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Exploring associations between urine levels of phthalates and autism spectrum disorder symptoms: a case–control study in Tianjin, China

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Abstract

Autism spectrum disorder (ASD) comprises a group of neurodevelopmental disorders. The etiology of autism remains unclear, but a growing body of evidence indicates that phthalates play a role in its pathogenesis. The aim of this study was to compare the urine levels of phthalates in children with ASD and healthy children. We also explored whether phthalates have an effect on ASD symptoms. The participants in this study included 101 children with ASD (79 boys and 22 girls) and 101 sex- and age-matched controls. The levels of phthalates were analyzed by gas chromatography–mass spectrometry (GC–MS). We detected significant differences in monoethyl phthalate (MEP) levels between the severe ASD and control groups (p < 0.05). Mono-n-butyl phthalate (MBP) concentration was positively correlated with language skill impairment in ASD (β: 0.387, p = 0.041). MEP levels were associated with the CARS “Imitation” score in all children (OR: 1.470). MBP levels were associated with the “Nonverbal Communication” score among boys (OR: 1.233), and MEP levels were associated with the “Nonverbal Communication” score among girls (OR: 2.648). MEP levels were related to the CARS total score after adjustment for sex (β: 1.524, p = 0.047). Compared with the reference mono(2-ethylhexyl) phthalate (MEHP) group, children with ASD in the medium-exposure group had an OR of 3.370 for aggravating ASD severity. These results suggested that increased exposure to phthalates contributes to more ASD symptoms and that there are potentially sex-specific associations. These findings warrant further confirmation.

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Acknowledgements

We thank all the participants, their schools, and their families for their support and participation.

Data availability

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

Funding

This work was supported by grants from the National Natural Science Foundation of China (Nos. 81773459 and 81973070).

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  1. Y. Han and S. H. Jin contributed equally to this work, and they shared co-first authorship.

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  1. Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Tianjin, 300070, People’s Republic of China

    Yu Han, Shihao Jin, Liyuan Liu, Zhiyi Qu, Lei Gao, Peiying Li, Wenjuan Xiong & Xin Zhang

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  1. Yu Han
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Contributions

Conceptualization: Xin Zhang; methodology: Yu Han, Zhiyi Qu, and Lei Gao; formal analysis and investigation: Shihao Jin, Liyuan Liu, Peiying Li, and Wenjuan Xiong; writing — original draft preparation: Yu Han and Shihao Jin; funding acquisition: Xin Zhang; resources: Zhiyi Qu and Wenjuan Xiong; and supervision: Xin Zhang.

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Correspondence to Xin Zhang.

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The study protocol was approved by the Institutional Review Board of Tianjin Medical University and adhered to the tenets of the Declaration of Helsinki. Written informed consent to collect data was obtained from the parents or caregivers of all children.

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Han, Y., Jin, S., Liu, L. et al. Exploring associations between urine levels of phthalates and autism spectrum disorder symptoms: a case–control study in Tianjin, China. Environ Sci Pollut Res 29, 80805–80816 (2022). https://doi.org/10.1007/s11356-022-21526-x

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