Global Serum Per- and Polyfluoroalkyl Substances Exposures and Their Correlation with Lipids: A Systematic Review and Meta-Analysis

Exposure to PFAS is associated with alterations in serum lipids, although findings across studies remain inconsistent. To clarify these associations, we conducted a systematic review and meta-analysis of 74 epidemiological studies published through December 2023, examining PFAS exposure in adults, children, and pregnant women across both high and general exposure settings. Legacy PFAS, including PFOS, PFOA, PFNA, PFHxS, and PFDA, were the most frequently reported. Geographic variations had little impact on PFAS concentrations, whereas studies conducted near contamination sources showed higher serum PFAS concentrations. Meta-analyses and sign tests demonstrated positive associations between PFOA and PFOS exposure and increased total cholesterol and low-density lipoprotein cholesterol levels in adults, with no clear evidence for associations with high-density lipoprotein cholesterol or total triglyceride. Studies on pregnant women did not show significant associations between PFAS and lipids in either meta-analyses or sign tests. Newly published studies from January 2024 to May 2025 further support and expand upon these results. Limitations of existing studies include a primary focus on legacy PFAS, with less attention on PFAS alternatives and mixtures.