Skip to main content

Currently Skimming:

Appendix E: White Paper: Review of the PFAS Personal Intervention Literature
Pages 240-280

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 240...
... Appendix E White Paper: Review of the PFAS Personal Intervention Literature Prepared for: Elizabeth B Boyle Senior Program Officer Board on Environmental Studies and Toxicology Board on Population Health and Public Health Practice National Academies of Sciences, Engineering, and Medicine and Committee on the Guidance on PFAS Testing and Health Outcomes Washington, DC, USA Prepared by: Judy S
From page 241...
... 250 Food Preparation: Fish, Shellfish, and Mollusks, 250 Food Preparation: Other, 253 Local Food Consumption Advisories, 254 Drinking Water, 255 Breast Milk and Infant Formula, 258 Indoor Dust, 264 Other Potential Interventions, 264 Modeled Intakes as the Basis for Recommendations for Reducing Exposure to PFAS, 265 E-4 DISCUSSION .................................................................................................................................
From page 242...
... acetic acid MRL Minimum Reporting Level n-EtPFOSAA n-ethyl-perfluoro-1 octanesulfonamido acetic acid. n-MePFOSAA n-methylperfluoro-1 octanesulfonamido acetic acid n-PFOA n-perfluorooctanoic acid n-PFOS n-perfluorooctane sulfonic acid NEtFOSE N-ethyl perfluorooctane sulfonamidoethanol NHANES National Health and Nutrition Examination Survey NIEHS National Institute of Environmental Health Sciences PBDE polybrominated diphenyl ether PCB polychlorinated biphenyl PFAA perfluoroalkyl acid PFAS per- and polyfluoroalkyl substances PFBA perfluorobutanoate PFBS perfluorobutane sulfonic acid PFC perfluorinated compound PFCA perfluoroalkyl carboxylic acid PFDA perfluorodecanoic acid PFDcA perfluorodecanoate PFDoA (PFDoDA)
From page 243...
... Appendix E 243 PFHpA perfluoroheptanoic acid PFHpS perfluoroheptane sulfonate PFHxA perfluorohexanoate PFHxS perfluorohexane sulfonic acid PFNA perfluorononanoic acid PFOA perfluorooctanoic acid PFOS perfluorooctane sulfonic acid PFOSA or FOSA perfluorooctane sulfonamide PFPeA perfluoropentanoate PFTeA perfluorotetradecanoate PFTeDA perfluorotetradecanoic acid PFTrA perfluorotridecanoate PFTrDA perfluorotridecanoic acid PFUA perfluoroundecanoate PFUnA perfluoroundecanoic acid PFUnDA perfluoroundecanoic acid POE point of entry POTW publicly owned treatment work POU point of use RO reverse osmosis Sb-PFOA branched perfluorooctanoic acid SD standard deviation Sm-PFOS perfluoromethylheptane sulfonic acid UCMR Unregulated Contaminant Monitoring Rule ww wet weight
From page 244...
... Breastfeeding is an important potential source of exposure for infants; the effect of lactation on mothers' PFAS levels is unclear. For communities with high levels of PFAS in drinking water, interventions related to tap water filtration showed some efficacy in reducing PFAS levels in the water.
From page 245...
... , exposure to PFAS is ongoing. It has been well documented that PFAS are present in numerous media and products, including drinking water; breast milk; other foods and food packaging material; cosmetics; and household products, including carpets, stain- and water-repellent fabrics, nonstick products, polishes, waxes, paints, and cleaning products (D'Hollander et al., 2010; EFSA, 2020; Eichler and Little, 2020; Fromme et al., 2009; Sajid and Ilyas, 2017; Sunderland et al., 2019)
From page 246...
... Second, "effectively" refers to changes in personal behavior that can result in measurable or substantial reductions in exposures. FIGURE E-1 Human PFAS exposure pathways.
From page 247...
... In this case, a reduction in the PFAS source may not result in a meaningful reduction in human PFAS exposure. Fourth, actions to reduce PFAS exposure from one pathway may result in exposure to PFAS or other chemicals from a new pathway (e.g., an action to remove exposure to one food item with known PFAS levels may result in exposure to another food item that has not yet been analyzed for PFAS or other chemicals)
From page 248...
... We used such keywords as "(PFBS OR PFDA OR PFDoA OR PFHpA OR PFHxS OR PFNA OR PFOA OR n-PFOA OR sb-PFOA OR PFOS OR n-PFOS OR Sm-PFOS OR PFOSA OR FOSA OR EtFOSAA OR MeFOSAA OR PFUnDA OR PFAS) ," "PFAS," "perfluoroalkyl," "human," "exposure," "cooking," "dust," "fish," "shellfish," "water," "nail polish," "cleaning," "consumer products," "filter," "water filter," "filtration," "intervention," "determinant," "reduction," "diet," "vacuum," "popcorn," "biomonitor," "breast milk," "breastfeeding," "infant formula," "milk powder," "carpeting," "packaging," "indoor," "bottled water," "air conditioning," "fabrics," "well water," "water treatment," "apparel," "inhalation," "ventilation," "cosmetics," "dental floss," and "personal care products," as well as various combinations of these and related keywords.
From page 249...
... To assess the utility of the available evidence for providing recommendations for behavior modifications to reduce PFAS exposures, we examined such factors as (1) the number of available studies for each medium/PFAS chemical/intervention type combination, (2)
From page 250...
... Literature on breast milk/infant formula and both mother and infant PFAS exposure reduction is discussed. Finally, studies on source contributions to overall PFAS intake in the United States were identified.
From page 251...
... While cooking with potatoes further reduced PFAS levels in the mackerel, it also increased the levels in the potatoes.
From page 252...
... The results from the studies reviewed here indicate that the effects of preparation of fish and shellfish on PFAS levels are inconsistent (examples are shown in Figure E-3)
From page 253...
... FOOD PREPARATION: OTHER Two studies were identified that examined the effect of preparation on PFAS levels in foods other than fish (Binnington et al., 2017; Jogsten et al., 2009)
From page 254...
... TABLE E-1 Summary of Results of Studies Examining the Effect of Food Preparation on PFAS Levels Study Food Source PFAS Location Type Number Concentration Jogsten et al., PFBuS Spain Beef, pork, Two composite samples from at PFOS, ng/g fresh weight 2009 PFHxS chicken least six subsamples for each food (standard deviation) PFOS type from each of two sampling Veal PFHxA locations raw: <0.015 PFHpA grilled: <0.008 PFOA fried: <0.018 PFNA Pork PFDA raw: <0.008 PFUnDA grilled: 0.011 (0.009)
From page 255...
... The second addresses whether the use of purchased bottled water results in lower PFAS exposure compared with the use of tap water. Because PFAS levels in water can vary widely, we focus on studies that measured PFAS in tap and bottled water obtained from the same geographic area.
From page 256...
... conclude that household water purifiers are effective at reducing PFAS levels in drinking water. Patterson and colleagues (2019)
From page 257...
... These studies suggest that pitcher-type, POE, and POU filtration systems can reduce PFAS levels in drinking water under the conditions tested. It is worth noting that optimal filtration depends on the user's actively maintaining these devices, and no study has yet looked at the effectiveness of these interventions in real-world circumstances.9 Bottled Water (Versus Tap Water)
From page 258...
... As described above, while PFAS levels in bottled water tend to be approximately between
From page 259...
... . At the same time, breast milk includes environmental chemicals (LaKind et al., 2001, 2018; Lehmann et al., 2018)
From page 260...
... , it is instructive to review available data on levels of PFAS in breast milk versus infant formula in the United States to assess whether levels in formula are lower than those found in breast milk. As an additional complication, it is not uncommon to purchase powdered formula and reconstitute it with drinking water.
From page 261...
... reviewed the international literature on PFAS levels in bottled water (with none from the United States) and report levels of various PFAS in the low ng/L range, with some levels as high as the low 100s ng/L depending on the type and number of PFAS included in the reporting.
From page 262...
... FIGURE E-6 Limited data on PFAS levels in breast milk and infant formula in the United States show general overlapping concentrations, which also overlap with PFAS concentrations in drinking water that could be used to reconstitute formula. NOTES: Double-headed arrows indicate that these bars could extend in either direction as new data are obtained.
From page 263...
... Another approach to assessing the impact of breastfeeding on maternal PFAS exposure is to examine changes in PFAS levels in breast milk over the course of lactation. If stores of PFAS predominate over current exposures via diet and other sources, and if lactation resulted in mobilization and excretion of those stores, then lactation (with either breastfeeding or "pump-and-dump")
From page 264...
... Second, a single measurement may not capture the infant's actual exposure as PFAS levels in milk may change over the duration of lactation, and the direction and rate of change are not well understood. INDOOR DUST Dust is a potential exposure pathway for PFAS compounds (Trudel et al., 2008)
From page 265...
... Fiber Intake Studies have observed relationships between higher fiber intake and lower serum PFAS levels (e.g., PFOA, PFOS, and PFNA [Dzierlenga et al., 2021] ; PFOS and PFOA [Halldorsson et al., 2008]
From page 266...
... PFOA levels in drinking water were estimated from surface water concentrations in various parts of the United States (New York, North Carolina, New Jersey [drinking water] , Great Lakes, Tennessee, and Florida)
From page 267...
... SOURCE: Data from Sunderland et al., 2019. FIGURE E-8 Relative contribution percentiles for various pathways of exposure to PFOS.
From page 268...
... Vestergren and Cousins (2009) explored this possibility by estimating relative intakes for those with exposure to background PFAS levels, exposure to higher levels in drinking water or drinking water impacted by a PFAS point source, or occupational exposures; they found substantial differences in the relative contributions to overall intakes (see Figure E-9)
From page 269...
... Sunderland and colleagues (2019) describe the changes in serum PFAS levels following the phase-out of production of PFOS and its precursors, with PFOS declining, but other PFAS, such as PFHxS, increasing.
From page 270...
... It is important to acknowledge that communities across the United States have received guidance from state and federal agencies regarding PFAS exposure reduction, including advisories around consumption of drinking water and fish. While it may seem obvious that avoiding exposure to sources of PFAS would result in reduced intake of PFAS and, in turn, lower internal PFAS levels, some caution in assuming that exposure and risk reduction would ensue is warranted.
From page 271...
... . Information will be needed on local levels of PFAS in drinking water, as well as levels in breast milk, for any recommendations regarding infant nutrition to be well supported.
From page 272...
... 2019. Characteristic and human exposure risk assessment of per- and polyfluoroalkyl substances: A study based on indoor dust and drinking water in China.
From page 273...
... through drinking water: A review of the recent scientific literature. Environmental Research 177:108648.
From page 274...
... 2020. Assessing the effectiveness of point-of-use residential drinking water filters for perfluoroalkyl substances (PFASs)
From page 275...
... 2021. Effectiveness of household water purifiers in removing perfluoroalkyl substances from drinking water.
From page 276...
... 2018. Per- and polyfluoroalkyl substances in human breast milk and current analytical methods.
From page 277...
... 2019. Effectiveness of point-of-use/point-of-entry systems to remove per- and polyfluoroalkyl substances from drinking water.
From page 278...
... 2010. Changes in concentrations of perfluorinated compounds, polybrominated diphenyl ethers, and polychlorinated biphenyls in Norwegian breast-milk during twelve months of lactation.
From page 279...
... 2021. Impact of "healthier" materials interventions on dust concentrations of per and polyfluoroalkyl substances, polybrominated diphenyl ethers, and organophosphate esters.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.