Table 2.

A summary of studies reporting the metabolomic associations related to both PFAS exposures and health outcomes.

Publication	Health outcomes	Main findings
(Schillemans et al. 2020)	Type 2 diabetes (T2D)	PFAS were associated with two groups of lipid species with opposite relations to T2D risk: glycerophospholipids were correlated positively with PFAS and were inversely associated with risk for T2D, while diacylglycerols were correlated positively with both PFAS and risk for T2D.
(Chen et al. 2020)	Cardiometabolic outcomes (OGTT measures, body fat and lipid profiles)	Increased lipolysis and fatty acid oxidation were contributing to the biological mechanisms linking PFAS exposure and impaired glucose metabolism among young adults.
(Jin et al. 2020)	Non-alcoholic fatty liver disease (NAFLD)	Each interquartile range increase of PFHxS was associated with increased odds for liver fibrosis, lobular inflammation, and higher NAFLD activity score. A cluster of children with nonalcoholic steatohepatitis was characterized by increased PFAS levels and altered metabolite patterns including higher plasma levels of phosphoethanolamine, tyrosine, phenylalanine, aspartate and creatine, and decreased plasma levels of betaine.
(Alderete et al. 2019)	Changes in glucose homeostasis from a baseline visit to a 1-to-3-yr visit among adolescents at risk of T2D	Higher PFAS exposure was associated with dysregulation of several lipid and amino acid pathways and longitudinal alterations in glucose homeostasis in Hispanic youth.

Abbreviations: OGTT, oral glucose tolerance test; PFAS, per- and polyfluoroalkyl substances; PFHxS, perfluorohexane sulfonic acid; PFOA, perfluorooctanoic acid; PFOS, perfluorooctane sulfonate.