Abstract
Chlorinated polyfluorinated ether sulfonic acids (Cl-PFESAs, including 6:2 Cl-PFESA and 8:2 Cl-PFESA), one of poly- and perfluoroalkyl substances (PFAS), used as perfluorooctane sulfonate (PFOS) alternatives in electroplating industry. Evidence in vivo and in vitro indicates that Cl-PFESAs might disrupt lipid metabolism. However, the association between Cl-PFESAs exposure and the prevalence of overweight/obesity in human is unknown. We conducted a cross-sectional study to investigate associations of serum 6:2 Cl-PFESA and 8:2 Cl-PFESA exposure with overweight/obesity status in adults. We quantified four perfluoroalkyl substances (PFAS), including 6:2 Cl-PFESA, 8:2 Cl-PFESA, PFOS, and perfluorooctanoic acid (PFOA) in 1275 Chinese adults from the Isomers of C8 Health Project in China study. Characteristics of participants were gathered from interviewer-administered questionnaires and anthropometric measurements. We classified overweight/obesity based on body mass index (BMI) according to WHO. Participants were categorized into normal weight group (BMI < 25 kg/m2) and overweight/obesity group (BMI ≥ 25 kg/m2). The detection proportion of 6:2 Cl-PFESA was 100% among the participants in this study. Adjusted for potential confounders, BMI in the second quartile of each ln-ng/mL greater concentration of 6:2 Cl-PFESA and 8:2 Cl-PFESA was 0.45 [95% confidence interval (CI): 0.08, 0.82], and 0.39 (95% CI:0.03, 0.76) significantly higher than the lowest quartile, respectively. Cl-PFESAs displayed inverted U-shaped associations with the risk of overweight/obesity, and the inflection point of 6:2 Cl-PFESA and 8:2 Cl-PFESA was 1.80 ng/mL, 0.01 ng/mL, respectively. For example, The risk of overweight/obesity increased (OR= 1.94; 95%CI: 1.24, 3.01) until around 1.80 ng/mL of predicted 6:2 Cl-PFESA concentration and then decreased (OR= 0.69; 95%CI: 0.39, 1.21). PFOS was associated with waist circumference (WC) but not BMI in each quartile. For PFOA, the associations with outcomes were linearly positive (P for trend < 0.05). This study reports the first observations on non-monotonic associations between serum 6:2 Cl-PFESA and 8:2 Cl-PFESA concentrations and the prevalence of overweight/obesity in adults. Our findings suggest that Cl-PFESAs may have endocrine disrupting characteristics, and this exposure-outcome association is a challenge for risk assessment of Cl-PFESAs. But more epidemiological investigations are required to confirm the observed associations.
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References
Aas CB, Fuglei E, Herzke D, Yoccoz NG, Routti H (2014) Effect of body condition on tissue distribution of perfluoroalkyl substances (PFASs) in Arctic fox (Vulpes lagopus). Environ Sci Technol 48:11654–11661. https://doi.org/10.1021/es503147n
Audrain-McGovern J, Benowitz NL (2011) Cigarette smoking, nicotine, and body weight. Clin Pharmacol Ther 90:164–168. https://doi.org/10.1038/clpt.2011.105
Averina M, Brox J, Huber S, Furberg AS (2021) Exposure to perfluoroalkyl substances (PFAS) and dyslipidemia, hypertension and obesity in adolescents. Fit Futur Study, Environ Res 195:110740. https://doi.org/10.1016/j.envres.2021.110740
Bao WW, Qian ZM, Geiger SD, Liu E, Liu Y, Wang SQ, Lawrence WR, Yang BY, Hu LW, Zeng XW, Dong GH (2017) Gender-specific associations between serum isomers of perfluoroalkyl substances and blood pressure among Chinese: isomers of C8 Health Project in China. Sci Total Environ 607–608:1304–1312. https://doi.org/10.1016/j.scitotenv.2017.07.124
Basterfield L, Jones AR, Parkinson KN, Reilly J, Pearce MS, Reilly JJ, Adamson AJ, Gateshead T (2014) Millennium Study Core, physical activity, diet and BMI in children aged 6–8 years: a cross-sectional analysis. BMJ Open 4:e005001. https://doi.org/10.1136/bmjopen-2014-005001
Brantsaeter AL, Whitworth KW, Ydersbond TA, Haug LS, Haugen M, Knutsen HK, Thomsen C, Meltzer HM, Becher G, Sabaredzovic A, Hoppin JA, Eggesbo M, Longnecker MP (2013) Determinants of plasma concentrations of perfluoroalkyl substances in pregnant Norwegian women. Environ Int 54:74–84. https://doi.org/10.1016/j.envint.2012.12.014
Brase RA, Mullin EJ, Spink DC (2021) Legacy and emerging per- and polyfluoroalkyl substances: analytical techniques. Environ Fate Health Effects Int J Mol Sci 22:995. https://doi.org/10.3390/ijms22030995
Carreras-Torres R, Johansson M, Haycock PC, Relton CL, Davey Smith G, Brennan P, Martin RM (2018) Role of obesity in smoking behaviour: Mendelian randomisation study in UK Biobank. BMJ. https://doi.org/10.1136/bmj.k1767
Chamorro-Garcia R, Veiga-Lopez A (2021) The new kids on the block: emerging obesogens. Adv Pharmacol 92:457–484. https://doi.org/10.1016/bs.apha.2021.05.003
Chen F, Yin S, Kelly BC, Liu W (2017) Chlorinated polyfluoroalkyl ether sulfonic acids in matched maternal, cord, and placenta samples: a study of transplacental transfer. Environ Sci Technol 51:6387–6394. https://doi.org/10.1021/acs.est.6b06049
Chen A, Jandarov R, Zhou L, Calafat AM, Zhang G, Urbina EM, Sarac J, Augustin DH, Caric T, Bockor L, Petranovic MZ, Novokmet N, Missoni S, Rudan P, Deka R (2019) Association of perfluoroalkyl substances exposure with cardiometabolic traits in an island population of the eastern Adriatic coast of Croatia. Sci Total Environ 683:29–36. https://doi.org/10.1016/j.scitotenv.2019.05.250
Chiolero A, Faeh D, Paccaud F, Cornuz J (2008) Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr 87:801–809. https://doi.org/10.1093/ajcn/87.4.801
Choi SI, Kwon HY, Han X, Men X, Choi YE, Jang GW, Park KT, Han J, Lee OH (2021) Environmental obesogens (bisphenols, phthalates and parabens) and their impacts on adipogenic transcription factors in the absence of dexamethasone in 3T3-L1 cells. J Steroid Biochem Mol Biol 214:105994. https://doi.org/10.1016/j.jsbmb.2021.105994
Christensen KY, Raymond M, Thompson BA, Anderson HA (2016) Perfluoroalkyl substances in older male anglers in Wisconsin. Environ Int 91:312–318. https://doi.org/10.1016/j.envint.2016.03.012
Chu C, Zhou Y, Li Q-Q, Bloom MS, Lin S, Yu Y-J, Chen D, Yu H-Y, Hu L-W, Yang B-Y, Zeng X-W, Dong G-H (2020) Are perfluorooctane sulfonate alternatives safer? New Insights Birth Cohort Study Environ Int 135:105365. https://doi.org/10.1016/j.envint.2019.105365
CMoH, Chinese Ministry of Health. Anthropometric measurements method in health surveillance. http://www.chinacdc.cn/jkzt/yyhspws/xzdc/201501/P020170721492982626973.pdf, in, 2013.
Cong J, Chu C, Li QQ, Zhou Y, Min Qian Z, Dee Geiger S, Vaughn MG, Zeng XW, Liu RQ, Hu LW, Yang BY, Chen G, Zeeshan M, Sun X, Xiang M, Dong GH (2021) Associations of perfluorooctane sulfonate alternatives and serum lipids in Chinese adults. Environ Int 155:106596. https://doi.org/10.1016/j.envint.2021.106596
Cui Q, Pan Y, Zhang H, Sheng N, Wang J, Guo Y, Dai J (2018) Occurrence and tissue distribution of novel perfluoroether carboxylic and sulfonic acids and legacy per/polyfluoroalkyl Substances in black-spotted frog (Pelophylax nigromaculatus). Environ Sci Technol 52:982–990. https://doi.org/10.1021/acs.est.7b03662
Cui Q, Pan Y, Wang J, Liu H, Yao B, Dai J (2020) Exposure to per- and polyfluoroalkyl substances (PFASs) in serum versus semen and their association with male reproductive hormones. Environ Pollut 266:115330. https://doi.org/10.1016/j.envpol.2020.115330
Dhore R, Murthy GS (2021) Per/polyfluoroalkyl substances production, applications and environmental impacts. Bioresour Technol 341:125808. https://doi.org/10.1016/j.biortech.2021.125808
Egusquiza RJ, Blumberg B (2020) Environmental obesogens and their impact on susceptibility to obesity: new mechanisms and chemicals. Endocrinology 161:bqaa024. https://doi.org/10.1210/endocr/bqaa024
Eriksen KT, Sorensen M, McLaughlin JK, Tjonneland A, Overvad K, Raaschou-Nielsen O (2011) Determinants of plasma PFOA and PFOS levels among 652 Danish men. Environ Sci Technol 45:8137–8143. https://doi.org/10.1021/es100626h
Fabrega F, Kumar V, Schuhmacher M, Domingo JL, Nadal M (2014) PBPK modeling for PFOS and PFOA: validation with human experimental data. Toxicol Lett 230:244–251. https://doi.org/10.1016/j.toxlet.2014.01.007
Flegal KM, Kit BK, Orpana H, Graubard BI (2013) Association of all-cause mortality with overweight and obesity using standard body mass index categories a systematic review and meta-analysis. Jama-J Am Med Assoc 309:71–82. https://doi.org/10.1001/jama.2012.113905
Geiger SD, Yao P, Vaughn MG, Qian Z (2021) PFAS exposure and overweight/obesity among children in a nationally representative sample. Chemosphere 268:128852. https://doi.org/10.1016/j.chemosphere.2020.128852
C.M. Hales, M.D. Carroll, C.D. Fryar, C.L. Ogden, Prevalence of Obesity Among Adults and Youth: United States, 2015–2016, in: NCHS Data Brief, 2017, pp. 1–8.
Hankinson AL, Daviglus ML, Bouchard C, Carnethon M, Lewis CE, Schreiner PJ, Liu K, Sidney S (2010) Maintaining a high physical activity level over 20 years and weight gain. JAMA 304:2603–2610. https://doi.org/10.1001/jama.2010.1843
Haslam DW, James WPT (2005) Obesity. Lancet 366:1197–1209. https://doi.org/10.1016/s0140-6736(05)67483-1
Heindel JJ, Blumberg B (2019) Environmental obesogens: mechanisms and controversies. Annu Rev Pharmacol Toxicol 59:89–106. https://doi.org/10.1146/annurev-pharmtox-010818-021304
Hornung RW (1990) Reed, laurence D., estimation of average concentration in the presence of nondetectable values. Appl Occup Environ Hyg 5:46–51. https://doi.org/10.1080/1047322X.1990.10389587
Huynh T, Ramachandran G, Banerjee S, Monteiro J, Stenzel M, Sandler DP, Engel LS, Kwok RK, Blair A, Stewart PA (2014) Comparison of methods for analyzing left-censored occupational exposure data. Ann Occup Hyg 58:1126–1142. https://doi.org/10.1093/annhyg/meu067
Jaacks LM, Vandevijvere S, Pan A, McGowan CJ, Wallace C, Imamura F, Mozaffarian D, Swinburn B, Ezzati M (2019) The obesity transition: stages of the global epidemic. Lancet Diabetes Endocrinol 7:231–240. https://doi.org/10.1016/s2213-8587(19)30026-9
Jain RB (2014) Contribution of diet and other factors to the levels of selected polyfluorinated compounds: data from NHANES 2003–2008. Int J Hyg Environ Health 217:52–61. https://doi.org/10.1016/j.ijheh.2013.03.008
Jain RB (2020) Impact of the co-occurrence of obesity with diabetes, anemia, hypertension, and albuminuria on concentrations of selected perfluoroalkyl acids. Environ Pollut 266:115207. https://doi.org/10.1016/j.envpol.2020.115207
Lagarde F, Beausoleil C, Belcher SM, Belzunces LP, Emond C, Guerbet M, Rousselle C (2015) Non-monotonic dose-response relationships and endocrine disruptors: a qualitative method of assessment. Environ Health 14:13. https://doi.org/10.1186/1476-069X-14-13
Li CH, Ren XM, Ruan T, Cao LY, Xin Y, Guo LH, Jiang G (2018) Chlorinated polyfluorinated ether sulfonates exhibit higher activity toward peroxisome proliferator-activated receptors signaling pathways than perfluorooctanesulfonate. Environ Sci Technol 52:3232–3239. https://doi.org/10.1021/acs.est.7b06327
Liao S, Yao W, Cheang I, Tang X, Yin T, Lu X, Zhou Y, Zhang H, Li X (2020) Association between perfluoroalkyl acids and the prevalence of hypertension among US adults. Ecotoxicol Environ Saf 196:110589. https://doi.org/10.1016/j.ecoenv.2020.110589
Lin CY, Chen PC, Lin YC, Lin LY (2009) Association among serum perfluoroalkyl chemicals, glucose homeostasis, and metabolic syndrome in adolescents and adults. Diabetes Care 32:702–707. https://doi.org/10.2337/dc08-1816
Liu G, Dhana K, Furtado JD, Rood J, Zong G, Liang L, Qi L, Bray GA, DeJonge L, Coull B, Grandjean P, Sun Q (2018) Perfluoroalkyl substances and changes in body weight and resting metabolic rate in response to weight-loss diets: a prospective study. PLoS Med 15:e1002502. https://doi.org/10.1371/journal.pmed.1002502
Liu X, Chen D, Wang B, Xu F, Pang Y, Zhang L, Zhang Y, Jin L, Li Z, Ren A (2020a) Does low maternal exposure to per- and polyfluoroalkyl substances elevate the risk of spontaneous preterm birth? Nested Case-Control Study in China. Environ Sci Technol 54:8259–8268. https://doi.org/10.1021/acs.est.0c01930
Liu H, Pan Y, Jin S, Li Y, Zhao L, Sun X, Cui Q, Zhang B, Zheng T, Xia W, Zhou A, Campana AM, Dai J, Xu S (2020b) Associations of per-/polyfluoroalkyl substances with glucocorticoids and progestogens in newborns. Environ Int. https://doi.org/10.1016/j.envint.2020b.105636
Nadal A, Quesada I, Tuduri E, Nogueiras R, Alonso-Magdalena P (2017) Endocrine-disrupting chemicals and the regulation of energy balance. Nat Rev Endocrinol 13:536–546. https://doi.org/10.1038/nrendo.2017.51
Nelson JW, Hatch EE, Webster TF (2010) Exposure to polyfluoroalkyl chemicals and cholesterol, body weight, and insulin resistance in the general U.S. population. Environ Health Perspect 118:197–202. https://doi.org/10.1289/ehp.0901165
Pan Y, Zhu Y, Zheng T, Cui Q, Buka SL, Zhang B, Guo Y, Xia W, Yeung LW, Li Y, Zhou A, Qiu L, Liu H, Jiang M, Wu C, Xu S, Dai J (2017) Novel chlorinated polyfluorinated ether sulfonates and legacy per-/polyfluoroalkyl substances: placental transfer and relationship with serum albumin and glomerular filtration rate. Environ Sci Technol 51:634–644. https://doi.org/10.1021/acs.est.6b04590
Pan Y, Qin H, Liu W, Zhang Q, Zheng L, Zhou C, Quan X (2019) Effects of chlorinated polyfluoroalkyl ether sulfonate in comparison with perfluoroalkyl acids on gene profiles and stemness in human mesenchymal stem cells. Chemosphere 237:124402. https://doi.org/10.1016/j.chemosphere.2019.124402
Riaz H, Khan MS, Siddiqi TJ, Usman MS, Shah N, Goyal A, Khan SS, Mookadam F, Krasuski RA, Ahmed H (2018) Association between obesity and cardiovascular outcomes: a systematic review and meta-analysis of mendelian randomization studies. JAMA Netw Open 1:e183788. https://doi.org/10.1001/jamanetworkopen.2018.3788
Richardson DB, Ciampi A (2003) Effects of exposure measurement error when an exposure variable is constrained by a lower limit. Am J Epidemiol 157:355–363. https://doi.org/10.1093/aje/kwf217
Schisterman EF, Vexler A, Whitcomb BW, Liu A (2006) The limitations due to exposure detection limits for regression models. Am J Epidemiol 163:374–383. https://doi.org/10.1093/aje/kwj039
Schulz K, Silva MR, Klaper R (2020) Distribution and effects of branched versus linear isomers of PFOA PFOS, and PFHxS: a review of recent literature. Sci Total Environ 733:139186. https://doi.org/10.1016/j.scitotenv.2020.139186
Sheng N, Cui R, Wang J, Guo Y, Wang J, Dai J (2018) Cytotoxicity of novel fluorinated alternatives to long-chain perfluoroalkyl substances to human liver cell line and their binding capacity to human liver fatty acid binding protein. Arch Toxicol 92:359–369. https://doi.org/10.1007/s00204-017-2055-1
Shi Y, Vestergren R, Xu L, Zhou Z, Li C, Liang Y, Cai Y (2016) Human exposure and elimination kinetics of chlorinated polyfluoroalkyl ether sulfonic acids (Cl-PFESAs). Environ Sci Technol 50:2396–2404. https://doi.org/10.1021/acs.est.5b05849
Shi G, Cui Q, Wang J, Guo H, Pan Y, Sheng N, Guo Y, Dai J (2019) Chronic exposure to 6:2 chlorinated polyfluorinated ether sulfonate acid (F-53B) induced hepatotoxic effects in adult zebrafish and disrupted the PPAR signaling pathway in their offspring. Environ Pollut 249:550–559. https://doi.org/10.1016/j.envpol.2019.03.032
Sim F (2015) Alcoholic drinks contribute to obesity and should come with mandatory calorie counts. BMJ 350:h2047. https://doi.org/10.1136/bmj.h2047
Sunderland EM, Hu XC, Dassuncao C, Tokranov AK, Wagner CC, Allen JG (2019) 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 29:131–147. https://doi.org/10.1038/s41370-018-0094-1
Taxvig C, Dreisig K, Boberg J, Nellemann C, Schelde AB, Pedersen D, Boergesen M, Mandrup S, Vinggaard AM (2012) Differential effects of environmental chemicals and food contaminants on adipogenesis, biomarker release and PPARgamma activation. Mol Cell Endocrinol 361:106–115. https://doi.org/10.1016/j.mce.2012.03.021
Tian YP, Zeng XW, Bloom MS, Lin S, Wang SQ, Yim SHL, Yang M, Chu C, Gurram N, Hu LW, Liu KK, Yang BY, Feng D, Liu RQ, Nian M, Dong GH (2019) Isomers of perfluoroalkyl substances and overweight status among Chinese by sex status: ISOMERS of C8 Health Project in China. Environ Int 124:130–138. https://doi.org/10.1016/j.envint.2019.01.006
Timmermann CA, Rossing LI, Grontved A, Ried-Larsen M, Dalgard C, Andersen LB, Grandjean P, Nielsen F, Svendsen KD, Scheike T, Jensen TK (2014) Adiposity and glycemic control in children exposed to perfluorinated compounds. J Clin Endocrinol Metab 99:E608-614. https://doi.org/10.1210/jc.2013-3460
Tu W, Martinez R, Navarro-Martin L, Kostyniuk DJ, Hum C, Huang J, Deng M, Jin Y, Chan HM, Mennigen JA (2019) Bioconcentration and metabolic effects of emerging PFOS alternatives in developing zebrafish. Environ Sci Technol 53:13427–13439. https://doi.org/10.1021/acs.est.9b03820
Vassilopoulou L, Psycharakis C, Petrakis D, Tsiaoussis J, Tsatsakis AM (2017) Obesity, persistent organic pollutants and related health problems. In: Engin AB, Engin A (eds) Obesity and lipotoxicity. Springer International Publishing, Cham, pp 81–110
Wang S, Huang J, Yang Y, Hui Y, Ge Y, Larssen T, Yu G, Deng S, Wang B, Harman C (2013) First report of a Chinese PFOS alternative overlooked for 30 years: its toxicity, persistence, and presence in the environment. Environ Sci Technol 47:10163–10170. https://doi.org/10.1021/es401525n
WHO, Obesity and overweight, https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight, in, 2021.
Wu Y, Deng M, Jin Y, Liu X, Mai Z, You H, Mu X, He X, Alharthi R, Kostyniuk DJ, Yang C, Tu W (2019) Toxicokinetics and toxic effects of a Chinese PFOS alternative F-53B in adult zebrafish. Ecotoxicol Environ Saf 171:460–466. https://doi.org/10.1016/j.ecoenv.2019.01.010
Xin Y, Wan B, Yu B, Fan Y, Chen LHG (2020) Chlorinated polyfluoroalkylether sulfonic acids exhibit stronger estrogenic effects than perfluorooctane sulfonate by activating nuclear estrogen receptor pathways. Environ Sci Technol 54:3455–3464. https://doi.org/10.1021/acs.est.9b07708
Yao J, Pan Y, Sheng N, Su Z, Guo Y, Wang J, Dai J (2020) Novel perfluoroalkyl ether carboxylic acids (PFECAs) and sulfonic Acids (PFESAs): occurrence and association with serum biochemical parameters in residents living near a fluorochemical plant in China. Environ Sci Technol 54:13389–13398. https://doi.org/10.1021/acs.est.0c02888
Yeung LW, So MK, Jiang G, Taniyasu S, Yamashita N, Song M, Wu Y, Li J, Giesy JP, Guruge KS, Lam PK (2006) Perfluorooctanesulfonate and related fluorochemicals in human blood samples from China. Environ Sci Technol 40:715–720. https://doi.org/10.1021/es052067y
Yu S, Feng WR, Liang ZM, Zeng XY, Bloom MS, Hu GC, Zhou Y, Ou YQ, Chu C, Li QQ, Yu Y, Zeng XW, Dong GH (2021) Perfluorooctane sulfonate alternatives and metabolic syndrome in adults: New evidence from the Isomers of C8 Health Project in China. Environ Pollut 283:117078. https://doi.org/10.1016/j.envpol.2021.117078
Zeeshan M, Yang Y, Zhou Y, Huang W, Wang Z, Zeng XY, Liu RQ, Yang BY, Hu LW, Zeng XW, Sun X, Yu Y, Dong GH (2020) Incidence of ocular conditions associated with perfluoroalkyl substances exposure: isomers of C8 Health Project in China. Environ Int 137:105555. https://doi.org/10.1016/j.envint.2020.105555
Zhang H, Zhou X, Sheng N, Cui R, Cui Q, Guo H, Guo Y, Sun Y, Dai J (2018) Subchronic hepatotoxicity effects of 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA), a novel perfluorooctanesulfonate (PFOS) alternative, on adult male mice. Environ Sci Technol 52:12809–12818. https://doi.org/10.1021/acs.est.8b04368
Acknowledgements
The authors thank all of participants in this study. The research was funded by National Key Research and Development Program of China [No. 2018YFE0106900], National Natural Science Foundation of China [No.82173471; No.82003409; No.82073503; No.M-0420; No.81903287; No. 81950410633], Fundamental Research Funds for the Central Universities [19ykjc01], Natural Science Foundation of Guangdong Province [No. 2021A1515012212; No. 2021A151011754; No. 2021B1515020015; No. 2020A1515011131; No. 2019A050510017; No. 2018B05052007; No. 2017A090905042], Science and Technology Program of Guangzhou [No. 201807010032; No. 201803010054; No. 201903010023], the Guangdong Basic and Applied Basic Research Foundation [2020B1515020001].
Funding
Funding was provided by National Key Research and Development Program of China (Grant No. 2018YFE0106900), National Natural Science Foundation of China (Grant Nos. 82173471, 82003409, 82073503, M-0420, 81903287, 81950410633), Fundamental Research Funds for Central Universities (19ykjc01) Natural Science Foundation of Guangdong Province (Grant Nos. 2021A1515012212, 2021A151011754, 2021B1515020015, 2020A1515011131, 2019A050510017, 2018B05052007, 2017A090905042), Science and Technology Program of Guangzhou (Grant No. 201807010032, 201803010054, 201903010023), the Guangdong Basic and Applied Basic Research Foundation (Grant No. 2020B1515020001).
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Chu, C., Fang, QL., Cui, XX. et al. Non-monotonic Association Between Chlorinated Polyfluorinated Ether Sulfonic Acids Exposure and the Risk of Overweight/Obesity Status in Adults. Expo Health 15, 539–549 (2023). https://doi.org/10.1007/s12403-022-00506-z
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DOI: https://doi.org/10.1007/s12403-022-00506-z