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      Phthalate exposure and blood pressure in U.S. children aged 8–17 years (NHANES 2013–2018)

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          Abstract

          Background

          Current evidence from epidemiologic studies suggested that phthalate metabolites might be associated with blood pressure (BP) changes. However, the special relationship between phthalate metabolites and BP changes in children has not been clearly elucidated in existing researches.

          Objectives

          We investigated the links between phthalate metabolites and various BP parameters, including systolic/diastolic BP, mean arterial pressure (MAP), and the presence of hypertension.

          Methods

          The population sample consisted of 1036 children aged 8 to 17 years from the 2013–2018 NHANES in the United States. High performance liquid chromatography-electrospray ionization-tandem mass spectrometry was used to measure urinary concentrations of 19 phthalate metabolites. Systolic/diastolic BP were derived from the average of three valid measurements, and MAP was calculated as (systolic BP + 2 × diastolic BP)/3. Hypertension was defined as mean systolic BP and/or diastolic BP that was ≥ 95th percentile for gender, age, and height reference. Linear regression, logistic regression, and weighted quantile sum (WQS) regression models were employed to assess the associations between phthalate exposure and systolic/diastolic BP, MAP, and hypertension.

          Results

          Ten of 19 phthalate metabolites including MCNP, MCOP, MECPP, MBP, MCPP, MEP, MEHHP, MiBP, MEOHP, and MBzP had detection frequencies > 85% with samples more than 1000. MCNP, MCOP, MECPP, MBP, MCPP, MEHHP, MiBP, MEOHP, and MBzP were generally negatively associated with systolic/diastolic BP and MAP, but not protective factors for hypertension. These associations were not modified by age (8–12 and 13–17 years) or sex (boys and girls). The above-mentioned associations were further confirmed by the application of the WQS analysis, and MCOP was identified as the chemical with the highest weight.

          Conclusion

          Phthalate metabolites were associated with modest reductions in systolic/diastolic BP, and MAP in children, while appeared not protective factors for hypertension. Given the inconsistent results among existing studies, our findings should be confirmed by other cohort studies.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s40001-024-01785-9.

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          Most cited references34

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          Characterization of Weighted Quantile Sum Regression for Highly Correlated Data in a Risk Analysis Setting

          Pam Factor-Litvak, Chris Gennings, Caroline Carrico … (2015)
          In risk evaluation, the effect of mixtures of environmental chemicals on a common adverse outcome is of interest. However, due to the high dimensionality and inherent correlations among chemicals that occur together, the traditional methods (e.g. ordinary or logistic regression) suffer from collinearity and variance inflation, and shrinkage methods have limitations in selecting among correlated components. We propose a weighted quantile sum (WQS) approach to estimating a body burden index, which identifies "bad actors" in a set of highly correlated environmental chemicals. We evaluate and characterize the accuracy of WQS regression in variable selection through extensive simulation studies through sensitivity and specificity (i.e., ability of the WQS method to select the bad actors correctly and not incorrect ones). We demonstrate the improvement in accuracy this method provides over traditional ordinary regression and shrinkage methods (lasso, adaptive lasso, and elastic net). Results from simulations demonstrate that WQS regression is accurate under some environmentally relevant conditions, but its accuracy decreases for a fixed correlation pattern as the association with a response variable diminishes. Nonzero weights (i.e., weights exceeding a selection threshold parameter) may be used to identify bad actors; however, components within a cluster of highly correlated active components tend to have lower weights, with the sum of their weights representative of the set.
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            Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis

            Peige Song, Yan Yan Zhang, Jinyue Yu … (2019)
            This systematic review and meta-analysis examines prevalence of hypertension in the general pediatric population. What is the prevalence of hypertension in the general pediatric population? In this systematic review and meta-analysis of 47 articles, the prevalence of childhood hypertension increased from 1994 to 2018 and the increase was associated with higher body mass index, with the pooled estimate being 4.00% among individuals 19 years and younger. In 2015, the prevalence of childhood hypertension ranged from 4.32% among children aged 6 years to 3.28% among those aged 19 years and peaked at 7.89% among those aged 14 years. The findings suggest that childhood hypertension is becoming more common in the general pediatric population, representing a considerable public health challenge worldwide. Reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment. However, the prevalence of childhood hypertension has rarely been synthesized at the global level. To conduct a systematic review and meta-analysis to assess the prevalence of hypertension in the general pediatric population. PubMed, MEDLINE, Embase, Global Health, and Global Health Library were searched from inception until June 2018, using search terms related to hypertension ( hypertension OR high blood pressure OR elevated blood pressure ), children ( children OR adolescents ), and prevalence ( prevalence OR epidemiology ). Studies that were conducted in the general pediatric population and quantified the prevalence of childhood hypertension were eligible. Included studies had blood pressure measurements from at least 3 separate occasions. Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence. Variations in the prevalence estimates in different subgroups, including age group, sex, setting, device, investigation period, BMI group, World Health Organization region and World Bank region, were examined by subgroup meta-analysis. Meta-regression was used to establish the age-specific prevalence of childhood hypertension and to assess its secular trend. Prevalence of childhood hypertension overall and by subgroup. A total of 47 articles were included in the meta-analysis. The pooled prevalence was 4.00% (95% CI, 3.29%-4.78%) for hypertension, 9.67% (95% CI, 7.26%-12.38%) for prehypertension, 4.00% (95% CI, 2.10%-6.48%) for stage 1 hypertension, and 0.95% (95% CI, 0.48%-1.57%) for stage 2 hypertension in children 19 years and younger. In subgroup meta-analyses, the prevalence of childhood hypertension was higher when measured by aneroid sphygmomanometer (7.23% vs 4.59% by mercury sphygmomanometer vs 2.94% by oscillometric sphygmomanometer) and among overweight and obese children (15.27% and 4.99% vs 1.90% among normal-weight children). A trend of increasing prevalence of childhood hypertension was observed during the past 2 decades, with a relative increasing rate of 75% to 79% from 2000 to 2015. In 2015, the prevalence of hypertension ranged from 4.32% (95% CI, 2.79%-6.63%) among children aged 6 years to 3.28% (95% CI, 2.25%-4.77%) among those aged 19 years and peaked at 7.89% (95% CI, 5.75%-10.75%) among those aged 14 years. This study provides a global estimation of childhood hypertension prevalence based on blood pressure measurements in at least 3 separate visits. More high-quality epidemiologic investigations on childhood hypertension are still needed.
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              Phthalates impact human health: Epidemiological evidences and plausible mechanism of action.

              Kenji Takahashi, Eiji Masai, Robin C. Anderson … (2017)
              Disregarding the rising alarm on the hazardous nature of various phthalates and their metabolites, ruthless usage of phthalates as plasticizer in plastics and as additives in innumerable consumer products continues due low their cost, attractive properties, and lack of suitable alternatives. Globally, in silico computational, in vitro mechanistic, in vivo preclinical and limited clinical or epidemiological human studies showed that over a dozen phthalates and their metabolites ingested passively by man from the general environment, foods, drinks, breathing air, and routine household products cause various dysfunctions. Thus, this review addresses the health hazards posed by phthalates on children and adolescents, epigenetic modulation, reproductive toxicity in women and men; insulin resistance and type II diabetes; overweight and obesity, skeletal anomalies, allergy and asthma, cancer, etc., coupled with the description of major phthalates and their general uses, phthalate exposure routes, biomonitoring and risk assessment, special account on endocrine disruption; and finally, a plausible molecular cross-talk with a unique mechanism of action. This clinically focused comprehensive review on the hazards of phthalates would benefit the general population, academia, scientists, clinicians, environmentalists, and law or policy makers to decide upon whether usage of phthalates to be continued swiftly without sufficient deceleration or regulated by law or to be phased out from earth forever.
              Article 0 comments Cited 147 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Guodong Ding: dingguodong@sjtu.edu.cn
                Li Shen: shenli@shchildren.com.cn
                Journal
                Journal ID (nlm-ta): Eur J Med Res
                Journal ID (iso-abbrev): Eur J Med Res
                Title: European Journal of Medical Research
                Publisher: BioMed Central (London )
                ISSN (Print): 0949-2321
                ISSN (Electronic): 2047-783X
                Publication date (Electronic): 25 March 2024
                Publication date PMC-release: 25 March 2024
                Publication date Collection: 2024
                Volume: 29
                Electronic Location Identifier: 192
                Affiliations
                [1 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Department of Cardiothoracic Surgery, , Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, ; Shanghai, China
                [2 ]GRID grid.24516.34, ISNI 0000000123704535, Department of Anesthesiology, , Shanghai East Hospital, Tongji University, ; Shanghai, China
                [3 ]GRID grid.415625.1, ISNI 0000 0004 0467 3069, Department of Traditional Chinese Medicine, , Shanghai Children’s Hospital, Shanghai Jiao Tong University, School of Medicine, ; Shanghai, China
                [4 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Department of Pediatric Respiratory Medicine, , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, ; Shanghai, 200092 China
                Article
                Publisher ID: 1785
                DOI: 10.1186/s40001-024-01785-9
                PMC ID: 10962091
                PubMed ID: 38528598
                SO-VID: 1b5585fe-d6c3-41df-aec2-e2934599e72e
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 2 January 2024
                Date accepted : 11 March 2024
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2024

                ScienceOpen disciplines: Medicine
                Keywords: phthalate metabolites,blood pressure,children,hypertension,nhanes
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: phthalate metabolites, blood pressure, children, hypertension, nhanes

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