Exposure to certain phthalates linked to death from all causes


Exposure to certain endocrine disrupting chemicals can cost Americans their lives, researchers said.

In a cohort study of more than 5,300 people (median age 56.5 years) in the United States, people continuously exposed to high molecular weight phthalates – commonly found in plastics for Floor coverings, food packaging and intravenous lines – saw a 14% higher risk. all-cause mortality (HR 1.14, 95% CI 1.06-1.23), reported Leonardo Trasande, MD, MPP, of the NYU Grossman School of Medicine in New York, and colleagues.

The association was primarily due to exposure to di-2-ethylhexylphthalate (DEHP), a certain type of high molecular weight phthalate commonly used in industrial food processing and medical devices. Continuous exposure to this chemical was linked to a 10% higher risk of mortality in adults aged 55 to 64 (HR 1.10, 95% CI 1.03-1.19), they said. written in Environmental pollution.

However, the association appeared to be dose-dependent, with those in the highest of the three exposure tertiles – representing a median exposure level of 0.63 μmol / L to high molecular weight phthalates – seeing a 48% higher risk of death. than those with the least exposure (median level of 0.08 μmol / L).

Likewise, those most exposed to DEHP (median 0.47 mol / L) had a 42% higher risk of death than the group with the lowest DEHP exposure (median 0.05 μmol / L). .

The researchers also determined that between 2013 and 2014, phthalate exposure likely cost the country about $ 47.1 billion in economic productivity. For this age group in 2014 dollars, phthalate exposure cost each adult approximately $ 439,313 in lifetime economic productivity.

Looking more closely at specific metabolites, there were a few linked to cardiovascular (CV) character. A metabolite of DEHP – mono- (2-ethyl-5-oxohexyl) phthalate – has been associated with a 74% increased risk of cardiovascular mortality in those most at risk (HR 1.74, CI at 95% 1.05-2.88).

The higher level of exposure to monoethyl phthalate – a low molecular weight metabolite – was also linked to a higher risk of cardiovascular death (HR 1.64, 95% CI 1.07-2, 51). Low molecular weight phthalates are more commonly used in shampoos, lotions, and other cosmetics, as well as in personal care products to preserve odor. Continuous exposure to low molecular weight molecules, however, was not related to all-cause mortality.

And none of the 11 specific metabolites examined were linked to cancer mortality.

Overall, Trasande’s group estimated that 107,283 deaths among people aged 55 to 64 in 2014 could be attributed to high exposure to phthalates.

“Our results reveal that increased phthalate exposure is linked to early death, particularly from heart disease,” Trasande said in a statement. “Until now, we understood that chemicals were linked to heart disease and that heart disease in turn was a major cause of death, but we had not yet linked the chemicals themselves to death. . “

His group added that they were not particularly surprised to find a link between CV mortality in relation to phthalate exposures, and more specifically a link between phthalates used in food packaging.

“Mono- (2-ethylhexyl) phthalate (MEHP), a metabolite of DEHP, increases the expression of three receptors activated by peroxisome proliferators that play key roles in lipid and carbohydrate metabolism, providing biological plausibility for DEHP metabolites in childhood and diabetes, ”they wrote. . “Emerging animal evidence also suggests that DEHP may produce arrhythmia, alter metabolic profiles, and produce dysfunction in cardiac myocytes.”

“Our research suggests that the toll of this chemical on society is far greater than we initially thought,” Trasande added in the statement. “The evidence is overwhelmingly clear that limiting exposure to toxic phthalates can help protect the physical and financial well-being of Americans.”

Trasande’s group used data from the National Health and Nutrition Examination Survey 2001-2010, reducing the cohort to 5,303 adults (more than half of women; majority non-Hispanic white). The survey data was then linked to mortality data in 2015.

Exposure to phthalates was quantified using urine samples. Exposure patterns were all adjusted for age, race / ethnicity, urinary creatinine, education levels, family income, smoking, alcohol consumption, physical activity, total energy intake, healthy eating index score 2010, survey year and BMI.

“Regulators have the power to mandate the use of safer alternatives in cosmetics, personal care products and food packaging,” the group from Trasande said. “Already the United States, Canada, Israel, Brazil, Hong Kong, Australia and China have all restricted or banned … DEHP, dibutylphthalate (DBP) and butylbenzylphthalate (BBP) in toys . However, there are fewer limits on phthalates in food contact materials and cosmetics. “

The group suggested that a quick way to reduce exposure now is to use alternatives to plastic food containers, such as glass or stainless steel.

  • Kristen Monaco is editor-in-chief, specializing in news in endocrinology, psychiatry and nephrology. Based in the New York office, she has been with the company since 2015.


The study was funded by the NIH.

Trasande and his co-authors have disclosed relationships with Houghton Mifflin Harcourt, Audible, Paidos, Kobunsha, Endocrine Society, WHO, UNEP, Japanese Ministries of Environment and Health, American Academy of Pediatrics, Beautycounter, IS-Global and Footprint.


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