Objective To examine the longitudinal associations of urinary phthalate metabolite exposure with incident overweight/obesity, elevated blood pressure, and their comorbidity among school-aged children. Methods This study used the phthalate repeated-measurement subcohort of the Xiamen Pubertal Development Cohort. In 2018, 823 children had valid data; 816 contributed at least one adjacent follow-up interval, yielding 1 542 intervals. Seven urinary phthalate metabolites were measured, and three molar-sum indices were calculated (∑LMWP, ∑DEHP, and ∑PAEs). All exposure measures were adjusted for expected creatinine, natural-log-transformed, and standardised to the interquartile range (IQR). Generalized estimating equation logistic models assessed associations between exposure at the previous wave and subsequent incident outcomes, adjusting for follow-up interval and demographic, family, and lifestyle factors. Sensitivity analyses additionally adjusted for pubertal development and cardiometabolic status at the previous wave. Results A total of 56 incident overweight/obesity events, 238 elevated blood pressure events and 90 incident comorbidity events occurred. In fully adjusted models, each IQR increase in MEHHP and ∑DEHP was associated with incident comorbidity [OR=1.307 (95% CI: 1.018-1.679), P=0.036; OR=1.340 (95% CI: 1.013-1.772), P=0.040]; both q values were 0.202. No stable associations were observed for incident overweight/obesity or elevated blood pressure alone. No statistically significant interactions were observed between exposure and follow-up interval or sex. In sensitivity analyses,the effect estimates for MEHHP and ∑DEHP remained above 1.0 but were not statistically significant. Conclusion Exposure to DEHP-related phthalate metabolites may be positively associated with incident comorbidity of overweight/obesity and elevated blood pressure, and further confirmation is warranted.
Key words
phthalates /
endocrine-disrupting chemicals /
overweight and obesity /
elevated blood pressure /
comorbidity
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 国务院新闻办公室.《中国居民营养与慢性病状况报告(2020年)》发布会图文实录[EB/OL]. (2020-12-23)[2026-06-17].https://www.scio.gov.cn/xwfb/gwyxwbgsxwfbh/wqfbh_2284/2020n_4408/2020n12y23rsw/twzb_5755/202207/t20220716_230693.html.
[2] 国家卫生健康委员会,教育部,国家市场监督管理总局,等.关于印发儿童青少年肥胖防控实施方案的通知[EB/OL].(2020-10-16)[2026-06-17].https://www.nhc.gov.cn/wjw/c100175/202010/2ad950e3ddf64ad9b5b3a694a4a67539.shtml.
[3] Hong Y, Ullah R, Wang JB, et al. Trends of obesity and overweight among children and adolescents in China[J]. World J Pediatr, 2023, 19(12): 1115-1126.
[4] Jeong SI, Kim SH. Obesity and hypertension in children and adolescents[J]. Clin Hypertens, 2024, 30(1): 23.
[5] Jacobs DR Jr, Woo JG, Sinaiko AR, et al. Childhood cardiovascular risk factors and adult cardiovascular events[J]. N Engl J Med, 2022, 386(20): 1877-1888.
[6] Robinson CH, Hussain J, Jeyakumar N, et al. Long-term cardiovascular outcomes in children and adolescents with hypertension[J]. JAMA Pediatr, 2024, 178(7): 688-698.
[7] Ghassabian A, Vandenberg L, Kannan K, et al. Endocrine-disrupting chemicals and child health[J]. Annu Rev Pharmacol Toxicol, 2022, 62: 573-594.
[8] Landrigan PJ, Raps H, Cropper M, et al. The minderoo-Monaco commission on plastics and human health[J]. Ann Glob Health, 2023, 89(1): 23.
[9] Ma CX, Ma XN, Li HL, et al. Endocrine-disrupting chemicals exposure: Cardiometabolic health risk in humans[J]. Cardiovasc Diabetol, 2025, 24(1): 381.
[10] Perez-Diaz C, Uriz-Martínez M, Ortega-Rico C, et al. Phthalate exposure and risk of metabolic syndrome components: A systematic review[J]. Environ Pollut, 2024, 340(Pt 1): 122714.
[11] Yao Y, Chen DY, Yin JW, et al. Phthalate exposure linked to high blood pressure in Chinese children[J]. Environ Int, 2020, 143: 105958.
[12] Cheng T, Lou C, Jing X, et al. Phthalate exposure and blood pressure in U.S. children aged 8-17 years (NHANES 2013-2018)[J]. Eur J Med Res, 2024, 29(1): 192.
[13] Gao D, Zou Z, Li Y, et al. Association between urinary phthalate metabolites and dyslipidemia in children: Results from a Chinese cohort study[J]. Environ Pollut, 2022, 295: 118632.
[14] Liu J, Song J, Gao D, et al. Exploring the associations between phthalate exposure and cardiometabolic risk factors clustering among children: The potential mediating role of insulin-resistant-related genes DNA methylation[J]. J Hazard Mater, 2024, 461: 132578.
[15] Guo T, Zhang Y, Chen L, et al. The role of lifestyle in the impact of constant phthalate exposure on overweight and obesity: A longitudinal cohort study in China[J]. Pediatr Obes, 2025, 20(7): e70011.
[16] Hashemi M, Amin MM, Chavoshani A, et al. Relationship of urinary phthalate metabolites with cardiometabolic risk factors and oxidative stress markers in children and adolescents[J]. J Environ Public Health, 2021, 2021:5514073.
[17] Heindel JJ, Lustig RH, Howard S, et al. Obesogens: A unifying theory for the global rise in obesity[J]. Int J Obes (Lond), 2024, 48(4): 449-460.
[18] Symeonides C, Aromataris E, Mulders Y, et al. An umbrella review of meta-analyses evaluating associations between human health and exposure to major classes of plastic-associated chemicals[J]. Ann Glob Health, 2024, 90(1): 52.
[19] Kalloo G, Janis JA, Seshasayee SM, et al. Predictors of urinary biomarker concentrations of phthalates and some of their replacements in children in the Project Viva cohort[J]. J Expo Sci Environ Epidemiol, 2023, 33(2): 255-263.
[20] Mariana M, Castelo-Branco M, Soares AM, et al. Phthalates' exposure leads to an increasing concern on cardiovascular health[J]. J Hazard Mater, 2023, 457:131680.
PDF(1344 KB)
