REFERENCES
1. Glüge, J.; Scheringer, M.; Cousins, I. T.; et al. An overview of the uses of per- and polyfluoroalkyl substances (PFAS). Environ. Sci. Processes. Impacts. 2020, 22, 2345-73.
2. Calafat, A. M.; Wong, L.; Kuklenyik, Z.; Reidy, J. A.; Needham, L. L. Polyfluoroalkyl chemicals in the U.S. population: data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and comparisons with NHANES 1999-2000. Environ. Health. Perspect. 2007, 115, 1596-602.
3. Nelson, J. W.; Hatch, E. E.; Webster, T. F. Exposure to polyfluoroalkyl chemicals and cholesterol, body weight, and insulin resistance in the general U.S. population. Environ. Health. Perspect. 2010, 118, 197-202.
4. Winquist, A.; Steenland, K. Modeled PFOA exposure and coronary artery disease, hypertension, and high cholesterol in community and worker cohorts. Environ. Health. Perspect. 2014, 122, 1299-305.
5. Schlezinger, J.; Hyötyläinen, T.; Sinioja, T.; et al. Perfluorooctanoic acid induces liver and serum dyslipidemia in humanized PPARα mice fed an American diet. Toxicol. Appl. Pharmacol. 2021, 426, 115644.
6. Ward-Caviness, C. K.; Moyer, J.; Weaver, A.; Devlin, R.; Diaz-Sanchez, D. Associations between PFAS occurrence and multimorbidity as observed in an electronic health record cohort. Environ. Epidemiol. 2022, 6, e217.
7. Nian, M.; Li, Q.; Bloom, M.; et al. Liver function biomarkers disorder is associated with exposure to perfluoroalkyl acids in adults: isomers of C8 Health Project in China. Environ. Res. 2019, 172, 81-8.
8. Baumert, B. O.; Maretti-Mira, A. C.; Walker, D. I.; et al. Translational framework linking perfluoroheptanoic acid (PFHpA) exposure to metabolic dysfunction associated steatotic liver disease in adolescents. Commun. Med. 2025, 5, 430.
9. Sagiv, S. K.; Rifas-Shiman, S. L.; Fleisch, A. F.; et al. Early-pregnancy plasma concentrations of perfluoroalkyl substances and birth outcomes in project Viva: confounded by pregnancy hemodynamics? Am. J. Epidemiol. 2018, 187, 793-802.
10. Wikström, S.; Lin, P.; Lindh, C. H.; Shu, H.; Bornehag, C. Maternal serum levels of perfluoroalkyl substances in early pregnancy and offspring birth weight. Pediatr. Res. 2019, 87, 1093-9.
11. Budtz-Jørgensen, E.; Grandjean, P. Application of benchmark analysis for mixed contaminant exposures: mutual adjustment of perfluoroalkylate substances associated with immunotoxicity. PLoS. ONE. 2018, 13, e0205388.
12. Zahm, S.; Bonde, J. P.; Chiu, W. A.; et al. Carcinogenicity of perfluorooctanoic acid and perfluorooctanesulfonic acid. Lancet. Oncol. 2024, 25, 16-7.
13. MassDEP. Per- and polyfluoroalkyl substances (PFAS): an updated subgroup approach to groundwater and drinking water values. 2019. https://www.mass.gov/doc/per-and-polyfluoroalkyl-substances-pfas-an-updated-subgroup-approach-to-groundwater-and/download. (accessed 2026-07-10).
14. Dewitt, J. C.; Blossom, S. J.; Schaider, L. A. Exposure to per-fluoroalkyl and polyfluoroalkyl substances leads to immunotoxicity: epidemiological and toxicological evidence. J. Expo. Sci. Environ. Epidemiol. 2018, 29, 148-56.
15. Kaye, E.; Marques, E.; Agudelo Areiza, J.; Modaresi, S. M. S.; Slitt, A. Exposure to a PFOA, PFOS and PFHxS mixture during gestation and lactation alters the liver proteome in offspring of CD-1 mice. Toxics 2024, 12, 348.
16. Appel, M.; Forsthuber, M.; Ramos, R.; et al. The transplacental transfer efficiency of per- and polyfluoroalkyl substances (PFAS): a first meta-analysis. J. Toxicol. Environ. Health. B. Crit. Rev. 2021, 25, 23-42.
17. Midasch, O.; Drexler, H.; Hart, N.; Beckmann, M. W.; Angerer, J. Transplacental exposure of neonates to perfluorooctanesulfonate and perfluorooctanoate: a pilot study. Int. Arch. Occup. Environ. Health. 2007, 80, 643-8.
18. Goeden, H. M.; Greene, C. W.; Jacobus, J. A. A transgenerational toxicokinetic model and its use in derivation of Minnesota PFOA water guidance. J. Expo. Sci. Environ. Epidemiol. 2019, 29, 183-95.
19. Kingsley, S. L.; Eliot, M. N.; Kelsey, K. T.; et al. Variability and predictors of serum perfluoroalkyl substance concentrations during pregnancy and early childhood. Environ. Res. 2018, 165, 247-57.
20. Van Beijsterveldt, I. A.; Van Zelst, B. D.; De Fluiter, K. S.; Van Den Berg, S. A.; Van Der Steen, M.; Hokken-Koelega, A. C. Poly- and perfluoroalkyl substances (PFAS) exposure through infant feeding in early life. Environ. Int. 2022, 164, 107274.
21. Zheng, G.; Schreder, E.; Dempsey, J. C.; et al. Per- and polyfluoroalkyl substances (PFAS) in breast milk: concerning trends for current-use PFAS. Environ. Sci. Technol. 2021, 55, 7510-20.
22. De Silva, A. O.; Armitage, J. M.; Bruton, T. A.; et al. PFAS exposure pathways for humans and wildlife: a synthesis of current knowledge and key gaps in understanding. Environ. Toxicol. Chem. 2021, 40, 631-57.
23. Deluca, N. M.; Minucci, J. M.; Mullikin, A.; Slover, R.; Cohen Hubal, E. A. Human exposure pathways to poly- and perfluoroalkyl substances (PFAS) from indoor media: a systematic review. Environ. Int. 2022, 162, 107149.
24. EFSA, Panel. on. Contaminants. in. the. Food. Chain. (EFSA. C. O. N. T. A. M. Panel).; Schrenk D. Risk to human health related to the presence of perfluoroalkyl substances in food. EFSA. J. 2020, 18, e06223.
25. Haug, L. S.; Thomsen, C.; Brantsæter, A. L.; et al. Diet and particularly seafood are major sources of perfluorinated compounds in humans. Environ. Int. 2010, 36, 772-8.
26. Vestergren, R.; Cousins, I. T. 12 - Human dietary exposure to per- and poly-fluoroalkyl substances (PFASs). In Persistent organic pollutants and toxic metals in foods. Woodhead Publishing; 2013. pp. 279-307.
27. Haug, L. S.; Huber, S.; Schlabach, M.; Becher, G.; Thomsen, C. Investigation on per- and polyfluorinated compounds in paired samples of house dust and indoor air from norwegian homes. Environ. Sci. Technol. 2011, 45, 7991-8.
28. Holder, C.; Cohen Hubal, E. A.; Luh, J.; Lee, M. G.; Melnyk, L. J.; Thomas, K. Systematic evidence mapping of potential correlates of exposure for per- and poly-fluoroalkyl substances (PFAS) based on measured occurrence in biomatrices and surveys of dietary consumption and product use. Int. J. Hyg. Environ. Health. 2024, 259, 114384.
29. Pennoyer, E. H.; Fillman, T.; Heiger-Bernays, W.; et al. Exposure to legacy per- and polyfluoroalkyl substances from diet and drinking water in California adults, 2018-2020. Environ. Sci. Technol. 2025, 59, 9896-906.
30. Hu, X. C.; Tokranov, A. K.; Liddie, J.; et al. Tap water contributions to plasma concentrations of poly- and perfluoroalkyl substances (PFAS) in a nationwide prospective cohort of U.S. women. Environ. Health. Perspect. 2019, 127, 067006.
31. Hurley, S.; Houtz, E.; Goldberg, D.; et al. Preliminary associations between the detection of perfluoroalkyl acids (PFAAs) in drinking water and serum concentrations in a sample of California women. Environ. Sci. Technol. Lett. 2016, 3, 264-9.
32. Shin, H.; Vieira, V. M.; Ryan, P. B.; Steenland, K.; Bartell, S. M. Retrospective exposure estimation and predicted versus observed serum perfluorooctanoic acid concentrations for participants in the C8 Health Project. Environ. Health. Perspect. 2011, 119, 1760-5.
33. Hoffman, K.; Webster, T. F.; Bartell, S. M.; Weisskopf, M. G.; Fletcher, T.; Vieira, V. M. Private drinking water wells as a source of exposure to perfluorooctanoic acid (PFOA) in communities surrounding a fluoropolymer production facility. Environ. Health. Perspect. 2011, 119, 92-7.
34. Graber, J. M.; Alexander, C.; Laumbach, R. J.; et al. Per and polyfluoroalkyl substances (PFAS) blood levels after contamination of a community water supply and comparison with 2013-2014 NHANES. J. Expo. Sci. Environ. Epidemiol. 2018, 29, 172-82.
35. Xu, Y.; Nielsen, C.; Li, Y.; et al. Serum perfluoroalkyl substances in residents following long-term drinking water contamination from firefighting foam in Ronneby, Sweden. Environ. Int. 2021, 147, 106333.
36. Daly, E. R.; Chan, B. P.; Talbot, E. A.; et al. Per- and polyfluoroalkyl substance (PFAS) exposure assessment in a community exposed to contaminated drinking water, New Hampshire, 2015. Int. J. Hyg. Environ. Health. 2018, 221, 569-77.
37. Landsteiner, A.; Huset, C.; Johnson, J.; Williams, A. Biomonitoring for perfluorochemicals in a Minnesota community with known drinking water contamination. J. Environ. Health. 2014, 77, 14-9.
38. Cserbik, D.; Casas, M.; Flores, C.; et al. Concentrations of per- and polyfluoroalkyl substances (PFAS) in paired tap water and blood samples during pregnancy. J. Expo. Sci. Environ. Epidemiol. 2023, 34, 90-6.
39. Post, G. B. Recent US State and Federal drinking water guidelines for per- and polyfluoroalkyl substances. Environ. Toxicol. Chem. 2021, 40, 550-63.
40. USEPA. Per- and polyfluoroalkyl substances national primary drinking water regulation [EPA-HQ-OW-2022-0114]. 2024. https://www.regulations.gov/document/EPA-HQ-OW-2022-0114-3076. (accessed 2026-07-10).
41. USEPA. Rescission of regulatory determinations and removal of related provisions for four PFAS substances (PFHxS, PFNA, HFPO-DA (GenX), and the mixture of these three PFAS plus PFBS) [EPA-HQ-OW-2025-0654; FRL 12843-01-OW]. 2026. https://www.govinfo.gov/content/pkg/FR-2026-05-20/pdf/2026-10085.pdf. (accessed 2026-07-10).
42. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Division on Earth and Life Studies; Board on Population Health and Public Health Practice; Board on Environmental Studies and Toxicology; Committee on the Guidance on PFAS Testing and Health Outcomes. Guidance on PFAS exposure, testing, and clinical follow-up. Washington, D.C.: National Academies Press; 2022.
43. Lynch, M. T.; Lay, C. R.; Sokolinski, S.; et al. Community-facing toxicokineticmodels to estimate PFAS serum levels based on life history and drinking water exposures. Environ. Int. 2023, 176, 107974.
44. Chiu, W. A.; Lynch, M. T.; Lay, C. R.; et al. Bayesian estimation of human population toxicokinetics of PFOA, PFOS, PFHxS, and PFNA from studies of contaminated drinking water. Environ. Health. Perspect. 2022, 130, 127001.
45. USEPA. Perfluorodecanoic acid (PFDA) [CASRN 335-76-2]. Toxicological review of perfluorodecanoic acid (PFDA) and related salts (Final Report, 2024). https://iris.epa.gov/document/&deid=361797. (accessed 2026-07-10).
46. Dawson, D. E.; Lau, C.; Pradeep, P.; et al. A machine learning model to estimate toxicokinetic half-lives of per- and polyfluoro-alkyl substances (PFAS) in multiple species. Toxics 2023, 11, 98.
47. Ohmori, K.; Kudo, N.; Katayama, K.; Kawashima, Y:. Comparison. of. the. toxicokinetics. between. perfluorocarboxylic. acids. with. different. carbon. chain. length. Toxicology 2003;184:135-40.
48. Kabadi, S. V.; Fisher, J.; Aungst, J.; Rice, P. Internal exposure-based pharmacokinetic evaluation of potential for biopersistence of 6:2 fluorotelomer alcohol (FTOH) and its metabolites. Food. Chem. Toxicol. 2018, 112, 375-82.
49. Greene, C. W.; Bogdan, A. R.; Goeden, H. M. A revised and improved toxicokinetic model to simulate serum concentrations of bioaccumulative PFAS. J. Environ. Expo. Assess. 2024, 3, 12.
50. Zheng, P.; Liu, Y.; An, Q.; et al. Prenatal and postnatal exposure to emerging and legacy per-/polyfluoroalkyl substances: levels and transfer in maternal serum, cord serum, and breast milk. Sci. Total. Environ. 2022, 812, 152446.
51. Mahfouz, M.; Harmouche-Karaki, M.; Matta, J.; et al. Maternal serum, cord and human milk levels of per- and polyfluoroalkyl substances (PFAS), association with predictors and effect on newborn anthropometry. Toxics 2023, 11, 455.
52. Blomberg, A. J.; Haug, L. S.; Lindh, C.; et al. Changes in perfluoroalkyl substances (PFAS) concentrations in human milk over the course of lactation: a study in Ronneby mother-child cohort. Environ. Res. 2023, 219, 115096.
53. USEPA. Update for Chapter 3 of the Exposure Factors Handbook: Ingestion of water and other select liquids. 2019. https://www.epa.gov/sites/default/files/2019-02/documents/efh_-_chapter_3_update.pdf. (accessed 2026-07-10).
54. USEPA. Exposure Factors Handbook: Chapter 15 - Human milk intake. 2011. https://www.epa.gov/system/files/documents/2025-01/efh-chapter15_508.pdf. (accessed 2026-07-10).
55. Belgorodski, N.; Greiner, M.; Tolksdorf, K.; Schueller, K.; Flor, M.; Göhring, L. Package ‘rriskDistributions’: fitting distributions to given data or known quantiles. ver.2.1.2, 2017. https://cran.r-project.org/web/packages/rriskDistributions/rriskDistributions.pdf. (accessed 2026-07-10).
56. USEPA. Methodology for deriving ambient water quality criteria for the protection of human health (2000) [EPA 822-B-00-004]. 2000. https://19january2021snapshot.epa.gov/sites/static/files/2018-10/documents/methodology-wqc-protection-hh-2000.pdf. (accessed 2026-07-10).
57. USEPA. 2018 Edition of the Drinking Water Standards and Health Advisories Tables [EPA 822-F-18-001]. 2018. https://www.epa.gov/system/files/documents/2022-01/dwtable2018.pdf. (accessed 2026-07-10).
58. R Core Team. R: a language and environment for statistical computing. ver.4.5.1. 2025. https://www.R-project.org/. (accessed 2026-07-10).
59. Morris, T. P.; White, I. R.; Crowther, M. J. Using simulation studies to evaluate statistical methods. Stat. Med. 2019, 38, 2074-102.
60. Hölzer, J.; Midasch, O.; Rauchfuss, K.; et al. Biomonitoring of perfluorinated compounds in children and adults exposed to perfluorooctanoate-contaminated drinking water. Environ. Health. Perspect. 2008, 116, 651-7.
61. Babayev, M.; Capozzi, S. L.; Miller, P.; et al. PFAS in drinking water and serum of the people of a southeast Alaska community: a pilot study. Environ. Pollut. 2022, 305, 119246.
62. Hall, S. M.; Zhang, S.; Tait, G. H.; et al. PFAS levels in paired drinking water and serum samples collected from an exposed community in Central North Carolina. Sci. Total. Environ. 2023, 895, 165091.
63. Criswell, R. L.; Simones, T.; Chatterjee, M.; Waite, J.; Diaz, S.; Smith, A. Quantifying levels of per- and polyfluoroalkyl substances (PFAS) in water and serum after contamination from agricultural biosolid application. Environ. Int. 2024, 190, 108850.
64. Fromme, H.; Mosch, C.; Morovitz, M.; et al. Pre- and postnatal exposure to perfluorinated compounds (PFCs). Environ. Sci. Technol. 2010, 44, 7123-9.
65. Varsi, K.; Torsvik, I. K.; Huber, S.; Averina, M.; Brox, J.; Bjørke-Monsen, A. Impaired gross motor development in infants with higher PFAS concentrations. Environ. Res. 2022, 204, 112392.
66. Bartell, S. M. Online serum PFOA calculator for adults. Environ. Health. Perspect. 2017, 125, 104502.
67. Arzuaga, X.; Druwe, I. L.; Bateson, T. F.; et al. IRIS toxicological review of perfluorohexanesulfonic acid (PFHxS, CASRN 335-46-4) and related salts. Washington (DC): U.S. Environmental Protection Agency; 2025. https://www.ncbi.nlm.nih.gov/books/NBK614202/. (accessed 2026-07-10).
68. USEPA. Human health toxicity assessment for perfluorooctanoic acid (PFOA) and related salts, final [815R24006]. 2024. https://www.epa.gov/system/files/documents/2024-05/final-human-health-toxicity-assessment-pfoa.pdf. (accessed 2026-07-10).
69. USEPA. Human health toxicity assessment for perfluorooctane sulfonic acid (PFOS) and related salts, final [815R24007] 2024. https://www.epa.gov/system/files/documents/2024-05/final-human-health-toxicity-assessment-pfos.pdf. (accessed 2026-07-10).
70. USEPA. IRIS toxicological review of perfluorononanoic acid (PFNA) and related salts (Public Comment and External Review Draft) [EPA/635/R-24/031a] 2024. https://assessments.epa.gov/risk/document/&deid%3D355409. (accessed 2026-07-10).
71. USEPA. Maximum contaminant level goals (MCLGs) for three individual per- and polyfluoroalkyl substances (PFAS) and a mixture of four PFAS, final [EPA-815-R-24-004]. 2024. https://www.epa.gov/system/files/documents/2024-04/pfas-hi-mclg_final508.pdf. (accessed 2026-07-10).
72. USEPA. Guidelines for the health risk assessment of chemical mixtures [EPA/630/R-98/002]. 1986. https://www.epa.gov/sites/default/files/2014-11/documents/chem_mix_1986.pdf. (accessed 2026-07-10).
73. USEPA. Supplementary guidance for conducting health risk assessment of chemical mixtures [EPA/630/R-00/002]. 2000. https://ordspub.epa.gov/ords/eims/eimscomm.getfile?p_download_id=4486. (accessed 2026-07-10).
74. Mogensen, U. B.; Grandjean, P.; Nielsen, F.; Weihe, P.; Budtz-Jørgensen, E. Breastfeeding as an exposure pathway for perfluorinated alkylates. Environ. Sci. Technol. 2015, 49, 10466-73.
75. Koponen, J.; Winkens, K.; Airaksinen, R.; et al. Longitudinal trends of per- and polyfluoroalkyl substances in children’s serum. Environ. Int. 2018, 121, 591-9.
76. Mondal, D.; Weldon, R. H.; Armstrong, B. G.; et al. Breastfeeding: a potential excretion route for mothers and implications for infant exposure to perfluoroalkyl acids. Environ. Health. Perspect. 2014, 122, 187-92.
77. Papadopoulou, E.; Sabaredzovic, A.; Namork, E.; Nygaard, U. C.; Granum, B.; Haug, L. S. Exposure of Norwegian toddlers to perfluoroalkyl substances (PFAS): the association with breastfeeding and maternal PFAS concentrations. Environ. Int. 2016, 94, 687-94.
78. Vannoy, B. N.; Lam, J.; Zota, A. R. Breastfeeding as a predictor of serum concentrations of per- and polyfluorinated alkyl substances in reproductive-aged women and young children: a rapid systematic review. Curr. Environ. Health. Rep. 2018, 5, 213-24.
79. Pétré, M. A.; Salk, K. R.; Stapleton, H. M.; et al. Per- and polyfluoroalkyl substances (PFAS) in river discharge: modeling loads upstream and downstream of a PFAS manufacturing plant in the Cape Fear watershed, North Carolina. Sci. Total. Environ. 2022, 831, 154763.
80. Johanson, G.; Gyllenhammar, I.; Ekstrand, C.; et al. Quantitative relationships of perfluoroalkyl acids in drinking water associated with serum concentrations above background in adults living near contamination hotspots in Sweden. Environ. Res. 2023, 219, 115024.
81. Zhang, S.; Kang, Q.; Peng, H.; et al. Relationship between perfluorooctanoate and perfluorooctane sulfonate blood concentrations in the general population and routine drinking water exposure. Environ. Int. 2019, 126, 54-60.
82. Bogdan, A. R.; Fossen Johnson, S.; Goeden, H. Estimation of serum PFOA concentrations from drinking and non–drinking water exposures. Environ. Health. Perspect. 2023, 131, 067701.
83. McDonough, C. A.; Choyke, S.; Barton, K. E.; et al. Unsaturated PFOS and other PFASs in human serum and drinking water from an AFFF-impacted community. Environ. Sci. Technol. 2021, 55, 8139-48.
84. Lewis-Michl, E. L.; Forand, S. P.; Hsu, W.; et al. Perfluorooctanoic acid serum concentrations and half-lives in a community exposed to contaminated drinking water in New York State. J. Expo. Sci. Environ. Epidemiol. 2025, 35, 403-13.
85. Xu, Y.; Fletcher, T.; Pineda, D.; et al. Serum half-lives for short- and long-chain perfluoroalkyl acids after ceasing exposure from drinking water contaminated by firefighting foam. Environ. Health. Perspect. 2020, 128, 077004.
86. Emmett, E. A.; Shofer, F. S.; Zhang, H.; Freeman, D.; Desai, C.; Shaw, L. M. Community exposure to perfluorooctanoate: relationships between serum concentrations and exposure sources. J. Occup. Environ. Med. 2006, 48, 759-70.





