No association between perfluoroalkyl chemicals and hypertension in children

Integrated Blood Pressure Control Dovepress open access to scientific and medical research Original Research Integrated Blood Pressure Control downloaded from https://www.dovepress.com/ by 213.32.59.121 on 12-Jul-2018 For personal use only. Open Access Full Text Article No association between perfluoroalkyl chemicals and hypertension in children This article was published in the following Dove Press journal: Integrated Blood Pressure Control 13 January 2014 Number of times this article has been viewed Sarah Dee Geiger 1 Jie Xiao 2 Anoop Shankar 3 Department of Public Health, Northern Illinois University, School of Nursing and Health Studies, DeKalb, IL, 2Registration and Records, North Carolina State University, Raleigh, NC, 3Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA 1 Background: Hypertension is a leading cause of cardiovascular disease worldwide. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are perfluoroalkyl chemicals (PFCs) used in the manufacture of common consumer products and detected in the blood of the majority of Americans. Emerging biological data suggest that PFC exposure may have a role in the development of hypertension. However, the association between PFCs and hypertension has not yet been explored in humans. Therefore, we examined this association in a representative sample of US children. Methods: A cross-sectional study was performed on 1,655 children from the National Health and Nutrition Examination Survey, 1999–2000 and 2003–2008. The main outcome of interest was hypertension, defined as age, height, and sex specific systolic and/or diastolic blood pressure level at the 95th percentile. Results: We found no association between serum levels of PFOA and PFOS and hypertension in either unadjusted or multivariable-adjusted analyses controlling for age, sex, race-ethnicity, body mass index, annual household income, moderate activity, total serum cholesterol, and serum cotinine. Compared with the lowest quartile, the multivariable-adjusted odds ratio (95% confidence interval) of hypertension in the highest quartile of exposure was 0.69 (0.41–1.17) for PFOA and 0.77 (0.37–1.61) for PFOS (all P-trend values .0.30). Conclusion: Our findings indicate that exposure to PFOA or PFOS is not significantly associated with hypertension in children at the lower PFC exposure levels typical of the general population. Keywords: perfluorooctanoic acid, perfluorooctane sulfonate, perfluoroalkyl chemicals, blood pressure, children Introduction Correspondence: Sarah D Geiger Department of Public Health, Northern Illinois University 255 Wirtz Hall, DeKalb, IL 60115, USA Tel +1 815 753 5590 Fax +1 815 753 5406 Email 1 submit your manuscript | www.dovepress.com Integrated Blood Pressure Control 2014:7 1–7 Dovepress © 2014 Geiger et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/IBPC.S47660 Powered by TCPDF (www.tcpdf.org) Perfluoroalkyl chemicals (PFCs) are detectable in the blood of more than 98% of the US population.1 They persist in the environment, bioaccumulate, biomagnify along food chains, and have been shown to cause developmental, endocrine, and other adverse health outcomes in laboratory animals.2,3 PFCs are found in surfactants, lubricants, polishes, paper and textile coatings, food packaging, and fire-retarding foams, among many other consumer products. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are two of the most studied PFCs. Hypertension is present in 29.0% of the adult US population and 3.2% of adolescents aged 11–17 years.4 It is also the leading cause of cardiovascular disease worldwide.5 Hypertension accounted for 56.5% of all-cause mortality in 2006, and death rates from hypertension increased by 19.5% from 1996 to 2006.6 While traditional Dovepress Integrated Blood Pressure Control downloaded from https://www.dovepress.com/ by 213.32.59.121 on 12-Jul-2018 For personal use only. Geiger et al factors such as weight gain,7,8 smoking,9 and lack of physical activity10 have been shown to be positively associated with hypertension, emerging literature suggests a role for common environmental exposures, including other manmade organic compounds,11–15 in the development of hypertension. A positive association between exposure to PFCs and hypertension is plausible. In a 2012 study, PFOA was reported to be linked to pregnancy-induced hypertension; this represents the only known epidemiologic study examining the association between PFOA and any form of high blood pressure.16 However, PFCs such as PFOA and PFOS have been linked to higher cholesterol levels,17 hyperuricemia,18,19 metabolic syndrome,20 insulin resistance, 20 and high serum gamma-glutamyl transpeptidase in previous epidemiologic studies,21–24 all of which are factors reported to be independently related to hypertension.18,25–28 In vitro studies have shown PFC exposure to be associated with oxidative stress29,30 and endothelial dysfunction.31,32 To our knowledge, the association between PFCs and hypertension has not been explored in children. Therefore, we sought to examine the association between PFCs and blood pressure levels in children using data from the nationally representative National Health and Nutrition Examination Survey (NHANES). Materials and methods Study population This study uses 8 years of merged data from the NHANES, years 1999–2000, 2003–2004, 2005–2006, and 2007–2008. PFC data were not available for years 2001–2002. Data collection methods for NHANES have been published and are available online.33 NHANES included a stratified multistage probability sample, representative of the noninstitutionalized civilian US population. Selection was based on counties, census blocks, households, and individuals within households, and included the oversampling of non-Hispanic Blacks and Mexican Americans in order to provide stable estimates of these groups. Subjects were required to sign a consent form before their participation, and approval was obtained from the Human Subjects Committee in the US Department of Health and Human Service. The survey also includes biomonitoring for select environmental chemicals, including PFCs, in a random one third subsample of participants by the National Center for Environmental Health. The central variables for this analysis are laboratory measurements of PFOA, PFOS, and blood press (...truncated)