title: The association between phthalates and metabolic syndrome: the National Health and Nutrition Examination Survey 2001-2010.
abstract: BACKGROUND
  Higher exposure to certain phthalates is associated with a diabetes and insulin resistance, with sex differences seen. Yet, little is known about the association between phthalates and metabolic syndrome (MetS), particularly with consideration for differences by sex and menopausal status.
  
  
  METHODS
  We analyzed data from 2719 participants in the National Health and Nutrition Examination Survey (NHANES) 2001-2010 aged 20-80 years. Five urinary phthalate metabolites (MEP, MnBP, MiBP, MBzP, and MCPP) and DEHP metabolites were analyzed by the Centers for Disease Control and Prevention and were evaluated as population-specific quartiles. MetS was defined by National Cholesterol Education Program's Adult Treatment Panel III report criteria. Prevalence odds ratios (POR) and 95 % confidence intervals (CI) were calculated using multivariable logistic regression, adjusting for potential confounders and stratifying by sex and menopausal status.
  
  
  RESULTS
  Participants with MetS (32 % of the study population) had higher concentrations for all urinary phthalate metabolites. After full adjustment, higher DEHP metabolite concentrations were associated with an increased odds of MetS in men, but not women (adj. POR for men Q4 versus Q1: 2.20; 95 % CI: 1.32, 3.68 and adj. POR for women Q4 versus Q1: 1.50; 95 % CI: 0.89, 2.52). When evaluating by menopausal status, pre-menopausal women with higher concentrations of MBzP had close to a 4-fold increased odds of MetS compared to pre-menopausal women with the lowest concentrations of MBzP (adj POR: Q4 versus Q1: 3.88; 95 % CI: 1.59, 9.49).
  
  
  CONCLUSIONS
  Higher concentrations of certain phthalate metabolites were associated with an increased odds of MetS. Higher DEHP metabolite concentrations were associated with an increased odds of MetS for men. In women, the strongest association was between higher concentrations of MBzP and MetS, but only among pre-menopausal women.
authors.affiliation: Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Bldg. 1, 14th Floor, Boston, MA, 02115, USA. tjtodd@hsph.harvard.edu.|Division of Women's Health, Department of Medicine, Connors Center for Women's Health and Gender Biology, 1620 Tremont St., 3rd Floor, Boston, MA, 02115, USA. tjtodd@hsph.harvard.edu.|Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave., Boston, MA, 02115, USA. tjtodd@hsph.harvard.edu.
authors.forename: Tamarra M
authors.initials: TM
authors.lastname: James-Todd
authors.affiliation: Division of Women's Health, Department of Medicine, Connors Center for Women's Health and Gender Biology, 1620 Tremont St., 3rd Floor, Boston, MA, 02115, USA.|Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Tianyi
authors.initials: T
authors.lastname: Huang
authors.affiliation: Division of Endocrine, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave., 3rd Floor, Boston, MA, 02115, USA.
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Seely
authors.affiliation: Division of Endocrine, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave., 3rd Floor, Boston, MA, 02115, USA.
authors.forename: Aditi R
authors.initials: AR
authors.lastname: Saxena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004785:Environmental Pollutants / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008593:Menopause / Q000652:urine; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000652:urine*; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D010795:Phthalic Acids / Q000652:urine*; D014481:United States; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D010795:Phthalic Acids
keywords: Blood pressure; Cholesterol; Metabolic syndrome; Obesity; Phthalates; Sex