Multiple pathways of human exposure to poly- and perfluoroalkyl substances (PFASs): From external exposure to human blood

Exposure to PFASs may result in adverse health effects. This study aimed to characterise the exposure to PFASs from diet, house dust, indoor air, and dermal contact and the relative contribution from different external exposure pathways to human serum concentrations. Daily intakes of 18 perfluoroalkyl acids (PFAAs) and 12 PFAA precursors from diet, dust ingestion, inhalation of indoor air and dermal absorption were estimated using a comprehensive dataset comprising 61 adults from the Oslo area, Norway. Concentrations of PFAAs and PFAA precursors in house dust, indoor air, hand wipes, foods and drinks were utilised to estimate the daily intakes. Perfluorooctanesulfonate (PFOS) was the predominant PFAS in serum for this study group. On a median level, perfluorooctanoate (PFOA) contributed most to the total estimated daily intake of PFAAs, with a median intake of 280 (range: 72-1810) pg·kg bw^-1·day^-1, covering both direct and indirect (precursors) exposure. Out of this, only 3% (range: <1-48%) of the total PFOA intake came from indirect exposure. Dietary exposure from ingestion of food and drinks was in general the predominant exposure pathway, followed by exposure from ingestion of house dust, inhalation of indoor air, and dermal absorption, but considerable variations were observed among individuals. House dust ingestion and indoor air inhalation contributed most to the total intakes for some participants, for which most of them were among the 20% participants with the highest total estimated intakes. Some statistical significant associations between concentrations of PFASs measured in serum and estimated intakes were observed. Measured serum concentrations and modelled serum concentrations based on external exposure estimates were in the same order of magnitude for PFOS, PFHxS, PFOA, and PFNA, but only PFOA concentrations were comparable, 1.9 and 2.0 ng mL^-1 for observed and modelled serum concentrations, respectively. The estimated daily intakes of PFASs in this study were lower than the health-based guidance values, e.g. the tolerable weekly intakes derived by EFSA. This study underlines the importance of performing studies considering multiple exposure pathways on an individual basis.