High (n = 847) p-value Low (n = 848) High (n = 847) p-value Low (n = 848)a High (n = 847) p-value Low (n = 850) High (n = 845) p-value Low (n = 848) High (n = 847) p-value
Age 41.0 ± 0.21 58.2 ± 0.13 < 0.001b 40.4 ± 0.05 59.7 ± 0.06 < 0.001 42.0 ± 0.16 56.1 ± 0.37 < 0.001b 40.7 ± 0.18 60.1 ± 0.04 < 0.001 41.5 ± 0.23 58.8 ± 0.10 < 0.001
BMI group 0.002c < 0.001 0.009c < 0.001 < 0.001
≤ 25 kg/m2 534 (61.6) 448 (38.4) 542 (63.8) 440 (36.2) 525 (59.4) 457 (40.6) 559 (66.6) 423 (33.4) 535 (64.1) 447 (35.9)
> 25 kg/m2 314 (49.1) 399 (50.9) 306 (49.3) 407 (50.7) 323 (46.2) 390 (53.8) 291 (50.1) 422 (49.9) 313 (52.4) 400 (47.6)
Marital status < 0.001 < 0.001 0.001 < 0.001 < 0.001
Single 150 (85.7) 28 (14.3) 154 (86.3) 24 (13.7) 142 (81.3) 36 (18.7) 162 (91.9) 16 (8.1) 159 (89.0) 19 (11.0)
Married 610 (53.9) 641 (46.1) 615 (56.1) 636 (43.9) 620 (51.3) 631 (48.7) 617 (57.9) 634 (42.1) 612 (56.9) 639 (43.1)
Others 88 (30.4) 178 (69.6) 79 (29.6) 187 (70.4) 86 (31.0) 180 (69.0) 71 (27.7) 195 (72.3) 77 (31.9) 189 (68.1)
Smoking < 0.001 < 0.001 0.025 < 0.001 < 0.001
None or ex-smoker 818 (56.0) 830 (44.0) 816 (57.6) 832 (42.4) 824 (54.0) 824 (46.0) 820 (59.5) 828 (40.5) 820 (59.0) 828 (41.0)
Current smoker 30 (78.2) 17 (21.8) 32 (74.9) 15 (25.1) 24 (61.3) 23 (38.7) 30 (78.9) 17 (21.1) 28 (74.9) 19 (25.1)
Coated frying pans usage 0.285 0.125 0.018 0.002 0.003
< Once a week 43 (57.0) 60 (43.0) 45 (60.8) 58 (39.2) 51 (58.2) 52 (41.8) 36 (50.9) 67 (49.1) 37 (51.9) 66 (48.1)
≥ Once a week 805 (56.6) 787 (43.4) 803 (58.0) 789 (42.0) 797 (54.0) 765 (46.0) 814 (60.6) 778 (39.4) 811 (59.9) 781 (40.1)
Coated pot usage 0.134 0.081 0.004 0.132 0.063
< Once a week 337 (55.4) 370 (44.6) 338 (56.4) 369 (43.6) 362 (56.0) 345 (44.0) 339 (58.4) 368 (41.6) 331 (57.3) 376 (42.7)
≥ Once a week 511 (57.6) 477 (42.4) 510 (59.4) 478 (40.6) 486 (52.9) 502 (47.1) 511 (61.4) 477 (38.6) 517 (61.2) 471 (38.8)
Coated electric cookers usage 0.002 0.752 0.358 0.085 0.007
< Once a week 108 (54.7) 130 (45.3) 113 (58.2) 125 (41.8) 112 (53.3) 126 (46.7) 115 (59.4) 123 (40.6) 122 (64.1) 116 (35.9)
≥ Once a week 740 (57.0) 717 (43.0) 735 (58.1) 722 (41.9) 736 (54.3) 721 (45.7) 735 (60.2) 722 (39.8) 726 (58.8) 731 (41.2)
Coated containers usage 0.009 0.013 0.035 0.005 0.012
< Once a week 713 (55.4) 755 (44.6) 710 (56.8) 758 (43.2) 723 (53.2) 745 (46.8) 703 (58.5) 765 (41.5) 703 (58.1) 765 (41.9)
≥ Once a week 135 (64.9) 92 (35.1) 138 (66.6) 89 (33.4) 125 (60.4) 102 (39.6) 147 (70.4) 80 (29.6) 145 (69.0) 82 (31.0)
Hiking suit usage 0.006 0.001 0.009 < 0.001 0.002
< Once a week 617 (60.5) 555 (39.5) 615 (62.8) 557 (37.2) 605 (57.6) 567 (42.4) 619 (63.3) 553 (36.7) 615 (62.7) 557 (37.3)
≥ Once a week 231 (47.8) 292 (52.2) 233 (47.3) 290 (52.7) 243 (46.3) 280 (53.7) 231 (52.7) 292 (47.3) 233 (52.0) 290 (48.0)
Hiking boots and sneakers usage 0.011 0.038 0.030 0.008 0.001
< Once a week 590 (57.9) 574 (42.1) 589 (59.1) 575 (40.9) 576 (55.0) 588 (45.0) 602 (61.8) 562 (38.2) 603 (61.4) 561 (38.6)
≥ Once a week 258 (53.9) 273 (46.1) 259 (55.9) 272 (44.1) 272 (52.4) 259 (47.6) 248 (56.4) 283 (43.6) 245 (55.2) 286 (44.8)
Disposable paper cups usage 0.002 < 0.001 0.483 0.007 0.026
< Once a week 415 (54.6) 452 (45.4) 398 (53.5) 469 (46.5) 427 (54.0) 440 (46.0) 395 (56.6) 472 (43.4) 405 (57.4) 462 (42.6)
≥ Once a week 433 (58.9) 395 (41.1) 450 (63.1) 378 (36.9) 421 (54.4) 407 (45.6) 455 (63.9) 373 (36.1) 443 (61.7) 385 (38.3)
Coated agent or polish usage < 0.001 < 0.001 0.001 < 0.001 < 0.001
< Once a week 846 (56.8) 844 (43.2) 845 (58.2) 845 (41.8) 846 (54.3) 844 (45.7) 848 (60.3) 842 (39.7) 846 (59.7) 844 (40.3)
≥ Once a week 2 (18.0) 3 (82.0) 3 (38.0) 2 (62.0) 2 (18.0) 3 (82.0) 2 (18.0) 3 (82.0) 2 (18.0) 3 (82.0)
Consumption of grilled meat < 0.001 < 0.001 0.005 < 0.001 < 0.001
< Once a week 484 (52.2) 599 (47.8) 478 (52.6) 605 (47.4) 501 (49.6) 582 (50.4) 471 (53.5) 612 (46.5) 483 (52.8) 600 (47.2)
≥ Once a week 364 (63.3) 248 (36.7) 370 (66.3) 242 (33.7) 347 (61.0) 265 (39.0) 379 (70.1) 233 (29.9) 365 (69.5) 247 (30.5)
Consumption of grilled fish 0.002 0.002 0.222 0.003 < 0.001
< Once a week 704 (58.0) 654 (42.0) 712 (60.0) 646 (40.0) 679 (54.5) 679 (45.5) 716 (61.4) 642 (38.6) 714 (61.4) 644 (38.6)
≥ Once a week 144 (50.6) 193 (49.4) 136 (49.9) 201 (50.1) 169 (52.8) 168 (47.2) 134 (54.7) 203 (45.3) 134 (51.4) 203 (48.6)
Consumption of popcorn 0.007 0.046 0.313 0.010 0.010
< Once a week 840 (56.4) 845 (43.6) 839 (57.9) 846 (42.1) 841 (54.1) 844 (45.9) 842 (59.9) 843 (40.1) 840 (59.3) 845 (40.7)
≥ Once a week 8 (87.9) 2 (12.1) 9 (92.3) 1 (7.7) 7 (67.8) 3 (32.2) 8 (87.9) 2 (12.1) 8 (87.9) 2 (12.1)
Consumption of hamburger-pizza-fried chicken 0.002 < 0.001 0.004 < 0.001 0.002
< Once a week 673 (51.9) 801 (48.1) 670 (53.0) 804 (47.0) 700 (51.5) 774 (48.5) 664 (55.0) 810 (45.0) 668 (54.3) 806 (45.7)
≥ Once a week 175 (80.5) 46 (19.5) 178 (83.7) 43 (16.3) 148 (67.9) 73 (32.1) 186 (86.1) 35 (13.9) 180 (85.9) 41 (14.1)
Consumption of large fish and tuna 0.006 < 0.001 0.006 < 0.001 0.004
< Once a week 747 (55.1) 805 (44.9) 745 (56.4) 807 (43.6) 754 (53.1) 798 (46.9) 750 (58.8) 802 (41.2) 749 (58.1) 803 (41.9)
≥ Once a week 101 (73.9) 42 (26.1) 103 (76.9) 40 (23.1) 94 (65.9) 49 (34.1) 100 (74.5) 43 (25.5) 99 (75.3) 44 (24.7)
Consumption of fish 0.002 0.002 < 0.001 0.001 0.003
< Once a week 486 (66.0) 311 (34.0) 490 (67.7) 307 (32.3) 442 (60.1) 355 (39.9) 501 (69.6) 296 (30.4) 501 (68.8) 296 (31.2)
≥ Once a week 362 (46.9) 536 (53.1) 358 (48.2) 540 (51.8) 406 (48.1) 492 (51.9) 349 (50.3) 549 (49.7) 347 (49.9) 551 (50.1)
Consumption of crustacean 0.050 0.032 0.141 0.006 0.001
< Once a week 792 (57.0) 772 (43.0) 783 (58.2) 781 (41.8) 793 (54.8) 771 (45.2) 793 (60.6) 771 (39.4) 793 (59.9) 771 (40.1)
≥ Once a week 56 (53.2) 75 (46.8) 65 (57.5) 66 (42.5) 55 (46.8) 76 (53.2) 57 (54.7) 74 (45.3) 55 (55.7) 76 (44.3)
Consumption of seaweed < 0.001 0.022 0.003 0.014 0.083
< Once a week 232 (62.5) 181 (37.5) 213 (61.2) 200 (38.8) 220 (61.3) 193 (38.7) 231 (65.8) 182 (34.2) 221 (62.0) 192 (38.0)
≥ Once a week 616 (54.8) 666 (45.2) 635 (57.1) 647 (42.9) 628 (51.9) 654 (48.1) 619 (58.3) 663 (41.7) 627 (58.7) 655 (41.3)
Consumption of shellfish 0.005 < 0.001 0.004 0.001 < 0.001
< Once a week 772 (59.4) 707 (40.6) 764 (60.1) 715 (39.9) 762 (56.6) 717 (43.4) 780 (63.3) 699 (36.7) 783 (63.1) 696 (36.9)
≥ Once a week 76 (39.2) 140 (60.8) 84 (45.5) 132 (54.5) 86 (38.6) 130 (61.4) 70 (39.8) 146 (60.2) 65 (36.5) 151 (63.5)
Consumption of other seafood items 0.047 0.059 0.353 0.115 0.844
< Once a week 747 (56.1) 762 (43.9) 751 (57.7) 758 (42.3) 758 (54.1) 751 (45.9) 757 (60.3) 752 (39.7) 758 (59.5) 751 (40.5)
≥ Once a week 101 (61.0) 85 (39.0) 97 (61.2) 89 (38.8) 90 (55.1) 96 (44.9) 93 (58.8) 93 (41.2) 90 (59.4) 96 (40.6)
Type of water drinking indoor 0.004 0.008 < 0.001 0.004 0.007
Water purifier, bottled water, etc. 624 (60.9) 527 (39.1) 631 (62.2) 520 (37.8) 602 (59.0) 549 (41.0) 647 (65.6) 504 (34.4) 626 (63.9) 525 (36.1)
Underground water, small-scale water-supply system, tap water 224 (46.9) 320 (53.1) 217 (48.8) 327 (51.2) 246 (43.2) 298 (56.8) 203 (47.8) 341 (52.2) 222 (49.7) 322 (50.3)
Type of water drinking outdoor < 0.001 0.003 < 0.001 < 0.001 < 0.001
Water purifier, bottled water, etc. 794 (58.9) 746 (41.1) 800 (60.4) 740 (39.6) 782 (56.1) 758 (43.9) 808 (62.8) 732 (37.2) 800 (62.0) 740 (38.0)
Underground water, small-scale water-supply system, tap water 54 (32.6) 101 (67.4) 48 (33.9) 107 (66.1) 66 (34.0) 89 (66.0) 42 (31.1) 113 (68.9) 48 (33.3) 107 (66.7)
Average ventilation time per day 0.012 0.067 0.003 0.017 0.013
< 30 min 82 (44.4) 98 (55.6) 88 (52.5) 92 (47.5) 80 (43.1) 100 (56.9) 80 (47.0) 100 (53.0) 80 (47.0) 100 (53.0)
≥ 30 min, < 60 min 94 (54.8) 121 (45.2) 101 (56.4) 114 (43.6) 96 (50.2) 119 (49.8) 101 (61.4) 114 (38.6) 98 (56.4) 117 (43.6)
≥ 60 min, < 600 min 314 (55.9) 310 (44.1) 301 (57.1) 323 (42.9) 316 (51.8) 308 (40.2) 299 (56.9) 325 (43.1) 300 (56.5) 324 (43.5)
≥ 600 min 358 (60.5) 318 (39.5) 358 (60.6) 318 (39.4) 356 (59.7) 320 (40.3) 370 (65.4) 306 (34.6) 370 (65.6) 306 (34.4)
Usage of hair products 0.011 0.519 0.011 0.490 0.241
< Once a week 468 (57.9) 449 (42.1) 455 (58.4) 462 (41.6) 466 (55.5) 451 (44.5) 462 (59.9) 455 (40.1) 460 (59.2) 457 (40.8)
≥ Once a week 380 (55.2) 398 (44.8) 393 (57.7) 385 (42.3) 382 (52.6) 396 (47.4) 388 (60.4) 390 (39.6) 388 (60.0) 390 (40.0)
Usage of make-up products 0.388 < 0.001 0.001 0.005 0.006
< Once a week 130 (57.2) 130 (42.8) 112 (52.2) 148 (47.8) 123 (47.9) 137 (52.1) 117 (54.1) 143 (45.9) 122 (54.1) 138 (45.9)
≥ Once a week 718 (56.6) 717 (43.4) 736 (59.1) 699 (40.9) 725 (55.2) 710 (44.8) 733 (61.1) 702 (38.9) 726 (60.4) 709 (39.6)
Usage of ultraviolet block sunscreens 0.067 0.001 0.006 0.031 0.060
< Once a week 157 (54.3) 162 (45.7) 140 (50.9) 179 (49.1) 161 (49.9) 158 (50.1) 143 (54.5) 176 (45.5) 156 (55.5) 163 (44.5)
≥ Once a week 691 (57.1) 685 (42.9) 708 (59.5) 668 (40.5) 687 (55.0) 689 (45.0) 707 (61.2) 669 (38.8) 692 (60.3) 684 (39.7)
Data are presented as number (%) for categorical variables and as mean ± standard error for continuous variables.
PFOA: perfluorooctanoic acid; PFOS: perfluorooctanesulfonic acid; PFHxS: perfluorohexanesulfonic acid; PFNA: perfluorononanoic acid; PFDeA: perfluorodecanoic acid; BMI: body mass index.
aUnweighted count; bp-value by t-test; cp-value by χ2 test.
Table 4 describes the results of multiple logistic regression analysis, indicating the association between crustacean consumption and serum PFAS concentration in males and females. The OR was higher in males with ≥once a week crustacean consumption than those with < once a week consumption: PFOA 1.57 (95% CI: 0.85–2.90), PFOS 0.94 (95% CI: 0.71–1.25), PFHxS 2.15 (95% CI: 1.53–3.02), PFNA 1.23 (95% CI: 1.07–1.41), and PFDeA 1.42 (95% CI: 1.17–1.74). The OR was higher in females with ≥ once a week crustacean consumption: PFOA 1.48 (95% CI: 1.19–1.84), PFOS 1.39 (95% CI: 1.27–1.52), PFHxS 1.56 (95% CI: 0.68–3.57), PFNA 1.70 (95% CI: 1.29–2.26), and PFDeA 1.43 (95% CI: 1.32–1.54).
Table 4

Adjusted ORs and 95% CIs of crustacean consumption with high concentrations of serum PFAS

Category Men Women
Unadjusted Adjusteda Unadjusted Adjusteda
< Once a week ≥ Once a week < Once a week ≥ Once a week < Once a week ≥ Once a week < Once a week ≥ Once a week
PFOA 1 2.38 (1.80–3.15) 1 1.57 (0.85–2.90) 1 1.16 (1.00–1.35) 1 1.48 (1.19–1.84)
PFOS 1 1.43 (1.24–1.64) 1 0.94 (0.71–1.25) 1 1.02 (1.01–1.04) 1 1.39 (1.27–1.52)
PFHxS 1 2.25 (2.16–2.35) 1 2.15 (1.53–3.02) 1 1.38 (0.76–2.49) 1 1.56 (0.68–3.57)
PFNA 1 2.08 (1.98–2.18) 1 1.23 (1.07–1.41) 1 1.27 (1.17–1.37) 1 1.70 (1.29–2.26)
PFDeA 1 2.05 (1.98–2.12) 1 1.42 (1.17–1.74) 1 1.18 (1.15–1.21) 1 1.43 (1.32–1.54)
OR: odds ratio; CI: confidence interval; PFAS: perfluoroalkyl substances; PFOA: perfluorooctanoic acid; PFOS: perfluorooctanesulfonic acid; PFHxS: perfluorohexanesulfonic acid; PFNA: perfluorononanoic acid; PFDeA: perfluorodecanoic acid.
aAdjusted for age, body mass index, marital status, smoking, number of coated frying pans usage, number of coated pot usage, number of electric cookers usage, number of coated containers usage, number of hiking suit usage, number of hiking boots and sneakers usage, number of disposable paper cups usage, number of coated agent or polish usage, number of consumption of grilled meat, grilled fish, popcorn, hamburger-pizza-fried chicken, large fish and tuna, fish, crustacean, seaweed, shellfish, other seafood items, type of water drinking indoor, type of water drinking outdoor, average ventilation time per day, usage of hair products, usage of make-up products, usage of ultraviolet block sunscreens.
This study demonstrated that the OR for the HC of serum PFASs was higher in individuals with ≥once a week crustacean consumption than in those with < once a week crustacean consumption. PFASs exhibit developmental toxicity, carcinogenicity, hepatotoxicity, reproductive toxicity, immunotoxicity, neurotoxicity, and hormone toxicity.13,25,26 PFOS, PFOA, PFHxS, PFNA, and PFDeA decrease neonatal antibody concentration;27 PFOA, PFNA, and PFDeA cause congenital hypothyroidism;28 PFOA and PFOS increase LDL cholesterol, total cholesterol, and ALT while suppressing antibody responses t, vaccines.25 PFOA and PFOS are associated with testicular cancer, kidney cancer, and low birth weight infants.29,30 Furthermore, PFOA is associated with ulcerative colitis, thyroid disease, and pregnancy-induced hypertension, and PFHxS is associated with developmental disability.31,32,33,34
PFASs are mainly released to the marine environment from industrial and urban wastewater treatment plants.35 From the treatment plants, wastewater with incomplete removal of PFASs is released to river and ultimately flows into seawater.36 For this reason, rivers are considered the main source of PFASs in the marine environment.37 Among different PFASs, PFOA, PFOS, PFNA, PFHxS, and PFDeA (C ≥ 6) which has a linear isomer or long carbon chain exhibit high hydrophobicity to be present abundantly in seawater sediments.38,39 With thermal and chemical stability conferred by the strong C-F bond, PFASs are not readily degraded in the natural environment.1 The half-life of PFOS in underwater environment is 41 years and that of PFOA is 92 years, which is considerably longer in comparison.40 Hence, PFASs, once released into seawater, can persist for a long time without degradation to continuously exert negative effects on marine ecosystems.
A study on marine organisms collected from an urban estuary and a nearby coastal area in Rhodes Island, U.S., revealed a high concentration of PFASs found in crustaceans.41 In Tunisia, it was found that the sum of 8 kinds of PFAS was the highest in crustaceans (2.24 ng/g dry weight [dw]), followed by fish (0.751 ng/g dw), and mollusk (0.510 ng/g dw).42 In a study on seafood in a coastal area on the northeastern side of Brazil, PFOS concentration was the highest in shrimps.43 In a study examining the Bohai Sea in China, the total PFAS was 4.64 μg/kg in crustaceans, 1.82 μg/kg in fish, and 1.40 μg/kg in cephalopods.8 Total PFAS concentration varies where the habitat is, for example, Mexican crab shows 0.16–0.37 μg/kg, while Indonesian crab shows 0.6–2.2 μg/kg of total PFAS concentration.44 Crustaceans feed on PFAS-contaminated sediments, resulting in a higher level of PFAS exposure.10,44
Once absorbed through the gill and food intake by crustaceans, PFASs accumulate in the hepatopancreas, which is responsible for absorbing and storing nutrients.45,46 Long-chain PFASs accumulate at a high density in hepatopancreas due to high affinity to liver fatty acid binding proteins.9,45 In a study on Chinese mitten crab, high levels of perfluorododecanoic acid, perfluorotridecanoic acid, and perfluorotetradecanoic acid were observed in the hepatopancreas compared to muscle or shell tissues.9 In a study on PFOS in the crabs of the Bohai Sea in China, the PFOS concentration was higher in the intestines at 105 ng/g than in other parts at 1.17 ng/g.47,48 In a study conducted in Spain, the total concentration of PFASs was higher in the head of crustaceans, where the hepatopancreas is located.49 In previous study, the correlation between crustacean intestine consumption and blood cadmium level was already shown.15 For humans, PFAS exposure increases as the consumption of flesh and intestines of crustaceans increases.
The PFAS exposure pathways in the human body include oral intake, dust inhalation, and skin contact, while the main pathway is through food intake.11 A study analyzing the statistical data of the National Health and Nutrition Examination Survey in the U.S. reported that the concentrations of serum PFOA, PFOS, PFHxS, perfluoroundecanoic acid, PFNA, and PFDeA increased after crab consumption.50 A study conducted in Japan verified the association between crab or shrimp consumption and increased levels of PFOS and PFOA in blood.51 The largest proportion of PFASs (86%) absorbed via food intake is through seafood, especially fish and crustaceans which are the main causes of PFAS exposure.52 Currently, the European Food Safety Authority set the tolerable weekly intake of 4.4 ng/kg bw per week.25
PFASs consist of 2 parts: the anionic head and the aliphatic tail.53 These 2 parts exhibit strong binding with albumin, while they migrate to various organs via blood.45,47 As they reach the liver, PFASs accumulate inside hepatocytes through binding with liver fatty acid binding proteins.45,54 In the kidney, PFASs released in urine are reabsorbed by the organic anion transporter 4, and in the small intestine, PFASs are reabsorbed by organic anion transporting polypeptide, sodium taurocholate co-transporting polypeptide, and apical sodium-dependent bile acid transporter to remain in the body for long.45,55,56,57 The elimination half-life of PFASs in the human body is 2.7 years for PFOA, 3.4 years for PFOS, and 5.3 years for PFHxS.12 As a result, continuous consumption of crustaceans can cause prolonged effects of PFASs in the human body. Additionally, PFOA, PFOS, PFHxS, PFNA, and PFDeA can serve as key indicators in assessing PFAS exposure associated with crustacean consumption.
This study has limitations. First, the causality remains unidentified as this study was a cross-sectional study. Second, due to the COVID-19 pandemic, the KoNEHS in 2020 had been conducted using non-face-to-face methods and the number of participants in blood analysis was small. Third, the possibility of occupational exposure, such as work environment and use of protective gear, had not been taken into account. Fourth, since the data has only 5 kinds of PFASs in the KoNEHS 4th cycle, other types of PFAS frequently used nowadays were not accounted for.58 Fifth, it was impossible to identify the total PFAS concentration of crustacean in the KoNEHS 4th cycle. Finally, the comparison in this study was based on the frequency of crustacean consumption, the data of which were obtained through recall, implying potential recall bias.
So far, few large-scale studies have been conducted on the association between crustacean consumption and serum PFASs in the Korean population. This study is significant in exploring the association between crustacean consumption and concentrations of serum PFASs by analyzing the data of samples representing the general population of South Korea. Considering that the toxicity of PFASs in the human body is well-known, research on the amount of crustacean consumption which can affect human health, and periodic monitoring is necessary regarding the PFAS concentration in crustaceans.
This study revealed the association between crustacean consumption and concentrations of serum PFASs in general Korean population. Periodic monitoring of PFAS concentration in crustaceans is needed due to toxicity of PFAS on human.
This study used the Korean National Environmental Health Survey cycle 4 (2018–2020), made by National Institute of Environmental Research (NIER-2020-01-01-016). We appreciate National Institute of Environmental Research for making the raw data of Korean National Environmental Health Survey available.

AFFF

aqueous film forming foam

BMI

body mass index

CI

confidence interval

dw

dry weight

HC

high-concentration group

KoNEHS

Korean National Environmental Health Survey

LC

low-concentration group

LOD

limit of detection

OR

odds ratio

PFAS

perfluoroalkyl substance

PFDeA

perfluorodecanoic acid

PFHxS

perfluorohexanesulfonic acid

PFNA

perfluorononanoic acid

PFOA

perfluorooctanoic acid

PFOS

perfluorooctanesulfonic acid

UV

ultraviolet

Funding: This research was supported by the Soonchunhyang University Research Fund and Inha University Hospital’s Environmental Health Center for Training Environmental Medicine Professional funded by the Ministry of Environment, Republic of Korea (2024).

Competing interests: The authors declare that they have no competing interests.

Author contributions:

  • Conceptualization: Huh SW, Cho SY.

  • Data curation: Huh SW, Kim KW, Kang JS.

  • Formal analysis: Huh SW, Park HW.

  • Investigation: Cho SY.

  • Methodology: Yoon SY.

  • Software: Huh SW, Cho SY, Kang JS.

  • Validation: Huh SW, Cho SY, Kim DH Writing - original draft.

  • Writing - review & editing: Huh SW, Cho SY.

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Figure & Data

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      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  Published online April 19, 2024
      DOI: https://doi.org/10.35371/aoem.2024.36.e12
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    Relationship between crustacean consumption and serum perfluoroalkyl substances (PFAS): the Korean National Environmental Health Survey (KoNEHS) cycle 4
    Image
    Fig. 1 Flow chart of the selection of study participants.KoNEHS: Korean National Environmental Health Survey; PFAS: perfluoroalkyl substance.

    Fig. 1

    Relationship between crustacean consumption and serum perfluoroalkyl substances (PFAS): the Korean National Environmental Health Survey (KoNEHS) cycle 4
    CategoryTotal (n = 2,993)aMen (n = 1,298)Women (n = 1,695)p-value
    PFAS
    PFOA7.66 (7.33–8.00)7.99 (7.53–8.45)7.34 (7.13–7.55)< 0.001b
    PFOS18.87 (18.64–19.10)20.26 (19.53–20.98)17.48 (17.02–17.94)< 0.001
    PFHxS5.76 (5.39–6.12)6.42 (6.11–6.74)5.09 (4.68–5.50)< 0.001
    PFNA2.54 (2.52–2.57)2.73 (2.71–2.75)2.35 (2.32–2.39)< 0.001
    PFDeA1.08 (1.06–1.10)1.15 (1.13–1.17)1.01 (1.00–1.03)< 0.001
    Age47.4 ± 0.1346.4 ± 0.1848.5 ± 0.10< 0.001
    BMI group0.003c
    ≤ 25 kg/m2 1,577 (53.4)595 (46.1)982 (60.7)
    > 25 kg/m2 1,416 (46.6)703 (53.9)713 (39.3)
    Marital status0.001
    Single354 (22.8)176 (26.5)178 (19.2)
    Married2,286 (67.8)1,035 (69.0)1,251 (66.6)
    Others353 (9.4)87 (4.5)266 (14.2)
    Smoking< 0.001
    None or ex-smoker2,527 (80.9)879 (64.7)1,648 (97.0)
    Current smoker466 (19.1)419 (35.3)47 (3.0)
    Coated frying pans usage< 0.001
    < Once a week199 (5.5)96 (6.0)103 (5.0)
    ≥ Once a week2,794 (94.5)1,202 (94.0)1,592 (95.0)
    Coated pot usage0.046
    < Once a week1,250 (41.1)543 (39.7)707 (42.4)
    ≥ Once a week1,743 (58.9)755 (60.3)988 (57.6)
    Coated electric cookers usage0.770
    < Once a week411 (14.1)173 (14.1)238 (14.1)
    ≥ Once a week2,582 (85.9)1,125 (85.9)1,457 (85.9)
    Coated containers usage0.047
    < Once a week2,594 (86.4)1,126 (86.1)1,468 (86.7)
    ≥ Once a week399 (13.6)172 (13.9)227 (13.3)
    Hiking suit usage0.002
    < Once a week1,869 (62.4)697 (54.6)1,172 (70.0)
    ≥ Once a week1,124 (37.6)601 (45.4)523 (30.0)
    Hiking boots and sneakers usage< 0.001
    < Once a week1,872 (61.1)708 (52.9)1,164 (69.3)
    ≥ Once a week1,121 (38.9)590 (47.1)531 (30.7)
    Disposable paper cups usage< 0.001
    < Once a week1,286 (41.3)419 (30.8)867 (51.6)
    ≥ Once a week1,707 (58.7)879 (69.2)828 (48.4)
    Coated agent or polish usage0.006
    < Once a week2,969 (99.2)1,279 (98.7)1,690 (99.7)
    ≥ Once a week24 (0.8)19 (1.3)5 (0.3)
    Consumption of grilled meat0.001
    < Once a week1,813 (53.6)730 (47.2)1,083 (59.9)
    ≥ Once a week1,180 (46.4)568 (52.8)612 (40.1)
    Consumption of grilled fish0.001
    < Once a week2,377 (79.3)1,019 (77.3)1,358 (81.3)
    ≥ Once a week616 (20.7)279 (22.7)337 (18.7)
    Consumption of popcorn0.405
    < Once a week2,976 (99.1)1,291 (98.9)1,685 (99.3)
    ≥ Once a week17 (0.9)7 (1.1)10 (0.7)
    Consumption of hamburger-pizza-fried chicken< 0.001
    < Once a week2,558 (78.1)1,084 (72.7)1,474 (83.4)
    ≥ Once a week435 (21.9)214 (27.3)221 (16.6)
    Consumption of large fish and tuna0.002
    < Once a week2,700 (88.0)1,148 (84.5)1,552 (91.5)
    ≥ Once a week293 (12.0)150 (15.5)143 (8.5)
    Consumption of fish0.001
    < Once a week1,349 (48.9)552 (46.8)797 (50.9)
    ≥ Once a week1,644 (51.1)746 (53.2)898 (49.1)
    Consumption of crustacean0.076
    < Once a week2,753 (91.8)1,189 (91.6)1,564 (92.1)
    ≥ Once a week240 (8.2)109 (8.4)131 (7.9)
    Consumption of seaweed0.136
    < Once a week700 (23.6)287 (22.8)413 (24.4)
    ≥ Once a week2,293 (76.4)1,011 (77.2)1,282 (75.6)
    Consumption of shellfish0.001
    < Once a week2,600 (85.4)1,121 (84.2)1,479 (86.5)
    ≥ Once a week393 (14.6)177 (15.8)216 (13.5)
    Consumption of other seafood items0.004
    < Once a week2,634 (87.4)1,125 (85.3)1,509 (89.4)
    ≥ Once a week359 (12.6)173 (14.7)186 (10.6)
    Type of water drinking indoor0.001
    Water purifier, bottled water, etc.2,047 (71.4)896 (73.5)1,151 (69.4)
    Underground water, small-scale water-supply system, tap water946 (28.6)402 (26.5)544 (30.6)
    Type of water drinking outdoor< 0.001
    Water purifier, bottled water, etc.2,747 (93.3)1,207 (95.1)1,540 (91.4)
    Underground water, small-scale water-supply system, tap water246 (6.7)91 (4.9)155 (8.6)
    Average ventilation time per day0.043
    < 30 min354 (10.5)174 (11.3)180 (9.7)
    ≥ 30 min, < 60 min371 (11.1)156 (10.6)215 (11.4)
    ≥ 60 min, < 600 min1,112 (36.6)488 (37.7)624 (35.6)
    ≥ 600 min1,156 (41.8)480 (40.4)676 (43.3)
    Usage of hair products< 0.001
    < Once a week2,019 (67.6)1,102 (81.2)917 (54.1)
    ≥ Once a week974 (32.4)196 (18.8)778 (45.9)
    Usage of make-up products< 0.001
    < Once a week1,399 (50.7)1,139 (87.3)260 (14.4)
    ≥ Once a week1,594 (49.3)159 (12.7)1,435 (85.6)
    Usage of ultraviolet block sunscreens< 0.001
    < Once a week1,405 (49.2)1,086 (82.2)319 (16.4)
    ≥ Once a week1,588 (50.8)212 (17.8)1,376 (83.6)
    VariablePFOAPFOSPFHxSPFNAPFDeA
    Low (n = 649)aHigh (n = 649)p-valueLow (n = 649)High (n = 649)p-valueLow (n = 649)aHigh (n = 649)p-valueLow (n = 649)High (n = 649)p-valueLow (n = 649)High (n = 649)p-value
    Age40.5 ± 0.2754.4 ± 0.33< 0.001b 39.4 ± 0.2756.9 ± 0.23< 0.00140.8 ± 0.2552.9 ± 0.35< 0.001b 39.4 ± 0.3257.0 ± 0.08< 0.00139.2 ± 0.2958.0 ± 0.11< 0.001
    BMI group0.013c 0.4890.737c 0.7370.044
    ≤ 25 kg/m2 321 (59.9)274 (40.1)301 (60.3)294 (39.7)303 (54.0)292 (46.0)315 (60.6)280 (39.4)294 (59.8)301 (40.2)
    > 25 kg/m2 328 (55.9)375 (44.1)348 (60.6)355 (39.4)346 (54.3)357 (45.7)334 (60.3)369 (39.7)355 (63.8)348 (36.2)
    Marital status< 0.001< 0.0010.0010.0010.001
    Single145 (88.5)31 (11.5)153 (90.5)23 (9.5)135 (80.8)41 (19.2)159 (96.5)17 (3.5)162 (97.0)14 (3.0)
    Married452 (45.4)583 (54.6)452 (49.2)583 (50.8)477 (44.7)558 (55.3)445 (46.7)590 (53.3)442 (49.0)593 (51.0)
    Others52 (65.0)35 (35.0)44 (56.1)43 (43.9)37 (40.9)50 (59.1)45 (59.2)42 (40.8)45 (54.1)42 (45.9)
    Smoking0.190< 0.0010.6750.0070.004
    None or ex-smoker422 (56.9)457 (43.1)400 (57.7)479 (42.3)438 (54.4)441 (45.6)412 (58.9)467 (41.1)405 (59.4)474 (40.6)
    Current smoker227 (59.3)192 (40.7)249 (65.4)170 (34.6)211 (53.6)208 (46.4)237 (63.3)182 (36.7)244 (66.7)175 (33.3)
    Coated frying pans usage0.004< 0.0010.0020.001< 0.001
    < Once a week54 (76.0)42 (24.0)49 (75.6)47 (24.4)53 (72.6)43 (27.4)46 (64.7)50 (35.3)48 (73.3)48 (26.7)
    ≥ Once a week595 (56.6)607 (43.4)600 (59.5)602 (40.5)596 (53.0)606 (47.0)603 (60.2)599 (39.8)601 (61.3)601 (38.7)
    Coated pot usage0.3740.0180.1230.3040.485
    < Once a week258 (56.9)285 (43.1)252 (57.3)291 (42.7)274 (56.0)269 (44.0)267 (59.5)276 (40.5)265 (61.5)278 (38.5)
    ≥ Once a week391 (58.3)364 (41.7)397 (62.5)358 (37.5)375 (52.9)380 (47.1)382 (61.1)373 (38.9)384 (62.3)371 (37.7)
    Coated electric cookers usage0.8070.3110.0200.0810.340
    < Once a week84 (57.9)89 (42.1)83 (61.4)90 (38.6)88 (52.0)85 (48.0)82 (58.2)91 (41.8)83 (63.2)90 (36.8)
    ≥ Once a week565 (57.7)560 (42.3)566 (60.3)559 (39.7)561 (54.5)564 (45.5)567 (60.8)558 (39.2)566 (61.8)559 (38.2)
    Coated containers usage< 0.0010.0020.249< 0.0010.005
    < Once a week555 (56.3)571 (43.7)544 (58.7)582 (41.3)570 (53.8)556 (46.2)546 (58.9)580 (41.1)543 (60.1)583 (39.9)
    ≥ Once a week94 (66.6)78 (33.4)105 (71.0)67 (29.0)79 (56.6)93 (43.4)103 (69.9)69 (30.1)106 (73.4)66 (26.6)
    Hiking suit usage0.0210.4770.1360.0550.174
    < Once a week378 (61.7)319 (38.3)349 (61.0)348 (39.0)347 (55.3)350 (44.7)370 (62.8)327 (37.2)371 (62.7)326 (37.3)
    ≥ Once a week271 (52.9)330 (47.1)300 (59.8)301 (40.2)302 (52.8)299 (47.2)279 (57.6)322 (42.4)278 (61.1)323 (38.9)
    Hiking boots and sneakers usage0.0060.156< 0.0010.0530.103
    < Once a week372 (59.5)336 (40.5)357 (60.1)351 (39.9)365 (56.7)343 (43.3)365 (59.6)343 (40.4)365 (60.9)343 (39.1)
    ≥ Once a week277 (55.8)313 (44.2)292 (60.9)298 (39.1)284 (51.3)306 (48.7)284 (61.3)306 (38.7)284 (63.2)306 (36.8)
    Disposable paper cups usage0.0900.0050.0020.215< 0.001
    < Once a week214 (58.7)205 (41.3)192 (55.0)227 (45.0)204 (50.5)215 (49.5)209 (60.8)210 (39.2)210 (58.9)209 (41.1)
    ≥ Once a week435 (57.3)444 (42.7)457 (62.9)422 (37.1)445 (55.8)434 (44.2)440 (60.3)439 (39.7)439 (63.3)440 (36.7)
    Coated agent or polish usage0.0430.0760.0420.0110.007
    < Once a week641 (57.8)638 (42.2)640 (60.4)639 (39.6)641 (54.3)638 (45.7)641 (60.5)638 (39.5)641 (62.1)638 (37.9)
    ≥ Once a week8 (49.6)11 (50.4)9 (60.8)10 (39.2)8 (40.0)11 (60.0)8 (56.3)11 (43.7)8 (55.1)11 (44.9)
    Consumption of grilled meat0.1650.0040.0600.4940.029
    < Once a week358 (57.0)372 (73.0)317 (53.2)413 (46.8)362 (52.2)368 (47.8)345 (60.0)385 (40.0)337 (58.8)393 (41.2)
    ≥ Once a week291 (58.4)277 (41.6)332 (66.9)236 (33.1)287 (55.9)281 (44.1)304 (60.8)264 (39.2)312 (64.8)256 (35.2)
    Consumption of grilled fish< 0.0010.6490.0120.0730.034
    < Once a week526 (58.3)493 (41.7)530 (60.5)489 (39.5)508 (53.0)511 (47.0)532 (61.1)487 (38.9)537 (63.0)482 (37.0)
    ≥ Once a week123 (55.9)156 (44.1)119 (60.3)160 (39.7)141 (58.2)138 (41.8)117 (58.3)162 (41.7)112 (58.7)167 (41.3)
    Consumption of popcorn0.002< 0.001< 0.001< 0.001< 0.001
    < Once a week645 (57.5)646 (42.5)644 (60.1)647 (39.9)644 (53.8)647 (46.2)645 (60.3)646 (39.7)644 (61.7)647 (38.3)
    ≥ Once a week4 (74.5)3 (25.5)5 (87.4)2 (12.6)5 (87.4)2 (12.6)4 (74.5)3 (25.5)5 (87.4)2 (12.6)
    Consumption of hamburger-pizza-fried chicken< 0.001< 0.001< 0.001< 0.001< 0.001
    < Once a week492 (50.3)592 (49.7)476 (51.9)608 (48.1)514 (48.1)570 (51.9)479 (52.5)605 (47.5)472 (53.6)612 (46.4)
    ≥ Once a week157 (77.6)57 (22.4)173 (83.2)41 (16.8)135 (70.2)79 (29.8)170 (81.7)44 (18.3)177 (84.5)37 (15.5)
    Consumption of large fish and tuna< 0.001< 0.0010.0020.0020.002
    < Once a week553 (55.5)595 (44.5)547 (58.0)601 (42.0)562 (52.2)586 (47.8)544 (57.8)604 (42.2)544 (58.7)604 (41.3)
    ≥ Once a week96 (70.1)54 (29.9)102 (73.8)48 (26.2)87 (64.9)63 (35.1)105 (75.1)45 (24.9)105 (79.9)45 (20.1)
    Consumption of fish< 0.0010.002< 0.0010.0020.004
    < Once a week339 (69.9)213 (30.1)336 (69.9)216 (30.1)302 (59.9)250 (40.1)340 (72.2)212 (27.8)348 (73.3)204 (26.7)
    ≥ Once a week310 (47.0)436 (53.0)313 (52.1)433 (47.9)347 (49.1)399 (50.9)309 (50.1)437 (49.9)301 (52.0)445 (48.0)
    Consumption of crustacean0.0050.008< 0.001< 0.001< 0.001
    < Once a week602 (59.5)587 (40.5)590 (61.2)599 (38.8)606 (55.8)583 (44.2)594 (62.0)595 (38.0)592 (63.5)597 (36.5)
    ≥ Once a week47 (38.1)62 (61.9)59 (52.4)50 (47.6)43 (35.9)66 (64.1)55 (43.9)54 (56.1)57 (45.8)52 (54.2)
    Consumption of seaweed0.008< 0.0010.4500.0040.007
    < Once a week164 (66.5)123 (33.5)157 (65.6)130 (34.4)148 (54.4)139 (45.6)162 (71.7)125 (28.3)161 (70.6)126 (29.4)
    ≥ Once a week485 (55.1)526 (44.9)492 (58.9)519 (41.1)501 (54.1)510 (45.9)487 (57.1)524 (42.9)488 (59.4)523 (40.6)
    Consumption of shellfish< 0.001< 0.001< 0.0010.0030.004
    < Once a week588 (61.1)533 (38.9)574 (62.7)547 (37.3)582 (55.8)539 (44.2)580 (63.3)541 (36.7)576 (64.0)545 (36.0)
    ≥ Once a week61 (39.9)116 (60.1)75 (48.4)102 (51.6)67 (45.1)110 (54.9)69 (45.1)108 (54.9)73 (51.1)104 (48.9)
    Consumption of other seafood items0.0050.0110.0030.0400.286
    < Once a week564 (58.1)561 (41.9)554 (59.7)571 (40.3)556 (52.8)569 (47.2)560 (60.7)565 (39.3)560 (61.8)565 (38.2)
    ≥ Once a week85 (55.6)88 (44.4)95 (64.6)78 (35.4)93 (62.0)80 (38.0)89 (59.1)84 (40.9)89 (63.1)84 (36.9)
    Type of water drinking indoor0.0080.0020.0330.001< 0.001
    Water purifier, bottled water, etc.466 (60.6)430 (39.4)488 (65.6)408 (34.4)452 (56.4)444 (43.6)481 (65.1)415 (34.9)489 (67.0)407 (33.0)
    Underground water, small-scale water-supply system, tap water183 (49.6)219 (50.4)161 (46.1)241 (53.9)197 (48.0)205 (52.0)168 (47.6)234 (52.4)160 (48.1)242 (51.9)
    Type of water drinking outdoor< 0.0010.0050.0010.0030.002
    Water purifier, bottled water, etc.611 (58.7)596 (41.3)617 (61.4)590 (38.6)604 (55.1)603 (44.9)615 (61.5)592 (38.5)620 (63.3)587 (36.7)
    Underground water, small-scale water-supply system, tap water38 (38.9)53 (61.1)32 (41.9)59 (58.1)45 (35.7)46 (64.3)34 (40.0)57 (60.0)29 (36.8)62 (63.2)
    Average ventilation time per day< 0.0010.0390.0010.0190.012
    < 30 min72 (46.2)102 (53.8)78 (55.4)96 (44.6)76 (43.4)98 (56.6)72 (53.6)102 (46.4)76 (51.6)98 (48.4)
    ≥ 30 min, < 60 min81 (66.8)75 (33.2)78 (67.7)78 (32.3)77 (57.8)79 (42.2)80 (66.2)76 (33.8)76 (63.7)80 (36.3)
    ≥ 60 min, < 600 min240 (53.0)248 (47.0)240 (57.9)248 (42.1)242 (51.4)246 (48.6)239 (57.2)249 (42.8)234 (59.0)254 (41.0)
    ≥ 600 min256 (63.0)224 (37.0)253 (62.3)227 (33.7)254 (58.8)226 (41.2)258 (63.8)222 (36.2)263 (67.2)217 (32.8)
    Usage of hair products< 0.0010.0040.0020.0020.003
    < Once a week540 (55.6)562 (44.4)527 (57.1)575 (42.9)545 (52.8)557 (47.2)538 (58.0)564 (42.0)533 (59.0)569 (41.0)
    ≥ Once a week109 (67.1)87 (32.9)122 (74.7)74 (25.3)104 (60.0)92 (40.0)111 (71.0)85 (29.0)116 (74.7)80 (25.3)
    Usage of make-up products0.0020.0010.0580.0020.002
    < Once a week559 (55.7)580 (44.3)564 (59.3)575 (40.7)571 (53.7)568 (46.3)558 (58.6)581 (41.4)565 (60.1)574 (39.9)
    ≥ Once a week90 (71.6)69 (28.4)85 (68.0)74 (32.0)78 (57.2)81 (42.8)91 (73.4)68 (26.6)84 (75.0)75 (25.0)
    Usage of ultraviolet block sunscreens0.0070.0090.0080.0110.001
    < Once a week536 (55.6)550 (44.4)541 (58.9)545 (41.1)538 (52.6)548 (47.4)537 (59.1)549 (40.9)541 (59.7)545 (40.3)
    ≥ Once a week113 (67.5)99 (32.5)108 (67.7)104 (32.3)111 (61.3)101 (38.7)112 (66.9)100 (33.1)108 (72.5)104 (27.5)
    VariablePFOAPFOSPFHxSPFNAPFDeA
    Low (n = 848)aHigh (n = 847)p-valueLow (n = 848)High (n = 847)p-valueLow (n = 848)aHigh (n = 847)p-valueLow (n = 850)High (n = 845)p-valueLow (n = 848)High (n = 847)p-value
    Age41.0 ± 0.2158.2 ± 0.13< 0.001b 40.4 ± 0.0559.7 ± 0.06< 0.00142.0 ± 0.1656.1 ± 0.37< 0.001b 40.7 ± 0.1860.1 ± 0.04< 0.00141.5 ± 0.2358.8 ± 0.10< 0.001
    BMI group0.002c < 0.0010.009c < 0.001< 0.001
    ≤ 25 kg/m2 534 (61.6)448 (38.4)542 (63.8)440 (36.2)525 (59.4)457 (40.6)559 (66.6)423 (33.4)535 (64.1)447 (35.9)
    > 25 kg/m2 314 (49.1)399 (50.9)306 (49.3)407 (50.7)323 (46.2)390 (53.8)291 (50.1)422 (49.9)313 (52.4)400 (47.6)
    Marital status< 0.001< 0.0010.001< 0.001< 0.001
    Single150 (85.7)28 (14.3)154 (86.3)24 (13.7)142 (81.3)36 (18.7)162 (91.9)16 (8.1)159 (89.0)19 (11.0)
    Married610 (53.9)641 (46.1)615 (56.1)636 (43.9)620 (51.3)631 (48.7)617 (57.9)634 (42.1)612 (56.9)639 (43.1)
    Others88 (30.4)178 (69.6)79 (29.6)187 (70.4)86 (31.0)180 (69.0)71 (27.7)195 (72.3)77 (31.9)189 (68.1)
    Smoking< 0.001< 0.0010.025< 0.001< 0.001
    None or ex-smoker818 (56.0)830 (44.0)816 (57.6)832 (42.4)824 (54.0)824 (46.0)820 (59.5)828 (40.5)820 (59.0)828 (41.0)
    Current smoker30 (78.2)17 (21.8)32 (74.9)15 (25.1)24 (61.3)23 (38.7)30 (78.9)17 (21.1)28 (74.9)19 (25.1)
    Coated frying pans usage0.2850.1250.0180.0020.003
    < Once a week43 (57.0)60 (43.0)45 (60.8)58 (39.2)51 (58.2)52 (41.8)36 (50.9)67 (49.1)37 (51.9)66 (48.1)
    ≥ Once a week805 (56.6)787 (43.4)803 (58.0)789 (42.0)797 (54.0)765 (46.0)814 (60.6)778 (39.4)811 (59.9)781 (40.1)
    Coated pot usage0.1340.0810.0040.1320.063
    < Once a week337 (55.4)370 (44.6)338 (56.4)369 (43.6)362 (56.0)345 (44.0)339 (58.4)368 (41.6)331 (57.3)376 (42.7)
    ≥ Once a week511 (57.6)477 (42.4)510 (59.4)478 (40.6)486 (52.9)502 (47.1)511 (61.4)477 (38.6)517 (61.2)471 (38.8)
    Coated electric cookers usage0.0020.7520.3580.0850.007
    < Once a week108 (54.7)130 (45.3)113 (58.2)125 (41.8)112 (53.3)126 (46.7)115 (59.4)123 (40.6)122 (64.1)116 (35.9)
    ≥ Once a week740 (57.0)717 (43.0)735 (58.1)722 (41.9)736 (54.3)721 (45.7)735 (60.2)722 (39.8)726 (58.8)731 (41.2)
    Coated containers usage0.0090.0130.0350.0050.012
    < Once a week713 (55.4)755 (44.6)710 (56.8)758 (43.2)723 (53.2)745 (46.8)703 (58.5)765 (41.5)703 (58.1)765 (41.9)
    ≥ Once a week135 (64.9)92 (35.1)138 (66.6)89 (33.4)125 (60.4)102 (39.6)147 (70.4)80 (29.6)145 (69.0)82 (31.0)
    Hiking suit usage0.0060.0010.009< 0.0010.002
    < Once a week617 (60.5)555 (39.5)615 (62.8)557 (37.2)605 (57.6)567 (42.4)619 (63.3)553 (36.7)615 (62.7)557 (37.3)
    ≥ Once a week231 (47.8)292 (52.2)233 (47.3)290 (52.7)243 (46.3)280 (53.7)231 (52.7)292 (47.3)233 (52.0)290 (48.0)
    Hiking boots and sneakers usage0.0110.0380.0300.0080.001
    < Once a week590 (57.9)574 (42.1)589 (59.1)575 (40.9)576 (55.0)588 (45.0)602 (61.8)562 (38.2)603 (61.4)561 (38.6)
    ≥ Once a week258 (53.9)273 (46.1)259 (55.9)272 (44.1)272 (52.4)259 (47.6)248 (56.4)283 (43.6)245 (55.2)286 (44.8)
    Disposable paper cups usage0.002< 0.0010.4830.0070.026
    < Once a week415 (54.6)452 (45.4)398 (53.5)469 (46.5)427 (54.0)440 (46.0)395 (56.6)472 (43.4)405 (57.4)462 (42.6)
    ≥ Once a week433 (58.9)395 (41.1)450 (63.1)378 (36.9)421 (54.4)407 (45.6)455 (63.9)373 (36.1)443 (61.7)385 (38.3)
    Coated agent or polish usage< 0.001< 0.0010.001< 0.001< 0.001
    < Once a week846 (56.8)844 (43.2)845 (58.2)845 (41.8)846 (54.3)844 (45.7)848 (60.3)842 (39.7)846 (59.7)844 (40.3)
    ≥ Once a week2 (18.0)3 (82.0)3 (38.0)2 (62.0)2 (18.0)3 (82.0)2 (18.0)3 (82.0)2 (18.0)3 (82.0)
    Consumption of grilled meat< 0.001< 0.0010.005< 0.001< 0.001
    < Once a week484 (52.2)599 (47.8)478 (52.6)605 (47.4)501 (49.6)582 (50.4)471 (53.5)612 (46.5)483 (52.8)600 (47.2)
    ≥ Once a week364 (63.3)248 (36.7)370 (66.3)242 (33.7)347 (61.0)265 (39.0)379 (70.1)233 (29.9)365 (69.5)247 (30.5)
    Consumption of grilled fish0.0020.0020.2220.003< 0.001
    < Once a week704 (58.0)654 (42.0)712 (60.0)646 (40.0)679 (54.5)679 (45.5)716 (61.4)642 (38.6)714 (61.4)644 (38.6)
    ≥ Once a week144 (50.6)193 (49.4)136 (49.9)201 (50.1)169 (52.8)168 (47.2)134 (54.7)203 (45.3)134 (51.4)203 (48.6)
    Consumption of popcorn0.0070.0460.3130.0100.010
    < Once a week840 (56.4)845 (43.6)839 (57.9)846 (42.1)841 (54.1)844 (45.9)842 (59.9)843 (40.1)840 (59.3)845 (40.7)
    ≥ Once a week8 (87.9)2 (12.1)9 (92.3)1 (7.7)7 (67.8)3 (32.2)8 (87.9)2 (12.1)8 (87.9)2 (12.1)
    Consumption of hamburger-pizza-fried chicken0.002< 0.0010.004< 0.0010.002
    < Once a week673 (51.9)801 (48.1)670 (53.0)804 (47.0)700 (51.5)774 (48.5)664 (55.0)810 (45.0)668 (54.3)806 (45.7)
    ≥ Once a week175 (80.5)46 (19.5)178 (83.7)43 (16.3)148 (67.9)73 (32.1)186 (86.1)35 (13.9)180 (85.9)41 (14.1)
    Consumption of large fish and tuna0.006< 0.0010.006< 0.0010.004
    < Once a week747 (55.1)805 (44.9)745 (56.4)807 (43.6)754 (53.1)798 (46.9)750 (58.8)802 (41.2)749 (58.1)803 (41.9)
    ≥ Once a week101 (73.9)42 (26.1)103 (76.9)40 (23.1)94 (65.9)49 (34.1)100 (74.5)43 (25.5)99 (75.3)44 (24.7)
    Consumption of fish0.0020.002< 0.0010.0010.003
    < Once a week486 (66.0)311 (34.0)490 (67.7)307 (32.3)442 (60.1)355 (39.9)501 (69.6)296 (30.4)501 (68.8)296 (31.2)
    ≥ Once a week362 (46.9)536 (53.1)358 (48.2)540 (51.8)406 (48.1)492 (51.9)349 (50.3)549 (49.7)347 (49.9)551 (50.1)
    Consumption of crustacean0.0500.0320.1410.0060.001
    < Once a week792 (57.0)772 (43.0)783 (58.2)781 (41.8)793 (54.8)771 (45.2)793 (60.6)771 (39.4)793 (59.9)771 (40.1)
    ≥ Once a week56 (53.2)75 (46.8)65 (57.5)66 (42.5)55 (46.8)76 (53.2)57 (54.7)74 (45.3)55 (55.7)76 (44.3)
    Consumption of seaweed< 0.0010.0220.0030.0140.083
    < Once a week232 (62.5)181 (37.5)213 (61.2)200 (38.8)220 (61.3)193 (38.7)231 (65.8)182 (34.2)221 (62.0)192 (38.0)
    ≥ Once a week616 (54.8)666 (45.2)635 (57.1)647 (42.9)628 (51.9)654 (48.1)619 (58.3)663 (41.7)627 (58.7)655 (41.3)
    Consumption of shellfish0.005< 0.0010.0040.001< 0.001
    < Once a week772 (59.4)707 (40.6)764 (60.1)715 (39.9)762 (56.6)717 (43.4)780 (63.3)699 (36.7)783 (63.1)696 (36.9)
    ≥ Once a week76 (39.2)140 (60.8)84 (45.5)132 (54.5)86 (38.6)130 (61.4)70 (39.8)146 (60.2)65 (36.5)151 (63.5)
    Consumption of other seafood items0.0470.0590.3530.1150.844
    < Once a week747 (56.1)762 (43.9)751 (57.7)758 (42.3)758 (54.1)751 (45.9)757 (60.3)752 (39.7)758 (59.5)751 (40.5)
    ≥ Once a week101 (61.0)85 (39.0)97 (61.2)89 (38.8)90 (55.1)96 (44.9)93 (58.8)93 (41.2)90 (59.4)96 (40.6)
    Type of water drinking indoor0.0040.008< 0.0010.0040.007
    Water purifier, bottled water, etc.624 (60.9)527 (39.1)631 (62.2)520 (37.8)602 (59.0)549 (41.0)647 (65.6)504 (34.4)626 (63.9)525 (36.1)
    Underground water, small-scale water-supply system, tap water224 (46.9)320 (53.1)217 (48.8)327 (51.2)246 (43.2)298 (56.8)203 (47.8)341 (52.2)222 (49.7)322 (50.3)
    Type of water drinking outdoor< 0.0010.003< 0.001< 0.001< 0.001
    Water purifier, bottled water, etc.794 (58.9)746 (41.1)800 (60.4)740 (39.6)782 (56.1)758 (43.9)808 (62.8)732 (37.2)800 (62.0)740 (38.0)
    Underground water, small-scale water-supply system, tap water54 (32.6)101 (67.4)48 (33.9)107 (66.1)66 (34.0)89 (66.0)42 (31.1)113 (68.9)48 (33.3)107 (66.7)
    Average ventilation time per day0.0120.0670.0030.0170.013
    < 30 min82 (44.4)98 (55.6)88 (52.5)92 (47.5)80 (43.1)100 (56.9)80 (47.0)100 (53.0)80 (47.0)100 (53.0)
    ≥ 30 min, < 60 min94 (54.8)121 (45.2)101 (56.4)114 (43.6)96 (50.2)119 (49.8)101 (61.4)114 (38.6)98 (56.4)117 (43.6)
    ≥ 60 min, < 600 min314 (55.9)310 (44.1)301 (57.1)323 (42.9)316 (51.8)308 (40.2)299 (56.9)325 (43.1)300 (56.5)324 (43.5)
    ≥ 600 min358 (60.5)318 (39.5)358 (60.6)318 (39.4)356 (59.7)320 (40.3)370 (65.4)306 (34.6)370 (65.6)306 (34.4)
    Usage of hair products0.0110.5190.0110.4900.241
    < Once a week468 (57.9)449 (42.1)455 (58.4)462 (41.6)466 (55.5)451 (44.5)462 (59.9)455 (40.1)460 (59.2)457 (40.8)
    ≥ Once a week380 (55.2)398 (44.8)393 (57.7)385 (42.3)382 (52.6)396 (47.4)388 (60.4)390 (39.6)388 (60.0)390 (40.0)
    Usage of make-up products0.388< 0.0010.0010.0050.006
    < Once a week130 (57.2)130 (42.8)112 (52.2)148 (47.8)123 (47.9)137 (52.1)117 (54.1)143 (45.9)122 (54.1)138 (45.9)
    ≥ Once a week718 (56.6)717 (43.4)736 (59.1)699 (40.9)725 (55.2)710 (44.8)733 (61.1)702 (38.9)726 (60.4)709 (39.6)
    Usage of ultraviolet block sunscreens0.0670.0010.0060.0310.060
    < Once a week157 (54.3)162 (45.7)140 (50.9)179 (49.1)161 (49.9)158 (50.1)143 (54.5)176 (45.5)156 (55.5)163 (44.5)
    ≥ Once a week691 (57.1)685 (42.9)708 (59.5)668 (40.5)687 (55.0)689 (45.0)707 (61.2)669 (38.8)692 (60.3)684 (39.7)
    CategoryMenWomen
    UnadjustedAdjustedaUnadjustedAdjusteda
    < Once a week≥ Once a week< Once a week≥ Once a week< Once a week≥ Once a week< Once a week≥ Once a week
    PFOA12.38 (1.80–3.15)11.57 (0.85–2.90)11.16 (1.00–1.35)11.48 (1.19–1.84)
    PFOS11.43 (1.24–1.64)10.94 (0.71–1.25)11.02 (1.01–1.04)11.39 (1.27–1.52)
    PFHxS12.25 (2.16–2.35)12.15 (1.53–3.02)11.38 (0.76–2.49)11.56 (0.68–3.57)
    PFNA12.08 (1.98–2.18)11.23 (1.07–1.41)11.27 (1.17–1.37)11.70 (1.29–2.26)
    PFDeA12.05 (1.98–2.12)11.42 (1.17–1.74)11.18 (1.15–1.21)11.43 (1.32–1.54)
    Table 1 Baseline characteristics of the participants

    Data are presented as mean (95% confidence interval), number (%) for categorical variables and as mean ± standard error for continuous variables.

    PFAS: perfluoroalkyl substances; PFOA: perfluorooctanoic acid; PFOS: perfluorooctanesulfonic acid; PFHxS: perfluorohexanesulfonic acid; PFNA: perfluorononanoic acid; PFDeA: perfluorodecanoic acid; BMI: body mass index.

    aUnweighted count; bp-value by t-test; cp-value by χ2 test.

    Table 2 Baseline characteristics of the men according to serum perfluoroalkyl substances: PFOA, PFOS, PFHxS, PFNA, PFDeA

    Data are presented as number (%) for categorical variables and as mean ± standard error for continuous variables

    PFOA: perfluorooctanoic acid; PFOS: perfluorooctanesulfonic acid; PFHxS: perfluorohexanesulfonic acid; PFNA: perfluorononanoic acid; PFDeA: perfluorodecanoic acid; BMI: body mass index

    aUnweighted count; bp-value by t-test; cp-value by χ2 test.

    Table 3 Baseline characteristics of the women according to serum perfluoroalkyl substances: PFOA, PFOS, PFHxS, PFNA, PFDeA

    Data are presented as number (%) for categorical variables and as mean ± standard error for continuous variables.

    PFOA: perfluorooctanoic acid; PFOS: perfluorooctanesulfonic acid; PFHxS: perfluorohexanesulfonic acid; PFNA: perfluorononanoic acid; PFDeA: perfluorodecanoic acid; BMI: body mass index.

    aUnweighted count; bp-value by t-test; cp-value by χ2 test.

    Table 4 Adjusted ORs and 95% CIs of crustacean consumption with high concentrations of serum PFAS

    OR: odds ratio; CI: confidence interval; PFAS: perfluoroalkyl substances; PFOA: perfluorooctanoic acid; PFOS: perfluorooctanesulfonic acid; PFHxS: perfluorohexanesulfonic acid; PFNA: perfluorononanoic acid; PFDeA: perfluorodecanoic acid.

    aAdjusted for age, body mass index, marital status, smoking, number of coated frying pans usage, number of coated pot usage, number of electric cookers usage, number of coated containers usage, number of hiking suit usage, number of hiking boots and sneakers usage, number of disposable paper cups usage, number of coated agent or polish usage, number of consumption of grilled meat, grilled fish, popcorn, hamburger-pizza-fried chicken, large fish and tuna, fish, crustacean, seaweed, shellfish, other seafood items, type of water drinking indoor, type of water drinking outdoor, average ventilation time per day, usage of hair products, usage of make-up products, usage of ultraviolet block sunscreens.

    Table 1

    Table 2

    Table 3

    Table 4

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