Abstract

Per- and polyfluoroalkyl substances (PFAS) are chemicals linked to obesity and metabolic dysfunction, but their role in bariatric surgery remains poorly understood. This prospective pilot study examined correlations between plasma PFAS concentrations, body composition, and glycemic measures in adults undergoing bariatric surgery. Thirty-two patients (91% female; 66% Black; mean age 43 years) were enrolled preoperatively; twenty-two completed follow-up at a mean 8.6 months post-surgery. Three PFAS (PFHxS, PFNA, and PFOS) were quantified by plasma liquid chromatography-mass spectrometry; body composition and insulin sensitivity were assessed by dual-energy X-ray absorptiometry and intravenous glucose tolerance testing. At baseline, higher plasma PFNA and PFOS concentrations tracked with lower total lean mass (ρs = -0.46 and -0.48, respectively) and lean mass index (ρs = -0.46 and -0.42), and PFNA was inversely correlated with body weight (ρs = -0.40). No baseline associations were observed with adiposity or glycemic indices. Postoperatively, PFHxS concentrations decreased (median = -1.103 ng/mL, p < 0.001), whereas PFNA and PFOS did not change. Average PFNA was positively correlated with postoperative changes in HOMA-IR (ρs = 0.51) and total lean mass (ρs = 0.49). No significant associations were observed for average PFHxS or PFOS. These findings suggest that PFNA and PFOS may be linked to reduced lean tissue at baseline, and that PFNA burden modestly tracks with attenuated metabolic and body composition recovery. In an ANCOVA, baseline PFNA was not significantly associated with postoperative HOMA-IR or total lean mass. Larger, longitudinal studies are needed to clarify how PFAS influence these associations.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was supported by the National Institutes of Health grants NIEHS R21 ES028903 (V.L.C., T.R.Z.), P30 ES019776 (D.P.J., T.R.Z.), R01 ES033688 (D.V.), P30 ES023515 (D.V.), R01 ES030364 (V.L.C.), R01 ES029944 (V.L.C.), U01 HG013288 (V.L.C.), P30 ES007048 (V.L.C.), and UG1HD107688 (UAB Diabetes Research Center); and the Georgia Clinical and Translational Science Alliance grants UL1 TR002378 (M.R.S.) and 1IK2BX005913-01A2 (M.R.S.). The remaining authors declare that no specific financial support was received for their contribution to this work. None of the funders had a role in the design, analysis or writing of this article.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board of Emory University School of Medicine gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability Statement

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

AbbreviationsAIRgacute insulin response to glucose;ANCOVAanalysis of covariance;BMIbody mass index;CIconfidence interval;CRCClinical Research Center;DIdisposition index;DXAdual-energy X-ray absorptiometry;HOMA-IRHomeostatic Model Assessment of Insulin Resistance;IQRinterquartile range;IVGTTintravenous glucose tolerance test;LC-MSliquid chromatography–mass spectrometry;LODlimit of detection;MS/MStandem mass spectrometry;PFASper- and polyfluoroalkyl substances;PFHxSperfluorohexanesulfonic acid;PFNAperfluorononanoic acid;PFOSperfluorooctanesulfonic acid;RYGBRoux-en-Y gastric bypass;SDstandard deviation;SEstandard error;SIsensitivity index;UABUniversity of Alabama at Birmingham