title: The effects of phthalate and nonylphenol exposure on body size and secondary sexual characteristics during puberty.
abstract: BACKGROUND
  Some phthalic acid esters (PAEs) and nonylphenol (NP) are endocrine-disrupting chemicals (EDCs) that are widely used in consumer products. Consequently, the general population is exposed simultaneously to both groups of chemicals.
  
  
  OBJECTIVE
  To investigate the single- and co-exposure effects of PAEs (DMP, DEP, DnBP, DiBP, BBzP, and DEHP) and NP on obesity and pubertal maturity to compare the body sizes of general adolescents with the complainants of the phthalate-tainted foods scandal that occurred in Taiwan.
  
  
  METHODS
  This study included 270 general adolescents aged 6.5-15.0 years and 38 complainants aged 6.5-8.5 years. Nine metabolites of the five PAEs and of NP were measured in urine. We used a questionnaire to evaluate pubertal maturity, measured anthropometric indices (APs) to assess body size, and collected urine samples to measure the two groups of chemicals.
  
  
  RESULTS
  We found that urinary PAE metabolite concentrations (specifically, metabolites of DEP, DnBP, DiBP, and DEHP) were positively associated with the APs for abdominal obesity (including skinfold thickness, waist circumference, waist-to-height ratio, and waist-to-hip) and indicated a dose-response relationship. Mono-methyl phthalate (MMP) exposure was inversely associated with pubarche among boys. The daily intake of DEHP in general adolescents exceeded the reference doses (RfD-20 μg/kgbw/day) and tolerable daily intake (TDI-50 μg/kgbw/day) by 3.4% and 0.4%, respectively. No associations were observed between NP exposure or co-exposure and the APs or pubertal maturity. No significant differences were observed between general adolescents and the complainants with regard to weight, height, or BMI.
  
  
  CONCLUSIONS
  The study suggests that PAE (specifically, DEP, DnBP, DiBP, and DEHP) exposure is associated with abdominal obesity in adolescents and that the APs for abdominal obesity are more sensitive than BMI for measuring obesity among adolescents. We suggest that the RfD and TDI for PAEs should be revised to provide sufficient protection.
authors.affiliation: Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Jia-Woei
authors.initials: JW
authors.lastname: Hou
authors.affiliation: School of Medicine, Fu Jen Catholic University, Taipei, Taiwan; Department of Endocrinology & Metabolism, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Ching-Ling
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yen-An
authors.initials: YA
authors.lastname: Tsai
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chia-Huang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kai-Wei
authors.initials: KW
authors.lastname: Liao
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ching-Jung
authors.initials: CJ
authors.lastname: Yu
authors.affiliation: Department of Pediatric, Taipei City Hospital, Taiwan.
authors.forename: Winnie
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Pediatric, Taipei City Hospital, Taiwan.
authors.forename: Ming-Jun
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: National Environmental Health Research Center, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Po-Chin
authors.initials: PC
authors.lastname: Huang
authors.affiliation: Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Sun
authors.affiliation: Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Yin-Han
authors.initials: YH
authors.lastname: Wang
authors.affiliation: Division of Health Policy Translation, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Fang-Ru
authors.initials: FR
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Wen-Chiu
authors.initials: WC
authors.lastname: Wu
authors.affiliation: Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lee
authors.affiliation: Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
authors.forename: Wen-Harn
authors.initials: WH
authors.lastname: Pan
authors.affiliation: Department of Laboratory Medicine and Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Bai-Hsiun
authors.initials: BH
authors.lastname: Chen
authors.affiliation: Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center of Environmental and Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
authors.forename: Ming-Tsang
authors.initials: MT
authors.lastname: Wu
authors.affiliation: Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Chu-Chih
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Wang
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Research Center of Environmental Trace Toxic Substance, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Chao Agnes
authors.initials: CA
authors.lastname: Hsiung
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: mlchen@ym.edu.tw.
authors.forename: Mei-Lien
authors.initials: ML
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D049628:Body Size / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects*; D002648:Child; D004051:Diethylhexyl Phthalate / Q000009:adverse effects / Q000652:urine; D052244:Endocrine Disruptors / Q000009:adverse effects* / Q000652:urine; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D004785:Environmental Pollutants / Q000009:adverse effects / Q000652:urine; D005260:Female; D005506:Food Contamination; D006801:Humans; D008297:Male; D056128:Obesity, Abdominal / Q000209:etiology / Q000652:urine; D063766:Pediatric Obesity / Q000209:etiology* / Q000652:urine; D010636:Phenols / Q000009:adverse effects* / Q000652:urine; D010795:Phthalic Acids / Q000009:adverse effects* / Q000652:urine; D011627:Puberty / Q000187:drug effects*; D012016:Reference Values; D012727:Sex Characteristics; D013624:Taiwan
chemical_list: D052244:Endocrine Disruptors; D004785:Environmental Pollutants; D010636:Phenols; D010795:Phthalic Acids; C517284:monomethyl phthalate; C032279:phthalic acid; C025256:nonylphenol; D004051:Diethylhexyl Phthalate
keywords: Endocrine-disrupting chemicals; Nonylphenol; Obesity; Phthalic acid esters; Pubertal maturity