Eun-Kyung Won1, Yeni Kim2, Mina Ha3, Eunae Burm4, Young-Suk Kim5, Hyungryul Lim6, Da-Eun Jung1, Sinye Lim7, Soo-Young Kim8, Yu-Mi Kim9, Hwan-Cheol Kim10, Kee Jae Lee11, Hae-Kwan Cheong12, Hee-Tae Kang13, Mia Son14, Joon Sakong15, Gyung-Jae Oh16, Chul-Gab Lee17, Su Young Kim18, Jung Min Ryu19, Sue Jin Kim19. 1. Department of Child Psychiatry, National Center for Child and Adolescent Psychiatry, Seoul National Hospital, Seoul, Republic of Korea. 2. Department of Child Psychiatry, National Center for Child and Adolescent Psychiatry, Seoul National Hospital, Seoul, Republic of Korea. Electronic address: yeni1004@gmail.com. 3. Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea. Electronic address: minaha@dku.edu. 4. Department of Nursing, Munkyung College, Munkyung, Republic of Korea. 5. Department of Dental Hygiene, Yeongdong University, Yeongdong, Republic of Korea. 6. Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea. 7. Department of Occupational and Environmental Medicine, College of Medicine, Kyunghee University, Seoul, Republic of Korea. 8. Department of Preventive Medicine, School of Medicine, Eulji University, Daejeon, Republic of Korea. 9. Department of Preventive Medicine, School of Medicine, Dong-A University, Busan, Republic of Korea. 10. Department of Occupational and Environmental Medicine, School of Medicine, Inha University, Incheon, Republic of Korea. 11. Department of Information Statistics, College of Natural Science, Korean National Open University, Seoul, Republic of Korea. 12. Department of Social and Preventive Medicine, School of Medicine, Sungkyunkwan University, Suwon, Republic of Korea. 13. Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea. 14. Department of Preventive Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea. 15. Department of Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Daegu, Republic of Korea. 16. Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea. 17. Department of Occupational and Environmental Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea. 18. Department of Preventive Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea. 19. Department of Environmental Epidemiology, Division of Environmental Health, National Institute of Environment, Incheon, Republic of Korea.
Abstract
BACKGROUND: Previous studies have indicated that phthalate exposure may influence the development of children, but the current data are limited, and controversy remains regarding the sex-specific and age-specific effects of phthalate exposure. METHODS: We investigated the sex- and age-specific associations of current phthalate exposure with neurobehavioral development scores in a nationally representative sample of 6-18-year-olds participating in the Korean Environmental Health Survey in Children and Adolescents (KorEHS-C). Neurobehavioral development was assessed using the Korean Child Behavior Checklist (CBCL, N=1723) and the Korean Attention Deficit Hyperactivity Disorder Rating Scale (ARS, N=867). We measured the concentrations of phthalate metabolites in urine samples using high-performance liquid chromatography tandem mass spectrometry. The associations between urine phthalate metabolite concentrations and neurobehavioral development were examined by survey regression analysis for complex sampling and penalized regression splines using a generalized additive model. RESULTS: Survey regression analysis revealed that a higher mono-n-butyl phthalate (MnBP) level was associated with social (β=0.60; 95% confidence interval=0.15-1.05), thought (0.55; 0.08-1.03), and attention (0.68; 0.21-1.14) problems on the CBCL. A significant association was found between the MnBP level and the ARS hyperactivity subscale score (0.42; 0.05-0.58). Higher levels of MnBP (0.87; 0.20-1.54), mono-2-ethyl-5-oxohexyl phthalate (MEOHP, 0.61; 0.11-1.11) and mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP, 0.51; 0.04-0.97) were associated with an increase in thought problems among the girls. Among the younger children aged 6-11 years, significant positive associations between the MnBP (0.71; 0.09-1.33), MECPP (0.74, 0.14-1.34), MEOHP (0.65; 0.10-1.20), and MEHHP (0.71; 0.21-1.21) levels and social problems and between the MnBP (1.11; 0.37-1.84), MEOHP (0.64; 0.13-1.15), and MEHHP (0.66; 0.18-1.14) levels and attention problems were observed. The penalized regression splines for the age-specific relationships between the urinary MnBP, MEOHP, and MEHHP levels and social and attention problems exhibited positive supralinear relationships with downward curvature in the 6-11 year age group. In contrast, the score for social problems exhibited nearly linear relationships with these levels in the 12-18 year age group. CONCLUSIONS: In this national sample, increased phthalate exposure exhibited supralinear associations with social, thought and attention problems in children aged 6-11 years, who showed greater vulnerability to phthalate exposure. The results highlight the need for the environmental regulation of phthalate exposure in younger children, even at low dosages.
BACKGROUND: Previous studies have indicated that phthalate exposure may influence the development of children, but the current data are limited, and controversy remains regarding the sex-specific and age-specific effects of phthalate exposure. METHODS: We investigated the sex- and age-specific associations of current phthalate exposure with neurobehavioral development scores in a nationally representative sample of 6-18-year-olds participating in the Korean Environmental Health Survey in Children and Adolescents (KorEHS-C). Neurobehavioral development was assessed using the Korean Child Behavior Checklist (CBCL, N=1723) and the Korean Attention Deficit Hyperactivity Disorder Rating Scale (ARS, N=867). We measured the concentrations of phthalate metabolites in urine samples using high-performance liquid chromatography tandem mass spectrometry. The associations between urine phthalate metabolite concentrations and neurobehavioral development were examined by survey regression analysis for complex sampling and penalized regression splines using a generalized additive model. RESULTS: Survey regression analysis revealed that a higher mono-n-butyl phthalate (MnBP) level was associated with social (β=0.60; 95% confidence interval=0.15-1.05), thought (0.55; 0.08-1.03), and attention (0.68; 0.21-1.14) problems on the CBCL. A significant association was found between the MnBP level and the ARS hyperactivity subscale score (0.42; 0.05-0.58). Higher levels of MnBP (0.87; 0.20-1.54), mono-2-ethyl-5-oxohexyl phthalate (MEOHP, 0.61; 0.11-1.11) and mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP, 0.51; 0.04-0.97) were associated with an increase in thought problems among the girls. Among the younger children aged 6-11 years, significant positive associations between the MnBP (0.71; 0.09-1.33), MECPP (0.74, 0.14-1.34), MEOHP (0.65; 0.10-1.20), and MEHHP (0.71; 0.21-1.21) levels and social problems and between the MnBP (1.11; 0.37-1.84), MEOHP (0.64; 0.13-1.15), and MEHHP (0.66; 0.18-1.14) levels and attention problems were observed. The penalized regression splines for the age-specific relationships between the urinary MnBP, MEOHP, and MEHHP levels and social and attention problems exhibited positive supralinear relationships with downward curvature in the 6-11 year age group. In contrast, the score for social problems exhibited nearly linear relationships with these levels in the 12-18 year age group. CONCLUSIONS: In this national sample, increased phthalate exposure exhibited supralinear associations with social, thought and attention problems in children aged 6-11 years, who showed greater vulnerability to phthalate exposure. The results highlight the need for the environmental regulation of phthalate exposure in younger children, even at low dosages.
Authors: J William Gaynor; Richard F Ittenbach; Antonia M Calafat; Nancy B Burnham; Asa Bradman; David C Bellinger; Frederick M Henretig; Erin E Wehrung; J Laurenson Ward; William W Russell; Thomas L Spray Journal: Ann Thorac Surg Date: 2018-07-30 Impact factor: 5.102
Authors: Rose O Sulentic; Irina Dumitrascu; Nicole C Deziel; Anca E Gurzau Journal: Int J Environ Res Public Health Date: 2018-09-25 Impact factor: 3.390