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Phthalates, physical activity, and diet, which are the most strongly associated with obesity? A case-control study of Chinese children

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Abstract

Purpose

Phthalate esters have been a research hotspot recently owing to potential obesogenic activity, but conflicting results have been reported. This case-control study was designed to investigate whether there was an association between phthalate metabolites and childhood obesity in China.

Methods

A total of 240 pairs of obese/overweight children and age- (±3 months) and gender-matched controls were recruited. Nine phthalate metabolites were analyzed in the first morning urine sample. Physical activity and dietary intake were recorded using validated questionnaires.

Results

In monofactor analysis, the levels of monomethyl phthalate (MMP) and monobutyl phthalate (MnBP) in controls were significantly higher than those of overweight/obese children (p < 0.05). Moderate physical activity (p = 0.004), consumption of vegetables, fruits, and tonic were significantly higher in controls (all p < 0.05), and consumption of fried food, western fast food, carbonated drinks, and juice were higher in cases (all p < 0.05). After adjusting for physical activity and dietary intake, neither MMP [OR = 0.825, (95% CI: 0.559–1.217)] nor MnBP [(OR = 0.808, 95% CI: 0.556–1.176)], were significantly associated with obesity. In all models, moderate physical activity was negatively associated and high glucose high fat dietary patterns were positively associated with the risk of childhood obesity (p < 0.01).

Conclusion

Diet and physical activity, but not phthalate metabolites were associated with childhood obesity. Further studies are needed to verify our findings.

The trial was registered at clinicaltrials.gov as NCT05622513.

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Acknowledgements

The authors would like to thank all the volunteers and their parents/guardians for participating in this study. We are also grateful to the monitoring schools for their kind assistance in data and sample collection. This research was supported by the National Natural Science Foundation of China (Grant No. 81673201), Science and Technology Plan Project in Shenzhen (Grant No. JCYJ20190807103801661), and Research Funding for the Post-Doctors in Shenzhen (Grant No. ZX2021005).

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Author notes

  1. These authors contributed equally: Di Li, Yao Yao

Authors and Affiliations

  1. Department of Clinical Nutrition, Shenzhen University General Hospital, Shenzhen University, Shenzhen, Guangdong Province, China

    Di Li

  2. Department of School Hygiene, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China

    Di Li, Yao Yao, Dingyan Chen, Yu Wu, Yi Liao & Li Zhou

  3. Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity&Child Healthcare Hospital of Shenzhen City), Shenzhen, Guangdong Province, China

    Yao Yao

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Contributions

Conceptualization, L.Z.; Methodology and Data collection, D.L. and Y.Y.; Validation, D.C.; Statistical Analysis, Y.W. and Y.L.; Writing, L.Z. and D.L.; Funding Acquisition, L.Z. and D.L.

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Correspondence to Li Zhou.

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Li, D., Yao, Y., Chen, D. et al. Phthalates, physical activity, and diet, which are the most strongly associated with obesity? A case-control study of Chinese children. Endocrine 82, 69–77 (2023). https://doi.org/10.1007/s12020-023-03465-w

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