Environmental influences on chronic disease risk: patient-oriented research and mentoring

Exposures to environmental chemicals such as per- and polyfluoroalkyl substances (PFAS), in early life and beyond, significantly impact chronic disease risk. PFAS are persistent and ubiquitous ‘forever chemicals’ that contaminate water and food. There is a critical need to strengthen the pipeline of both research and trained investigators dedicated to understanding the health impact of PFAS to inform preventive policies and clinical guidelines. The overall goals of this K24 application are to provide Dr. Abby Fleisch, MD, MPH with protected time to mentor junior clinician investigators toward independent careers in patient-oriented environmental health research, foster her continued growth as an exceptional mentor, and support new scientific aims that build upon her NIH-funded patient-oriented research focused on the impact of PFAS on body composition and cardiometabolic risk. As one of few experts in the US with training in both pediatric endocrinology and environmental health, she has already successfully served as a research mentor to 15 individuals, including 7 clinicians or clinicians-in-training. The proposed K24 award will allow Dr. Fleisch to expand her mentorship skills and portfolio at a critical stage in her career, as she strengthens her independent research program and seeks to increase her ability and availability to support junior clinical investigators. The award will also support a new research investigation that will build on Dr. Fleisch’s ongoing NIH-funded work, create additional opportunities for mentorship, and leverage her longstanding collaboration with the pre-birth cohort study Project Viva. This new research will utilize Project Viva’s well-phenotyped covariate and outcome data, existing measures of prenatal and mid-childhood PFAS concentrations, and support new assays of PFAS in 525 participants in late adolescence. This proposed work will characterize within- and between-individual variation in PFAS prenatally through late adolescence and create cumulative PFAS exposure estimates to generate more comprehensive risk assessment data in relation to late adolescent adiposity and cardiometabolic risk. Further, this work will identify windows of heightened susceptibility to PFAS exposure which is essential for understanding the potential benefits of clinical treatments for PFAS body burden reduction at specific life stages. Finally, this project will explore the mitigating effect of healthy diet and exercise, thereby informing behavior modification advice for individuals highly exposed to PFAS. This work will guide both local and national prevention and intervention strategies and build a pipeline of clinician scientists to conduct impactful environmental health research and translate that research into clinical care, with implications for risk reduction of costly and debilitating chronic diseases. Project Number: 1K24ES038632-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Environmental Health Sciences (NIEHS) | Principal Investigator: Abby Fleisch | Institution: MAINEHEALTH, PORTLAND, ME | Award Amount: $212,998 | Activity Code: K24 | Study Section: Special Emphasis Panel[ZRG1 SCIL-X (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11351809