Abstract
PURPOSE: Cataract, a major health concern among the elderly, can be influenced by environmental exposures. This study examines the association between per- and polyfluoroalkyl substance (PFAS) exposure and cataract prevalence. METHODS: Six serum PFAS concentrations were detected among 2119 U.S. adults aged 40 years or older based on the National Health and Nutrition Examination Survey. Multivariable models, including weighted logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression, were used to assess the association between individual and overall PFAS exposure and cataract prevalence. A mediation analysis was conducted for inflammation biomarkers. RESULTS: Single exposure to perfluorohexane sulfonic acid (PFHS) and perfluorononanoic acid (PFNA) was found to be markedly associated with cataract prevalence after adjustment for covariates (PFHS: odds ratio [OR], 1.579; 95% CI, 1.003-2.514; PFNA: OR, 1.629; 95% CI, 1.065-2.506). The WQS index was significantly associated with cataract (OR, 1.441; 95% CI, 1.130-1.837). PFNA and PFHS were the most influential exposures in the PFAS mixture. In the Bayesian kernel machine regression model, PFNA and PFHS exhibited the highest group posterior inclusion probability, aligning with the WQS results. Moreover, serum albumin and neutrophil counts were found to mediate the relationship between PFHS and cataract, accounting for -26.20% and -5.95% of the mediation effect, respectively. CONCLUSIONS: Exposure to PFAS was positively associated with cataract, primarily driven by PFHS and PFNA. Mediation of serum albumin and neutrophil count was observed. TRANSLATIONAL RELEVANCE: This study links PFAS exposure to cataract prevalence, suggesting reducing exposure could help in cataract prevention.