title: Exposure Estimation for Risk Assessment of the Phthalate Incident in Taiwan.
abstract: BACKGROUND
  In May 2011, di(2-ethylhexyl) phthalates (DEHP) and, to a lesser extent, di-iso-nonyl phthalate (DiNP) were found to have been illegally used for many years in Taiwan as clouding agents in foods including sports drinks, juice beverages, tea drinks, fruit jam/nectar/jelly, and health or nutrient supplements.
  
  
  OBJECTIVE
  To estimate the DEHP exposure for the study participants for the follow-up epidemiological study and health risk assessment.
  
  
  METHODS
  A total of 347 individuals possibly highly exposed to phthalate-tainted foods participated in the study. Exposure assessment was performed based on the participants' responses to a structured questionnaire, self-report of exposure history, urinary metabolite concentrations, and DEHP concentration information in 2449 food records. A Bayesian statistical approach using Markov chain Monte Carlo simulation was employed to deal with the uncertainties in the DEHP concentrations of the contaminated foods and the participants' likelihood of being exposed.
  
  
  RESULTS
  An estimated 37% and 15% of children younger than 12 years old were exposed to DEHP at medium (20-50 μg / kg_bw / day) and high AvDIs (50-100 μg / kg_bw / day), respectively, prior to the episode (9% and 3% in adults, respectively). Moreover, 11% of children and 1% of adults were highly exposed (> 100 μg / kg_bw / day), with a maximum of 414.1 μg / kg_bw / day and 126.4 μg / kg_bw / day, respectively.
  
  
  CONCLUSIONS
  The phthalate exposure-associated adverse health effects for these participants warrant further investigation. The estimation procedure may be applied to other exposure assessment with various sources of uncertainties.
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: National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Wang
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: Yin-Han
authors.initials: YH
authors.lastname: Wang
authors.affiliation: National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Po-Chin
authors.initials: PC
authors.lastname: Huang
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: National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Sun
authors.affiliation: Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Health, Kaohsiung City Government, Kaohsiung, Taiwan.
authors.forename: Chi-Kung
authors.initials: CK
authors.lastname: Ho
authors.affiliation: Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Yang-Chih
authors.initials: YC
authors.lastname: Shih
authors.affiliation: Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Ming-Neng
authors.initials: MN
authors.lastname: Shiu
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: 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 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: Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Chao A
authors.initials: CA
authors.lastname: Hsiung
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D001628:Beverages / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects; D004784:Environmental Monitoring; D004785:Environmental Pollutants / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010795:Phthalic Acids / Q000032:analysis*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D010795:Phthalic Acids; C032279:phthalic acid