The Role of Perfluoroalkyl Substances (PFAS) contaminated food for male infertility : A Scoping review

Abstract: Background: The trend of male infertility is increasing and it correlates with industrial development which has introduced various industrial contaminants in the environment and human life. PFASs are one of those contaminants. Humans are exposed to PFAS through various routes and sources, especially through food and diet. On the other hand, some foods are beneficial for the male reproductive system. Aim: The study aim is to investigate the role of per-or poly-fluoroalkyl substances (PFASs) contaminated food in male infertility. Method: This study has used scoping review to assess the current knowledge concerning the aim that what has been done in this field. A systematic search was done in three databases namely PubMed, Web of Science, and Scopus, as well as manual search of related articles and reference lists during March-April 2023, and found 68 articles. Inclusion criteria included all articles written in English, related to humans, and PFAS exposure to adult males through food worldwide. Articles related to only the female population, other non-human species, human exposure to PFAS in fetal life, molecular level information, information about transport mechanisms of PFAS in food, other environmental contaminants and with no food contamination, toxicological, or health impact information were excluded. Titles, abstracts, and selected full-length articles were read and evaluated. CEBMa checklist for critical appraisal of the cross-sectional study, CASP checklist for systematic review, and randomized control trial were used as quality assessments of articles. Results: In total 68 abstracts were initially found, of which 15 were included in the review. Majority of the studies were either from Europe (European panel data from 16 different European countries) (n=2) or any European country (Italy=2, Georgia=1, Denmark=1, Sweden=1, Spain=1, Denmark + Sweden=1, Denmark + USA + Faroe Islands=1) and the rest were from USA (n=2), Australia (n=2) and Peru (n=1). The articles were analyzed according to the concept combinations of PFAS, food, or male fertility. Out of 15 included studies 3 deals with Pfas in food, 8 with Pfas and male fertility, 2 with male infertility related to PFAS in food, 1 with diet and human PFAS levels, and 1 with relation of food to male fertility. The articles included were of either good or moderate quality. Studies related to the direct impact of PFAS through food on male fertility are scarce. According to most of studies, PFASs have a significant impact on male hormones and sperm morphology but there was no significant association was found between PFAS levels to other seminal parameters. The combination of different PFAS and the combination of PFAS with other contaminants may alter the impact on male fertility. PFAS may have a long-term effect on human spermatogonial cells. Mediterranean diet is associated with high serum levels of PFAS in humans. Fish is a major source of PFAS exposure through food. 8 oz. of fish is recommended without causing health hazards, provided thatthe levels of PFAS contaminations in fish are not high. Conclusion: More studies especially longitudinal studies concerning PFAS exposure through food and its impact on male fertility are needed. No studies are found from the African continent and low-income countries. There is a need to check the levels of contamination of PFAS in food so that the health impacts on male fertility can be avoided.