{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:10:39Z","timestamp":1785924639418,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003569","name":"Ministry of Food and Drug Safety","doi-asserted-by":"publisher","award":["21162MFDS076"],"award-info":[{"award-number":["21162MFDS076"]}],"id":[{"id":"10.13039\/501100003569","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Perfluorooctanoic acid (PFOA) is widely used throughout different industries, including the food industry, because it is resistant to heat and prevents water or oil from easily permeating into or contaminating materials coated by PFOA. Although many studies have reported an association between PFOA exposure and the risk of developing hepatic diseases, it is still in debate because they have shown conflicting results. Therefore, this study conducted a systematic review and meta-analysis on the relationship between PFOA exposure and hepatic diseases. Methods: This study searched studies related to hepatic diseases due to PFOA exposure until 31 December 2021, using PubMed, EMBASE, and Web of Science. This study performed a systematic review and meta-analysis through research question development, literature screening, data extraction, and risk of bias evaluation. This study found 8280 studies after excluding duplicate literature and selected 5 studies in the final stage. Among them, two studies were included in the meta-analysis. Results: The results of the meta-analysis showed that the ALT of people exposed to PFOA was 117% higher than the ALT of those not exposed to PFOA, and it was significantly different (OR = 1.167; 95% CI, 1.086\u20131.254). Conclusion: However, since the number of studies included in the analysis was not large enough to conclude that PFOA exposure was associated with the development of hepatic diseases, more observational studies are needed to confirm its long-term effects.<\/jats:p>","DOI":"10.3390\/ijerph191811318","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T20:50:27Z","timestamp":1662670227000},"page":"11318","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Human Evidence of Perfluorooctanoic Acid (PFOA) Exposure on Hepatic Disease: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7801-7513","authenticated-orcid":false,"given":"Jihee","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Food and Nutrition, College of Bionanotechnology, Gachon University, Seongnam-si 13120, Gyeonggi-do, Korea"},{"name":"Institute for Aging and Clinical Nutrition Research, Gachon University, Seongnam-si 13120, Gyeonggi-do, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4881-9325","authenticated-orcid":false,"given":"Jong-Yeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Institute for Aging and Clinical Nutrition Research, Gachon University, Seongnam-si 13120, Gyeonggi-do, Korea"},{"name":"Department of Food Science and Biotechnology, Gachon University, Seongnam-si 13120, Gyeonggi-do, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8353-3619","authenticated-orcid":false,"given":"Hae-Jeung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Food and Nutrition, College of Bionanotechnology, Gachon University, Seongnam-si 13120, Gyeonggi-do, Korea"},{"name":"Institute for Aging and Clinical Nutrition Research, Gachon University, Seongnam-si 13120, Gyeonggi-do, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4399","DOI":"10.1002\/fsn3.1737","article-title":"Effect of washing, soaking, and cooking methods on perfluorinated compounds in mackerel (Scomber japonicus)","volume":"8","author":"Kim","year":"2020","journal-title":"Food Sci. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3109\/10408444.2014.952400","article-title":"Perfluoroalkyl and polyfluoroalkyl substances and human fetal growth: A systematic review","volume":"45","author":"Bach","year":"2015","journal-title":"Crit. Rev. Toxicol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.earlhumdev.2017.04.004","article-title":"Prenatal concentrations of Perfluoroalkyl substances and early communication development in British girls","volume":"109","author":"Jeddy","year":"2017","journal-title":"Early Hum. Dev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1021\/es0512475","article-title":"Sources, fate and transport of perfluorocarboxylates","volume":"40","author":"Prevedouros","year":"2006","journal-title":"Environ. Sci. Technol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1080\/01480540600561361","article-title":"Absorption, distribution, and excretion of ammonium perfluorooctanoate (APFO) after oral administration to various species","volume":"29","author":"Hundley","year":"2006","journal-title":"Drug Chem. Toxicol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111114","DOI":"10.1016\/j.fct.2020.111114","article-title":"Immunotoxicity and allergenic potential induced by topical application of perfluorooctanoic acid (PFOA) in a murine model","volume":"136","author":"Shane","year":"2020","journal-title":"Food Chem. Toxicol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105220","DOI":"10.1016\/j.envint.2019.105220","article-title":"Perfluoroalkyl substances and severity of nonalcoholic fatty liver in Children: An untargeted metabolomics approach","volume":"134","author":"Jin","year":"2020","journal-title":"Environ. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"18866","DOI":"10.1007\/s11356-019-05258-z","article-title":"Maternal exposure to perfluorooctanoic acid (PFOA) causes liver toxicity through PPAR-alpha pathway and lowered histone acetylation in female offspring mice","volume":"26","author":"Li","year":"2019","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_9","unstructured":"Naturv\u00e5rdsverket, N. (2022, August 26). Swedish National Implementation Plan for the Stockholm Convention on Persistent Organic Pollutants: Update 2020 to Include Substances Listed 2017 and 2019. Available online: https:\/\/www.naturvardsverket.se\/om-oss\/publikationer\/6900\/swedish-national-implementation-plan-for-the-stockholm-convention-on-persistent-organic-pollutants\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"130287","DOI":"10.1016\/j.chemosphere.2021.130287","article-title":"Regional occurrence of perfluoroalkane substances in human milk for the global monitoring plan under the Stockholm Convention on Persistent Organic Pollutants during 2016\u20132019","volume":"277","author":"Fiedler","year":"2021","journal-title":"Chemosphere"},{"key":"ref_11","unstructured":"EPA (2019). Systematic Review Protocol for the PFBA, PFHxA, PFHxS, PFNA, and PFDA IRIS Assessments, Environmental Protection Agency."},{"key":"ref_12","unstructured":"Higgins, J.P., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., Welch, V.A., and Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (Updated February 2021) (2021, September 29). The Cochrane Collaboration. Available online: https:\/\/training.cochrane.org\/handbook\/current."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Harrison, H., Griffin, S.J., Kuhn, I., and Usher-Smith, J.A. (2020). Software tools to support title and abstract screening for systematic reviews in healthcare: An evaluation. BMC Med. Res. Methodol., 20.","DOI":"10.1186\/s12874-020-0897-3"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.envint.2018.04.052","article-title":"Changes in markers of liver function in relation to changes in perfluoroalkyl substances-a longitudinal study","volume":"117","author":"Salihovic","year":"2018","journal-title":"Environ. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1289\/ehp.1510391","article-title":"Modeled perfluorooctanoic acid (PFOA) exposure and liver function in a mid-Ohio valley community","volume":"124","author":"Darrow","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1136\/oemed-2014-102364","article-title":"A cohort incidence study of workers exposed to perfluorooctanoic acid (PFOA)","volume":"72","author":"Steenland","year":"2015","journal-title":"Occup. Environ. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1289\/ehp.1205829","article-title":"Perfluorooctanoic acid exposure and cancer outcomes in a contaminated community: A geographic analysis","volume":"121","author":"Vieira","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1093\/jnci\/djp041","article-title":"Perfluorooctanoate and perfluorooctanesulfonate plasma levels and risk of cancer in the general Danish population","volume":"101","author":"Eriksen","year":"2009","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1097\/EDE.0000000000000903","article-title":"Serum perfluorooctanoic acid and birthweight: An updated meta-analysis with bias analysis","volume":"29","author":"Steenland","year":"2018","journal-title":"Epidemiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"057002","DOI":"10.1289\/EHP5444","article-title":"Early life exposure to perfluoroalkyl substances (PFAS) and ADHD: A meta-analysis of nine European population-based studies","volume":"128","author":"Forns","year":"2020","journal-title":"Environ. Health Perspect."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Liu, P., Yang, F., Wang, Y., and Yuan, Z. (2018). Perfluorooctanoic acid (PFOA) exposure in early life increases risk of childhood adiposity: A meta-analysis of prospective cohort studies. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15102070"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"110145","DOI":"10.1016\/j.envres.2020.110145","article-title":"Exposure to perfluoroalkyl substances and allergic outcomes in children: A systematic review and meta-analysis","volume":"191","author":"Luo","year":"2020","journal-title":"Environ. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"67053","DOI":"10.1007\/s11356-021-15061-4","article-title":"The relationship between maternal perfluoroalkylated substances exposure and low birth weight of offspring: A systematic review and meta-analysis","volume":"28","author":"Cao","year":"2021","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"67066","DOI":"10.1007\/s11356-021-15136-2","article-title":"The association between maternal perfluoroalkyl substances exposure and early attention deficit hyperactivity disorder in children: A systematic review and meta-analysis","volume":"28","author":"Qu","year":"2021","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1289\/ehp.1307893","article-title":"The Navigation Guide\u2014evidence-based medicine meets environmental health: Systematic review of human evidence for PFOA effects on fetal growth","volume":"122","author":"Johnson","year":"2014","journal-title":"Environ. Health Perspect."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Abdullah Soheimi, S.S., Abdul Rahman, A., Abd Latip, N., Ibrahim, E., and Sheikh Abdul Kadir, S.H. (2021). Understanding the Impact of Perfluorinated Compounds on Cardiovascular Diseases and Their Risk Factors: A Meta-Analysis Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168345"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1373\/jalm.2016.020412","article-title":"\u03b1-Glutathione S-Transferase: A New Biomarker for Liver Injury?","volume":"1","author":"Maina","year":"2016","journal-title":"J. Appl. Lab. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1038\/clpt.2012.108","article-title":"Alanine aminotransferase: A clinical and regulatory tool for detecting liver injury-past, present, and future","volume":"92","author":"Senior","year":"2012","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.toxlet.2021.12.016","article-title":"iTRAQ-based quantitative proteomics analysis of Sprague-Dawley rats liver reveals perfluorooctanoic acid-induced lipid metabolism and urea cycle dysfunction","volume":"357","author":"Liu","year":"2022","journal-title":"Toxicol. Lett."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jhazmat.2016.03.077","article-title":"Low dose perfluorooctanoate exposure promotes cell proliferation in a human non-tumor liver cell line","volume":"313","author":"Zhang","year":"2016","journal-title":"J. Hazard. Mater."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e02168","DOI":"10.1016\/j.heliyon.2019.e02168","article-title":"Concentration of selected liver enzymes across the stages of glomerular function: The associations with PFOA and PFOS","volume":"5","author":"Jain","year":"2019","journal-title":"Heliyon"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Contaminants in the Food Chain (CONTAM), Knutsen, H.K., Alexander, J., Barreg\u00e5rd, L., Bignami, M., Br\u00fcschweiler, B., Ceccatelli, S., Cottrill, B., Dinovi, M., and Schwerdtle, T. (2018). Risk to human health related to the presence of perfluorooctane sulfonic acid and perfluorooctanoic acid in food. EFSA J., 16, e05194.","DOI":"10.2903\/j.efsa.2018.5194"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.envint.2013.08.021","article-title":"Fluorinated alternatives to long-chain perfluoroalkyl carboxylic acids (PFCAs), perfluoroalkane sulfonic acids (PFSAs) and their potential precursors","volume":"60","author":"Wang","year":"2013","journal-title":"Environ. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"105185","DOI":"10.1016\/j.yrtph.2022.105185","article-title":"The Conundrum of the PFOA human half-life, an international collaboration","volume":"132","author":"Campbell","year":"2022","journal-title":"Regul. Toxicol. Pharmacol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"115644","DOI":"10.1016\/j.taap.2021.115644","article-title":"Perfluorooctanoic acid induces liver and serum dyslipidemia in humanized ppar\u03b1 mice fed an american diet","volume":"426","author":"Schlezinger","year":"2021","journal-title":"Toxicol. Appl. Pharmacol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/18\/11318\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:27:52Z","timestamp":1760142472000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/18\/11318"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,8]]},"references-count":36,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["ijerph191811318"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191811318","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,8]]}}}