Department of Epidemiology, Emory University School of Public Health , Atlanta, GA , USA .
Crit Rev Toxicol. 2014 Feb;44(2):151-75. doi: 10.3109/10408444.2013.860076. Epub 2014 Jan 14.
Phthalates, a class of commonly used compounds with widespread human exposure, have been described as obesogens, or chemicals that disrupt lipid metabolism and produce metabolic changes leading to increased risk of type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). This communication provides a systematic review of the available epidemiologic evidence on associations between phthalate ester metabolites in urine or blood and various health endpoints related to overweight/obesity, DM or CVD.
We followed the current methodological guidelines for systematic reviews to identify, retrieve and summarize the relevant epidemiological literature on the relation between phthalates and overweight/obesity, DM, CVD or related biomarkers. Each eligible paper was summarized with respect to methods and results with particular attention to study design and exposure assessment. As quantitative meta-analysis was not feasible, the study results were assessed qualitatively for inter- and intra-study consistency.
We identified 26 publications of epidemiologic studies that assessed associations between either urinary or serum phthalate metabolites and outcomes of interest. These studies represented 18 independent data sources. We found no inter- or intra-study consistency for any phthalate metabolite for any of the indicators of overweight/obesity, DM or CVD in children or adults. Most reported associations were not statistically significantly different from the null, some were positive, and others were inverse. All studies except two used cross-sectional analyses and for this reason could not be used to test causal hypotheses.
The current epidemiological data do not support or refute the hypothesis that phthalates act as obesogens in humans.
邻苯二甲酸酯是一类广泛存在于人类环境中的常用化合物，被描述为致肥胖物，即会破坏脂质代谢并产生代谢变化，从而增加 2 型糖尿病（DM）和心血管疾病（CVD）风险的化学物质。本通讯对尿液或血液中邻苯二甲酸酯代谢物与超重/肥胖、DM 或 CVD 相关的各种健康终点之间的关联进行了系统评价，提供了流行病学证据。
我们遵循当前系统评价的方法学指南，以确定、检索和总结有关邻苯二甲酸酯与超重/肥胖、DM、CVD 或相关生物标志物之间关系的相关流行病学文献。对每篇合格的论文，我们从方法和结果两个方面进行了总结，特别关注研究设计和暴露评估。由于无法进行定量荟萃分析，因此我们对研究结果进行了定性评估，以确定其在不同研究之间和研究内部的一致性。
我们确定了 26 篇评估尿液或血清邻苯二甲酸酯代谢物与感兴趣结局之间关联的流行病学研究。这些研究代表了 18 个独立的数据来源。我们没有发现任何邻苯二甲酸酯代谢物与儿童或成人超重/肥胖、DM 或 CVD 的任何指标之间存在研究内或研究间的一致性。大多数报告的关联与零值没有统计学上的显著差异，有些是阳性的，有些则是相反的。除了两项研究之外，所有研究都使用了横断面分析，因此不能用于检验因果假说。
目前的流行病学数据既不支持也不反驳邻苯二甲酸酯在人类中作为致肥胖物的假说。
