title: Dietary phthalates and low-grade albuminuria in US children and adolescents.
abstract: BACKGROUND
  Low-grade albuminuria is an indicator of endothelial dysfunction and is associated with an increased risk of cardiovascular disease. A graded level of exposure to bisphenol A was recently identified to be associated with increased risk of low-grade albuminuria in children and adults. Because bisphenol A and phthalates coexist as dietary contaminants, this study investigated whether exposure to phthalates is also associated with low-grade albuminuria.
  
  
  METHODS
  Data were examined from 667 children who participated in the 2009-2010 National Health and Nutrition Examination Survey and who had results for urinary phthalate metabolites and albumin excretion. Urinary albumin and creatinine concentrations were measured in a first morning specimen using a solid-phase fluorescent immunoassay and a Roche/Hitachi Modular P Chemistry Analyzer with an enzymatic method, respectively. Phthalate metabolites were analyzed in a separate spot urine sample from each participant, using high-performance liquid chromatography and tandem mass spectroscopy.
  
  
  RESULTS
  For each (roughly) 3-fold increase in metabolites of di-2-ethylhexylphthalate (a high molecular weight phthalate commonly found in foods), a 0.55 mg/g increase in albumin/creatinine ratio (ACR) was identified (P=0.02), whereas a 1.30-fold odds of a higher ACR quartile was also identified for each (roughly) 3-fold increase (P=0.02). Higher ACR was not identified in relationship to metabolites of lower molecular phthalates commonly found in lotions or shampoos, suggesting specificity.
  
  
  CONCLUSIONS
  Although reverse causation and unmeasured confounders represent alternative explanations, these findings, in conjunction with our earlier data on bisphenol A, indicate that a wide array of environmental toxins may adversely affect albuminuria and potentially increase the risk of cardiovascular disease. In view of the potential long-term health implications of ongoing exposure in this vulnerable subpopulation, our data support both further study and renewed regulatory efforts to limit exposure during childhood.
authors.affiliation: Departments of Pediatrics,, †Environmental Medicine, and, ‡Population Health, New York University School of Medicine, New York, New York;, §New York University Wagner School of Public Service, New York, New York;, ‖Department of Nutrition, Food, and Public Health, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York, ¶Seattle Children's Research Institute, University of Washington, Seattle, Washington.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
authors.forename: Sheela
authors.initials: S
authors.lastname: Sathyanarayana
authors.forename: Howard
authors.initials: H
authors.lastname: Trachtman
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000419:Albuminuria / Q000139:chemically induced* / Q000175:diagnosis / Q000652:urine; D015415:Biomarkers / Q000652:urine; D002648:Child; D002851:Chromatography, High Pressure Liquid; D003404:Creatinine / Q000652:urine; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants / Q000009:adverse effects* / Q000652:urine; D005260:Female; D005506:Food Contamination; D006801:Humans; D007118:Immunoassay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D016017:Odds Ratio; D010795:Phthalic Acids / Q000009:adverse effects* / Q000652:urine; D018570:Risk Assessment; D012307:Risk Factors; D053719:Tandem Mass Spectrometry; D014481:United States; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004785:Environmental Pollutants; D010795:Phthalic Acids; D003404:Creatinine