Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Taiwan Biobank, Academia Sinica, Taipei, Taiwan.
Ecotoxicol Environ Saf. 2023 Sep 15;263:115208. doi: 10.1016/j.ecoenv.2023.115208. Epub 2023 Jul 5.
Taiwan had the high incidence of chronic kidney disease (CKD) worldwide. Our objective was to examine associations between daily exposure of phthalates and melamine, two common nephrotoxins, and kidney damage risk in a well-established nationwide cohort. Study subjects were from Taiwan Biobank (TWB) with existing data of questionnaire and biochemical examinations. Average daily intake (ADI) levels of melamine and seven parental phthalates, including DEHP (di-2-ethylhexylphthalate), DiBP (Dibutyl phthalate), DnBP (Di-n-butyl phthalate), BBzP (Butyl benzyl phthalate), DEP (Diethyl phthalate), and DMP (Dimethyl phthalate) were estimated using a creatinine excretion-based model from urine melamine and 10 phthalate metabolites. Urine microalbumin to creatinine ratio (ACR) was used to represent for the outcome of kidney damage. Two statistical strategies were used: First, a weighted quantile sum (WQS) regression model to select the most important exposure variables of ADI levels of phthalates and melamine associated with ACR; Second, to examine effects of those most important exposure variables on ACR in multivariable linear regression models. In total, 1153 eligible adults were left for analyses. Of them, 591 (51.3%) and 562 (48.7%) were men and women, respectively, with a median age of 49 years old. By WQS, a significant and positive association was found between ADI of melamine and phthalates and ACR (β = 0.14, p = 0.002). ADI levels of melamine had the highest weight (0.57), followed by DEHP (0.13). Next, examining the two most important exposures in association with ACR, we found that the higher the melamine and DEHP intakes, the higher the ACR levels were found. An interaction effect was also found between melamine and DEHP intakes on urine ACR (p = 0.015). This result was more prominent in men (p = 0.008) than in women (p = 0.651). Environmental co-exposure of melamine and DEHP can potentially affect ACR in the community-dwelling Taiwanese adult population.
台湾是世界上慢性肾脏病 (CKD) 发病率较高的地区之一。我们的目的是在一个已建立的全国性队列中，研究邻苯二甲酸酯和三聚氰胺这两种常见的肾毒物的每日暴露与肾脏损伤风险之间的关联。研究对象来自台湾生物银行 (TWB)，并具有问卷调查和生化检查的现有数据。通过基于尿液中三聚氰胺和 10 种邻苯二甲酸代谢物的肌酐排泄模型，估计了三聚氰胺和 7 种邻苯二甲酸酯（包括邻苯二甲酸二(2-乙基己基)酯 (DEHP)、邻苯二甲酸二丁酯 (DiBP)、邻苯二甲酸二正丁酯 (DnBP)、邻苯二甲酸丁基苄基酯 (BBzP)、邻苯二甲酸二乙酯 (DEP) 和邻苯二甲酸二甲酯 (DMP)）的平均日摄入量 (ADI) 水平。尿微量白蛋白与肌酐比值 (ACR) 用于表示肾脏损伤的结果。使用了两种统计策略：首先，使用加权分位数总和 (WQS) 回归模型来选择与 ACR 相关的 ADI 水平的最重要的邻苯二甲酸酯和三聚氰胺暴露变量；其次，在多变量线性回归模型中检查这些最重要的暴露变量对 ACR 的影响。共纳入 1153 名符合条件的成年人进行分析。其中，591 名 (51.3%) 为男性，562 名 (48.7%) 为女性，中位年龄为 49 岁。通过 WQS，发现三聚氰胺和邻苯二甲酸酯的 ADI 与 ACR 呈显著正相关 (β=0.14，p=0.002)。三聚氰胺的 ADI 水平权重最高 (0.57)，其次是 DEHP (0.13)。接下来，研究与 ACR 相关的两个最重要的暴露因素，我们发现三聚氰胺和 DEHP 摄入水平越高，ACR 水平越高。还发现三聚氰胺和 DEHP 摄入量之间存在交互作用，对尿液 ACR 有影响 (p=0.015)。这种结果在男性中更为明显 (p=0.008)，而在女性中则不明显 (p=0.651)。环境中三聚氰胺和 DEHP 的共同暴露可能会对台湾成年居民的 ACR 产生潜在影响。
