title: Case study: Possible differences in phthalates exposure among the Czech, Hungarian, and Slovak populations identified based on the DEMOCOPHES pilot study results.
abstract: OBJECTIVE
  Phthalates and their metabolites are classified as endocrine modulators. They affect the hormonal balance in both children and adults. The aim of this publication was to compare the urinary levels of phthalate metabolites in selected populations of the Czech Republic (CZ), Slovakia (SK), and Hungary (HU) in relation to the sources of phthalate exposure identified by means of questionnaire (personal care products, floor and wall coverings, plastic toys, and some kinds of foods).
  
  
  METHODS
  Data were obtained through the twin projects COPHES (COnsortium to Perform Human biomonitoring on a European Scale) and DEMOCOPHES (DEMOnstration of a study to COordinate and Perform Human biomonitoring on a European Scale) from 2009 to 2012. The target groups were children aged 6-11 years old and their mothers up to 45 years of age. The metabolites of phthalates (monomethyl phthalate (MMP), monoethyl phthalate (MEP), monobenzyl phthalate (MBzP), mono-cyclohexyl phthalate (MCHP), mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (5OH-MEHP), and mono-(2-ethyl-5-oxohexyl) phthalate (5OXO-MEHP)) were analysed in first morning urine samples. After enzymatic glucuronide cleavage, the urine sample analyses were performed using ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry (UHPLC-ESI-MS/MS) in one laboratory that qualified in the External Quality Assessment exercises organised by COPHES.
  
  
  RESULTS
  Significant differences in phthalate exposure between countries were revealed for children only but not for mothers. The concentrations of 5-OH-MEHP (P<0.001), 5OXO-MEHP (P<0.001), and their sum (P<0.001) were the highest in SK compared to CZ and HU. The health based guidance values for the sum of DEHP metabolites 5-OH MEHP and 5OXO-MEHP established by the German Commission for biomonitoring of 300 µg/L and 500 µg/L for women adults and children, respectively, were only exceeded in one mother and three boys. A significant difference was also found for MEP (P=0.0149), with the highest concentrations detected in HU. In all countries, the increasing frequency of using personal care products significantly elevated the concentrations of MEP.
  
  
  CONCLUSIONS
  Some differences were observed between countries in the concentrations of individual urinary phthalate metabolites in children. However, the questionnaire results give no direct explanation for the differences between the countries except the variation in using personal care products.
authors.affiliation: National Institute of Public Health, Šrobárova 48, Prague 10 100 42, Czech Republic; Charles University, Third Faculty of Medicine, Prague, Czech Republic. Electronic address: mcerna@szu.cz.
authors.forename: Milena
authors.initials: M
authors.lastname: Černá
authors.affiliation: National Institute of Public Health, Šrobárova 48, Prague 10 100 42, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Malý
authors.affiliation: National Institute of Environmental Health, Budapest, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Rudnai
authors.affiliation: National Institute of Environmental Health, Budapest, Hungary.
authors.forename: Szilvia
authors.initials: S
authors.lastname: Középesy
authors.affiliation: National Labour Office, Department for Occupational Health, Budapest, Hungary.
authors.forename: Miklós
authors.initials: M
authors.lastname: Náray
authors.affiliation: Authority of Public Health of the Slovak Republic, Bratislava, Slovakia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Halzlová
authors.affiliation: Authority of Public Health of the Slovak Republic, Bratislava, Slovakia.
authors.forename: Michal
authors.initials: M
authors.lastname: Jajcaj
authors.affiliation: National Institute of Public Health, Šrobárova 48, Prague 10 100 42, Czech Republic.
authors.forename: Anna
authors.initials: A
authors.lastname: Grafnetterová
authors.affiliation: National Institute of Public Health, Šrobárova 48, Prague 10 100 42, Czech Republic.
authors.forename: Andrea
authors.initials: A
authors.lastname: Krsková
authors.affiliation: National Institute of Public Health, Šrobárova 48, Prague 10 100 42, Czech Republic.
authors.forename: Danuše
authors.initials: D
authors.lastname: Antošová
authors.affiliation: Public Health Agency based in Liberec, Czech Republic.
authors.forename: Kateřina
authors.initials: K
authors.lastname: Forysová
authors.affiliation: Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Belgium.
authors.forename: Elly
authors.initials: E
authors.lastname: Den Hond
authors.affiliation: VITO, Environmental Risk and Health Unit, Boeretang 200, 2400 Mol, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Schoeters
authors.affiliation: BiPRO, Munich, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Joas
authors.affiliation: KU Leuven-Centrum Menselijke Erfelijkheid, Belgium.
authors.forename: Ludwine
authors.initials: L
authors.lastname: Casteleyn
authors.affiliation: BiPRO, Munich, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Joas
authors.affiliation: Federal Public Service Health, Food Chain Safety and Environment-DG Environment, Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Biot
authors.affiliation: Federal Public Service Health, Food Chain Safety and Environment-DG Environment, Brussels, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Aerts
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-Universität Bochum (IPA), Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Angerer
authors.affiliation: Environmental Health Sciences International, Hulst, The Netherlands.
authors.forename: Louis
authors.initials: L
authors.lastname: Bloemen
authors.affiliation: Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Argelia
authors.initials: A
authors.lastname: Castaño
authors.affiliation: Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Esteban
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-Universität Bochum (IPA), Germany.
authors.forename: Holger M
authors.initials: HM
authors.lastname: Koch
authors.affiliation: Federal Environment Agency (UBA), Berlin, Germany.
authors.forename: Marike
authors.initials: M
authors.lastname: Kolossa-Gehring
authors.affiliation: Centre de Recherche Public-Gabriel Lippmann, Belvaux, Luxembourg.
authors.forename: Arno C
authors.initials: AC
authors.lastname: Gutleb
authors.affiliation: National Institute of Public Health, Šrobárova 48, Prague 10 100 42, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Pavloušková
authors.affiliation: National Institute of Public Health, Šrobárova 48, Prague 10 100 42, Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Vrbík
mesh_terms: D000328:Adult; D002648:Child; D002851:Chromatography, High Pressure Liquid; D018153:Czech Republic; D003627:Data Interpretation, Statistical; D004781:Environmental Exposure / Q000032:analysis* / Q000706:statistics & numerical data; D004784:Environmental Monitoring / Q000379:methods / Q000706:statistics & numerical data; D004785:Environmental Pollutants / Q000378:metabolism / Q000652:urine*; D005260:Female; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D010795:Phthalic Acids / Q000378:metabolism / Q000652:urine*; D010865:Pilot Projects; D018154:Slovakia; D012907:Smoking / Q000453:epidemiology; D021241:Spectrometry, Mass, Electrospray Ionization; D011795:Surveys and Questionnaires; D053719:Tandem Mass Spectrometry
chemical_list: D004785:Environmental Pollutants; D010795:Phthalic Acids
keywords: Czech Republic; DEMOCOPHES; Hungary; Slovakia; Urinary phthalate metabolites