title: Urinary phthalates and increased insulin resistance in adolescents.
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.
authors: Departments of Pediatrics, New York University, New York, NY 10016, USA. leonardo.trasande@nyumc.org
authors: Leonardo
authors: L
authors: Trasande
authors: Adam J
authors: AJ
authors: Spanier
authors: Sheela
authors: S
authors: Sathyanarayana
authors: Teresa M
authors: TM
authors: Attina
authors: Jan
authors: J
authors: Blustein
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000652:urine; D004051:Diethylhexyl Phthalate / Q000633:toxicity / Q000652:urine*; D004785:Environmental Pollutants / Q000633:toxicity* / Q000652:urine; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D009749:Nutrition Surveys; D010795:Phthalic Acids / Q000633:toxicity* / Q000652:urine; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D010795:Phthalic Acids; D004051:Diethylhexyl Phthalate
keywords: insulin resistance; phthalates
references: Diabetes Metab Res Rev. 2011 Jan;27(1):3-13
references: 21218503
references: Int J Androl. 2006 Feb;29(1):134-9; discussion 181-5
references: 16466533
references: Environ Health Perspect. 2002 May;110(5):515-8
references: 12003755
references: Crit Rev Toxicol. 2006 May;36(5):459-79
references: 16954067
references: Environ Health Perspect. 2005 Feb;113(2):192-200
references: 15687057
references: J Biol Chem. 2007 Jun 29;282(26):19152-66
references: 17468099
references: Environ Health Perspect. 2010 Jul;118(7):998-1003
references: 20392686
references: Toxicol Sci. 2004 Nov;82(1):170-82
references: 15310864
references: Circulation. 2005 Aug 9;112(6):862-9
references: 16061737
references: Bull Environ Contam Toxicol. 1974 Dec;12(6):721-5
references: 4457184
references: JAMA. 2007 Jun 27;297(24):2716-24
references: 17595272
references: Environ Res. 2012 Jan;112:186-93
references: 22222007
references: Environ Health. 2008 Jun 03;7:27
references: 18522739
references: Mol Nutr Food Res. 2007 Jul;51(7):899-911
references: 17604388
references: Environ Int. 2007 Nov;33(8):1012-20
references: 17610953
references: Environ Health Perspect. 2007 Jun;115(6):876-82
references: 17589594
references: Environ Health Perspect. 2013 Apr;121(4):501-6
references: 23428635
references: Diabetes Care. 2006 Nov;29(11):2427-32
references: 17065679
references: Int J Hyg Environ Health. 2004 Oct;207(5):409-17
references: 15575555
references: Food Addit Contam. 2002 Jun;19(6):602-10
references: 12042027
references: Compr Rev Food Sci Food Saf. 2010 Jan;9(1):21-43
references: 33467808
references: Environ Health Perspect. 2004 Mar;112(3):331-8
references: 14998749
references: Prev Sci. 2007 Sep;8(3):206-13
references: 17549635
references: Curr Probl Pediatr Adolesc Health Care. 2008 Feb;38(2):34-49
references: 18237855
references: Environ Health Perspect. 2012 Sep;120(9):1307-13
references: 22796563
references: J Med Chem. 2001 Aug 2;44(16):2675-8
references: 11472221
references: Am J Public Health. 1977 Dec;67(12):1188-91
references: 596503
references: Mol Endocrinol. 2006 Sep;20(9):2141-55
references: 16613991
references: Diabetes Care. 2004 Jun;27(6):1487-95
references: 15161807
references: Int J Androl. 2012 Jun;35(3):216-26
references: 22428786
references: Toxicology. 2005 Jun 1;210(2-3):123-33
references: 15840426
references: Occup Environ Med. 2005 Nov;62(11):806-18
references: 16234408
references: Diabetologia. 1985 Jul;28(7):412-9
references: 3899825
references: Environ Health Perspect. 2011 Jul;119(7):914-20
references: 21450549
references: Pediatrics. 2002 Jan;109(1):45-60
references: 11773541
references: Environ Health Perspect. 2004 Dec;112(17):1734-40
references: 15579421
references: Mol Cell Endocrinol. 2009 May 25;304(1-2):43-8
references: 19433246
references: Toxicol Sci. 2003 Aug;74(2):297-308
references: 12805656
references: JAMA. 2012 Sep 19;308(11):1113-21
references: 22990270