Abstract
Diet is a major source of exposure to certain phthalates, a class of environmental chemicals associated with endocrine disruption in animal models and humans. Several studies have attempted to lower phthalate exposure through carefully designed dietary interventions, with inconsistent results. We conducted a dietary intervention pilot study with the objective to lower phthalate exposure in low-income pregnant women, a particularly vulnerable population. Ten pregnant women consumed a provided diet consisting of mostly fresh, organic foods for 3 days. We collected urine samples before, during, and after the intervention and conducted semi-structured interviews to assess the feasibility and acceptability of the intervention. We used repeated measures ANOVA and paired t-tests to assess differences in urinary phthalate metabolite concentrations across the study, focusing on the metabolites of di-2-ethylhexyl phthalate (DEHP), a phthalate of particular interest, and their molar sum (∑DEHP). Phthalate metabolite concentrations did not change appreciably during the intervention period. We observed no significant difference in ∑DEHP metabolite concentrations across the three time periods (F = 0.21; adjusted p value = 0.65), and no reduction during the intervention as compared to baseline (t = −1.07, adjusted p value = 0.51). Results of interviews indicated that participants were not motivated to make dietary changes to potentially reduce chemical exposures outside of the study. Despite the small sample size, our results suggest that promoting dietary changes to lower phthalate exposure may not be an effective public health measure. Reducing the use of phthalates in food processing and packaging may be a better solution to lowering exposure on a population level.
References
ACOG. (2013).Committee Opinion No. 575: Exposure to toxic environmental agents. Obstetrics and Gynecology, 122(4):931–5. doi:10.1097/01.aog.0000435416.21944.54
Bjornberg, K. A., Vahter, M., Grawe, K. P., et al. (2005). Methyl mercury exposure in Swedish women with high fish consumption. Science of the Total Environment, 341(1–3), 45–52. doi:10.1016/j.scitotenv.2004.09.033.
Nair, A., Jordan, M., Watkins, S., et al. (2014). Fish consumption and hair mercury levels in women of childbearing age, Martin County, Florida. Maternal and Child Health Journal,. doi:10.1007/s10995-014-1475-2.
Svensson, B. G., Schutz, A., Nilsson, A., et al. (1992). Fish as a source of exposure to mercury and selenium. Science of the Total Environment, 126(1–2), 61–74.
Lu, C., Barr, D. B., Pearson, M. A., et al. (2008). Dietary intake and its contribution to longitudinal organophosphorus pesticide exposure in urban/suburban children. Environmental Health Perspectives, 116(4), 537–542. doi:10.1289/ehp.10912.
CDC (2009). Fourth report on human exposure to environmental chemicals. In Services USDoHaH (Ed.). Atlanta, GA: Centers for Disease Control and Prevention; 2009.
Woodruff, T. J., Zota, A. R., & Schwartz, J. M. (2011). Environmental chemicals in pregnant women in the United States: NHANES 2003–2004. Environmental Health Perspectives, 119(6), 878–885. doi:10.1289/ehp.1002727.
Silva, M. J., Barr, D. B., Reidy, J. A., et al. (2004). Urinary levels of seven phthalate metabolites in the U.S. population from the National Health and Nutrition Examination Survey (NHANES) 1999–2000. Environmental Health Perspectives, 112(3), 331–338.
Koch, H. M., & Calafat, A. M. (2009). Human body burdens of chemicals used in plastic manufacture. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 364(1526), 2063–2078. doi:10.1098/rstb.2008.0208.
Swan, S. H., Main, K. M., Liu, F., et al. (2005). Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environmental Health Perspectives, 113(8), 1056–1061.
Suzuki, Y., Yoshinaga, J., Mizumoto, Y., et al. (2012). Foetal exposure to phthalate esters and anogenital distance in male newborns. International Journal of Andrology, 35(3), 236–244. doi:10.1111/j.1365-2605.2011.01190.x.
Gray, L. E., Ostby, J., Furr, J., et al. (2001). Effects of environmental antiandrogens on reproductive development in experimental animals. Human Reproduction Update, 7(3), 248–264.
Kim, Y., Ha, E. H., Kim, E. J., et al. (2011). Prenatal exposure to phthalates and infant development at 6 months: Prospective mothers and children’s environmental health (MOCEH) study. Environmental Health Perspectives, 119(10), 1495–1500. doi:10.1289/ehp.1003178.
Engel, S. M., Miodovnik, A., Canfield, R. L., et al. (2010). Prenatal phthalate exposure is associated with childhood behavior and executive functioning. Environmental Health Perspectives, 118(4), 565–571. doi:10.1289/ehp.0901470.
Ferguson, K. K., McElrath, T. F., & Meeker, J. D. (2014). Environmental phthalate exposure and preterm birth. JAMA Pediatrics, 168(1), 61–67. doi:10.1001/jamapediatrics.2013.3699.
Kobrosly, R. W., Evans, S., Miodovnik, A., et al. (2014). Prenatal phthalate exposures and neurobehavioral development scores in boys and girls at 6–10 years of age. Environmental Health Perspectives, 122(5), 521–528. doi:10.1289/ehp.1307063.
Bornehag, C. G., Carlstedt, F., Jonsson, B. A., et al. (2014). Prenatal phthalate exposures and anogenital distance in Swedish boys. Environmental Health Perspectives,. doi:10.1289/ehp.1408163.
Ferguson, K. K., McElrath, T. F., Ko, Y. A., et al. (2014). Variability in urinary phthalate metabolite levels across pregnancy and sensitive windows of exposure for the risk of preterm birth. Environment International, 70, 118–124. doi:10.1016/j.envint.2014.05.016.
Lien, Y. J., Ku, H. Y., Su, P. H., et al. (2014). Prenatal exposure to phthalate esters and behavioral syndromes in children at eight years of age: Taiwan maternal and infant cohort study. Environmental Health Perspectives,. doi:10.1289/ehp.1307154.
Whyatt, R. M., Perzanowski, M. S., Just, A. C., et al. (2014). Asthma in inner-city children at 5–11 years of age and prenatal exposure to phthalates: The Columbia Center for children’s environmental health cohort. Environmental Health Perspectives, 122(10), 1141–1146. doi:10.1289/ehp.1307670.
Koch, H. M., Lorber, M., Christensen, K. L., et al. (2013). Identifying sources of phthalate exposure with human biomonitoring: results of a 48 h fasting study with urine collection and personal activity patterns. International Journal of Hygiene and Environmental Health, 216(6), 672–681. doi:10.1016/j.ijheh.2012.12.002.
Wormuth, M., Scheringer, M., Vollenweider, M., et al. (2006). What are the sources of exposure to eight frequently used phthalic acid esters in Europeans? Risk Analysis, 26(3), 803–824. doi:10.1111/j.1539-6924.2006.00770.x.
Kessler, W., Numtip, W., Volkel, W., et al. (2012). Kinetics of di(2-ethylhexyl) phthalate (DEHP) and mono(2-ethylhexyl) phthalate in blood and of DEHP metabolites in urine of male volunteers after single ingestion of ring-deuterated DEHP. Toxicology and Applied Pharmacology, 264(2), 284–291. doi:10.1016/j.taap.2012.08.009.
Ji, K., Lim Kho, Y., Park, Y., et al. (2010). Influence of a five-day vegetarian diet on urinary levels of antibiotics and phthalate metabolites: A pilot study with “Temple Stay” participants. Environmental Research, 110(4), 375–382. doi:10.1016/j.envres.2010.02.008.
RCOG. Chemical exposures during pregnancy: Dealing with potential, but unproven, risks to child health: Royal College of Obstetricians and Gynecologists2013 May 2013 Contract No.: 37.
Rudel, R. A., Gray, J. M., Engel, C. L., et al. (2011). Food packaging and bisphenol A and bis(2-ethyhexyl) phthalate exposure: Findings from a dietary intervention. Environmental Health Perspectives, 119(7), 914–920. doi:10.1289/ehp.1003170.
Sathyanarayana, S., Alcedo, G., Saelens, B. E., et al. (2013). Unexpected results in a randomized dietary trial to reduce phthalate and bisphenol A exposures. Journal of Exposure Science & Environmental Epidemiology,. doi:10.1038/jes.2013.9.
FDA. Food safety for pregnant women: Food and Drug Administration; 2011. Available from: http://www.fda.gov/Food/FoodborneIllnessContaminants/PeopleAtRisk/ucm312704.htm
Kaiser, L., & Allen, L. H. (2008). Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. Journal of the American Dietetic Association, 108(3), 553–561.
Lowe, W. L, Jr, & Karban, J. (2014). Genetics, genomics and metabolomics: New insights into maternal metabolism during pregnancy. Diabetic Medicine, 31(3), 254–262. doi:10.1111/dme.12352.
Environmental Protection Agency (EPA). (2012). Results from inert ingredient test orders issued under EPA’s endocrine disruptor screening program: New data compensation claims; Potential disapproval of inert uses pending public comment. Federal Register, pp. 15101–15104.
Silva, M. J., Samandar, E., Preau, J. L., Jr., et al. (2007). Quantification of 22 phthalate metabolites in human urine. Journal of Chromatography B, Analytical Technologies in the Biomedical and Life Sciences, 860(1), 106–112. doi:10.1016/j.jchromb.2007.10.023
Chen, S., Barrett, E. S., Velez, M., et al. (2014). Using the health belief model to illustrate factors that influence risk assessment during pregnancy and implications for prenatal education about endocrine disruptors. Policy futures in education, 12(7), 961–974.
Gale, N., Heath, G., Cameron, E., et al. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, 117–124.
Hornung, R., & Reed, L. (1990). Estimation of average concentration in the presence of nondetectable values. Applied Occupational and Environmental Hygiene, 5(1), 46–51.
Boeniger, M. F., Lowry, L. K., & Rosenberg, J. (1993). Interpretation of urine results used to assess chemical exposure with emphasis on creatinine adjustments: A review. American Industrial Hygiene Association Journal, 54(10), 615–627. doi:10.1080/15298669391355134.
Wolff, M. S., Engel, S. M., Berkowitz, G. S., et al. (2008). Prenatal phenol and phthalate exposures and birth outcomes. Environmental Health Perspectives, 116(8), 1092–1097. doi:10.1289/ehp.11007.
Davis, C. S. (2002). Statistical methods for the analysis of repeated measurements. New York: Springer.
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B, 57, 289–300.
Team RC. (2014). R: A language and environment for statistical computing.
Consumer Product Safety Improvement Act. In Congress HR-t (Ed.). GovTrack.us2007.
Acknowledgments
This study was supported by NIH grants P30 ES001247 and K12 ES019852-01. We thank the URMC CTSI Bionutrition core, particularly Pat Stewart, Nellie Wixom, and Robin Peck. We gratefully acknowledge Antonia Calafat, Xiaoyun Ye, Manori Silva, Ella Samandar, Jim Preau, and Tao Jia for technical assistance in measuring urinary phthalate metabolite concentrations.
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Barrett, E.S., Velez, M., Qiu, X. et al. Reducing Prenatal Phthalate Exposure Through Maternal Dietary Changes: Results from a Pilot Study. Matern Child Health J 19, 1936–1942 (2015). https://doi.org/10.1007/s10995-015-1707-0
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DOI: https://doi.org/10.1007/s10995-015-1707-0