Per- and Poly-fluoroalkyl Substances in the Food Chain: A Review of Exposure Pathways and Long-term Health Consequences

Abstract

The pervasive presence of per- and poly-fluoroalkyl substances (PFAS) in the food chain poses significant threats to human health and ecosystem integrity due to their persistence, bioaccumulation potential, and widespread environmental contamination. This review summarizes current evidence on the pathways of PFAS exposure through dietary and environmental routes and examines their long-term health implications. There is an urgent need to consolidate existing knowledge to inform regulatory actions, risk assessments, and public health interventions aimed at reducing PFAS exposure. This review covers the primary exposure pathways of PFAS, including contaminated irrigation water, soil, and food processing materials, as well as bioaccumulation in aquatic and terrestrial food webs. It discusses the chemical properties influencing PFAS behavior, such as chain length and functional groups, and details the mechanisms of bioaccumulation and bioavailability across species. The health consequences of PFAS exposure are thoroughly examined, including links to cancer, metabolic and endocrine disorders, reproductive and developmental issues, and immunotoxicity. Clinical and epidemiological studies highlighting associations with cardiovascular mortality, type 2 diabetes, dyslipidemia, and reduced bone density are summarized. The review also addresses the heightened vulnerability of certain populations, such as pregnant women and children, and evaluates global exposure patterns. Finally, current mitigation strategies—ranging from regulatory measures and technological innovations to sustainable agricultural practices—are assessed for their effectiveness in reducing PFAS contamination. Future research should prioritize longitudinal studies on emerging PFAS compounds and their mixtures, particularly their effects during critical developmental windows. There is also a need to develop more sensitive and standardized methods for detecting PFAS in complex matrices and to evaluate the long-term efficacy of remediation technologies in real-world settings. Ultimately, interdisciplinary efforts are essential to bridge existing knowledge gaps and support evidence-based policies that safeguard public health and the environment.