Association of Exposure to Di-2-Ethylhexylphthalate Replacements With Increased Blood Pressure in Children and Adolescents

Abstract

Phthalates are environmental chemicals widely used in consumer and personal care products. In this study we examined associations of urinary phthalates with blood pressure, triglycerides and lipoproteins in children and adolescents, performing a cross-sectional analysis of a subsample of US children 6–19 years of age who participated in the National Health and Nutrition Examination Survey between the years 2009–2012. We quantified exposure to common environmental phthalates, with a focus on the dietary contaminant di-2-ethylhexylphthalate and two increasingly used replacements, di-isononyl phthalate and di-isodecyl phthalate, based on micromolar concentration of urinary metabolites. We assessed descriptive, univariate and multivariable associations with blood pressure and lipids. Controlling for an array of sociodemographic and behavioral factors, as well as diet and body mass, metabolites of di-2-ethylhexylphthalate , di-isononyl phthalate and di-isodecyl phthalate were associated with higher age-, gender- and height-standardized blood pressure. For each log unit increase in di-isodecyl phthalate metabolites, a 0.105 standard deviation unit increase in systolic blood pressure z score was identified (p=0.004); for di-isononyl phthalate metabolites, a 0.113 standard deviation unit increment was identified (p=0.008). For di-2-ethylhexylphthalate metabolites, a 0.103 standard deviation unit increment (p=0.013) was detected. Metabolites of low molecular weight phthalates commonly found in cosmetics and personal care products showed an association with blood pressure (≥90th percentile) in univariate analysis, but this was no longer significant in our full multivariable model, suggesting specificity. Phthalate metabolites were not associated with triglycerides or high-density lipoproteins. Further, longitudinal studies are needed to confirm these associations, and to assess opportunities for intervention.

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

“…308 -310 • Phthalates: Antenatal and childhood exposure to phthalates has recently been associated with higher childhood BP 311 -313 but not with the development of overt HTN. Specific metabolites of these ubiquitous chemicals may have differential effects on BP, 313 indicating that much more detailed study is needed to completely understand the effect of such exposure.…”

Sex Differences in the Association of Urinary Concentrations of Phthalates Metabolites with Self-Reported Diabetes and Cardiovascular Diseases in Shanghai Adults

“…The majority of previous studies have been limited to children, pregnant women, mothers of children in birth cohorts and so on [31,32]. Even in these specific populations, the link between phthalates and CVD is inconsistent [27,33].…”

Urine Levels of Phthalate Metabolites and Bisphenol A in Relation to Main Metabolic Syndrome Components: Dyslipidemia, Hypertension and Type 2 Diabetes. A pilot study

“…Phthalates and bisphenol A are considered to be causative in the pathogenesis of diabetes type 2 and metabolic syndrome (1)(2)(3)(4)(5). Also, in a short exposure study where volunteers were exposed to phthalates (9), a non-significant trend to metabolic syndrome was also found.…”