Skip to main content
SpringerLink
Log in

The association of phthalate metabolites with childhood waist circumference and abdominal obesity

  • Research
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The association between phthalates exposure and childhood abdominal obesity is still unclear. This study aimed to assess phthalates (PAEs) exposure level and explore the association between PAEs metabolites exposure and the risk of abdominal obesity in Chinese students aged 7–10 years. A total of 798 students aged 7–10 years were selected from the baseline survey of the cohort of Childhood Blood Pressure and Environmental Factors (CBPEF), which was established in Xiamen City, Fujian province, East China, from August to November in 2018. Urine samples were collected from these students to analyze the concentrations of seven PAEs metabolites using the method of high-performance liquid chromatography–tandem triple quadrupole mass spectrometry. Waist circumference was used to define abdominal obesity. The logistic regression model was used to analyze the association of urinary creatinine-adjusted PAEs metabolites with childhood abdominal obesity risk. The prevalence of childhood abdominal obesity is 12.0% (96/798). Apart from mono(2-ethylhexyl) phthalate (62.5% for boys and 47.0% for girls), the detection rate of the others PAEs metabolites ranged from 82.6 to 100%. Boys had higher concentrations of PAEs metabolites than girls (P < 0.05), except for monoethyl phthalate. Compared with the Q1 group of PAEs metabolites, the risk of childhood abdominal obesity increased to 429% (OR = 5.29; 95% CI: 2.09, 13.39) and 273% (OR = 3.73; 95% CI: 1.57, 8.86) for the Q4 group of monoethyl phthalate and monoisobutyl phthalate, respectively.

Conclusion: The detection rate of PAEs metabolites is common, and the exposure level of PAEs metabolites was associated with the risk of abdominal obesity in Chinese students aged 7–10 years.

What is Known:

• The prevalence of childhood abdominal obesity had increased sharply from 4.9% in 1993 to 17.5% in 2014 in China. More than 80% of the Chinese children and adolescents have measurable level of several PAEs metabolites in the urine. Previous studies with limited sample had explored the association between DEHP metabolites exposure and childhood abdominal obesity risk, however, the association were inconsistent.

What is New:

• The detection rate of PAEs metabolites is common among Chinese children aged 7-10 years. Boys had higher concentrations of PAEs metabolites than girls (P < 0.05), except for monoethyl phthalate. Compared with the Q1 group of PAEs metabolites, the risk of childhood abdominal obesity increased to 429% and 273% for the Q4 group of monoethyl phthalate and monoisobutyl phthalate, respectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

PAEs:

Phthalates

CBPEF:

Childhood Blood Pressure and Environmental Factors

MMP:

Monomethyl phthalate

MEP:

Monoethyl phthalate

MBP:

Mono-n-butyl phthalate

MiBP:

Monoisobutyl phthalate

MEHP:

Mono(2-ethylhexyl) phthalate

MEOHP:

Mono(2-ethyl-5-oxyethyl) phthalate

MEHHP:

Mono(2-ethyl-phthalate) 5-hydroxyethyl) ester

IPAQ-SF:

International Physical Activity Questionnaire short form

LBW:

Low birth weight

NBW:

Normal birth weight

HBW:

High birth weight

BMI:

Body mass index

SD:

Standard deviation

LOD:

Limit of detection

WC:

Waist circumference

References

  1. Liang YJ, Xi B, Song AQ, Liu JX, Mi J (2012) Trends in general and abdominal obesity among Chinese children and adolescents 1993–2009. Pediatr Obes 7(5):355–364

    Article  Google Scholar 

  2. Yang Z, Dong B, Song Y, Wang X, Dong Y, Gao D et al (2020) Association between birth weight and risk of abdominal obesity in children and adolescents: a school-based epidemiology survey in China. BMC Public Health 20(1):1686

    Article  Google Scholar 

  3. Nehus E, Mitsnefes M (2019) Childhood obesity and the metabolic syndrome. Pediatr Clin North Am 66(1):31–43

    Article  Google Scholar 

  4. Hou YP, Li ZX, Yang L, Zhao M, Xi B (2020) Effect of abdominal obesity in childhood on abdominal obesity in adulthood. Zhonghua Liu Xing Bing Xue Za Zhi 41(3):385–388

    CAS  Google Scholar 

  5. Weihrauch-Bluher S, Wiegand S (2018) Risk factors and implications of childhood obesity. Curr Obes Rep 7(4):254–259

    Article  Google Scholar 

  6. Bushnik T, Wong SL, Holloway AC, Thomson EM (2020) Association of urinary polycyclic aromatic hydrocarbons and obesity in children aged 3–18: Canadian Health Measures Survey 2009–2015. J Dev Orig Health Dis 11(6):623–631

    Article  Google Scholar 

  7. Li K, Yin R, Wang Y, Zhao D (2021) Associations between exposure to polycyclic aromatic hydrocarbons and metabolic syndrome in U.S. adolescents: cross-sectional results from the National Health and Nutrition Examination Survey (2003–2016) data. Environ Res 202:111747

  8. Li YL, Lv J, Du ZP, Feng S, Sheng J, Jin ZX et al (2020) The levels of phthalate exposure and associations with obesity in an elderly population in China. Ecotoxicol Environ Saf 201:110749

    Article  CAS  Google Scholar 

  9. Wang W, Leung AOW, Chu LH, Wong MH (2018) Phthalates contamination in China: status, trends and human exposure-with an emphasis on oral intake. Environ Pollut 238:771–782

    Article  CAS  Google Scholar 

  10. Gao D, Zou Z, Li Y, Chen M, Ma Y, Chen L et al (2022) Association between urinary phthalate metabolites and dyslipidemia in children: results from a Chinese cohort study. Environ Pollut 295:118632

    Article  CAS  Google Scholar 

  11. Ma X, Yang J, Jia H, Li X, Wang D, Fu H et al (2019) Androgenic/antiandrogenic activities of PAEs determined by a novel AR-mediated reporter gene assay based on LLC-MK2 cells. Toxicology research 8(4):522–530

    Article  CAS  Google Scholar 

  12. Radke EG, Braun JM, Meeker JD, Cooper GS (2018) Phthalate exposure and male reproductive outcomes: a systematic review of the human epidemiological evidence. Environ Int 121(Pt 1):764–793

    Article  CAS  Google Scholar 

  13. Woodward MJ, Obsekov V, Jacobson MH, Kahn LG, Trasande L (2020) Phthalates and sex steroid hormones among men from NHANES, 2013–2016. J Clin Endocrinol Metab 105(4)

  14. Cathey A, Watkins DJ, Sanchez BN, Tamayo-Ortiz M, Solano-Gonzalez M, Torres-Olascoaga L et al (2020) Onset and tempo of sexual maturation is differentially associated with gestational phthalate exposure between boys and girls in a Mexico City birth cohort. Environ Int 136:105469

    Article  CAS  Google Scholar 

  15. Yang TC, Peterson KE, Meeker JD, Sanchez BN, Zhang Z, Cantoral A et al (2017) Bisphenol A and phthalates in utero and in childhood: association with child BMI z-score and adiposity. Environ Res 156:326–333

    Article  CAS  Google Scholar 

  16. Amin MM, Parastar S, Ebrahimpour K, Shoshtari-Yeganeh B, Hashemi M, Mansourian M et al (2018) Association of urinary phthalate metabolites concentrations with body mass index and waist circumference. Environ Sci Pollut Res Int 25(11):11143–11151

    Article  CAS  Google Scholar 

  17. Teitelbaum SL, Mervish N, Moshier EL, Vangeepuram N, Galvez MP, Calafat AM et al (2012) Associations between phthalate metabolite urinary concentrations and body size measures in New York City children. Environ Res 112:186–193

    Article  CAS  Google Scholar 

  18. Kataria A, Levine D, Wertenteil S, Vento S, Xue J, Rajendiran K et al (2017) Exposure to bisphenols and phthalates and association with oxidant stress, insulin resistance, and endothelial dysfunction in children. Pediatr Res 81(6):857–864

    Article  CAS  Google Scholar 

  19. Shoaff J, Papandonatos GD, Calafat AM, Ye X, Chen A, Lanphear BP et al (2017) Early-life phthalate exposure and adiposity at 8 years of age. Environ Health Perspect 125(9):097008

    Article  Google Scholar 

  20. Choi J, Eom J, Kim J, Lee S, Kim Y (2014) Association between some endocrine-disrupting chemicals and childhood obesity in biological samples of young girls: a cross-sectional study. Environ Toxicol Pharmacol 38(1):51–57

    Article  CAS  Google Scholar 

  21. Wang H, Zhou Y, Tang C, He Y, Wu J, Chen Y et al (2013) Urinary phthalate metabolites are associated with body mass index and waist circumference in Chinese school children. PLoS ONE 8(2):e56800

    Article  CAS  Google Scholar 

  22. Hou JW, Lin CL, Tsai YA, Chang CH, Liao KW, Yu CJ et al (2015) The effects of phthalate and nonylphenol exposure on body size and secondary sexual characteristics during puberty. Int J Hyg Environ Health 218(7):603–615

    Article  CAS  Google Scholar 

  23. Hatch EE, Nelson JW, Qureshi MM, Weinberg J, Moore LL, Singer M et al (2008) Association of urinary phthalate metabolite concentrations with body mass index and waist circumference: a cross-sectional study of NHANES data, 1999–2002. Environ Health Glob Access Sci 7:27

    Article  Google Scholar 

  24. Rehm CD, Penalvo JL, Afshin A, Mozaffarian D (2016) Dietary intake among US adults, 1999–2012. JAMA 315(23):2542–2553

    Article  CAS  Google Scholar 

  25. Lee PH, Macfarlane DJ, Lam TH, Stewart SM (2011) Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act 8:115

    Article  Google Scholar 

  26. Behrman R, Kliegman R, Jenson H (2003) Nelson’s Textbook of Pediatrics, 17th edn. Saunders, Philadelphia

    Google Scholar 

  27. National Health Commission of the People’s Republic of China (2018) High waist circumference screening threshold among children and adolescents aged 7~18 years Beijing: National Health Commission of the People’s Republic of China. Available from: http://www.nhc.gov.cn/wjw/pqt/201807/417de6982ab8493b91aba925b51a8a19.shtml. Accessed 28 Jun 2022

  28. Hashemi M, Amin MM, Chavoshani A, Rafiei N, Ebrahimpour K, Kelishadi R (2021) Relationship of urinary phthalate metabolites with cardiometabolic risk factors and oxidative stress markers in children and adolescents. J Environ Public Health 2021:5514073

    Article  Google Scholar 

  29. Monfort N, Ventura R, Balcells G, Segura J (2012) Determination of five di-(2-ethylhexyl)phthalate metabolites in urine by UPLC-MS/MS, markers of blood transfusion misuse in sports. J Chromatogr, B: Anal Technol Biomed Life Sci 908:113–121

    Article  CAS  Google Scholar 

  30. Koch HM, Lorber M, Christensen KL, Palmke C, Koslitz S, Bruning T (2013) Identifying sources of phthalate exposure with human biomonitoring: results of a 48h fasting study with urine collection and personal activity patterns. Int J Hyg Environ Health 216(6):672–681

    Article  CAS  Google Scholar 

  31. Ferguson KK, Cantonwine DE, Rivera-Gonzalez LO, Loch-Caruso R, Mukherjee B, Anzalota Del Toro LV et al (2014) Urinary phthalate metabolite associations with biomarkers of inflammation and oxidative stress across pregnancy in Puerto Rico. Environ Sci Technol 48(12):7018–7025

    Article  CAS  Google Scholar 

  32. Dong Y, Gao D, Li Y, Yang Z, Wang X, Chen M et al (2022) Effect of childhood phthalates exposure on the risk of overweight and obesity: a nested case-control study in China. Environ Int 158:106886

    Article  CAS  Google Scholar 

  33. Kim SH, Park MJ (2014) Phthalate exposure and childhood obesity. Ann Pediatr Endocrinol Metab 19(2):69–75

    Article  Google Scholar 

  34. Hatch EE, Nelson JW, Stahlhut RW, Webster TF (2010) Association of endocrine disruptors and obesity: perspectives from epidemiological studies. Int J Androl 33(2):324–332

    Article  CAS  Google Scholar 

  35. Braun JM (2017) Early-life exposure to EDCs: role in childhood obesity and neurodevelopment. Nat Rev Endocrinol 13(3):161–173

    Article  CAS  Google Scholar 

  36. Wang G, Chen Q, Tian P, Wang L, Li X, Lee YK et al (2020) Gut microbiota dysbiosis might be responsible to different toxicity caused by Di-(2-ethylhexyl) phthalate exposure in murine rodents. Environ Pollut 261:114164

    Article  CAS  Google Scholar 

  37. Schwiertz A, Taras D, Schafer K, Beijer S, Bos NA, Donus C et al (2010) Microbiota and SCFA in lean and overweight healthy subjects. Obesity (Silver Spring) 18(1):190–195

    Article  Google Scholar 

  38. Cai XX, Gao H, Yan SQ, Sheng J, Gu CL, Jin ZX et al (2018) Association between the internal exposure levels of phthalates and executive function of preschool children. Zhonghua Yu Fang Yi Xue Za Zhi 52(3):296–302

    CAS  Google Scholar 

  39. Ma TT, Wu LH, Chen L, Zhang HB, Teng Y, Luo YM (2015) Phthalate esters contamination in soils and vegetables of plastic film greenhouses of suburb Nanjing, China and the potential human health risk. Environ Sci Pollut Res Int 22(16):12018–12028

    Article  CAS  Google Scholar 

  40. Korfali SI, Sabra R, Jurdi M, Taleb RI (2013) Assessment of toxic metals and phthalates in children’s toys and clays. Arch Environ Contam Toxicol 65(3):368–381

    Article  CAS  Google Scholar 

  41. Hauser R, Meeker JD, Park S, Silva MJ, Calafat AM (2004) Temporal variability of urinary phthalate metabolite levels in men of reproductive age. Environ Health Perspect 112(17):1734–1740

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors greatly appreciate the Educational Administration Leaderships and primary and middle school health nurses in Xiamen City. The authors would additionally acknowledge all participants and investigators for their cooperation and efforts.

Funding

The project was supported by the Guangdong Medical Research Fund (A2022501), the Science and Technology Program of Guangzhou (No.202201011070), and the National Science Foundation of China (NSFC 81,773,454).

Author information

Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, Southern Medical University, No.1023, South Shatai Road, Guangzhou, 510000, Guangdong, China

    Zheng-he Wang

  2. School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing, 100191, China

    Di Gao & Zhi-yong Zou

Authors
  1. Zheng-he Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Di Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhi-yong Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ZZ and ZW were co-investigators and designed the study, ZW and DG carried out the initial analysis, and ZZ and ZW supervised data analysis. All authors were involved in writing the paper and had final approval of the submitted and published versions. ZZ take full responsibility for the whole work.

Corresponding authors

Correspondence to Zheng-he Wang or Zhi-yong Zou.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Medical Ethical Committee of Peking University Health Science Center (IRB00001052-17026). Written informed consent was obtained from all participants and their parents or guardians.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 416 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Zh., Gao, D. & Zou, Zy. The association of phthalate metabolites with childhood waist circumference and abdominal obesity. Eur J Pediatr 182, 803–812 (2023). https://doi.org/10.1007/s00431-022-04751-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-022-04751-x

Keywords

Search

Navigation