, Volume 57, Issue 3, pp 473–479 | Cite as

Circulating levels of perfluoroalkyl substances and prevalent diabetes in the elderly

  • Lars Lind
  • Björn Zethelius
  • Samira Salihovic
  • Bert van Bavel
  • P. Monica LindEmail author



Several environmental contaminants, such as polychlorinated biphenyls, dioxins, bisphenol A and phthalates, have been linked to diabetes. We therefore investigated whether other kinds of contaminants, perfluoroalkyl substances (PFAS), also called perfluorinated compounds (PFCs), are also associated with diabetes.


The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study investigated 1,016 men and women aged 70 years. Seven PFAS were detected in almost all participant sera by ultra-high performance liquid chromatograph/tandem mass spectrometry. Diabetes was defined as use of hypoglycaemic agents or fasting glucose >7.0 mmol/l.


114 people had diabetes. In the linear analysis, no significant relationships were seen between the seven PFAS and prevalent diabetes. However, inclusion of the quadratic terms of the PFAS revealed a significant non-linear relationship between perfluorononanoic acid (PFNA) and diabetes, even after adjusting for multiple confounders (OR 1.96, 95% CI 1.19, 3.22, p = 0.008 for the linear term and OR 1.25, 95% CI 1.08, 1.44, p = 0.002 for the quadratic term). Perfluorooctanoic acid (PFOA) also showed such a relationship (p = 0.01). PFOA was related to the proinsulin/insulin ratio (a marker of insulin secretion), but none of the PFAS was related to the HOMA-IR (a marker of insulin resistance) following adjustment for multiple confounders.


PFNA was related to prevalent diabetes in a non-monotonic fashion in this cross-sectional study, supporting the view that this perfluoroalkyl substance might influence glucose metabolism in humans at the level of exposure seen in the general elderly population.


Diabetes Elderly Environmental contaminants Epidemiology Insulin Perfluoroalkyl substances 



Linear isomer of perfluorooctane sulfonic acid


Polychlorinated biphenyl


Perfluoroalkyl substances


Perfluorobutane sulfonic acid


Perfluorinated compound


Perfluorodecanoic acid


Perfluorodecane sulfonic acid


Perfluorododecanoic acid


Perfluoroheptanoic acid


Perfluorohexanoic acid


Perfluorohexane sulfonic acid


Perfluorononanoic acid


Perfluorooctanoic acid


Perfluorooctane sulfonic acid


Perfluorooctane sulfonamide


Perfluoropentanoic acid


Perfluorotridecanoic acid


Perfluoroundecanoic acid


Prospective Investigation of the Vasculature in Uppsala Seniors


Peroxisome proliferator-activated receptor



This study was supported by the Swedish Research Council (VR) and the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (FORMAS).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript. No potential conflicts of interest relevant to this article were reported. BZ is employed by the Medical Products Agency (MPA), Uppsala, Sweden, and the views of the present study are not necessarily official views of the MPA.

Contribution statement

PML conceived the project and contributed to critical revision of the manuscript for important intellectual content. BZ was responsible for laboratory analyses of insulin and proinsulin measurements. LL performed data analysis. Also, LL is principal investigator of PIVUS and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SS and BvB performed the analysis of the PFAS. LL wrote the first draft of the manuscript. All authors contributed to critical revision of the manuscript and approved the final version of the manuscript.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Lars Lind
    • 1
  • Björn Zethelius
    • 2
    • 3
  • Samira Salihovic
    • 1
    • 4
  • Bert van Bavel
    • 4
  • P. Monica Lind
    • 5
    Email author
  1. 1.Department of Medical Sciences, Cardiovascular EpidemiologyUppsala UniversityUppsalaSweden
  2. 2.Department of Public Health/GeriatricsUppsala UniversityUppsalaSweden
  3. 3.Medical Product AgencyUppsalaSweden
  4. 4.MTM Research CentreÖrebro UniversityÖrebroSweden
  5. 5.Department of Medical Sciences, Occupational and Environmental MedicineUppsala UniversityUppsalaSweden

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