Association of exposure to phthalates with cardiometabolic risk factors in children and adolescents: a systematic review and meta-analysis

Abstract

Recent studies revealed controversial results on the association of exposure to phthalates with cardiometabolic risk factors in children and adolescents. Therefore, this systematic review and meta-analysis was conducted in this regard. At first, we searched English-language papers in Scopus, Web of Science, and PubMed databases, with no restriction of time, till the end of the year 2018. We performed a comprehensive literature search for association between phthalate exposure and cardiometabolic risk factors including obesity, hypertension, hyperglycemia, and dyslipidemia. Among 99 published papers found in scientific databases, 17 cohort, 15 cross-sectional, and three case-control studies were included in the meta-analysis. We observed a significant association between the concentrations of phthalates and their metabolites with body mass index (BMI), BMI z-score, waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and glucose in serum. In addition, significant association was observed between prenatal phthalate exposure and birth weight. To the best of our knowledge, this is the first meta-analysis of its kind. It shows positive association between phthalate exposure and some cardiometabolic risk factors in children and adolescents. Therefore, prevention of exposure to phthalates and reduction of their use should be underscored in strategies for primordial prevention of cardiovascular diseases.

Recent studies revealed controversial results on the association of exposure to phthalates with cardiometabolic risk factors in children and adolescents. Therefore, this systematic review and meta-analysis was conducted in this regard.

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Fig. 1.

Abbreviations

TG:

Triglyceride

HMWP:

High molecular weight phthalate

LMWP:

Low molecular weight phthalate

EDCs:

Endocrine disrupting chemicals

HDL-C:

High-density lipoprotein cholesterol

LDL-C:

Low density lipoprotein cholesterol

DEHP:

Di-2-ethylhexyl phthalate

MeSH:

Medical subject heading

STROBE:

Strengthening the reporting of observational studies in epidemiology

MECPP:

Mono(2-ethyl-5-carboxypentyl)phthalate

PI:

Ponderal index

MMP:

Monomethylphthalate

MEP:

Monoethylphthalate

MEHP:

Mono(2-ethylhexyl)phthalate

MCPP:

Mono(3-carboxyprpoyl)phthalate

MCNP:

Monocarboxy-isononyl phthalate

MnBP:

Monobutylphthalate

MEOHP:

Mono(2-ethyl-5-oxohexyl)phthalate

MBzP:

Monobenzylphthalate

MiBP:

Monoisobutylphthalate

MEHHP:

Mono(2-ethyl-5-hydroxyhexyl)phthalate

BF:

Body fat

MBP:

Monobutylphthalate

DEP:

Diethylphthalate

DBP:

Dibutylphthalate

BBzP:

Butylbenzylphthalate

SBP:

Systolic blood pressure

FBS:

Fast blood sugar

MCOP:

Monocarboxyoctylphthalate

MOP:

Monooctylphthalate

DBP:

Diastolic blood pressure

BMI:

Body mass index

WC:

Waist circumference

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Acknowledgments

The authors are grateful to Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences for supporting this work.

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Correspondence to Roya Kelishadi.

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Research highlights

• A systematic review and meta-analysis on phthalate exposure and cardiometabolic risk factors in the pediatric age group was conducted.

• Significant association was observed between phthalates and generalized and abdominal obesity, as well as hypertension.

• The serum levels of lipids and glucose of children and adolescents were associated with urinary phthalate metabolites.

• Maternal phthalates exposure might be associated with cardiometabolic risk factors in their offspring.

Responsible editor: Philippe Garrigues

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Golestanzadeh, M., Riahi, R. & Kelishadi, R. Association of exposure to phthalates with cardiometabolic risk factors in children and adolescents: a systematic review and meta-analysis. Environ Sci Pollut Res 26, 35670–35686 (2019). https://doi.org/10.1007/s11356-019-06589-7

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Keywords

  • Environmental exposure
  • Endocrine disruptors
  • Adolescent
  • Child
  • Systematic review
  • Meta-analysis