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The modifying effect of vitamin C on the association between perfluorinated compounds and insulin resistance in the Korean elderly: a double-blind, randomized, placebo-controlled crossover trial



There is limited evidence whether environmental exposure to perfluorinated compounds (PFCs) affects insulin resistance (IR) and whether vitamin C intake protects against the adverse effect of PFCs. This study was carried out to investigate the effect of PFCs on IR through oxidative stress, and the effects of a 4-week consumption of vitamin C supplement compared placebo on development of IR by PFCs.


For a double-blind, community-based, randomized, placebo-controlled crossover intervention of vitamin C, we assigned 141 elderly subjects to both vitamin C and placebo treatments for 4 weeks. We measured serum levels of PFCs to estimate PFC exposures and urinary levels of malondialdehyde (MDA) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) for oxidative stress. We also measured levels of fasting glucose and insulin and derived the homeostatic model assessment (HOMA) index to assess IR.


Perfluorooctane sulfonate (PFOS) and perfluorododecanoic acid (PFDoDA) levels were found to be positively associated with HOMA index at the baseline and after placebo treatment. Risks of IR for the top decile of PFOS and PFDoDA exposures were significantly elevated compared with those with lower PFOS and PFDoDA exposures (both, P < 0.0001). However, the effects of PFOS and PFDoDA on HOMA disappeared after vitamin C supplementation (both, P > 0.30). Furthermore, PFOS and PFDoDA levels were also significantly associated with MDA and 8-OHdG levels, and MDA levels were positively associated with HOMA index.


PFOS and PFDoDA exposures were positively associated with IR and oxidative stress, and vitamin C supplementation protected against the adverse effects of PFOS and PFDoDA on IR.

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This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (2013R1A1A3A04004612), Republic of Korea. J. H. Kim drew the conception, researched data, and wrote the manuscript. Y. C. Hong discussed, reviewed, and edited manuscript. H. Y. Park performed the health examination and is the guarantor of this work, and as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. J. D. Jeon, Y. Kho, and S. K. Kim contributed reagents/materials/analysis tools. M. S. Park performed the health examination and reviewed the manuscript.

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical standards

Each study participant provided written informed consent. The study protocol was conducted in accordance with guidelines laid down in the Declaration of Helsinki, and all procedures were approved by the Institutional Review Board at Seoul National University Hospital (IRB no., C-1105-043-361).

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Corresponding author

Correspondence to Yun-Chul Hong.

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Kim, J.H., Park, H.Y., Jeon, J.D. et al. The modifying effect of vitamin C on the association between perfluorinated compounds and insulin resistance in the Korean elderly: a double-blind, randomized, placebo-controlled crossover trial. Eur J Nutr 55, 1011–1020 (2016).

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  • Perfluorinated compounds
  • Insulin resistance
  • Oxidative stress
  • Vitamin C supplementation