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Lee A, Choi S, Park NY, Kho Y, Kim S, Choi K, Moon HB, Park J. Effects of dietary sources and personal care products on paraben exposure in young Korean adults: A crossover intervention study. CHEMOSPHERE 2025; 374:144209. [PMID: 39965282 DOI: 10.1016/j.chemosphere.2025.144209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 01/10/2025] [Accepted: 02/08/2025] [Indexed: 02/20/2025]
Abstract
Parabens including methyl-(MeP), ethyl-(EtP), and propyl-(PrP) parabens, are widely used as antimicrobial preservatives in foods, cosmetics, and personal care products (CPCPs), and drugs. However, studies evaluating the contribution of exposure sources to paraben exposure are limited, and most focus primarily on CPCPs. This study conducted a crossover intervention to assess the contributions of foods and CPCPs to paraben exposure among young Korean adults. Twenty-seven college students participated in a 6-day intervention. They used preservative-free CPCPs throughout the study and were served a 'diet with paraben-free sauces' on days 3-4, followed by a 'diet with paraben-containing sauces' on days 5-6. Urine samples collected at each intervention point were analyzed for nine parabens, including MeP, EtP, and normal propyl-paraben (nPrP), using HPLC-MS/MS. Before the intervention, the geometric mean urinary concentrations of MeP, EtP, and nPrP were 6.05, 76.9, and 0.52 ng/mL, respectively-approximately 3 to 14 times higher than levels reported in other countries. No significant changes in urinary paraben concentrations were observed after the CPCPs-only intervention. However, following the diet with paraben-free sauces, urinary EtP levels significantly decreased by 79.7% (95% CI -89.2, -61.8). After diet with paraben-containing sauces, urinary EtP and MeP levels increased significantly (EtP 2830% (1310-5990); MeP 84.4% (25.7, 170)). This study highlights the substantial impact of diet on paraben exposure, especially EtP, suggesting that dietary sources play a significant role.
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Affiliation(s)
- Aram Lee
- Department of Environmental Health Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Sohyeon Choi
- Department of Environmental Health Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Na-Youn Park
- Department of Health, Environment and Safety, Eulji University, Seongnam, Gyeonggi, Republic of Korea
| | - Younglim Kho
- Department of Health, Environment and Safety, Eulji University, Seongnam, Gyeonggi, Republic of Korea
| | - Sungkyoon Kim
- Department of Environmental Health Sciences, Seoul National University, Seoul, Republic of Korea
| | - Kyungho Choi
- Department of Environmental Health Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyo-Bang Moon
- Department of Marine Sciences and Convergent Technology, Hanyang University, Ansan, Republic of Korea
| | - Jeongim Park
- Department of Environmental Health Sciences, Soonchunhyang University, Asan, Republic of Korea.
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Phanumartwiwath A, Liana D, Duan H. Association of environmental phenol and paraben exposure with allergic biomarkers in eczema: findings from NHANES 2005-2006. Arch Dermatol Res 2025; 317:452. [PMID: 39987402 DOI: 10.1007/s00403-025-03981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Revised: 01/31/2025] [Accepted: 02/03/2025] [Indexed: 02/24/2025]
Abstract
Endocrine-disrupting chemicals such as phenols and parabens can promote allergic conditions including eczema. We aimed to analyze the association between exposure to environmental phenols and parabens and allergic biomarkers-including total serum Immunoglobulin E (IgE), C-reactive protein (CRP), and eosinophils-in individuals with eczema, using the dataset from NHANES 2005-2006. This analysis was based on urinary biomarker levels of phenols and parabens, including bisphenol A, benzophenone-3, 4-tert-octylphenol, triclosan, as well as methyl, ethyl, propyl, and butyl parabens. The urinary biomarkers of phenols and parabens were quantified using online SPE-HPLC-MS/MS, while IgE, CRP, and eosinophil levels were analyzed using fluorescent-enzyme immunoassay, the ImmunoCAP 1000 system, latex-enhanced nephelometry, and the Beckman Coulter method, respectively. Following data extraction, we obtained 159 individuals with a history of eczema and categorized them by age for analysis. Our findings showed positive correlations between bisphenol A, triclosan, butyl paraben, methyl paraben, and propyl paraben and allergic biomarkers in children with eczema aged 6 to 8 years. Notably, a significant positive correlation was observed between methyl paraben exposure and IgE levels. In adults with eczema, 4-tert-octylphenol demonstrated a significant positive association with both IgE levels and eosinophil counts. These findings suggest that exposure to these chemicals may exacerbate eczema symptoms.
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Affiliation(s)
| | - Desy Liana
- College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Hongxiang Duan
- College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
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Jeong Y, Mok S, Kim S, Lee I, Lee G, Kho Y, Choi K, Kim KT, Moon HB. Comparison of urinary exposure profiles to phthalates and bisphenol analogues in kindergartens in Korea: Impact of environmental choices on children's health. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 288:117391. [PMID: 39603221 DOI: 10.1016/j.ecoenv.2024.117391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 11/19/2024] [Accepted: 11/20/2024] [Indexed: 11/29/2024]
Abstract
Phthalates and bisphenols (BPs) are well-known endocrine disrupting chemicals (EDCs) that are widely used in diverse consumer and personal care products. Despite their vulnerability, children are frequently exposed to phthalates and BPs in their surrounding environments. Although pre-school children spend most of their time in kindergarten, no comprehensive assessment of children' exposure to EDCs has been conducted according to the type of kindergarten. In this study, the urinary concentrations of phthalate metabolites and BPs were determined in Korean children attending conventional and eco-friendly kindergartens. The exposure levels and contaminant profiles were investigated according to kindergarten type and their association with oxidative stress was assessed. Di-(2-ethylhexyl) phthalate (DEHP) metabolites, such as mono-(2-ethyl-5-carboxypentyl) phthalate (median: 47.1 ng/mL) and mono-[(2-carboxymethyl)hexyl] phthalate (8.45 ng/mL) had the highest levels, indicating that they were the primary contaminants to which the children were exposed. Urinary concentrations of phthalate metabolites and bisphenol A (BPA) were higher in children from conventional kindergarten than an eco-friendly kindergarten. Conversely, bisphenol S (BPS) concentrations were significantly higher in children from the eco-friendly kindergarten than in those from conventional kindergartens, implying that eco-friendly plastic products might contain BPS as a replacement for BPA. The estimated daily intakes of BPA for all children exceeded the new tolerable daily intake proposed by the European Food Safety Authority. Malondialdehyde levels were significantly associated with the urinary concentrations of certain phthalate metabolites, indicating potential adverse health outcomes from phthalate exposure in children. The study highlights the need for targeted interventions to reduce EDC exposure in children, especially in settings where alternative chemicals may still pose health risks.
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Affiliation(s)
- Yunsun Jeong
- Department of Marine Science and Convergence Engineering, College of Science and Convergence Technology, Hanyang University, Ansan 15588, Republic of Korea
| | - Sori Mok
- Department of Marine Science and Convergence Engineering, College of Science and Convergence Technology, Hanyang University, Ansan 15588, Republic of Korea
| | - Sunmi Kim
- Chemical Analysis Center, Chemical Platform Technology Division, Korea Research Institute of Chemical Technology, Daejeon 34114, Republic of Korea
| | - Inae Lee
- Department of Public Health, Keimyung University, Daegu 42601, Republic of Korea
| | - Gowoon Lee
- Department of Safety Engineering, Korea National University of Transportation, Chungbuk 27469, Republic of Korea
| | - Younglim Kho
- Department of Health, Environment and Safety, Eulji University, Seongnam 13135, Republic of Korea
| | - Kyungho Choi
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
| | - Ki-Tae Kim
- Department of Environmental Engineering, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
| | - Hyo-Bang Moon
- Department of Marine Science and Convergence Engineering, College of Science and Convergence Technology, Hanyang University, Ansan 15588, Republic of Korea.
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Ucheana IA, Omeka ME, Ezugwu AL, Agbasi JC, Egbueri JC, Abugu HO, Aralu CC. A targeted review on occurrence, remediation, and risk assessments of bisphenol A in Africa. ENVIRONMENTAL MONITORING AND ASSESSMENT 2024; 196:1193. [PMID: 39532752 DOI: 10.1007/s10661-024-13337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/25/2024] [Indexed: 11/16/2024]
Abstract
Bisphenol A (BPA) is a vital raw material used to manufacture various household and commercial goods. However, BPA is a contaminant of emerging concern (CEC) and an endocrine-disrupting chemical (EDC) capable of migrating and bio-accumulating in environmental and biological compartments. At threshold levels, they become toxic causing adverse health and environmental issues. BPA's occurrence in food, food contact materials (FCMs), beverages, water, cosmetics, consumer goods, soil, sediments, and human/biological fluids across Africa was outlined. Unlike most reviews, it further collated data on BPA remediation techniques, including the human and ecological risk assessment studies conducted across Africa. A systematic scrutiny of the major indexing databases was employed extracting relevant data for this study. Results reveal that only 10 out of 54 countries have researched BPA in Africa. BPA levels in water were the most investigated, whereas levels in cosmetics and consumer goods were the least studied. Maximum BPA concentrations found in Africa were 3,590,000 ng/g (cosmetic and consumer goods), 154,820,000 ng/g (soils), 189 ng/mL (water), 1139 ng/g (food), and 208.55 ng/mL (biological fluids). The optimum percentage removal/degradation of BPA was within 70-100%. The potential health and ecological risk levels were assessed by comparing them with recommended limits and were found to fall within safe/low risks to unsafe/high risks. In conclusion, this study revealed that there is still little research on BPA in Africa. Levels detected in some matrices call for increased research, stricter health and environmental regulations, and surveillance.
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Affiliation(s)
- Ifeanyi Adolphus Ucheana
- Department of Pure and Industrial Chemistry, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
- Central Science Laboratory, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
| | - Michael Ekuru Omeka
- Department of Geology, University of Calabar, Etagbor, 540271, Cross River State, Nigeria
| | - Arinze Longinus Ezugwu
- Department of Pure and Industrial Chemistry, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
| | - Johnson C Agbasi
- Department of Geology, Chukwuemeka Odumegwu Ojukwu University, Uli, 431124, Anambra State, Nigeria
| | - Johnbosco C Egbueri
- Department of Geology, Chukwuemeka Odumegwu Ojukwu University, Uli, 431124, Anambra State, Nigeria
| | - Hillary Onyeka Abugu
- Department of Pure and Industrial Chemistry, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria.
| | - Chiedozie Chukwuemeka Aralu
- Department of Pure and Industrial Chemistry, Nnamdi Azikiwe University, Awka, 420007, Anambra State, Nigeria
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Oh Y, Hong SJ, Park YJ, Baek IH. Association between phthalate exposure and risk of allergic rhinitis in children: A systematic review and meta-analysis. Pediatr Allergy Immunol 2024; 35:e14230. [PMID: 39229646 DOI: 10.1111/pai.14230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/05/2024]
Abstract
Phthalates are ubiquitous in diverse environments and have been linked to a myriad of detrimental health outcomes. However, the association between phthalate exposure and allergic rhinitis (AR) remains unclear. To address this knowledge gap, we conducted a systematic review and meta-analysis to comprehensively evaluate the relationship between phthalate exposure and childhood AR risk. We searched the Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, and PubMed to collect relevant studies and estimated pooled odds ratios (OR) and 95% confidence intervals (CI) for risk estimation. Ultimately, 18 articles, including seven cross-sectional, seven case-control, and four prospective cohort studies, were selected for our systematic review and meta-analysis. Our pooled data revealed a significant association between di-2-ethylhexyl phthalate (DEHP) exposure in children's urine and AR risk (OR = 1.188; 95% CI = 1.016-1.389). Additionally, prenatal exposure to combined phthalates and their metabolites in maternal urine was significantly associated with the risk of childhood AR (OR = 1.041; 95% CI = 1.003-1.081), although specific types of phthalates and their metabolites were not significant. Furthermore, we examined environmental phthalate exposure in household dust and found no significant association with AR risk (OR = 1.021; 95% CI = 0.980-1.065). Our findings underscore the potential hazardous effects of phthalates on childhood AR and offer valuable insights into its pathogenesis and prevention.
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Affiliation(s)
- Yeonghun Oh
- College of Pharmacy, Kyungsung University, Busan, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Respiratory and Allergy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Joo Park
- College of Pharmacy, Kyungsung University, Busan, Korea
| | - In-Hwan Baek
- College of Pharmacy, Kyungsung University, Busan, Korea
- Functional Food & Drug Convergence Research Center, Industry-Academic Cooperation Foundation, Kyungsung University, Busan, Korea
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Lin YJ, Chen HC, Chang JW, Huang HB, Chang WT, Huang PC. Exposure characteristics and cumulative risk assessment of bisphenol A and its substitutes: the Taiwan environmental survey for toxicants 2013. Front Public Health 2024; 12:1396147. [PMID: 38846618 PMCID: PMC11153798 DOI: 10.3389/fpubh.2024.1396147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/29/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Ever since the use of bisphenol A (BPA) has been restricted, concerns have been raised regarding the use of its substitutes, such as bisphenol S (BPS) and bisphenol F (BPF). Meanwhile, the EU European Food Safety Authority (EFSA) issued the new tolerable daily intake (TDI) after the latest re-risk assessment for BPA, which enforced the need for cumulative risk assessment in the population. This study was conducted to identify BPA and its substitute's exposure characteristics of the general Taiwanese population and estimate the cumulative risk of bisphenol exposure. Methods Urine samples (N = 366 [adult, 271; minor, 95]) were collected from individuals who participated in the Taiwan Environmental Survey for Toxicants 2013. The samples were analyzed for BPA, BPS, and BPF through ultraperformance liquid chromatography-tandem mass spectrometry. Daily intake (DI) levels were calculated for each bisphenol. Hazard quotients (HQs) were calculated with the consideration of tolerable DI and a reference dose. Additionally, hazard index (HI; sum of HQs for each bisphenol) values were calculated. Results Our study found that the median level of BPA was significantly higher in adults (9.63 μg/g creatinine) than in minors (6.63 μg/g creatinine) (p < 0.001). The DI of BPS was higher in female (0.69 ng/kg/day) than in male (0.49 ng/kg/day); however, the DIs of BPF and BPS were higher in boys (1.15 and 0.26 ng/kg/day, respectively) than in girls (0.57 and 0.20 ng/kg/day, respectively). Most HI values exceeded 1 (99% of the participants) after EFSA re-establish the TDI of BPA. Discussion Our study revealed that the exposure profiles and risk of BPA and its substitute in Taiwanese varied by age and sex. Additionally, the exposure risk of BPA was deemed unacceptable in Taiwan according to new EFSA regulations, and food contamination could be the possible source of exposure. We suggest that the risk of exposure to BPA and its substitutes in most human biomonitoring studies should be reassessed based on new scientific evidence.
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Affiliation(s)
- Yu-Jung Lin
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Hsin-Chang Chen
- Department of Chemistry, Tunghai University, Taichung, Taiwan
| | - Jung-Wei Chang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Han-Bin Huang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wan-Ting Chang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Safety, Health and Environmental Engineering, National United University, Miaoli, Taiwan
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Moorchilot VS, P A, Aravind UK, Aravindakumar CT. Human exposure to methyl and butyl parabens and their transformation products in settled dust collected from urban, semi-urban, rural, and tribal settlements in a tropical environment. ENVIRONMENTAL RESEARCH 2024; 242:117805. [PMID: 38042518 DOI: 10.1016/j.envres.2023.117805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023]
Abstract
The present study involved monitoring the distribution of two widely consumed parabens (methyl paraben (MeP) and butyl paraben (BuP)) and their transformation products in indoor dust from different categories of settlement (urban, semi-urban, rural, and tribal homes). The results revealed a prevalent occurrence of parabens in all the settlement categories. A non-normal distribution pattern for MeP and BuP levels across the sampling sites was noted. While comparing the residence time of parabens in dust samples, it was found that the half-lives of the analytes were greater in the dust from urban (MeP t1/2: 47.510 h; BuP t1/2: 22.354 h) and rural (MeP t1/2: 27.725 h and BuP t1/2: 31.500 h) areas. The presence of paraben metabolites, such as hydroxy methylparaben (OH-MeP), para hydroxy benzoic acid (p-HBA), and benzoic acid (BA) in dust samples supports their transformation within indoor spaces. The average daily intake of parabens through dust ingestion and dermal absorption by children was higher than adults. BuP was the prime contributor (>85%) to the total estradiol equivalency quotient (tEEQ) in all the settlement categories.
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Affiliation(s)
- Vishnu S Moorchilot
- School of Environmental Sciences, Mahatma Gandhi University (MGU), Kottayam, 686560, Kerala, India
| | - Arun P
- Inter University Instrumentation Centre (IUIC), Mahatma Gandhi University (MGU), Kottayam, 686560, Kerala, India
| | - Usha K Aravind
- School of Environmental Studies, Cochin University of Science & Technology (CUSAT), Kochi, 682022, Kerala, India
| | - Charuvila T Aravindakumar
- School of Environmental Sciences, Mahatma Gandhi University (MGU), Kottayam, 686560, Kerala, India; Inter University Instrumentation Centre (IUIC), Mahatma Gandhi University (MGU), Kottayam, 686560, Kerala, India.
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Lee JY, Choi YH, Choi HI, Moon KW. Association between environmental mercury exposure and allergic disorders in Korean children: Korean National Environmental Health Survey (KoNEHS) cycles 3-4 (2015-2020). Sci Rep 2024; 14:1472. [PMID: 38233475 PMCID: PMC10794242 DOI: 10.1038/s41598-024-51811-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
Although previous studies have suggested potential adverse effects of mercury on a child's immune system, the associations have been inconsistent. We aimed to determine the association between urinary mercury levels and allergic diseases in Korean children with high mercury exposure. Data from 853 and 710 children aged 6-11 years in the Korean National Environmental Health Survey (KoNEHS) cycle 3 (2015-2017) and cycle 4 (2018-2020) were analyzed. We examined the association between mercury exposure and the prevalence of atopic dermatitis (AD), asthma, allergic rhinitis (AR), and allergic multimorbidity. After adjusting for all covariates, the urinary mercury level was positively associated with AD in the 2015-2017 study (OR = 1.34, 95% CI = 1.01, 1.79) and AR in 2018-2020 study (OR = 1.46, 95% CI = 1.01, 2.10). Pooled effects showed OR of 1.34 (95% CI = 1.01, 1.79) for AD and 1.47 (95% CI = 1.01, 2.12) for allergic multimorbidity. The association with allergic multimorbidity was greater in boys (OR = 1.88, 95% CI = 1.01, 3.49) than in girls (OR = 1.25, 95% CI = 0.73, 2.14). These results suggest that environmental mercury exposure may exacerbate symptoms of atopic dermatitis and allergic multimorbidity in children.
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Affiliation(s)
- Ji-Youn Lee
- School of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
| | - Yun-Hee Choi
- Department of Ophthalmology, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
| | - Hyeon-Il Choi
- Department of Infection Biology, College of Medicine, Chungnam National University, Munhwa-ro 266, Jung-gu, Daejeon, 35015, South Korea.
| | - Kyong Whan Moon
- School of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
- BK21 FOUR R&E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
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Choi YH, Huh DA, Moon KW. Exposure to biocides and its association with atopic dermatitis among children and adolescents: A population-based cross-sectional study in South Korea. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 270:115926. [PMID: 38181603 DOI: 10.1016/j.ecoenv.2023.115926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Biocides have emerged as a contributor to the rising cases of atopic dermatitis among children and adolescents. Previous animal studies suggested that phenols, parabens, and pyrethroid insecticides present in these products might play a role in atopic dermatitis. However, there's limited epidemiological evidence confirming the individual or combined effects of exposure to these chemicals on atopic dermatitis in young populations. This study aimed to investigate the association between phenol, paraben, and pyrethroid metabolite levels in urine and atopic dermatitis among Korean children and adolescents METHODS: We analyzed 556 preschool children (3-5 years), 701 schoolchildren (6-11 years), and 731 adolescents (12-17 years) enrolled in the 4th Korean National Environmental Health Survey (KoNEHS) (2018-2020). We used logistic regression and Bayesian kernel machine regression to evaluate the association between atopic dermatitis and individual or mixed exposure to urinary triclosan (TCS), parabens (methylparaben, ethylparaben, propylparaben, and butylparaben), and 3-phenoxybenzoic acid (3-PBA) levels. RESULTS Urinary TCS levels were positively associated with atopic dermatitis in schoolchildren. When stratified by sex, male schoolchildren exhibited an increasing prevalence of atopic dermatitis as their urinary TCS and 3-PBA levels increased. The combined effect of biocide mixtures on atopic dermatitis was also significantly increased in male schoolchildren, with TCS as the main contributor. CONCLUSIONS These study findings suggest that biocides at levels found in Korean children and adolescents affect atopic dermatitis.
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Affiliation(s)
- Yun-Hee Choi
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Da-An Huh
- Institute of Health Sciences, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, South Korea.
| | - Kyong Whan Moon
- School of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, South Korea
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Devi T, Saleh NM, Kamarudin NHN, Roslan NJ, Jalil R, Hamid HA. Efficient adsorption of organic pollutants phthalates and bisphenol A (BPA) utilizing magnetite functionalized covalent organic frameworks (MCOFs): A promising future material for industrial applications. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 268:115706. [PMID: 37992639 DOI: 10.1016/j.ecoenv.2023.115706] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
The utilization of phthalates and bisphenol A (BPA) as the major component in plastic and its derivative industry has raised concerns among the public due to the harmful effects caused by these organic pollutants. These pollutants are found to exhibit unique physicochemical properties that allow the pollutants to have prolonged existence in the environment, thus causing damage to the environment. Since phthalates and bisphenol A are used in a variety of industrial applications, the industry must recover these compounds from its water before releasing the pollutants into the environment. As a result, these materials have a promising future in industrial applications. Therefore, the discovery of new quick and reliable abatement technologies is important to ensure that these organic pollutants can be detected and removed from the water sources. This review highlights the use of the adsorption method to remove phthalates and BPA from water sources by employing novel modified adsorbent magnetite functionalized covalent organic frameworks (MCOFs). MCOFs is a new class of porous materials that have demonstrated promising features in a variety of applications due to their adaptable structures, significant surface areas, configurable porosity, and customizable chemistry. The structural attributes, functional design strategies, and specialized for environmental applications before offering some closing thoughts and suggestions for further research were discussed in this paper in addition to developing an innovative solution for the industry to the accessibility for clean water.
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Affiliation(s)
- Tanusha Devi
- Department of Chemical and Process Engineering, Faculty of Engineering and Built Environment, The National University of Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia
| | - Noorashikin Md Saleh
- Department of Chemical and Process Engineering, Faculty of Engineering and Built Environment, The National University of Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia.
| | - Nur Hidayatul Nazirah Kamarudin
- Department of Chemical and Process Engineering, Faculty of Engineering and Built Environment, The National University of Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia
| | - Nursyafiqah Jori Roslan
- Department of Chemical and Process Engineering, Faculty of Engineering and Built Environment, The National University of Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia
| | - Rafidah Jalil
- Forest Products Division, Forest Research Institute Malaysia (FRIM), 52109 Kepong, Selangor, Malaysia
| | - Husna Abdul Hamid
- Unison Nutraceuticals Sdn. Bhd., No.13, Jln. TU 52, Tasek Utama Industrial Estate, Ayer Keroh, 75450 Melaka, Malaysia
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Han Q, Gao X, Wang S, Wei Z, Wang Y, Xu K, Chen M. Co-exposure to polystyrene microplastics and di-(2-ethylhexyl) phthalate aggravates allergic asthma through the TRPA1-p38 MAPK pathway. Toxicol Lett 2023; 384:73-85. [PMID: 37500026 DOI: 10.1016/j.toxlet.2023.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
Increasing attention has been paid to the potential impact of microplastics (MPs) pollution on human health. MPs and phthalates coexist in the environment, however, the effects of exposure to MPs alone or to a combination of di-(2-ethylhexyl) phthalate (DEHP) and MPs on allergic asthma are unclear. This study investigates the effects of exposure to polystyrene microplastics (PS-MPs) or co-exposure with DEHP, on allergic asthma, and the underlying molecular mechanisms. We established an allergic asthma model using ovalbumin, and mice were exposed to PS-MPs (5 mg/kg bw/day) alone, or combined with DEHP (0.5, 5 mg/kg bw/day), for 28 days. The results showed that in the presence of ovalbumin (OVA) sensitization, exposure to PS-MPs alone slightly affected airway inflammation, and airway hyperresponsiveness, while co-exposure to PS-MPs and DEHP caused more significant damage. Co-exposure also induced more oxidative stress and Th2 immune responses, and activation of the TRPA1 and p38 MAPK pathways. The aggravation of asthmatic symptoms induced by co-exposure to PS-MPs and DEHP were inhibited by blocking TRPA1 ion channel or p38 MAPK pathway. The results demonstrated that co-exposure to PS-MPs and DEHP exacerbates allergic asthma, by exacerbating oxidative stress and inflammatory responses, and activating the TRPA1-p38 MAPK pathway.
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Affiliation(s)
- Qi Han
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan 430079, Hubei, China
| | - Xiao Gao
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan 430079, Hubei, China
| | - Shuwei Wang
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan 430079, Hubei, China
| | - Zhaolan Wei
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan 430079, Hubei, China
| | - Yunyi Wang
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan 430079, Hubei, China
| | - Ke Xu
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan 430079, Hubei, China
| | - Mingqing Chen
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan 430079, Hubei, China.
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12
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Hu Y, Chen H, Tian Y, Wu D, Vinturache A, Ding G, Yu G. Association of parabens and bisphenols with lung function in children aged 5-12 years from Shanghai, China. Int J Hyg Environ Health 2023; 252:114210. [PMID: 37348164 DOI: 10.1016/j.ijheh.2023.114210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
Epidemiological studies have reported potential effects of individual paraben or bisphenol exposure on lung function, but few studies have estimated their joint effects. We conducted a cross sectional survey to investigate the associations of parabens and bisphenols exposure with lung function in 205 children aged 5-12 years from Shanghai, China. Urinary concentrations of six parabens [methyl-, ethyl-, propyl-, butyl-, benzyl-, and heptyl-paraben (MeP, EtP, PrP, BuP, BzP, and HeP)] and seven bisphenols [bisphenol A (BPA), bisphenol AF (BPAF), bisphenol AP (BPAP), bisphenol B (BPB), bisphenol P (BPP), bisphenol S (BPS), and bisphenol Z (BPZ)] were assessed by the high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Lung function, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF), and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75%), was further measured. Linear regression, bayesian kernel machine regression (BKMR), and weighted quantile sum regression (WQS) evaluated the individual and joint relationships of the parabens and bisphenols with the lung function parameters. Further, the analysis was stratified by child sex. Parabens (MeP, EtP, PrP, and BuP) and bisphenols (BPA, BPAP, BPB, and BPS) with detection rates >75% were included for analyses. In linear regressions, parabens (MeP, PrP, and BuP) were generally negatively associated with FEV1, FVC, PEF, and FEF25-75%, but no associations for bisphenols were found. The association of parabens with lung function was more pronounced in girls. The aforementioned negative associations between parabens and lung function were confirmed by both the BKMR and WQS, with MeP being considered most heavily weighing chemical. Our findings suggested that exposure to parabens, either individuals or as a mixture, were associated with decreased lung function in children aged 5-12 years, and these associations were stronger among girls. Considering the cross-sectional study design, large longitudinal studies are warranted to confirm our findings.
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Affiliation(s)
- Yi Hu
- Center for Medical Bioinformatics, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Chen
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Tian
- Department of Child Health Management, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Wu
- Center for Medical Bioinformatics, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Angela Vinturache
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Guodong Ding
- Department of Pediatric Respiratory Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Guangjun Yu
- Center for Medical Bioinformatics, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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13
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Zhang H, Chen S, Chen X, Zhang Y, Han Y, Li J, Chen X. Exposure to phthalate increases the risk of eczema in children: Findings from a systematic review and meta-analysis. CHEMOSPHERE 2023; 321:138139. [PMID: 36791818 DOI: 10.1016/j.chemosphere.2023.138139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/25/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
Emerging evidence indicated phthalate exposure might raise the risk of eczema in children. However, these findings were inconsistent. The relation between phthalate exposure and childhood eczema remained debated. Therefore, we performed this meta-analysis to assess their association. PubMed, Web of Science, and Embase were searched for eligible studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated for risk estimate. Thirty studies involving 12,615 participants were included in this meta-analysis. For prenatal phthalate exposure assessed with maternal samples, the pooled results showed gestational exposure to monobenzyl phthalate (MBzP) (OR: 1.17, 95% CI: 1.00-1.36), but not the other phthalates, was correlated with increased risk of eczema in children. For childhood exposure assessed using children's urine sample, our pooled results indicated that postnatal exposure to MBzP (OR: 1.10, 95% CI: 1.02-1.19), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) (OR: 1.32, 95% CI: 1.08-1.61), mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP) (OR: 1.24, 95% CI: 1.06-1.44), and molar summation of di-2-ethylhexyl phthalate (DEHP) (OR: 1.23, 95% CI: 1.06-1.42) were associated with higher risk of eczema. While for studies using household dust to estimate environmental phthalate exposure and eczema risk, the pooled results showed no significant association. Subgroup analyses indicated study country, diagnostic mode, and children's age contributed to the heterogeneity. The results of our meta-analysis demonstrated that phthalate exposure during both prenatal and postnatal periods was associated with elevated risk of eczema in children. However, such association was not strong as the pooled ORs were relatively small. Further studies are warranted to verify these findings and explore the underlying mechanism.
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Affiliation(s)
- Hong Zhang
- College of Environmental and Resource Science, Fujian Normal University, Fuzhou, 350007, China; College of Carbon Neutral Modern Industry, Fujian Normal University, Fuzhou, 350007, China; Fujian Key Laboratory of Pollution Control and Resource Reuse, Fuzhou, 350007, China
| | - Siyu Chen
- College of Environmental and Resource Science, Fujian Normal University, Fuzhou, 350007, China; College of Carbon Neutral Modern Industry, Fujian Normal University, Fuzhou, 350007, China; Fujian Key Laboratory of Pollution Control and Resource Reuse, Fuzhou, 350007, China
| | - Xinwang Chen
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
| | - Yong Zhang
- College of Environmental and Resource Science, Fujian Normal University, Fuzhou, 350007, China; College of Carbon Neutral Modern Industry, Fujian Normal University, Fuzhou, 350007, China; Fujian Key Laboratory of Pollution Control and Resource Reuse, Fuzhou, 350007, China
| | - Yonghe Han
- College of Environmental and Resource Science, Fujian Normal University, Fuzhou, 350007, China; College of Carbon Neutral Modern Industry, Fujian Normal University, Fuzhou, 350007, China; Fujian Key Laboratory of Pollution Control and Resource Reuse, Fuzhou, 350007, China
| | - Jiabing Li
- College of Environmental and Resource Science, Fujian Normal University, Fuzhou, 350007, China; College of Carbon Neutral Modern Industry, Fujian Normal University, Fuzhou, 350007, China; Fujian Key Laboratory of Pollution Control and Resource Reuse, Fuzhou, 350007, China
| | - Xiangqi Chen
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou, 350001, China
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Zhao Y, Sun Y, Zhu C, Zhang Y, Hou J, Zhang Q, Ataei Y. Phthalate Metabolites in Urine of Chinese Children and Their Association with Asthma and Allergic Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14083. [PMID: 36360961 PMCID: PMC9654528 DOI: 10.3390/ijerph192114083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Phthalates are ubiquitous 'modern' chemical compounds with potential negative impacts on children's health. A nested case-control study was designed to investigate associations of phthalate exposure with children's asthma and allergic symptoms. We collected 243 first morning urine samples from 4-8-year-old children in Tianjin, China. Eight metabolites (i.e., mono-ethyl phthalate (MEP), mono-isobutyl phthalate (MiBP), mono-n-butyl phthalate (MnBP), mono-benzyl phthalate (MBzP) and mono-2-ethylhexyl phthalate (MEHP), mono-(2-ethyl-5-carboxylpentyl) phthalate (MECPP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP)) of five phthalates were analyzed using HPLC-MS. MiBP, MnBP and MECPP were the dominant phthalate metabolites in urine of children in Tianjin with median concentrations of 31.6 μg/L, 26.24 μg/L and 46.12 μg/L, respectively. We found significantly positive associations of diagnosed asthma with MnBP (adjusted odds ratios (AOR): 1.96; 95% confidence intervals (CIs): 1.07-3.61), MEHHP (AOR: 2.00; 95% CI: 1.08-3.71) and MEOHP (AOR: 2.09; 95% CI: 1.06-4.10). Our study indicates that phthalate exposure in childhood, especially to di-n-butyl phthalate (DnBP) and di(2-ethylhexyl) phthalate (DEHP), may be a risk factor for children's asthma.
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Affiliation(s)
- Yuxuan Zhao
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Yuexia Sun
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Changqi Zhu
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Ying Zhang
- School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Jing Hou
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Qinghao Zhang
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Yeganeh Ataei
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
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15
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Diurnal Variation in Biomarkers of Exposure to Endocrine-Disrupting Chemicals and Their Association with Oxidative Damage in Norwegian Adults: The EuroMix Study. TOXICS 2022; 10:toxics10040181. [PMID: 35448442 PMCID: PMC9028082 DOI: 10.3390/toxics10040181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/27/2022] [Accepted: 04/02/2022] [Indexed: 11/23/2022]
Abstract
Much evidence on the adverse health effects of endocrine-disrupting chemicals (EDCs) has accumulated during recent decades. EDCs are commonly found in various foods and personal care products (PCP). Data documenting a diurnally varying EDC metabolism in humans is scarce. This study examined (i) the time-of-day effect on the diurnal magnitude and variance of urinary biomarkers of exposure to EDCs, and (ii) the association between EDC exposures and oxidative damage in a Norwegian adult subpopulation. This was a cross-sectional panel study using biobanked samples from the EuroMix project. During a typical weekday, participants were asked to collect all day’s urine voids and record dietary and PCP habitual uses in a diary. Collected time stamps of urine voids were classified into three distinct periods in the day (morning 6 a.m.−12 p.m., mid-day 12 p.m.−6 p.m., evening 6 p.m.−6 a.m.). Questionnaires regarding demographic characteristics, personal care product usage, and dietary habits were completed. Urinary levels of EDCs (phthalates, parabens, and bisphenols) were measured using mass spectrometry and adjusted for urinary volume using specific gravity. Urinary 4-hydroxynonenal (4HNE), a lipid peroxidation marker, was measured using an immunoassay kit. Linear mixed-effect models identified EDCs under the influence of a diurnal variation effect that was adjusted for dietary habits and PCP use and examined associations between EDC and 4HNE. p-values were FDR-adjusted. Most phthalates appeared to be diurnally varying with higher urinary levels towards the evening (q < 0.001) than those measured during mid-day; this strong diurnal variation effect was not present for parabens and bisphenols. Significant (q < 0.001) positive associations were observed between all phthalates, parabens, and bisphenols (except bisphenol S) and 4HNE. This study’s findings highlighted the diurnal variation of excretion for certain EDC, but not for others, in real-life conditions. The degree of EDC chronotoxicity in distinct diurnal windows of the day warrants further investigation with longitudinal human studies.
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Seo MY, Moon S, Kim SH, Park MJ. Associations of Phthalate Metabolites and Bisphenol A Levels with Obesity in Children: The Korean National Environmental Health Survey (KoNEHS) 2015 to 2017. Endocrinol Metab (Seoul) 2022; 37:249-260. [PMID: 35385971 PMCID: PMC9081310 DOI: 10.3803/enm.2021.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Phthalates and bisphenol A (BPA) are synthetic chemicals widely used in daily life. This study investigated urinary phthalate and BPA levels in Korean children and their associations with obesity. METHODS A total of 2,351 children aged 3 to 17 years who participated in the Korean National Environmental Health Survey 2015 to 2017 were included. Urinary dilution was corrected using covariate-adjusted standardization (CAS). We examined the geometric mean (GM) concentrations of urinary phthalate metabolites, including di (2-ethylhexyl) phthalate (DEHP) metabolites (mono [2-ethyl-5-hydroxyhexyl] phthalate, mono [2-ethyl-5-oxohexyl] phthalate, and mono [2-ethyl-5-carboxypentyl] phthalate [MECPP]), mono-benzyl-phthalate (MBzP), mono (carboxyoctyl) phthalate (MCOP), mono (carboxy-isononyl) phthalate (MCNP), mono (3-carboxypropyl) phthalate, and mono-n-butyl-phthalate (MnBP), and BPA. We also analyzed the odds ratio (OR) for obesity according to the quartiles of each analyte. RESULTS The urinary GM levels of DEHP metabolites and MnBP were notably higher among Korean children than among American, Canadian, and German children. The CAS-applied GM concentrations of most analytes, except for MBzP, MCOP, and MCNP, were higher in children aged 3 to 5 years than in those aged 6 to 17 years. The OR for obesity in the highest quartile of MECPP was significantly higher than in the lowest quartile after adjusting for covariates. However, the other phthalate metabolites and BPA were not significantly associated with obesity. CONCLUSION The concentrations of urinary DEHP metabolites and MnBP were higher in Korean children than in children in Western countries. Urinary MECPP exposure, but not other phthalates or BPA, showed a positive association with obesity in Korean children. Further studies are required to elucidate the causal relationships.
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Affiliation(s)
- Moon Young Seo
- Department of Pediatrics, Wonjin Green Hospital, Seoul, Korea
| | - Shinje Moon
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Shin-Hye Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
- Shin-Hye Kim Department of Pediatrics, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-8826, Fax: +82-2-950-1245, E-mail:
| | - Mi Jung Park
- Department of Pediatrics, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
- Corresponding authors: Mi Jung Park Department of Pediatrics, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-8826, Fax: +82-2-950-1245, E-mail:
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