Endocrinol Metab.  2022 Apr;37(2):249-260. 10.3803/EnM.2021.1235.

Associations of Phthalate Metabolites and Bisphenol A Levels with Obesity in Children: The Korean National Environmental Health Survey (KoNEHS) 2015 to 2017

Affiliations
  • 1Department of Pediatrics, Wonjin Green Hospital, Seoul, Korea
  • 2Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
  • 3Department of Pediatrics, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea

Abstract

Background
Phthalates and bisphenol A (BPA) are synthetic chemicals widely used in daily life. This study investigated urinary phthalate and BPA levels in Korean children and their associations with obesity. Methods: A total of 2,351 children aged 3 to 17 years who participated in the Korean National Environmental Health Survey 2015 to 2017 were included. Urinary dilution was corrected using covariate-adjusted standardization (CAS). We examined the geometric mean (GM) concentrations of urinary phthalate metabolites, including di (2-ethylhexyl) phthalate (DEHP) metabolites (mono [2-ethyl-5-hydroxyhexyl] phthalate, mono [2-ethyl-5-oxohexyl] phthalate, and mono [2-ethyl-5-carboxypentyl] phthalate [MECPP]), mono-benzyl-phthalate (MBzP), mono (carboxyoctyl) phthalate (MCOP), mono (carboxy-isononyl) phthalate (MCNP), mono (3-carboxypropyl) phthalate, and mono-n-butyl-phthalate (MnBP), and BPA. We also analyzed the odds ratio (OR) for obesity according to the quartiles of each analyte. Results: The urinary GM levels of DEHP metabolites and MnBP were notably higher among Korean children than among American, Canadian, and German children. The CAS-applied GM concentrations of most analytes, except for MBzP, MCOP, and MCNP, were higher in children aged 3 to 5 years than in those aged 6 to 17 years. The OR for obesity in the highest quartile of MECPP was significantly higher than in the lowest quartile after adjusting for covariates. However, the other phthalate metabolites and BPA were not significantly associated with obesity. Conclusion: The concentrations of urinary DEHP metabolites and MnBP were higher in Korean children than in children in Western countries. Urinary MECPP exposure, but not other phthalates or BPA, showed a positive association with obesity in Korean children. Further studies are required to elucidate the causal relationships.

Keyword

Phthalic acids; Bisphenol A; Pediatric obesity; Korea

Figure

  • Fig. 1. The geometric mean concentrations of urinary phthalate metabolites and bisphenol A by age group. Covariate-adjusted standardization was applied to the analysis of the geometric mean concentration of the substances. (A) Mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), (B) mono (2-ethyl-5-oxohexyl) phthalate (MEOHP), (C) mono (2-ethyl-5-carboxypentyl) phthalate (MECPP), (D) mono-benzylphthalate (MBzP), (E) mono (carboxyoctyl) phthalate (MCOP), (F) mono (carboxy-isononyl) phthalate (MCNP), (G) mono (3-carboxypropyl) phthalate (MCPP), (H) mono-n-butyl-phthalate (MnBP), (I) bisphenol A (BPA). aP<0.05; bP<0.01; cP<0.001.

  • Fig. 2. Adjusted odds ratios (95% confidence intervals) for obesity by quartiles of phthalate metabolite and bisphenol A (BPA) levels. Adjusted for age, sex, household income, urinary cotinine level, eating hamburgers or pizza ≥twice a week, and play/exercise with sweating ≥ 3 times a week. Covariate-adjusted standardization was applied to the analysis of the geometric mean concentration of each substance. The quartile values of urinary phthalate metabolite and BPA levels were as follows: (A) mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP; <14.18, 14.19–23.65, 23.67–38.75, >38.78 µg/L), (B) mono (2-ethyl-5-oxohexyl) phthalate (MEOHP; <9.70, 9.70–16.10, 16.14–26.32, >26.34 µg/L), (C) mono (2-ethyl-5-carboxypentyl) phthalate (MECPP; <23.97, 24.02–36.28, 36.29–57.26, 7gt;57.32 µg/L), (D) mono-benzyl-phthalate (MBzP; <1.49, 1.49–3.00, 3.00–6.41, >6.43 µg/L), (E) mono (carboxyoctyl) phthalate (MCOP; <1.18, 1.18–1.78, 1.78–2.82, >2.83 µg/L), (F) mono (carboxy-isononyl) phthalate (MCNP; <0.33, 0.33–0.48, 0.48–0.71, >0.71 µg/L), (G) mono (3-carboxypropyl) phthalate (MCPP; <1.09, 1.09–1.51, 1.51–2.13, >2.13 µg/L), (H) mono-n-butyl-phthalate (MnBP; <26.65, 26.80–41.77, 41.80–63.13, >63.18 µg/L), (I) BPA (<0.97, 0.97–1.89, 1.90–3.44, >3.44 µg/L). aP<0.05.


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