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Jacobson MH, Wu Y, Liu M, Attina TM, Naidu M, Karthikraj R, Kannan K, Warady BA, Furth S, Vento S, Trachtman H, Trasande L. Serially assessed bisphenol A and phthalate exposure and association with kidney function in children with chronic kidney disease in the US and Canada: A longitudinal cohort study. PLoS Med 2020; 17:e1003384. [PMID: 33052911 PMCID: PMC7556524 DOI: 10.1371/journal.pmed.1003384] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/11/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Exposure to environmental chemicals may be a modifiable risk factor for progression of chronic kidney disease (CKD). The purpose of this study was to examine the impact of serially assessed exposure to bisphenol A (BPA) and phthalates on measures of kidney function, tubular injury, and oxidative stress over time in a cohort of children with CKD. METHODS AND FINDINGS Samples were collected between 2005 and 2015 from 618 children and adolescents enrolled in the Chronic Kidney Disease in Children study, an observational cohort study of pediatric CKD patients from the US and Canada. Most study participants were male (63.8%) and white (58.3%), and participants had a median age of 11.0 years (interquartile range 7.6 to 14.6) at the baseline visit. In urine samples collected serially over an average of 3.0 years (standard deviation [SD] 1.6), concentrations of BPA, phthalic acid (PA), and phthalate metabolites were measured as well as biomarkers of tubular injury (kidney injury molecule-1 [KIM-1] and neutrophil gelatinase-associated lipocalin [NGAL]) and oxidative stress (8-hydroxy-2'-deoxyguanosine [8-OHdG] and F2-isoprostane). Clinical renal function measures included estimated glomerular filtration rate (eGFR), proteinuria, and blood pressure. Linear mixed models were fit to estimate the associations between urinary concentrations of 6 chemical exposure measures (i.e., BPA, PA, and 4 phthalate metabolite groups) and clinical renal outcomes and urinary concentrations of KIM-1, NGAL, 8-OHdG, and F2-isoprostane controlling for sex, age, race/ethnicity, glomerular status, birth weight, premature birth, angiotensin-converting enzyme inhibitor use, angiotensin receptor blocker use, BMI z-score for age and sex, and urinary creatinine. Urinary concentrations of BPA, PA, and phthalate metabolites were positively associated with urinary KIM-1, NGAL, 8-OHdG, and F2-isoprostane levels over time. For example, a 1-SD increase in ∑di-n-octyl phthalate metabolites was associated with increases in NGAL (β = 0.13 [95% CI: 0.05, 0.21], p = 0.001), KIM-1 (β = 0.30 [95% CI: 0.21, 0.40], p < 0.001), 8-OHdG (β = 0.10 [95% CI: 0.06, 0.13], p < 0.001), and F2-isoprostane (β = 0.13 [95% CI: 0.01, 0.25], p = 0.04) over time. BPA and phthalate metabolites were not associated with eGFR, proteinuria, or blood pressure, but PA was associated with lower eGFR over time. For a 1-SD increase in ln-transformed PA, there was an average decrease in eGFR of 0.38 ml/min/1.73 m2 (95% CI: -0.75, -0.01; p = 0.04). Limitations of this study included utilization of spot urine samples for exposure assessment of non-persistent compounds and lack of specific information on potential sources of exposure. CONCLUSIONS Although BPA and phthalate metabolites were not associated with clinical renal endpoints such as eGFR or proteinuria, there was a consistent pattern of increased tubular injury and oxidative stress over time, which have been shown to affect renal function in the long term. This raises concerns about the potential for clinically significant changes in renal function in relation to exposure to common environmental toxicants at current levels.
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Affiliation(s)
- Melanie H. Jacobson
- Division of Environmental Pediatrics, Department of Pediatrics, NYU Langone Medical Center, New York, New York, United States of America
| | - Yinxiang Wu
- Department of Population Health, NYU Langone Medical Center, New York, New York, United States of America
| | - Mengling Liu
- Department of Population Health, NYU Langone Medical Center, New York, New York, United States of America
- Department of Environmental Medicine, NYU Langone Medical Center, New York, New York, United States of America
| | - Teresa M. Attina
- Division of Environmental Pediatrics, Department of Pediatrics, NYU Langone Medical Center, New York, New York, United States of America
| | - Mrudula Naidu
- Division of Environmental Pediatrics, Department of Pediatrics, NYU Langone Medical Center, New York, New York, United States of America
| | - Rajendiran Karthikraj
- Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, New York, United States of America
| | - Kurunthachalam Kannan
- Division of Environmental Pediatrics, Department of Pediatrics, NYU Langone Medical Center, New York, New York, United States of America
- Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, New York, United States of America
| | - Bradley A. Warady
- Division of Nephrology, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri, United States of America
| | - Susan Furth
- Division of Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Suzanne Vento
- Division of Nephrology, Department of Pediatrics, NYU Langone Medical Center, New York, New York, United States of America
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, NYU Langone Medical Center, New York, New York, United States of America
| | - Leonardo Trasande
- Division of Environmental Pediatrics, Department of Pediatrics, NYU Langone Medical Center, New York, New York, United States of America
- Department of Population Health, NYU Langone Medical Center, New York, New York, United States of America
- Department of Environmental Medicine, NYU Langone Medical Center, New York, New York, United States of America
- Wagner Graduate School of Public Service, New York University, New York, New York, United States of America
- School of Global Public Health, New York University, New York, New York, United States of America
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Gaylord A, Berger KI, Naidu M, Attina TM, Gilbert J, Koshy TT, Han X, Marmor M, Shao Y, Giusti R, Goldring RM, Kannan K, Trasande L. Serum perfluoroalkyl substances and lung function in adolescents exposed to the World Trade Center disaster. Environ Res 2019; 172:266-272. [PMID: 30822559 PMCID: PMC8336627 DOI: 10.1016/j.envres.2019.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 05/04/2023]
Abstract
The effects of childhood exposure to perfluoroalkyl substances (PFASs) on lung function remain mostly unknown. Previous research indicates that children living or going to school near the World Trade Center (WTC) disaster were exposed to high levels of PFASs, among other toxic chemicals. To explore the effects of PFAS exposure on lung function, we measured serum PFASs in a cohort of children from the WTC Health Registry and a matched control group. Perfluorooctanesulfonate had the highest median concentrations in both groups (WTCHR = 3.72 ng/mL, Comparison = 2.75 ng/mL), while the lowest median concentrations were seen for perfluoroundecanoic acid (WTCHR = 0.12 ng/mL, Comparison = 0.01 ng/mL). Lung function outcomes were measured by spirometry, plethysmography, and oscillometry. Asthma diagnosis and serum eosinophil count were also recorded. We examined the relationships of each PFAS with lung function parameters and eosinophil count using linear regressions. Odds ratios for asthma were obtained for each PFAS using logistic regression. The effect of total PFASs on these outcomes was also assessed. All regression models were adjusted for sex, race/ethnicity, age, body mass index (BMI) and tobacco smoke exposure. We found that serum PFASs were not statistically associated with the measured lung function parameters, asthma diagnosis, or eosinophil count in this cohort (p < 0.05). These findings highlight the need for more longitudinal studies to explore the long-term effects of childhood PFAS exposure on lung function past adolescence and early adulthood.
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Affiliation(s)
- Abigail Gaylord
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kenneth I Berger
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Mrudula Naidu
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Teresa M Attina
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Joseph Gilbert
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Tony T Koshy
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Xiaoxia Han
- Public Health Sciences Department, Henry Ford Health System, Detroit, MI, USA
| | - Michael Marmor
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Robert Giusti
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Roberta M Goldring
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | | | - Leonardo Trasande
- Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Medicine, New York University School of Medicine, New York, NY, USA; Departments of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
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Attina TM, Malits J, Naidu M, Trasande L. Racial/ethnic disparities in disease burden and costs related to exposure to endocrine-disrupting chemicals in the United States: an exploratory analysis. J Clin Epidemiol 2019; 108:34-43. [PMID: 30529005 PMCID: PMC6455970 DOI: 10.1016/j.jclinepi.2018.11.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/01/2018] [Accepted: 11/30/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Studies have documented disparities in exposure to endocrine-disrupting chemicals (EDC), but no studies have investigated potential implications for racial/ethnic disparities in chronic disease and associated costs. Our objective was to examine EDC levels in the US population according to race/ethnicity and to quantify disease burden and associated costs. STUDY DESIGN AND SETTING EDC exposure levels in 2007-2010 were obtained from the National Health and Nutrition Examination Surveys. The associated disease burden and costs for 12 exposure-response relationships were determined for non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, Other Hispanics, and Other/Multicultural. RESULTS EDC exposure levels and associated burden of disease and costs were higher in non-Hispanic Blacks ($56.8 billion; 16.5% of total costs) and Mexican Americans ($50.1 billion; 14.6%) compared with their proportion of the total population (12.6% and 13.5%, respectively). Associated costs among non-Hispanic whites comprised 52.3% of total costs ($179.8 billion) although they comprise 66.1% of the US population. These disparities are driven by generally higher exposure to persistent pesticides and flame retardants among non-Hispanic blacks and Mexican Americans. CONCLUSION Our estimates suggest that racial/ethnic disparities in chronic diseases in the US may be because of chemical exposures and are an important tool to inform policies that address such disparities.
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Affiliation(s)
- Teresa M Attina
- Department of Pediatrics, NYU School of Medicine, New York, NY, USA
| | - Julia Malits
- Department of Pediatrics, NYU School of Medicine, New York, NY, USA
| | - Mrudula Naidu
- Department of Pediatrics, NYU School of Medicine, New York, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics, NYU School of Medicine, New York, NY, USA; Department of Environmental Medicine, NYU School of Medicine, New York, NY, USA; Department of Population Health, NYU School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; Department of Nutrition, Food & Public Health, NYU Steinhardt School of Culture, Education and Human Development, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
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Malits J, Attina TM, Karthikraj R, Kannan K, Naidu M, Furth S, Warady BA, Vento S, Trachtman H, Trasande L. Renal Function and exposure to Bisphenol A and phthalates in children with Chronic Kidney Disease. Environ Res 2018; 167:575-582. [PMID: 30172191 PMCID: PMC7409562 DOI: 10.1016/j.envres.2018.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 05/12/2023]
Abstract
RATIONALE AND OBJECTIVE Exposure to Bisphenol A (BPA) and phthalates is ubiquitous among adults and children in the United States. Among children and adolescents, those with chronic kidney disease (CKD) are potentially at greater risk of adverse effects from BPA and phthalate exposure. The objective of this study was to evaluate BPA and phthalate exposure among children with CKD and evaluate associations with three measures of kidney function. STUDY DESIGN Cross sectional study. SETTING, PARTICIPANTS, AND MEASUREMENTS The CKD population was represented by the Chronic Kidney Disease in Children (CKiD) Study, a multicenter, prospective cohort study of children with impaired kidney function in the US. The main outcome was assessment of the relationship between chemical exposures and clinical laboratory findings at enrollment into CKiD. Data collected at baseline from participants 1 to 17 years old (N = 538) were analyzed. Urinary BPA and phthalate levels were evaluated at this time point. Data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative pediatric population, were used for comparison to the CKiD cohort. RESULTS Urinary BPA and phthalate levels in the CKiD population were consistently lower than levels detected in healthy children. Additionally, BPA was not significantly associated with blood pressure, proteinuria, or estimated glomerular filtration rate (eGFR). Within the CKiD population, for select individual and combined phthalates, there was an inverse relationship with the urinary protein:creatinine ratio (LMW phthalates, - 9.53% change; 95% CI: - 14.21, - 4.21; p = 0.001), and in most cases, a positive relationship with eGFR (LMW phthalates, a 3.46 unit increase in eGFR, 95% CI: 1.85, 5.07; p < 0.001). LIMITATIONS Lack of longitudinal data, limited assessment of diet and nutritional status. CONCLUSION In the study cohort, children with CKD did not have increased exposure to BPA and phthalates. Longitudinal studies with repeated measures are likely to be more informative about the possible health effects of prolonged exposure to BPA and phthalates in pediatric patients with CKD.
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Affiliation(s)
- Julia Malits
- Department of Pediatrics, Divisions of Nephrology and Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Teresa M Attina
- Department of Pediatrics, Divisions of Nephrology and Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Rajendiran Karthikraj
- Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, NY, USA
| | - Kurunthachalam Kannan
- Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, NY, USA
| | - Mrudula Naidu
- Department of Pediatrics, Divisions of Nephrology and Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, PA, USA
| | - Bradley A Warady
- Department of Pediatrics, Division of Nephrology, University of Missouri-Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Suzanne Vento
- Department of Pediatrics, Divisions of Nephrology and Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Howard Trachtman
- Department of Pediatrics, Divisions of Nephrology and Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA.
| | - Leonardo Trasande
- Department of Pediatrics, Divisions of Nephrology and Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
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Trye A, Berger KI, Naidu M, Attina TM, Gilbert J, Koshy TT, Han X, Marmor M, Shao Y, Giusti R, Goldring RM, Trasande L. Respiratory Health and Lung Function in Children Exposed to the World Trade Center Disaster. J Pediatr 2018; 201:134-140.e6. [PMID: 30029866 PMCID: PMC8336626 DOI: 10.1016/j.jpeds.2018.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/09/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To compare lung function in a representative sample of World Trade Center (WTC)-exposed children with matched comparisons, and examine relationships with reported exposures. STUDY DESIGN Study population consisted of 402 participants. Oscillometry, spirometry, and plethysmography were performed on WTC Health Registry (WTCHR) respondents who were ≤8 years of age on September 11, 2001 (n = 180) and a sociodemographically matched group of New York City residents (n = 222). We compared lung function by study arm (WTCHR and comparison group) as well as dust cloud (acute); home dust (subchronic); and other traumatic, nondust exposures. RESULTS In multivariable models, post-9/11 risk of incident asthma was higher in the WTCHR participants than in the comparison group (OR 1.109, 95% CI 1.021, 1.206; P = .015). Comparing by exposure rather than by group, dust cloud (OR 1.223, 95% CI 1.095, 1.365; P < .001) and home dust (OR 1.123, 95% CI 1.029, 1.226; P = .009) exposures were also associated with a greater risk of incidence of post-9/11 asthma. No differences were identified for lung function measures. CONCLUSIONS Although we cannot exclude an alternative explanation to the null findings, these results may provide some measure of reassurance to exposed children and their families regarding long-term consequences. Further study with bronchodilation and/or methacholine challenge may be needed to identify and further evaluate effects of WTC exposure. Biomarker studies may also be more informative in delineating exposure-outcome relationships. TRIAL REGISTRATION ClinicalTrials.gov: NCT02068183.
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Affiliation(s)
- Alice Trye
- Department of Pediatrics, New York University School of Medicine
| | | | - Mrudula Naidu
- Department of Pediatrics, New York University School of Medicine
| | - Teresa M. Attina
- Department of Pediatrics, New York University School of Medicine
| | - Joseph Gilbert
- Department of Pediatrics, New York University School of Medicine
| | - Tony T. Koshy
- Department of Pediatrics, New York University School of Medicine
| | - Xiaoxia Han
- Department of Population Health, New York University School of Medicine
| | - Michael Marmor
- Department of Population Health, New York University School of Medicine
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine;,Department of Environmental Medicine, New York University School of Medicine
| | - Robert Giusti
- Department of Pediatrics, New York University School of Medicine
| | | | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY; Department of Population Health, New York University School of Medicine, New York, NY; Department of Environmental Medicine, New York University School of Medicine, New York, NY; New York University Wagner School of Public Service, New York, NY; New York University College of Global Public Health, New York, NY.
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Malits J, Blustein J, Trasande L, Attina TM. Perfluorooctanoic acid and low birth weight: Estimates of US attributable burden and economic costs from 2003 through 2014. Int J Hyg Environ Health 2018; 221:269-275. [DOI: 10.1016/j.ijheh.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
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Trasande L, Koshy TT, Gilbert J, Burdine LK, Marmor M, Han X, Shao Y, Chemtob C, Attina TM, Urbina EM. Cardiometabolic profiles of adolescents and young adults exposed to the World Trade Center Disaster. Environ Res 2018; 160:107-114. [PMID: 28972913 PMCID: PMC5712452 DOI: 10.1016/j.envres.2017.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/25/2017] [Accepted: 09/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Few studies have examined the possible cardiometabolic consequences of World Trade Center-related exposures on children who lived and/or attended school near the disaster site. Our objective was to compare cardiometabolic profiles of participants in the World Trade Center Health Registry (WTCHR) with a matched comparison group. METHODS We evaluated WTCHR enrollees who resided in New York City and were born between September 11, 1993 and September 10, 2001, and a matched comparison group. We assessed exposure to dust cloud, home dust, as well as traumatic exposure, and associations with blood pressure, arterial wall stiffness, body mass index (BMI), total cholesterol, triglycerides, HDL, and LDL. RESULTS A total of 402 participants completed the study, 222 in the comparison group and 180 in the WTCHR group. In multivariable regression analysis, after adjusting for relevant confounders we detected a weak association between participation in the WTCHR group and lower BMI (-1.12kg/m2, 95% CI -2.11, -0.12; p = 0.03), which became non-significant after adjusting for multiple comparisons. With respect to traumatic and psychosocial exposures, the only association that persisted in our multivariable model, below our predefined level of significance, was between post-traumatic stress disorder and higher BMI (2.06kg/m2, 95% CI 0.37, 3.74; p = 0.02). CONCLUSIONS Our findings do not support an association between self-reported exposures to the WTC disaster and adverse cardiometabolic profile. However, further longitudinal studies may better inform the full extent of WTC-related conditions associated with exposure to the disaster.
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Affiliation(s)
- Leonardo Trasande
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA; Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
| | - Tony T Koshy
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Joseph Gilbert
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Lauren K Burdine
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Michael Marmor
- Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; Medicine, New York University School of Medicine, New York, NY, USA
| | - Xiaoxia Han
- Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA
| | - Claude Chemtob
- Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Teresa M Attina
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, OH, USA
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Koshy TT, Attina TM, Ghassabian A, Gilbert J, Burdine LK, Marmor M, Honda M, Chu DB, Han X, Shao Y, Kannan K, Urbina EM, Trasande L. Serum perfluoroalkyl substances and cardiometabolic consequences in adolescents exposed to the World Trade Center disaster and a matched comparison group. Environ Int 2017; 109:128-135. [PMID: 28890218 PMCID: PMC5660646 DOI: 10.1016/j.envint.2017.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 05/02/2023]
Abstract
BACKGROUND Large amounts of various chemical contaminants, including perfluoroalkyl substances (PFASs), were released at the time of the World Trade Center (WTC) disaster. Thousands of children who lived and/or attended school near the disaster site were exposed to these substances but few studies have examined the possible consequences related to these exposures. OBJECTIVES To examine the relationship of PFASs serum levels with cardiometabolic profile in children and adolescents enrolled in the World Trade Center Health Registry (WTCHR) and a matched comparison group. METHODS We evaluated WTCHR enrollees who resided in New York City and were born between September 11, 1993 and September 10, 2001, and a matched comparison group consisting of individuals who were ineligible for WTCHR participation upon distance of their home, school or work from the WTC and lack of participation in rescue and recovery activities. Matching was based on date of birth, sex, race, ethnicity, and income. We assessed exposure to PFASs, as measured by serum levels and association with cardiometabolic profile as measured by arterial wall stiffness, body mass index, insulin resistance, fasting total cholesterol, HDL, LDL and triglycerides. RESULTS A total of 402 participants completed the study and serum samples were analyzed from 308 participants, 123 in the WTCHR group and 185 in the comparison group. In multivariable regression analysis, after adjusting for relevant confounders, we observed a significant, positive association of perfluorooctanoic acid (PFOA) with triglycerides (beta coefficient=0.14, 95% CI: 0.02, 0.27, 15.1% change), total cholesterol (beta coefficient=0.09, 95% CI: 0.04, 0.14, 9.2% change), and LDL cholesterol (beta coefficient=0.11, 95% CI: 0.03, 0.19, 11.5% change). Perfluorohexanesulfonic acid levels were associated with decreased insulin resistance (beta coefficient=-0.09, 95% CI: -0.18, -0.003, -8.6% change); PFOA and perfluorononanoic acid were associated with increased brachial artery distensibility. CONCLUSIONS This research adds to our knowledge of the physical health impacts in a large group of children exposed to the WTC disaster. Abnormal lipid levels in young adults might be an early marker of atherosclerosis and cardiovascular diseases and our findings highlight the importance of conducting longitudinal studies in this population.
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Affiliation(s)
- Tony T Koshy
- Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Teresa M Attina
- Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Akhgar Ghassabian
- Pediatrics, New York University School of Medicine, New York, NY, USA; Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Joseph Gilbert
- Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Lauren K Burdine
- Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Michael Marmor
- Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; Medicine, New York University School of Medicine, New York, NY, USA
| | - Masato Honda
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Dinh Binh Chu
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Xiaoxia Han
- Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA
| | | | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Leonardo Trasande
- Pediatrics, New York University School of Medicine, New York, NY, USA; Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; Medicine, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
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Trasande L, Koshy TT, Gilbert J, Burdine LK, Attina TM, Ghassabian A, Honda M, Marmor M, Chu DB, Han X, Shao Y, Kannan K. Serum perfluoroalkyl substances in children exposed to the world trade center disaster. Environ Res 2017; 154:212-221. [PMID: 28104511 PMCID: PMC5328959 DOI: 10.1016/j.envres.2017.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/06/2017] [Accepted: 01/08/2017] [Indexed: 05/18/2023]
Abstract
The World Trade Center (WTC) disaster released large amounts of various chemical substances into the environment, including perfluoroalkyl substances (PFASs). Yet, no studies have examined exposures in children living or attending schools near the disaster site. We measured serum PFASs in WTC Health Registry (WTCHR) respondents who were ≤8 years of age on September 11, 2001 and a sociodemographically-matched comparison group. We also examined the relationship of PFASs levels with dust cloud exposure; home dust exposure, and with traumatic exposure, the latter to take into account differences related to possible mental health consequences and associated behavioral problems. Serum samples, collected between 2014 and 2016, were analyzed from 123 WTCHR participants and from 185 participants in the comparison group. In the WTCHR group, median perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) levels were 1.81ng/mL and 3.72ng/mL, respectively. Controlling for sex, caloric intake, race/ethnicity, and date of birth, significant increases among WTCHR participants compared with the matched comparison group were detected for perfluorohexanesulfonate (0.23ng/mL increase or 0.24log unit increase, p=0.006); PFOS (0.86ng/mL increase or 0.16log unit increase, p=0.011); PFOA (0.35ng/mL increase or 0.18log unit increase, p<0.001); perfluorononanoic acid (0.12ng/mL increase or 0.17log unit increase, p=0.003); perfluorodecanoic acid (0.06ng/mL increase or 0.42log unit increase, p<0.001); and perfluoroundecanoic acid (0.03ng/mL increase or 0.32log unit increase, p=0.019). Stronger associations were identified for home dust exposures and traumatic exposures than dust cloud. These findings highlight the importance of conducting longitudinal studies in this population to assess possible cardiometabolic and renal consequences related to these exposures.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Medicine, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
| | - Tony T Koshy
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Joseph Gilbert
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Lauren K Burdine
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Teresa M Attina
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Masato Honda
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Michael Marmor
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Dinh Binh Chu
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Xiaoxia Han
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA
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Attina TM, Hauser R, Sathyanarayana S, Hunt PA, Bourguignon JP, Myers JP, DiGangi J, Zoeller RT, Trasande L. Exposure to endocrine-disrupting chemicals in the USA: a population-based disease burden and cost analysis. Lancet Diabetes Endocrinol 2016; 4:996-1003. [PMID: 27765541 DOI: 10.1016/s2213-8587(16)30275-3] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Endocrine-disrupting chemicals (EDCs) contribute to disease and dysfunction and incur high associated costs (>1% of the gross domestic product [GDP] in the European Union). Exposure to EDCs varies widely between the USA and Europe because of differences in regulations and, therefore, we aimed to quantify disease burdens and related economic costs to allow comparison. METHODS We used existing models for assessing epidemiological and toxicological studies to reach consensus on probabilities of causation for 15 exposure-response relations between substances and disorders. We used Monte Carlo methods to produce realistic probability ranges for costs across the exposure-response relation, taking into account uncertainties. Estimates were made based on population and costs in the USA in 2010. Costs for the European Union were converted to US$ (€1=$1·33). FINDINGS The disease costs of EDCs were much higher in the USA than in Europe ($340 billion [2·33% of GDP] vs $217 billion [1·28%]). The difference was driven mainly by intelligence quotient (IQ) points loss and intellectual disability due to polybrominated diphenyl ethers (11 million IQ points lost and 43 000 cases costing $266 billion in the USA vs 873 000 IQ points lost and 3290 cases costing $12·6 billion in the European Union). Accounting for probability of causation, in the European Union, organophosphate pesticides were the largest contributor to costs associated with EDC exposure ($121 billion), whereas in the USA costs due to pesticides were much lower ($42 billion). INTERPRETATION EDC exposure in the USA contributes to disease and dysfunction, with annual costs taking up more than 2% of the GDP. Differences from the European Union suggest the need for improved screening for chemical disruption to endocrine systems and proactive prevention. FUNDING Endocrine Society, Ralph S French Charitable Foundation, and Broad Reach Foundation.
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Affiliation(s)
- Teresa M Attina
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | | | - Patricia A Hunt
- School of Molecular Biosciences, Washington State University, Pullman, WA, USA
| | - Jean-Pierre Bourguignon
- Paediatric Endocrinology, CHU Liège and Neuroendocrinology Unit, GIGA Neurosciences, Université de Liège, Liège, Belgium
| | | | - Joseph DiGangi
- International Persistent Organic Pollutant Elimination Network, Gothenburg, Sweden
| | - R Thomas Zoeller
- Department of Biology, University of Massachusetts, Amherst, MA, USA
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; New York University Wagner School of Public Service, New York, NY, USA; NYU Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food and Public Health, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
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Trasande L, Malecha P, Attina TM. Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs. Environ Health Perspect 2016; 124:1913-1918. [PMID: 27022947 PMCID: PMC5132647 DOI: 10.1289/ehp.1510810] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/04/2015] [Accepted: 03/09/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States. OBJECTIVES We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010. METHODS Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07-1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars. RESULTS An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43-9.66 B], of which $760 million were spent for medical care (SA: $362 M-1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States. CONCLUSIONS PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy. Citation: Trasande L, Malecha P, Attina TM. 2016. Particulate matter exposure and preterm birth: estimates of U.S. attributable burden and economic costs. Environ Health Perspect 124:1913-1918; http://dx.doi.org/10.1289/ehp.1510810.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics,
- Department of Environmental Medicine, and
- Department of Population Health, New York University (NYU) School of Medicine, New York, New York, USA
- NYU Wagner School of Public Service, New York, New York, USA
- NYU College of Global Public Health, New York, New York, USA
- Address correspondence to L. Trasande, Department of Pediatrics, New York University School of Medicine, 403 East 34th St., Room 115, New York, NY 10016 USA. Telephone (646) 501-2520. E-mail:
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Abstract
Phthalates are environmental chemicals widely used in consumer and personal care products. In this study, we examined associations of urinary phthalates with blood pressure, triglycerides, and lipoproteins in children and adolescents, performing a cross-sectional analysis of a subsample of US children 6 to 19 years of age who participated in the National Health and Nutrition Examination Survey between the years 2009 and 2012. We quantified exposure to common environmental phthalates, with a focus on the dietary contaminant di-2-ethylhexylphthalate and 2 increasingly used replacements, di-isononyl phthalate and di-isodecyl phthalate, based on micromolar concentration of urinary metabolites. We assessed descriptive, univariate, and multivariable associations with blood pressure and lipids. Controlling for an array of sociodemographic and behavioral factors, as well as diet and body mass, metabolites of di-2-ethylhexylphthalate, di-isononyl phthalate, and di-isodecyl phthalate were associated with higher age-, sex- and height-standardized blood pressure. For each log unit increase in di-isodecyl phthalate metabolites, a 0.105 standard deviation unit increase in systolic blood pressure z score was identified (P=0.004); for di-isononyl phthalate metabolites, a 0.113 standard deviation unit increment was identified (P=0.008). For di-2-ethylhexylphthalate metabolites, a 0.103 standard deviation unit increment (P=0.013) was detected. Metabolites of low molecular weight phthalates commonly found in cosmetics and personal care products showed an association with blood pressure (≥90th percentile) in univariate analysis, but this was no longer significant in our full multivariable model, suggesting specificity. Phthalate metabolites were not associated with triglycerides or high-density lipoproteins. Further, longitudinal studies are needed to confirm these associations and to assess opportunities for intervention.
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Affiliation(s)
- Leonardo Trasande
- From the Departments of Pediatrics (L.T., T.M.A.), Environmental Medicine (L.T.), and Population Health (L.T.), New York University School of Medicine, NY; New York University Wagner School of Public Service, NY (L.T.); New York University Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food & Public Health, NY (L.T.); and New York University Global Institute of Public Health, NY (L.T.)
| | - Teresa M Attina
- From the Departments of Pediatrics (L.T., T.M.A.), Environmental Medicine (L.T.), and Population Health (L.T.), New York University School of Medicine, NY; New York University Wagner School of Public Service, NY (L.T.); New York University Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food & Public Health, NY (L.T.); and New York University Global Institute of Public Health, NY (L.T.).
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Attina TM, Trasande L. Association of Exposure to Di-2-Ethylhexylphthalate Replacements With Increased Insulin Resistance in Adolescents From NHANES 2009-2012. J Clin Endocrinol Metab 2015; 100:2640-50. [PMID: 25993640 PMCID: PMC4490310 DOI: 10.1210/jc.2015-1686] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Di-isononyl phthalate (DINP) and di-isodecyl phthalate (DIDP) are environmental chemicals increasingly used to replace di-2-ethylhexylphthalate (DEHP) and commonly found in processed foods. Phthalate exposures, in particular DEHP, have been associated with insulin resistance in adolescents, but there are no data regarding the two substitutes, DINP and DIDP. OBJECTIVE This study aimed to examine associations of DINP, DIDP, and DEHP with insulin resistance outcomes. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional analysis of 2009-2012 National Health and Nutrition Examination Surveys (NHANES) composed of 356 fasting 12-19-year-olds. MAIN OUTCOME MEASURES Insulin resistance as a categorical outcome expressed as homeostatic model assessment of insulin resistance (HOMA-IR), using a cut point of 4.39 to define insulin resistance. We also examined continuous HOMA-IR as an outcome in secondary analyses. RESULTS Controlling for demographic and behavioral factors, diet, age, body mass index, and urinary creatinine, for each log increase in DINP metabolite, a 0.08 (P = .001) increase in HOMA-IR was identified. Compared with the first tertile of DINP (23.4% adjusted prevalence), the third tertile was associated with a 34.4% prevalence (95% confidence interval [CI], 27.3-41.6%; P = .033) of insulin resistance. Similarly, compared with the first tertile of DEHP (20.5% adjusted prevalence), the third tertile had 37.7% prevalence (95% CI 29.8-45.6%; P = .003). CONCLUSIONS Urinary DINP concentrations were associated with increased insulin resistance in this cross-sectional study of adolescents. The previously identified association of DEHP with insulin resistance was also confirmed. Further, longitudinal studies are needed to confirm these associations, with the possibility to assess opportunities for intervention.
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Affiliation(s)
- Teresa M Attina
- Departments of Pediatrics (T.M.A., L.T.), Environmental Medicine (L.T.), and Population Health (L.T.), New York University School of Medicine, New York, New York 10016; New York University Wagner School of Public Service (L.T.), New York, New York 10012; New York University Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food & Public Health (L.T.), New York, New York 10003; and New York University Global Institute of Public Health (L.T.), New York, New York 10003
| | - Leonardo Trasande
- Departments of Pediatrics (T.M.A., L.T.), Environmental Medicine (L.T.), and Population Health (L.T.), New York University School of Medicine, New York, New York 10016; New York University Wagner School of Public Service (L.T.), New York, New York 10012; New York University Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food & Public Health (L.T.), New York, New York 10003; and New York University Global Institute of Public Health (L.T.), New York, New York 10003
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Trasande L, Sathyanarayana S, Jo Messito M, S Gross R, Attina TM, Mendelsohn AL. Phthalates and the diets of U.S. children and adolescents. Environ Res 2013; 126:84-90. [PMID: 24041780 DOI: 10.1016/j.envres.2013.07.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/16/2013] [Accepted: 07/21/2013] [Indexed: 05/02/2023]
Abstract
BACKGROUND Di-2-ethylhexylphthalate (DEHP) is an ester of phthalic acid commonly found in processed foods. DEHP may contribute to obesity and insulin resistance in children and adolescents, yet dietary exposures have been not been studied in this vulnerable subpopulation. OBJECTIVE To assess diet and its relation to urinary phthalates in a nationally representative sample of US children and adolescents. DESIGN Cross-sectional analysis of 24-h dietary recall and urinary phthalate metabolites from 2743 6-19 year olds participating in the 2003-8 National Health and Nutrition Examination Surveys. Regression analyses examined relationships of food consumption with log-transformed metabolite concentrations, examined as low-molecular weight, high molecular weight and di-2-ethylhexylphthalate categories, controlling for urinary creatinine, age group, body mass index category, race/ethnicity, caloric intake and gender. RESULTS We identified a -0.04% (95% CI: -0.08, -0.01) increment in di-2-ethylhexylphthalate metabolite concentration/additional gram fruit consumption, a +0.01% increment/additional calorie dietary intake (95% CI: +0.003, +0.02), and a +0.09% (95% CI: +0.02, +0.17) increment/additional gram meat/poultry/fish consumption. Soy consumption (-0.40% increment/additional gram consumed, 95% CI: -0.66, -0.14) was inversely associated with di-2-ethylhexylphthalate, while poultry (+0.23% increment/additional gram consumed, 95% CI: +0.12, +0.35) was positively associated. Findings were robust to examination of metabolite concentrations per unit body mass index and weight, and inclusion of fasting time. CONCLUSIONS Diet contributes to urinary phthalate concentrations in children and adolescents. Further study is needed to examine the implications of di-2-ethylhexylphthalate exposure, especially earlier in life, when more permanent metabolic changes may occur.
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Affiliation(s)
- Leonardo Trasande
- NYU School of Medicine, Departments of Pediatrics, NY 10016, USA; NYU School of Medicine, Department of Environmental Medicine, NY 10016, USA; NYU School of Medicine, Department of Population Health, NY 10016, USA; NYU Wagner School of Public Service, NY 10016, USA; NYU Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food & Public Health, NY 10016, USA.
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Attina TM, Trasande L. Economic costs of childhood lead exposure in low- and middle-income countries. Environ Health Perspect 2013; 121:1097-102. [PMID: 23797342 PMCID: PMC3764081 DOI: 10.1289/ehp.1206424] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 06/11/2013] [Indexed: 05/02/2023]
Abstract
BACKGROUND Children's blood lead levels have declined worldwide, especially after the removal of lead in gasoline. However, significant exposure remains, particularly in low- and middle-income countries. To date, there have been no global estimates of the costs related to lead exposure in children in developing countries. OBJECTIVE Our main aim was to estimate the economic costs attributable to childhood lead exposure in low- and middle-income countries. METHODS We developed a regression model to estimate mean blood lead levels in our population of interest, represented by each 1-year cohort of children < 5 years of age. We used an environmentally attributable fraction model to estimate lead-attributable economic costs and limited our analysis to the neurodevelopmental impacts of lead, assessed as decrements in IQ points. Our main outcome was lost lifetime economic productivity due to early childhood exposure. RESULTS We estimated a total cost of $977 billions of international dollars in low- and middle-income countries, with economic losses equal to $134.7 billion in Africa [4.03% of gross domestic product (GDP)], $142.3 billion in Latin America and the Caribbean (2.04% of GDP), and $699.9 billion in Asia (1.88% of GDP). Our sensitivity analysis indicates a total economic loss in the range of $728.6-1162.5 billion. CONCLUSIONS We estimated that, in low- and middle-income countries, the burden associated with childhood lead exposure amounts to 1.20% of world GDP in 2011. For comparison, in the United States and Europe lead-attributable economic costs have been estimated at $50.9 and $55 billion, respectively, suggesting that the largest burden of lead exposure is now borne by low- and middle-income countries.
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Affiliation(s)
- Teresa M Attina
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA.
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Abstract
BACKGROUND Di-2-ethylhexylphthalate (DEHP) is an environmental chemical commonly found in processed foods. Phthalate exposures, in particular to DEHP, have been associated with insulin resistance in adults, but have not been studied in adolescents. METHODS Using cross-sectional data from 766 fasting 12- to 19-year-olds in the 2003-2008 NHANES, we examined associations of phthalate metabolites with continuous and categorical measures of homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS Controlling for demographic and behavioral factors, diet, continuous age, BMI category, and urinary creatinine, for each log (roughly threefold) increase in DEHP metabolites, a 0.27 increase (95% confidence interval 0.14-0.40; P < .001) in HOMA-IR was identified. Compared with the first tertile of DEHP metabolite in the study population (14.5% insulin resistant), the third tertile had 21.6% prevalence (95% confidence interval 17.2%-26.0%; P = .02). Associations persisted despite controlling for bisphenol A, another endocrine-disrupting chemical commonly found in foods, and HOMA-IR and insulin resistance were not significantly associated with metabolites of lower molecular weight phthalates commonly found in cosmetics and other personal care products. CONCLUSIONS Urinary DEHP concentrations were associated with increased insulin resistance in this cross-sectional study of adolescents. This study cannot rule out the possibility that insulin-resistant children ingest food with higher phthalate content, or that insulin-resistant children excrete more DEHP.
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Affiliation(s)
- Leonardo Trasande
- Departments of Pediatrics, New York University, New York, NY 10016, USA.
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Trasande L, Sathyanarayana S, Spanier AJ, Trachtman H, Attina TM, Urbina EM. Urinary phthalates are associated with higher blood pressure in childhood. J Pediatr 2013; 163:747-53.e1. [PMID: 23706605 PMCID: PMC4074773 DOI: 10.1016/j.jpeds.2013.03.072] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/15/2013] [Accepted: 03/25/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine associations of urinary phthalate levels with blood pressure (BP) and serum triglyceride and lipoprotein levels in children. STUDY DESIGN We performed a cross-sectional analysis of a subsample of US children aged 6-19 years who participated in the National Health and Nutrition Examination Survey between 2003 and 2008. We quantified exposure to 3 families of phthalates--low molecular weight, high molecular weight and di-2-ethylhexylphthalate (DEHP)--based on molar concentration of urinary metabolites. We assessed descriptive, bivariate, and multivariate associations with BP and lipid levels. RESULTS Controlling for an array of sociodemographic and behavioral factors, as well as diet and body mass index, levels of metabolites of DEHP, a phthalate commonly found in processed foods, were associated with higher age-, sex-, and height-standardized BP. For each log unit (roughly 3-fold) increase in DEHP metabolites, a 0.041 SD unit increase in systolic BP z-score was identified (P = .047). Metabolites of low molecular weight phthalates commonly found in cosmetics and personal care products were not associated with BP. Phthalate metabolites were not associated with triglyceride levels, high-density lipoprotein level, or prehypertension. CONCLUSIONS Dietary phthalate exposure is associated with higher systolic BP in children and adolescents. Further work is needed to confirm these associations, as well as to evaluate opportunities for intervention.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY 10016, USA.
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Trasande L, Attina TM, Sathyanarayana S, Spanier AJ, Blustein J. Race/ethnicity-specific associations of urinary phthalates with childhood body mass in a nationally representative sample. Environ Health Perspect 2013; 121:501-6. [PMID: 23428635 PMCID: PMC3620751 DOI: 10.1289/ehp.1205526] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 01/24/2013] [Indexed: 05/17/2023]
Abstract
BACKGROUND Phthalates have antiandrogenic effects and may disrupt lipid and carbohydrate metabolism. Racial/ethnic subpopulations have been documented to have varying urinary phthalate concentrations and prevalences of childhood obesity. OBJECTIVE We examined associations between urinary phthalate metabolites and body mass outcomes in a nationally representative sample of U.S. children and adolescents. METHODS We performed stratified and whole-sample cross-sectional analyses of 2,884 children 6-19 years of age who participated in the 2003-2008 National Health and Nutrition Examination Survey. Multivariable linear and logistic analyses of body mass index z-score, overweight, and obesity were performed against molar concentrations of low-molecular-weight (LMW), high-molecular-weight (HMW), and di-2-ethylhexylphthalate (DEHP) metabolites, controlling for sex, television watching, caregiver education, caloric intake, poverty-income ratio, race/ethnicity, serum cotinine, and age group. We used sensitivity analysis to examine robustness of results to removing sample weighting, normalizing phthalate concentrations for molecular weight, and examining different dietary intake covariates. RESULTS In stratified, multivariable models, each log unit (roughly 3-fold) increase in LMW metabolites was associated with 21% and 22% increases in odds (95% CI: 1.05-1.39 and 1.07-1.39, respectively) of overweight and obesity, and a 0.090-SD unit increase in BMI z-score (95% CI: 0.003-0.18), among non-Hispanic blacks. Significant associations were not identified in any other racial/ethnic subgroup or in the study sample as a whole after controlling for potential confounders, associations were not significant for HMW or DEHP metabolites, and results did not change substantially with sensitivity analysis. CONCLUSIONS We identified a race/ethnicity-specific association of phthalates with childhood obesity in a nationally representative sample. Further study is needed to corroborate the association and evaluate genetic/epigenomic predisposition and/or increased phthalate exposure as possible explanations for differences among racial/ethnic subgroups.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, New York 10016, USA.
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Abstract
CONTEXT Bisphenol A (BPA), a manufactured chemical, is found in canned food, polycarbonate-bottled liquids, and other consumer products. In adults, elevated urinary BPA concentrations are associated with obesity and incident coronary artery disease. BPA exposure is plausibly linked to childhood obesity, but evidence is lacking to date. OBJECTIVE To examine associations between urinary BPA concentration and body mass outcomes in children. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of a nationally representative subsample of 2838 participants aged 6 through 19 years randomly selected for measurement of urinary BPA concentration in the 2003-2008 National Health and Nutrition Examination Surveys. MAIN OUTCOME MEASURES Body mass index (BMI), converted to sex- and age-standardized z scores and used to classify participants as overweight (BMI ≥85th percentile for age/sex) or obese (BMI ≥95th percentile). RESULTS Median urinary BPA concentration was 2.8 ng/mL (interquartile range, 1.5-5.6). Of the participants, 1047 (34.1% [SE, 1.5%]) were overweight and 590 (17.8% [SE, 1.3%]) were obese. Controlling for race/ethnicity, age, caregiver education, poverty to income ratio, sex, serum cotinine level, caloric intake, television watching, and urinary creatinine level, children in the lowest urinary BPA quartile had a lower estimated prevalence of obesity (10.3% [95% CI, 7.5%-13.1%]) than those in quartiles 2 (20.1% [95% CI, 14.5%-25.6%]), 3 (19.0% [95% CI, 13.7%-24.2%]), and 4 (22.3% [95% CI, 16.6%-27.9%]). Similar patterns of association were found in multivariable analyses examining the association between quartiled urinary BPA concentration and BMI z score and in analyses that examined the logarithm of urinary BPA concentration and the prevalence of obesity. Obesity was not associated with exposure to other environmental phenols commonly used in other consumer products, such as sunscreens and soaps. In stratified analysis, significant associations between urinary BPA concentrations and obesity were found among whites (P < .001) but not among blacks or Hispanics. CONCLUSIONS Urinary BPA concentration was significantly associated with obesity in this cross-sectional study of children and adolescents. Explanations of the association cannot rule out the possibility that obese children ingest food with higher BPA content or have greater adipose stores of BPA.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY 10016, USA.
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