What are PFAS and why “forever chemicals”
Per‑ and poly‑fluoroalkyl substances (PFAS) are a large family of synthetic chemicals used for decades in products like non-stick cookware, stain-resistant fabrics, firefighting foams, food packaging, waterproof clothing and more.
They are termed “forever chemicals” because their carbon-fluorine bonds are extremely strong, making them persistent in the environment and in human bodies.
PFAS exposure is now nearly ubiquitous, and this has raised concerns for a variety of health outcomes including metabolic disorders.
The disease: MASLD in Youth and Obesity
Metabolic dysfunction‑associated steatotic liver disease (formerly often called non-alcoholic fatty liver disease or NAFLD) is a condition in which excess fat accumulates in the liver, along with metabolic dysfunction (insulin resistance, dyslipidaemia, inflammation).
In adolescents with obesity the prevalence of MASLD is substantial: the USC team notes that among youth with obesity, more than ~30% may have MASLD.
MASLD in youth is concerning because it may progress to more serious liver injury – inflammation, fibrosis, cirrhosis – and is associated with greater risk of type 2 diabetes, cardiovascular disease and long-term liver complications.
Key Study: PFHpA and MASLD in Adolescents With Obesity
A recent study published in Communications Medicine by researchers at Keck School of Medicine of USC and their partners looked at adolescents with obesity who were undergoing bariatric surgery (the Teen‑Longitudinal Assessment of Bariatric Surgery (Teen‑LABS) cohort).
They measured plasma levels of PFAS including PFHpA and linked these to liver biopsy or other liver assessments. They found that a doubling of PFHpA levels was associated with approximately an ~80% higher odds (OR ≈ 1.8) of MASLD diagnosis in these adolescents.
Moreover, higher PFHpA was associated not only with presence of MASLD but with more advanced liver injury – inflammation and fibrosis – suggesting the chemical may influence severity.
In parallel, in vitro experiments using 3D human liver spheroids exposed to PFHpA revealed molecular mechanisms: perturbation of pathways involved in lipid metabolism, oxidative stress, inflammation and cellular injury.
Thus this translational work (human + lab) supports biologic plausibility for PFHpA contributing to liver disease progression in obese adolescents.
Why This Finding Matters
Adolescents with obesity are already at elevated risk for MASLD; identifying modifiable environmental exposures adds another layer to prevention.
That PFHpA (a less-recognized PFAS congener) is implicated indicates the problem goes beyond the “legacy” PFAS (such as PFOS/PFOA) and that newer/less-studied PFAS may also carry risk.
It raises questions of environmental justice, as populations with higher PFAS exposure (via water, food packaging, industrial contamination) may face increased metabolic-liver risk in youth.
It suggests that reducing PFAS exposure might become part of strategies for liver health in adolescents with obesity.
Public Health & Practical Implications
Clinicians managing adolescents with obesity and MASLD should consider environmental exposures as a contributing factor—not just diet, exercise, genetics.
Public health efforts to reduce PFAS exposures (in drinking water, food packaging, consumer products) may provide benefit not only for toxicology but for metabolic/liver disease prevention.
Families may be advised to reduce PFAS exposure where possible (e.g., avoiding nonstick cookware, minimizing certain packaging, using purified water if local contamination is known) although individual actions alone do not fully offset systemic exposure.
For countries like India (and especially cities like Mumbai), monitoring of PFAS in water supplies, food packaging and consumer goods becomes relevant—especially given rising adolescent obesity rates.
