title: Phthalates and the diets of U.S. children and adolescents.
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.
  
  
  METHODS
  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.
authors.affiliation: 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. Electronic address: Leonardo.trasande@nyumc.org.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
authors.forename: Sheela
authors.initials: S
authors.lastname: Sathyanarayana
authors.forename: Mary
authors.initials: M
authors.lastname: Jo Messito
authors.forename: Rachel
authors.initials: R
authors.lastname: S Gross
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Attina
authors.forename: Alan L
authors.initials: AL
authors.lastname: Mendelsohn
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D010795:Phthalic Acids / Q000652:urine*; D014481:United States; D055815:Young Adult
chemical_list: D010795:Phthalic Acids; C032279:phthalic acid
keywords: Children; Diet; Insulin resistance; MBP; MBzP; MCPP; MECPP; MEHHP; MEHP; MEOHP; MEP; MiBP; Obesity; Phthalates; SD; mono-(2-ethyl-5-carboxypentyl) phthalate; mono-(2-ethyl-5-hydroxyhexyl) phthalate; mono-(2-ethyl-5-oxohexyl) phthalate; mono-(2-ethylhexyl) phthalate; mono-(3-carboxypropyl) phthalate; mono-ethyl phthalate; mono-isobutyl phthalate; mono-n-butyl-phthalate; monobenzylphthalate; standard deviation