A Lifestyle Intervention of Exercise and Diet Attenuates Obesogenic Associations of Per- and Polyfluoroalkyl Substances: Results from the Diabetes Prevention Program

摘要

Background: Per- and polyfluoroalkyl substances (PFASs) are ubiquitous synthetic chemicals, widely detected across populations and suspected endocrine disruptors. We sought to determine the extent to which PFASs are prospectively associated with weight and body size and evaluate if a lifestyle intervention modifies this association. Methods: We utilized data from the Diabetes Prevention Program trial (DPP; 1996-2001) and Outcomes Study (DPPOS; 2002-2014) of participants initially randomized to a lifestyle intervention or placebo and followed for up to 15 years. The lifestyle intervention consisted of training in diet, physical activity, and behavior modification with the major goals of achieving 7% weight loss and 150 min/week physical activity. Participants randomized to placebo received standard information about diet and exercise. We quantified six plasma PFASs at baseline and two years post randomization, and calculated total PFAS by summing the means of the two measurements. Results: In this sample, 481 participants were initially randomized to a lifestyle intervention and 476 to placebo. PFAS concentrations were not different by treatment and similar to concentrations reported for the U.S. population in 1999-2000. Each doubling in total PFAS concentration was associated with 1.03-cm increase in hip girth during DPP (95% CI: 0.18, 1.88; P=0.017), an increase of 1.80-kg in weight from baseline to 9 years post-randomization (95% CI: 0.43, 3.17; P=0.01) and greater waist circumference trajectories (P=0.001) for the placebo group. No adverse associations were observed for the lifestyle intervention group. Conclusions: Among adults at high risk for diabetes we observed that higher plasma PFAS concentration was associated with increases in weight, waist circumference and hip girth, but a lifestyle intervention attenuated these associations. Our results suggest that diet and exercise may mitigate obesogenic effects of environmental chemicals.