Forever chemicals are tied to dangerous fatty liver disease in teens, researchers warn

Teenagers who are exposed to so-called “forever chemicals” – found in make-up, cookware, rainwear, food packaging and many other products – have a higher chance of developing a common form of chronic liver disease, according to new research.

The manufactured substances also known as PFAS may triple adolescents’ chances of contracting metabolic dysfunction-associated steatotic liver disease: one of the most common liver diseases in the U.S. and the most common forms of chronic liver disease among children and adolescents, according to a University of Hawai‘i study.

The disease affects as many as 10 percent of U.S. children and 30 percent of all Americans, leaving patients at a heightened risk of liver cancer, permanent liver scarring or for a liver transplant.

There are several identified causes of the liver disease, including obesity, an inherited genetic risk and type 2 diabetes. It’s not yet clear why or how the chances are tripled, but researchers said it was likely that lifestyle and genetics were also factors.

Pediatric cases of the liver condition have spiked in the U.S. as more children become obese. Children living with obesity have a 38 percent greater chance of developing the disease, according to Dr. Charina Ramirez, a pediatric gastroenterologist at Children’s Health pediatric hospital in Texas.

And adolescents are more vulnerable to the health effects of PFAS, with their bodies still developing and undergoing puberty, the university’s researchers pointed out.

What we know about ‘forever chemicals’

The researchers examined blood samples and took MRIs of the livers of more than 280 Southern California adolescents and young adults, who were a part of two University of Southern California studies. The participants were already at a higher risk for the disease because their parents had type 2 diabetes or were overweight.

People with twice as much of the forever chemicals PFOA – found in non-stick cookware – and fire fighting PFHpA in their blood were nearly three times more likely to have the liver disease. The risk was even higher in people with a genetic variant or those who smoked cigarettes.

“These findings suggest that PFAS exposures, genetics and lifestyle factors work together to influence who has greater risk of developing MASLD as a function of your life stage,” Dr. Max Aung, an assistant professor of population and public health sciences at the Keck School of Medicine, said in a statement.

“Understanding gene and environment interactions can help advance precision environmental health for MASLD.”

PFAS have previously been linked to developmental delays in children, reproductive effects and an increased risk of prostate, kidney and testicular cancers. More than 99 percent of people in the U.S. have measurable levels of PFAS in their blood and at least one chemical is in nearly half of U.S. drinking water supplies.

The Trump administration’s Environmental Protection Agency moved to weaken Biden-era PFAS drinking water regulations in September.

Knowledge is power

Metabolic dysfunction-associated steatotic liver disease occurs when fat builds up in the liver due to a metabolic issue, such as diabetes, obesity, high blood pressure or high cholesterol.

The condition can lead to inflammation in the liver and damage to liver cells known as steatohepatitis. Some people with the disease have reported feeling fatigued or experiencing abdominal pain. However, the condition doesn’t always come with noticeable symptoms.

“MASLD can progress silently for years before causing serious health problems,” Dr. Lida Chatzi, a professor of population and public health sciences at the university, said.

Most children are diagnosed with the disease using blood tests or ultrasound scans, the American Liver Foundation said.

Some people are able to reverse or slow down MASLD with treatment focusing on addressing the related lifestyle factors. That includes eating more healthily and controlling blood sugar levels, according to Boston Children’s Hospital.

Chatzi said working to limit exposure to PFAS could also help. “When liver fat starts accumulating in adolescence, it may set the stage for a lifetime of metabolic and liver health challenges. If we reduce PFAS exposure early, we may help prevent liver disease later,” she noted. “That’s a powerful public-health opportunity.”