European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall, TR1 3HD, UK.
School of Public Health and Community Medicine, University of New South Wales, Kensington, Sydney, 2052, Australia.
Environ Sci Pollut Res Int. 2019 Sep;26(27):28256-28269. doi: 10.1007/s11356-019-06003-2. Epub 2019 Jul 31.
Environmental exposure to phthalates may contribute to an increased risk of asthma in children and adults. We aimed to assess the direction and strength of the association between urinary phthalates metabolites and current asthma in children and adults that participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Data on ten urinary phthalate metabolites, self-reported questionnaires, spirometry measures, and covariates were obtained from 7765 participants (28.1% were children aged 6-17 years) taking part in the NHANES 2007-2012. Asthma was assessed using self-reported questionnaires for children and adults, and via spirometry measures for adults alone. We used crude and adjusted logistic regression models to estimate the odds ratios (ORs) and 95% confidence interval (CI) per one log unit change in the concentration of phthalate metabolites. We further modeled the effect modification by sex. Out of 10 metabolites, only mono-benzyl phthalate (MBzP) was positively associated with the prevalence of self-reported asthma in children, after adjusting for a range of potential confounders (odds ratio 1.54; 95% confidence interval 1.05-2.27). No significant relationship was observed for adults. The association of mono-ethyl phthalate (MEP) was modified by sex, with significantly increased odds of asthma among males [boys (2.00; 1.14-3.51); adult males (1.32; 1.04-1.69)]. While no other phthalates showed a positive relationship with current asthma in males, mono-(carboxynonyl) phthalate (MCNP) and mono-(3-carboxylpropyl) phthalate (MCPP) were inversely associated with spirometrically defined asthma in adult females. A sex-specific relationship in adults was evident when spirometry, but not self-reported measures were used to define asthma. We found no clear association between exposure to phthalates and current asthma, except for a significant relationship between MBzP metabolites and self-reported asthma in children. As a result, exposure to phthalates and asthma development and/or exacerbations remains controversial, suggesting a need for a well-designed longitudinal study.
环境暴露于邻苯二甲酸酯可能会增加儿童和成人患哮喘的风险。我们旨在评估儿童和成人尿液中邻苯二甲酸酯代谢物与当前哮喘之间的关联方向和强度，这些参与者参加了 2007-2012 年的国家健康和营养检查调查（NHANES）。从参与 2007-2012 年 NHANES 的 7765 名参与者（28.1%为 6-17 岁的儿童）中获得了关于十种尿液邻苯二甲酸酯代谢物、自我报告问卷、肺活量计测量值和协变量的数据。哮喘通过儿童和成人的自我报告问卷以及仅对成人进行的肺活量计测量来评估。我们使用未经调整和调整后的逻辑回归模型来估计邻苯二甲酸酯代谢物浓度每增加一个对数单位的比值比（OR）和 95%置信区间（CI）。我们进一步通过性别建模了效应修饰。在 10 种代谢物中，只有单苄基邻苯二甲酸酯（MBzP）在调整了一系列潜在混杂因素后，与儿童自我报告哮喘的患病率呈正相关（比值比 1.54；95%置信区间 1.05-2.27）。在成人中未观察到显著关系。单乙基邻苯二甲酸酯（MEP）的关联受到性别的修饰，男性患哮喘的几率显著增加[男孩（2.00；1.14-3.51）；成年男性（1.32；1.04-1.69）]。虽然其他邻苯二甲酸酯与男性当前哮喘没有正相关关系，但单-（羧基壬基）邻苯二甲酸酯（MCNP）和单-（3-羧基丙基）邻苯二甲酸酯（MCPP）与成年女性肺活量计定义的哮喘呈负相关。当使用肺活量计但不使用自我报告测量来定义哮喘时，成年人中存在明显的性别特异性关系。除了 MBzP 代谢物与儿童自我报告哮喘之间存在显著关系外，我们没有发现接触邻苯二甲酸酯与当前哮喘之间的明确关联。因此，邻苯二甲酸酯的暴露与哮喘的发展和/或恶化仍然存在争议，这表明需要进行一项精心设计的纵向研究。
