title: Intake of phthalate-tainted foods and microalbuminuria in children: The 2011 Taiwan food scandal.
abstract: BACKGROUND
  A major threat to public health involving phthalate-tainted foodstuffs occurred in Taiwan in 2011. Phthalates, mainly di-(2-ethylhexyl) phthalate (DEHP), were intentionally added to several categories of food commonly consumed by children. This study investigated the relationship between intake of the phthalate-tainted foods and renal function in children.
  
  
  METHODS
  Children aged ≤10years with possible phthalate exposure were enrolled in this study between August 2012 and January 2013. Questionnaires were used to collect details of exposure to phthalate-tainted foodstuffs, and blood and urine samples were collected for clinical biochemical workup. The clinical biomarkers of renal injury, including urinary microalbumin, N-acetyl-beta-d-glucosaminidase (NAG), and β2-microglobulin were measured. Exposure was categorized based on recommended tolerable daily intake level defined by the U.S. Environmental Protection Agency (0.02mg/kg/day) and the European Food Safety Authority (0.05mg/kg/day).
  
  
  RESULTS
  We analyzed intake and renal function of 184 children whose intake of DEHP-tainted foods was known. Higher DEHP exposure to DEHP-tainted foods was significantly associated with increase of urine albumin/creatinine ratio (ACR). Children in the high-exposed group (daily DEHP intake (DDI)>0.05mg/kg/day) had 10.395 times the risk of microalbuminuria than the low-exposed group (DDI≤0.02 and >0mg/kg/day) and no-exposed group combined after adjustment (95% CI=1.096-98.580, P=0.04).
  
  
  CONCLUSIONS
  Intake of DEHP from phthalate-tainted foods may be a potential risk factor for microalbuminuria, a marker of glomerular injury in children.
authors.affiliation: Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hui-Ju
authors.initials: HJ
authors.lastname: Tsai
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; Research Center of Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chia-Fang
authors.initials: CF
authors.lastname: Wu
authors.affiliation: National Environmental Health Research Center, National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Wang
authors.affiliation: National Environmental Health Research Center, National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Po-Chin
authors.initials: PC
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Mei-Lien
authors.initials: ML
authors.lastname: Chen
authors.affiliation: Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Health, Kaohsiung City Government, Kaohsiung, Taiwan.
authors.forename: Chi-Kung
authors.initials: CK
authors.lastname: Ho
authors.affiliation: Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan. Electronic address: hsiung@nhri.org.tw.
authors.forename: Chao A
authors.initials: CA
authors.lastname: Hsiung
authors.affiliation: Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center of Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Center of Environmental and Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: 960021@ms.kmuh.org.tw.
authors.forename: Ming-Tsang
authors.initials: MT
authors.lastname: Wu
mesh_terms: D000419:Albuminuria / Q000139:chemically induced / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004051:Diethylhexyl Phthalate / Q000032:analysis / Q000633:toxicity; D005260:Female; D005506:Food Contamination / Q000032:analysis*; D059022:Food Safety; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D010795:Phthalic Acids / Q000032:analysis* / Q000633:toxicity; D011634:Public Health; D013624:Taiwan / Q000453:epidemiology; D014481:United States; D014484:United States Environmental Protection Agency
chemical_list: D010795:Phthalic Acids; D004051:Diethylhexyl Phthalate
keywords: Children; DEHP; Food scandal; Microalbuminuria; Phthalates; di-(2-ethylhexyl) phthalate