Epidemiological perspectives on PFAS: Environmental fate, health risks, and global mitigation strategies

Global economic growth and advances in science and technology have brought many conveniences to human life, but they have also increased environmental pollution, and its effects finally act on human health. Therefore, governments and researchers around the world are focusing on the risk assessment and control of emerging pollutants, trying to solve the problem of “pollute first, treat later”. This review takes per- and polyfluoroalkyl substances (PFAS), a type of emerging pollutant, as the research subject, and by sorting out their sources, environmental fate, biological transfer, and their effects on the Earth’s environment and human health, it explains the hazards of these compounds in a systematic way. It also compares traditional PFAS with new PFAS alternatives in some sections, clarifies the toxicity of the new alternatives, and summarizes potential low-toxic or non-toxic PFAS substitutes. In addition, this review summarizes the control policies and their effects in major countries around the world, aiming to identify more effective measures, promote the scientific management of PFAS, and achieve the concept of “One Health”, which coordinates the health of the Earth, animals, and humans. • The role of PFAS in MASLD and disrupted lipid metabolism. • Sex-specific impacts on reproductive and developmental systems. • Mechanisms of neurotoxicity involving neurotransmitter imbalance. • Immunosuppressive effects, particularly following prenatal exposure. • Carcinogenic pathways in liver, thyroid, breast, lung, and colorectal cancers.