Phthalate exposure increased the risk of early renal impairment in Taiwanese without type 2 diabetes mellitus

Jung-Wei Chang; Kai-Wei Liao; Chien-Yuan Huang; Han-Bin Huang; Wan-Ting Chang; Jouni J K Jaakkola; Chih-Cheng Hsu; Pau-Chun Chen; Po-Chin Huang

doi:10.1016/j.ijheh.2019.10.009

Phthalate exposure increased the risk of early renal impairment in Taiwanese without type 2 diabetes mellitus

Int J Hyg Environ Health. 2020 Mar:224:113414. doi: 10.1016/j.ijheh.2019.10.009. Epub 2019 Nov 26.

Authors

Jung-Wei Chang¹, Kai-Wei Liao², Chien-Yuan Huang³, Han-Bin Huang⁴, Wan-Ting Chang⁵, Jouni J K Jaakkola⁶, Chih-Cheng Hsu⁷, Pau-Chun Chen⁸, Po-Chin Huang⁹

Affiliations

¹ Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
² National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; School of Food Safety, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
³ Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
⁴ School of Public Health, National Defense Medical Center, Taipei, Taiwan.
⁵ National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
⁶ Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
⁷ Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
⁸ Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Office of Occupational Safety and Health, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
⁹ National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Safety, Health and Environmental Engineering, National United University, Miaoli, Taiwan. Electronic address: pchuang@nhri.edu.tw.

PMID: 31784327
DOI: 10.1016/j.ijheh.2019.10.009

Abstract

Studies have suggested that phthalates may be a risk factor for microalbuminuria, whereas little is known regarding their nephrotoxic effects on adults. We enrolled 311 participants (≥18 y, N = 241; <18 y, N = 70) who provided questionnaire information as well as blood and urine samples from a nationally cross-sectional study. Urinary phthalate metabolites were analyzed through liquid chromatography-tandem mass spectrometry. From the renal function index, we measured the serum level of blood urea nitrogen (BUN), and the urinary levels of microalbumin, albumin, protein and creatinine. We used multiple logistic regressions and a cumulative risk assessment of renal effect to evaluate the relationship between phthalate exposure and renal function in our participants. We aimed to assess the relationship between phthalate exposure and renal function including serum level of BUN, and urinary levels of microalbumin, albumin, protein, and creatinine in 311 participants (≥18 y, N = 241; <18 y, N = 70) from a population-based study. The multiple logistic regression showed that the adjusted odds ratio of the highest tertile of estimated di-2-ethylhexyl phthalate (DEHP) daily intake in participants ≥18 y for early renal impairment (microalbumin >1.9 mg/dL) was 9.40 times higher (95% confidence interval = 1.67-52.84) than the lowest tertile. The cumulative hazard index of phthalate-induced nephrotoxicity (HI_nephro) was significantly positively associated with microalbumin (β: 0.98, P < 0.001), BUN (β: 0.19, P = 0.002), and urine protein (β: 0.75, P = 0.001) in participants ≥18 y without type 2 diabetes mellitus after adjusting for confounding factors, but not in those <18 y. Our findings suggest that daily exposure to DEHP and its metabolites were significantly positively associated with an increased risk of higher microalbumin in Taiwanese ≥18 y. Comprehensive or mechanistic studies are required to elucidate these associations.

Keywords: Cumulative risk assessment; Early renal impairment; Microalbumin; Phthalate metabolites.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Albuminuria
Creatinine
Cross-Sectional Studies
Diabetes Mellitus, Type 2 / epidemiology*
Diethylhexyl Phthalate
Environmental Exposure / statistics & numerical data*
Environmental Pollutants / metabolism*
Environmental Pollutants / toxicity
Female
Humans
Kidney
Logistic Models
Male
Odds Ratio
Phthalic Acids / metabolism*
Phthalic Acids / toxicity
Risk Assessment
Risk Factors
Taiwan / epidemiology

Substances

Environmental Pollutants
Phthalic Acids
phthalic acid
Creatinine
Diethylhexyl Phthalate