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Table 2 Summary of 38 studies that met the criteria for data extraction and estimated intake associated with statistically significant endpoints, grouped by population sampled

From: Role of epidemiology in risk assessment: a case study of five ortho-phthalates

Population sampled

Significant endpoint

Significant outcome

Parent phthalate

Estimated phthalate intake a

Lower concentration statistically significant

Reference

Women

Number of ovarian antral follicles

Decreased

DEHP

0.03–0.25b

1.63 μg/L-13.5 μg/L

[39]

Decreased

DIBP

0.13–0.19c

10.21 μg/L

Decreased

DBP

0.24–0.42

12.79 μg/L

Glucose levels

Decreased

DIBP

0.20

10.7 μg/L

[38]

Thyroid hormone T4

Decreased

DBP

0.20

9.6 μg/g CRE

[55]

Free thyroid hormone T4

Decreased

DEHP

0.53–1.80

1.69 μg/L-13.4 μg/L

[56]

Thyroid hormone T4 and free T4

Decreased

DBP

2.86

9.6 μg/g CRE

[49]

Total number of oocytes, fertilized oocytes, mature oocytes, top quality embryos

Decreased

DEHP

0.23–1.39

0.02 uM-0.12 uM

[57]

Total number of fertilized oocytes, mature oocytes, top quality embryos

Decreased

DBP

0.24

12.7 uM

Trophoblast differentiation genes

Decreased

DiBP

0.27

14.2 μg/L

[58]

Decreased

DBP

0.71

38 μg/L

Decreased

DEHP

4.21

221.2 μg/L

Body mass index and waist circumference

Increased

DBP

0.30

12.26 μg/g

[59]

Body mass index

Increased

DEHP

0.56

1.49 μg/g CRE

Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)

Increased

DEHP

1.56

12.51 μg/L

[60]

Serum inhibin

Decreased

DEHP

2.04

5.44 μg/g CRE

[61]

Gestational age

Shorter

DEHP

2.46

18.36 μg/L

[62]

Longer

DEHP

2.56–4.20

1.1 μg/L-5.1 μg/L

[63]

C-section

Increased likelihood

DEHP

2.56–4.20

1.1 μg/L-5.1 μg/L

[63]

Mothers (3 T)

Serum steroid hormone binding globulin

Increased

BBP

0.06

3.16 μg/L

[50]

Increased

DBP

0.63

33.4 μg/L

Serum dehydroepiandrosterone sulfate

Decreased

DBP

0.63

33.4 μg/L

Social problems

Increased

BBP

0.07–0.23

3.2 μg/g

[64]

Delinquent and externalizing behavior

Increased

DEHP

2.36

0.17 µmol/g CRE (sum DEHP)

Internalizing and externalizing problems

Increased

DEHP

6.27

16.7 μg/g CRE

Motor development

Delayed

DIBP

0.17

9.3 μg/L

[65]

Psychomotor development index

Decreased

DIBP

0.17

9.3 μg/L

Clinically withdrawn behavior and internalizing behavior

Increased

BBP

0.36

19 μg/L

Psychomotor and mental development index

Decreased

DBP

0.71

38 μg/L

Clinically withdrawn behavior

Increased

DBP

0.71

38 μg/L

Full scale IQ, perceptual reasoning, processing speed, verbal comprehension and working memory

Decreased

DIBP

0.36

19 μg/L

[36]

Decreased

DBP

1.5

79.8 μg/L

Perceptual reasoning

Decreased

BBP

0.56

30 μg/L

Mental and psychomotor development indices

Decreased in boys

DBP

0.38

16.9 μg/g CRE

[66]

Psychomotor development index

Decreased in boys

DEHP

2.7

13.2 μg/g CRE

Body mass index z-score

Decreased in girls

DEHP

1.77

0.128µM

[67]

Mothers (2 T)

Masculine play behavior

Decrease

DIBP

0.08

4 μg/L

[52]

Decrease

DEHP

0.38–0.88

1.4–4.7 μg/L

Internalizing behavior

Increased

BBP

0.26

12.8 μg/L

[68]

Increased

DBP

0.68

33.1 μg/L

Emotional symptom score and relationship problems

Increased

DBP

0.68

33.1 μg/L

Eczema

Increased

DIBP

0.51

25 μg/L

[53]

Attention deficit hyperactivity disorder

Increased

DEHP

2.66

0.21 µM

[69]

Mothers (1 T)

Anogenital distance

Shorter

DEHP

0.66–0.80

2–6.1 μg/L

[70]

Children (4–9 yo)

Thyroid hormone T3 and free T3

Decreased in girls

BBP

0.10

3.3 μg/L

[71]

Decreased in girls

DBP

1.97

63 μg/L

Decreased in boys

DBP

2.34

75 μg/L

Children (12 yo)

Height standard deviation

Decreased in obese pubertal children

DEHP

0.18

0.6 μg/g CRE

[72]

Insulin sensitive index

Increased in obese pre-pubertal children

DEHP

0.19

0.27 μg/g CRE

Waist circumference

Decreased in obese pre-pubertal children

DEHP

0.19–0.35

0.27–1.24 μg/g CRE

Puberty

Delayed in obese pre-pubertal children

DEHP

0.19–0.35

0.27–1.24 μg/g CRE

Waist to hip ratio

Increased in obese pre-pubertal children

DEHP

0.23

0.76 μg/g CRE

Children (8–14 yo)

Estrogen, testosterone and free testosterone

Decreased

DIBP

0.18

7.02 μg/L

[50]

Free testosterone

Decreased

DEHP

1.52

3.48 μg/L

Serum steroid hormone binding globulin

Increased

DEHP

1.52–5.09

3.48–29 μg/L

Children (8 yo)

Puberty

Delayed in girls

BBP

0.19

6.2 μg/L

[73]

Delayed in girls

DBP

1.56

50 μg/L

Delayed in girls

DEHP

4.63

74 μg/L

Children (8–10 yo)

Obesity

Increased in boys

DBP

0.95

30.4 μg/L

[74]

Decreased in girls

DEHP

1.72–4.31

3.3–32 μg/L

Children (6–19 yo)

Albumin/creatinine ratio

Increased

DEHP

1.60

0.1 µM

[75]

Systolic blood pressure

Increased

DEHP

3.20

0.166 µM

[76]

Children (12–19 yo)

Thyroid hormone T3

Increased

DEHP

2.2–2.89

5.76–10.3 μg/g CRE

[77]

Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)

Increased

DEHP

2.76

0.17 µM

[78]

Men

Sperm motility and concentration

Decreased

DBP

0.19

10.6 μg/L

[48]

Decreased

DBP

0.38

 

[79]

Sperm motility

Decreased

BBP

0.25

13.4 μg/L

[79]

Semen quality

Decreased

DEHP

242.55

20.16 μg/L

[47]

Testosterone, free testosterone, free androgen index

Decreased

DEHP

0.40–2.13

1.3–15.9 μg/L

[80]

Serum steroid hormone binding globulin

Increased

DEHP

0.41

1.3 μg/L

Testosterone, estrogen, free androgen index

Decreased

DEHP

0.99

3.18 μg/L

[81]

Testosterone/estrogen ratio

Increased

DEHP

0.99

3.18 μg/L

Thyroid hormone T3 and free thyroid hormone T4

Decreased

DEHP

0.99

3.18 μg/L

[82]

Thyroid stimulating hormone

Decreased

DEHP

242.55

21 µM

[47]

Men and women

Body mass index and waist circumference

Increased

BBP

0.58

30.9 μg/L

[51]

Decreased

DEHP

13.75

44 μg/L

Body mass index

Increased

DBP

0.72

38.4 μg/L

Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)

Increased

DEHP

3.16

18.51 μg/L

Thyroid hormone T4

Decreased

DEHP

1.48–1.97

5.43–9.84 μg/g CRE

[77]

Thyroid stimulating hormone

Increased

DEHP

1.97

9.84 μg/g CRE

  1. a In microgram per kilogram of body weight per day. See Supplemental Materials
  2. b For DEHP, a range is given when more than one metabolite was statistically significant for an endpoint
  3. c A range is given when statistical significance was observed at one or more tertile/quartiles
  4. d Q quartile
  5. Abbreviations: CRE creatinine; DEHP diethylhexyl phthalate; DBP dibutyl phthalate; BBP butylbenzyl phthalate; DIBP diisobutyl phthalate; IQ intelligence quotient; 1 T, 2 T, 3 T first, second and third trimester; yo year-old