Of the thousands
of per- and polyfluoroalkyl substances
(PFAS)
known to exist, only a small fraction (≤1%) are commonly monitored
in humans. This discrepancy has led to concerns that human exposure
may be underestimated. Here, we address this problem by applying a
comprehensive fluorine mass balance (FMB) approach, including total
fluorine (TF), extractable organic fluorine (EOF), total oxidizable
precursors (TOP), and selected target PFAS, to human serum samples
collected over a period of 28 years (1986, 2007, and 2015) in Tromsø,
Norway. While concentrations of TF did not change between sampling
years, EOF was significantly higher in 1986 compared to 2007 and 2015.
The ∑12PFAS concentrations were highest in 2007
compared to 1986 and 2015, and unidentified EOF (UEOF) decreased from
1986 (46%) to 2007 (10%) and then increased in 2015 (37%). While TF
and EOF were not influenced by sex, women had higher UEOF compared
to men, opposite to target PFAS. This is the first FMB in human serum
to include TOP, and it suggests that precursors with >4 perfluorinated
carbon atoms make a minor contribution to EOF (0–4%). Additional
tools are therefore needed to identify substances contributing to
the UEOF in human serum.