title: Effects of high di(2-ethylhexyl) phthalate (DEHP) exposure due to tainted food intake on pre-pubertal growth characteristics in a Taiwanese population.
abstract: On May 23, 2011, a major scandal involving the illegal use of phthalates as clouding agents in food products was reported. Specifically, di(2-ethylhexyl) phthalate (DEHP) was purposefully added to foods as a substitute emulsifier. The purpose of this study was to examine the effects of DEHP exposure on the growth characteristics of the child victims of this scandal. Eighty-eight victims, originating from northern, central, and southern Taiwan and ranging in age from 6.0 to 10.5 years, were invited to participate in this study during clinic visits. The participants underwent follow-up health examinations from August 2012 to February 2013. We collected information on each participant's history of exposure to tainted food products using a questionnaire, and we analyzed their urinary concentrations of DEHP metabolites using high-performance liquid chromatography/tandem mass spectrometry. These data were then used to estimate their daily DEHP intake (DIAll) during the scandal. We also measured physical development parameters (height, weight, and bone age) and hormone levels (thyroid, sex and growth hormones) to evaluate their overall growth characteristics. The average (SD) duration of DEHP intake from tainted nutrition supplements was 1.39 (1.01) years. The median DIAll values were 19.93 and 20.69μg/kg bw/day for boys and girls, respectively. Among the enrolled children, the DIAll values of 46.9% of boys and 51.3% of girls exceeded the reference dose (RfD) of 20μg/kg bw/day established by the US Environmental Protection Agency. Our results demonstrate that DIAll is negatively associated with the height percentile, weight percentile, bone age/chronological age, and insulin-like growth factor 1 (IGF-1) levels but not with IGF binding protein 3 (IGF-BP3) level, IGF-1/IGF-BP3, sex hormones, or thyroid hormone levels. The DEHP DIAll value exceeded the RfD at high rates among children of both genders. Our results suggest that high levels of DEHP exposure due to the consumption of tainted food products are negatively associated with body weight, height, bone age, and IGF-1 levels in children. The likelihood of delayed puberty among the affected children is therefore a reasonable concern, and further follow-up is required.
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: Department of Endocrinology & Metabolism, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Ching-Ling
authors.initials: CL
authors.lastname: Lin
authors.affiliation: School of Medicine, Fu Jen Catholic University, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Jia-Woei
authors.initials: JW
authors.lastname: Hou
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: 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: 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; 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. Electronic address: hsiung@nhri.org.tw.
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: D000886:Anthropometry; D001827:Body Height / Q000187:drug effects*; D001835:Body Weight / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects*; D002648:Child; D004051:Diethylhexyl Phthalate / Q000633:toxicity*; D004781:Environmental Exposure; D004785:Environmental Pollutants / Q000633:toxicity*; D005260:Female; D005506:Food Contamination; D006801:Humans; D008297:Male; D013624:Taiwan
chemical_list: D004785:Environmental Pollutants; D004051:Diethylhexyl Phthalate
keywords: Clouding agents; Daily intake; Di(2-ethylhexyl) phthalate; Growth