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.
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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
References
Amin MM, Parastar S, Ebrahimpour K, Shoshtari-Yeganeh B, Hashemi M, Mansourian M, Kelishadi R (2018a) Association of urinary phthalate metabolites concentrations with body mass index and waist circumference. Environ Sci Pollut Res 25:11143–11151
Amin MM, Ebrahimpour K, Parastar S, Shoshtari-Yeganeh B, Hashemi M, Mansourian M, Poursafa P, Fallah Z, Rafiei N, Kelishadi R (2018b) Association of urinary concentrations of phthalate metabolites with cardiometabolic risk factors and obesity in children and adolescents. Chemosphere 211:547–556
Barber TM, Franks S (2019) Chapter 27 - genetic and environmental factors in the etiology of polycystic ovary syndrome. In: Adashi EY (ed) Leung PCK. Academic Press, The Ovary (Third Edition), pp 437–459
Benjamin S, Masai E, Kamimura N, Takahashi K, Anderson RC, Faisal PA (2017) Phthalates impact human health: epidemiological evidences and plausible mechanism of action. J Hazard Mater 340:360–383
Botton J, Philippat C, Calafat AM, Carles S, Charles MA, Slama R, the Em-ccsg (2016) Phthalate pregnancy exposure and male offspring growth from the intra-uterine period to five years of age. Environ Res 151:601–609
Bowman JD, Choudhury M (2016) Phthalates in neonatal health: friend or foe? J Dev Orig Health Dis 7:652–664
Braun JM, Sathyanarayana S, Hauser R (2013) Phthalate exposure and children's health. Curr Opin Pediatr 25:247–254
Buckley JP, Engel SM, Braun JM, Whyatt RM, Daniels JL, Mendez MA, Richardson DB, Xu Y, Calafat AM, Wolff MS, Lanphear BP, Herring AH, Rundlec AG (2016a) Prenatal phthalate exposures and body mass index among 4-to 7-year-old children a pooled analysis. Epidemiology 27:449–458
Buckley JP, Engel SM, Mendez MA, Richardson DB, Daniels JL, Calafat AM, Wolff MS, Herring AH (2016b) Prenatal phthalate exposures and childhood fat mass in a New York city cohort. Environ Health Perspect 124:507–513
Bui TT, Giovanoulis G, Cousins AP, Magnér J, Cousins IT, de Wit CA (2016) Human exposure, hazard and risk of alternative plasticizers to phthalate esters. Sci Total Environ 541:451–467
Campbell JL, Yoon M, Ward PL, Fromme H, Kessler W, Phillips MB, Anderson WA, Clewell HJ, Longnecker MP (2018) Excretion of di-2-ethylhexyl phthalate (DEHP) metabolites in urine is related to body mass index because of higher energy intake in the overweight and obese. Environ Int 113:91–99
Cannon CP (2007) Cardiovascular disease and modifiable cardiometabolic risk factors. Clin Cornerstone 8:11–28
Chiang H-c, Kuo Y-T, Shen C-C, Lin Y-H, Wang S-L, Tsou T-C (2016) Mono(2-ethylhexyl)phthalate accumulation disturbs energy metabolism of fat cells. Arch Toxicol 90:589–601
Chiu YH, Bellavia A, James-Todd T, Correia KF, Valeri L, Messerlian C, Ford JB, Mínguez-Alarcón L, Calafat AM, Hauser R, Williams PL (2018) Evaluating effects of prenatal exposure to phthalate mixtures on birth weight: a comparison of three statistical approaches. Environ Int 113:231–239
Chou C-K, Yang Y-T, Yang H-C, Liang S-S, Wang T-N, Kuo P-L, Wang H-MD, Tsai E-M, Chiu C-C (2018) The impact of di(2-ethylhexyl)phthalate on cancer progression. Arch Immunol Ther Exp 66:183–197
Cirillo T, Amodio Cocchieri R (2013) 14 - phthalates in foods. Persistent organic pollutants and toxic metals in foods. Woodhead Publishing, 334-366 pp
Cunningham SA, Kramer MR, Narayan KMV (2014) Incidence of Childhood Obesity in the United States. New Engl J Med 370:403–411
Deierlein AL, Wolff MS, Pajak A, Pinney SM, Windham GC, Galvez MP, Silva MJ, Calafat AM, Kushi LH, Biro FM, Teitelbaum SL (2016) Longitudinal associations of phthalate exposures during childhood and body size measurements in young girls. Epidemiology 27:492–499
Ejaredar M, Nyanza EC, Ten Eycke K, Dewey D (2015) Phthalate exposure and childrens neurodevelopment: a systematic review. Environ Res 142:51–60
Evans RM, Barish GD, Wang Y-X (2004) PPARs and the complex journey to obesity. Nat Med 10:355–361
Ferguson KK, McElrath TF, Meeker JD (2014) Environmental phthalate exposure and preterm birth Environmental Phthalate Exposure and Preterm Birth Environmental Phthalate Exposure and Preterm Birth. JAMA Pediatr 168:61–67
Gao D-W, Wen Z-D (2016) Phthalate esters in the environment: a critical review of their occurrence, biodegradation, and removal during wastewater treatment processes. Sci Total Environ 541:986–1001
Gao D, Li Z, Wang H, Liang H (2018) An overview of phthalate acid ester pollution in China over the last decade: environmental occurrence and human exposure. Sci Total Environ 645:1400–1409
Gaston SA, Tulve NS (2019) Urinary phthalate metabolites and metabolic syndrome in U.S. adolescents: Cross-sectional results from the National Health and Nutrition Examination Survey (2003-2014) data. Int. J. Hyg. Environ. Health 222:195–204
Gesler RM (1973) Toxicology of di-2-ethylhexyl phthalate and other phthalic acid ester plasticizers. Environ Health Perspect 3:73–79
Goodman M, LaKind JS, Mattison DR (2014) Do phthalates act as obesogens in humans? A systematic review of the epidemiological literature. Crit Rev Toxicol 44:151–175
Harley KG, Berger K, Rauch S, Kogut K, Claus Henn B, Calafat AM, Huen K, Eskenazi B, Holland N (2017) Association of prenatal urinary phthalate metabolite concentrations and childhood BMI and obesity. Pediatr Res 82:405–415
Hatch EE, Nelson JW, Qureshi MM, Weinberg J, Moore LL, Singer M, Webster TF (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 7:27
Hayashi Y, Ito Y, Nakajima T (2014) Effects of exposure to di(2-ethylhexyl)phthalate during fetal period on next generation. Nihon Eiseigaku Zasshi 69:86–91
Henkel R (2018) Chapter 12 - environmental contamination and testicular function. In: Sikka SC, Hellstrom WJG (eds) Bioenvironmental Issues Affecting Men's Reproductive and Sexual Health. Academic Press, Boston, pp 191–208
Heudorf U, Mersch-Sundermann V, Angerer J (2007) Phthalates: toxicology and exposure. Int J Hyg Environ Health 210:623–634
Hou JW, Lin CL, Tsai YA, Chang CH, Liao KW, Yu CJ, Yang W, Lee MJ, Huang PC, Sun CW, Wang YH, Lin FR, Wu WC, Lee MC, Pan WH, Chen BH, Wu MT, Chen CC, Wang SL, Lee CC, Hsiung CA, Chen ML (2015) The effects of phthalate and nonylphenol exposure on body size and secondary sexual characteristics during puberty. Int J Hyg Environ Health 218:603–615
Huang T, Saxena AR, Isganaitis E, James-Todd T (2014) Gender and racial/ethnic differences in the associations of urinary phthalate metabolites with markers of diabetes risk: national health and nutrition examination survey 2001–2008. Environ Health 13:6
Hyun Kim D, Min Choi S, Soo Lim D, Roh T, Jun Kwack S, Yoon S, Kook Kim M, Sil Yoon K, Sik Kim H, Wook Kim D, Lee BM (2018) Risk assessment of endocrine disrupting phthalates and hormonal alterations in children and adolescents. J Toxicol Environ Health, Part A 81:1150–1164
Jeddi MZ, Janani L, Memari AH, Akhondzadeh S, Yunesian M (2016) The role of phthalate esters in autism development: a systematic review. Environ Res 151:493–504
Johnston M, Sharma N (2018) Addressing childhood obesity: one variable at a time. Pediatrics 141:584–584
Kamrin MA (2009) Phthalate risks, phthalate regulation, and public health: a review. J Toxicol Environ Health, Part B 12:157–174
Karačonji IB, Jurica SA, Lasić D, Jurica K (2017) Facts about phthalate toxicity in humans and their occurrence in alcoholic beverages. Arh Hig Rada Toksikol 68:81–92
Kasper-Sonnenberg M, Koch HM, Wittsiepe J, Brüning T, Wilhelm M (2014) Phthalate metabolites and bisphenol A in urines from German school-aged children: results of the Duisburg Birth Cohort and Bochum Cohort Studies. Int J Hyg Environ Health 217:830–838
Kay VR, Chambers C, Foster WG (2013) Reproductive and developmental effects of phthalate diesters in females. Crit Rev Toxicol 43:200–219
Kay VR, Bloom MS, Foster WG (2014) Reproductive and developmental effects of phthalate diesters in males. Crit Rev Toxicol 44:467–498
Kim SH, Park MJ (2014) Phthalate exposure and childhood obesity. Ann Pediatr Endocrinol Metab 19:69–75
Kim JH, Park H, Lee J, Cho G, Choi S, Choi G, Kim SY, Eun SH, Suh E, Kim SK, Kim HJ, Kim GH, Lee JJ, Kim YD, Eom S, Kim S, Moon HB, Park J, Choi K, Kim S, Kim S (2016) Association of diethylhexyl phthalate with obesityrelated markers and body mass change from birth to 3 months of age. J Epidemiol Community Health 70:466–472
Kim SH, On JW, Pyo H, Ko KS, Won JC, Yang J, Park MJ (2018) Percentage fractions of urinary di(2-ethylhexyl) phthalate metabolites: association with obesity and insulin resistance in Korean girls. PLoS One 13:e0208081
Krais AM, Andersen C, Eriksson AC, Johnsson E, Nielsen J, Pagels J, Gudmundsson A, Lindh CH, Wierzbicka A (2018) Excretion of urinary metabolites of the phthalate esters DEP and DEHP in 16 volunteers after inhalation and dermal exposure. Int J Environ Res Public Health 15:2514
Larsen ST (2017) 17 -Health and safety issues with plasticizers and plasticized materials. In: Wypych G (Editor), Handbook of Plasticizers (Third Edition). ChemTec Publishing, pp. 681-743
Latini G (2000) Potential hazards of exposure to di-(2-ethylhexyl)-phthalate in babies. Neonatology 78:269–276
Lien GW, Chen JH, Tien FW, Chen PC, Chen HW, Hwa HL, Fang CC, Weng TI, Chen PS (2018) Dilute-and-shoot enhances sensitivity of phthalate urinary concentrations for assessing the exposure in children. J Hazard Mater 351:124–130
Lin CY, Hsieh CJ, Lo SC, Chen PC, Torng PL, Hu A, Sung FC, Su TC (2016) Positive association between concentration of phthalate metabolites in urine and microparticles in adolescents and young adults. Environ Int 92-93:157–164
Lind L, Lind PM (2012) Can persistent organic pollutants and plastic-associated chemicals cause cardiovascular disease? J Intern Med 271:537–553
Lind PM, Roos V, Rönn M, Johansson L, Ahlström H, Kullberg J, Lind L (2012) Serum concentrations of phthalate metabolites are related to abdominal fat distribution two years later in elderly women. Environ Health 11:21
Lu X, Xu X, Lin Y, Zhang Y, Huo X (2018) Phthalate exposure as a risk factor for hypertension. Environ Sci Pollut Res 25:20550–20561
Lyche JL, Gutleb AC, Bergman Å, Eriksen GS, Murk AJ, Ropstad E, Saunders M, Skaare JU (2009) Reproductive and developmental toxicity of phthalates. J Toxicol Environ Health, Part B 12:225–249
Mason KE, Pearce N, Cummins S (2018) Associations between fast food and physical activity environments and adiposity in mid-life: cross-sectional, observational evidence from UK Biobank. Lancet Public Health 3:e24–e33
Minatoya M, Araki A, Miyashita C, Sasaki S, Goto Y, Nakajima T, Kishi R (2017) Prenatal di-2-ethylhexyl phthalate exposure and cord blood adipokine levels and birth size: the Hokkaido study on environment and children's health. Sci Total Environ 579:606–611
Miodovnik A, Edwards A, Bellinger DC, Hauser R (2014) Developmental neurotoxicity of ortho-phthalate diesters: review of human and experimental evidence. Neurotoxicology 41:112–122
Perez AL, Liong M, Plotkin K, Rickabaugh KP, Paustenbach DJ (2017) Health risk assessment of exposures to a high molecular weight plasticizer present in automobile interiors. Chemosphere 167:541–550
Perng W, Watkins DJ, Cantoral A, Mercado-García A, Meeker JD, Téllez-Rojo MM, Peterson KE (2017) Exposure to phthalates is associated with lipid profile in peripubertal Mexican youth. Environ Res 154:311–317
Peterson RA, Brown SP (2005) On the use of beta coefficients in meta-analysis. J Appl Psychol 90:175–181
Praveena SM, Teh SW, Rajendran RK, Kannan N, Lin C-C, Abdullah R, Kumar S (2018) Recent updates on phthalate exposure and human health: a special focus on liver toxicity and stem cell regeneration. Environ Sci Pollut Res 25:11333–11342
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 121:764–793
Rusyn I, Corton JC (2012) Mechanistic considerations for human relevance of cancer hazard of di(2-ethylhexyl) phthalate. Mutat Res Rev Mutat Res 750:141–158
Saengkaew T, Jantarat C, Nosoognoen W, Supornsilchai V (2017) Association between urinary phthalates and metabolic abnormalities in obese Thai children and adolescents. J Pediatr Endocrinol Metab 30:931–938
Schettler T (2006) Human exposure to phthalates via consumer products. Int J Androl 29:134–139
Schmidt J-S, Schaedlich K, Fiandanese N, Pocar P, Fischer B (2012) Effects of di(2-ethylhexyl) phthalate (DEHP) on female fertility and adipogenesis in C3H/N mice. Environ Health Perspect 120:1123–1129
Sharpe RM, Drake AJ (2013): Obesogens and obesity—an alternative view? Obesity 21, 1081-1083
Shoaff JR, Romano ME, Yolton K, Lanphear BP, Calafat AM, Braun JM (2016) Prenatal phthalate exposure and infant size at birth and gestational duration. Environ Res 150:52–58
Shoaff J, Papandonatos GD, Calafat AM, Ye X, Chen A, Lanphear BP, Yolton K, Braun JM (2017) Early-life phthalate exposure and adiposity at 8 years of age. Environ Health Perspect 125:097008
Smerieri A, Testa C, Lazzeroni P, Nuti F, Grossi E, Cesari S, Montanini L, Latini G, Bernasconi S, Papini AM, Street ME (2015) Di-(2-ethylhexyl) phthalate metabolites in urine show age-related changes and associations with adiposity and parameters of insulin sensitivity in childhood. PLoS One 10:e0117831
Smith CJ, Ryckman KK, Barnabei VM, Howard BV, Isasi CR, Sarto GE, Tom SE, Van Horn LV, Wallace RB, Robinson JG (2016) The impact of birth weight on cardiovascular disease risk in the Women's Health Initiative. Nutr Metab Cardiovasc Dis 26:239–245
Sugiyama S-i, Shimada N, Miyoshi H, Yamauchi K (2005) Detection of thyroid system–disrupting chemicals using in vitro and in vivo screening assays in Xenopus laevis. Toxicol Sci 88:367–374
Svechnikov K, Savchuk I, Morvan ML, Antignac JP, Le Bizec B, Söder O (2016) Phthalates exert multiple effects on Leydig Cell steroidogenesis. Horm Res Paediatr 86:253–263
Teitelbaum SL, Mervish NL, Moshier E, Vangeepuram N, Galvez MP, Calafat AM, Silva MJ, Brenner BL, Wolff MS (2012) Associations between phthalate metabolite urinary concentrations and body size measures in New York City children. Environ Res 112:186–193
Trasande L, Sathyanarayana S, Spanier AJ, Trachtman H, Attina TM, Urbina EM (2013a) Urinary phthalates are associated with higher blood pressure in childhood. J Pediatr 163:747–753.e1
Trasande L, Attina TM, Sathyanarayana S, Spanier AJ, Blustein J (2013b) Race/ethnicity-specific associations of urinary phthalates with childhood body mass in a nationally representative sample. Environ Health Perspect 121:501–506
Vafeiadi M, Myridakis A, Roumeliotaki T, Margetaki K, Chalkiadaki G, Dermitzaki E, Venihaki M, Sarri K, Vassilaki M, Leventakou V, Stephanou EG, Kogevinas M, Chatzi L (2018) Association of early life exposure to phthalates with obesity and cardiometabolic traits in childhood: sex specific associations. Front Public Health 6:327–327
Valvi D, Casas M, Romaguera D, Monfort N, Ventura R, Martinez D, Sunyer J, Vrijheid M (2015) Prenatal phthalate exposure and childhood growth and blood pressure: evidence from the Spanish inma-sabadell birth cohort study. Environ Health Perspect 123:1022–1029
Van Vliet ED, Reitano EM, Chhabra JS, Bergen GP, Whyatt RM (2011) A review of alternatives to di (2-ethylhexyl) phthalate-containing medical devices in the neonatal intensive care unit. J Perinatol 31:551–560
Van Vliet ED, Reitano EM, Chhabra JS, Bergen GP, Whyatt RM (2012) A review of alternatives to di (2-ethylhexyl) phthalate-containing medical devices in the neonatal intensive care unit. J Perinatol 32:648
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296
Wang H, Zhou Y, Tang C, He Y, Wu J, Chen Y, Jiang Q (2013) Urinary phthalate metabolites are associated with body mass index and waist circumference in Chinese school children. PLoS One 8:e56800
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
Wassenaar PNH, Legler J (2017) Systematic review and meta-analysis of early life exposure to di(2-ethylhexyl) phthalate and obesity related outcomes in rodents. Chemosphere 188:174–181
Wassenaar Pim Nicolaas H, Trasande L, Legler J (2017) Systematic review and meta-analysis of early-life exposure to bisphenol A and obesity-related outcomes in rodents. Environ Health Perspect 125:106001–1060015
Wijnhoven TM, van Raaij JM, Spinelli A, Starc G, Hassapidou M, Spiroski I, Rutter H, Martos É, Rito AI, Hovengen R, Pérez-Farinós N, Petrauskiene A, Eldin N, Braeckevelt L, Pudule I, Kunešová M, Breda J (2014) WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6–9-year-old children from school year 2007/2008 to school year 2009/2010. BMC Public Health 14:806
Wittassek M, Koch HM, Angerer J, Brüning T (2011) Assessing exposure to phthalates – the human biomonitoring approach. Mol Nutr Food Res 55:7–31
Wu W, Wu P, Yang F, Sun DL, Zhang DX, Zhou YK (2018) Association of phthalate exposure with anthropometric indices and blood pressure in first-grade children. Environ Sci Pollut Res 25:23125–23134
Xia B, Zhu Q, Zhao Y, Ge W, Zhao Y, Song Q, Zhou Y, Shi H, Zhang Y (2018) Phthalate exposure and childhood overweight and obesity: urinary metabolomic evidence. Environ Int 121:159–168
Zhang G (2015) Effect of diethyl phthalate on biochemical indicators of carp liver tissue. Toxin Rev 34:21–27
Zhang Y, Meng X, Chen L, Li D, Zhao L, Zhao Y, Li L, Shi H (2014) Age and sex-specific relationships between phthalate exposures and obesity in Chinese children at puberty. PLoS One 9:e104852
Zhang T, Shen W, De Felici M, Zhang X-F (2016) Di(2-ethylhexyl)phthalate: adverse effects on folliculogenesis that cannot be neglected. Environ Mol Mutagen 57:579–588
Zhang YW, Gao H, Mao LJ, Tao XY, Ge X, Huang K, Zhu P, Hao JH, Wang QN, Xu YY, Jin ZX, Sheng J, Xu YQ, Yan SQ, Tao XG, Tao FB (2018) Effects of the phthalate exposure during three gestation periods on birth weight and their gender differences: a birth cohort study in China. Sci Total Environ 613-614:1573–1578
Zhang Q, Chen X-Z, Huang X, Wang M, Wu J (2019) The association between prenatal exposure to phthalates and cognition and neurobehavior of children-evidence from birth cohorts. Neurotoxicology 73:199–212
Zhu J, Phillips SP, Cao XL (2016): Chemical contaminants: phthalates, Safety Analysis of Foods of Animal Origin, pp. 907-928
Zhu Y, Wan Y, Zhang B, Zhou A, Huo W, Wu C, Liu H, Jiang Y, Chen Z, Jiang M, Peng Y, Xu S, Xia W, Li Y (2018) Relationship between maternal phthalate exposure and offspring size at birth. Sci Total Environ 612:1072–1078
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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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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.
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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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DOI: https://doi.org/10.1007/s11356-019-06589-7