Cited by 755Effects and risks of endocrine disrupting chemicalsToxic Organic Pollutants ImpactPesticide Exposure and Toxicity

The DOI matches its Crossref record; 207 of the 212 references it cites were found in a registry or an index; 45 of the 86 sources its claims cite were checked for support.

A Review of Biomonitoring of Phthalate Exposures

Open access

Abstract

Phthalates (diesters of phthalic acid) are widely used as plasticizers and additives in many consumer products. Laboratory animal studies have reported the endocrine-disrupting and reproductive effects of phthalates, and human exposure to this class of chemicals is a concern. Several phthalates have been recognized as substances of high concern. Human exposure to phthalates occurs mainly via dietary sources, dermal absorption, and air inhalation. Phthalates are excreted as conjugated monoesters in urine, and some phthalates, such as di-2-ethylhexyl phthalate (DEHP), undergo secondary metabolism, including oxidative transformation, prior to urinary excretion. The occurrence of phthalates and their metabolites in urine, serum, breast milk, and semen has been widely reported. Urine has been the preferred matrix in human biomonitoring studies, and concentrations on the order of several tens to hundreds of nanograms per milliliter have been reported for several phthalate metabolites. Metabolites of diethyl phthalate (DEP), dibutyl- (DBP) and diisobutyl- (DiBP) phthalates, and DEHP were the most abundant compounds measured in urine. Temporal trends in phthalate exposures varied among countries. In the United States (US), DEHP exposure has declined since 2005, whereas DiNP exposure has increased. In China, DEHP exposure has increased since 2000. For many phthalates, exposures in children are higher than those in adults. Human epidemiological studies have shown a significant association between phthalate exposures and adverse reproductive outcomes in women and men, type II diabetes and insulin resistance, overweight/obesity, allergy, and asthma. This review compiles biomonitoring studies of phthalates and exposure doses to assess health risks from phthalate exposures in populations across the globe.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review compiles global human biomonitoring and selected epidemiological studies of phthalate exposures, focusing on urinary metabolites and other biological matrices. It reports ubiquitous exposure, higher levels in children, country-specific temporal trends, and associations with reproductive, metabolic, and allergic outcomes, while noting major data gaps.

Key findings

  • Phthalates are widely used plasticizers/additives; annual global production was 4.7 million metric tons in 2006 and ~8 million metric tons in 2015. DEHP, DiNP, and BzBP are common additives that migrate from products.
  • Urine is the preferred biomonitoring matrix; metabolites of DEP, DBP/DiBP, and DEHP are most abundant. Sum of 22 phthalate metabolites in urine was on the order of several to hundreds of µg/L. Kuwait samples from 2006–2007 had the highest median total phthalate metabolite concentration at 1,050 µg/L (maximum 19,300 µg/L), with MEP 411 µg/L, MBP 113 µg/L, and DEHP metabolites 180 µg/L.
  • Temporal trends varied by country: US DEHP exposure declined since 2005 while DiNP exposure increased; a 67% decline in US DEHP exposure was reported between 2005/6 and 2011/12. In China, DEHP exposure increased since 2000/2001. Children often had higher exposures than adults; in DEMOCOPHES, children vs mothers had geometric means of MBP 34.8 vs 23.9 µg/L, MiBP 45.4 vs 30.1 µg/L, and ΣDEHP 47.6 vs 29.2 µg/L, though MEP was higher in mothers (48.2 vs 34.4 µg/L).
  • Epidemiological studies reported associations between phthalate exposures and adverse reproductive outcomes, type II diabetes and insulin resistance, overweight/obesity, allergy, and asthma. For example, higher urinary MBP, MiBP, MBzP, MCPP, and DEHP metabolites were associated with increased diabetes diagnosis in US women, and DEHP metabolites were associated with obesity in adult females and older males.

Methods

  • Narrative review based on a literature search in Web of Science Core Collection, BIOSIS Previews, Derwent Innovations Index, MEDLINE, and SciELO Citation Index, using terms for phthalic acid/phthalates OR phthalate metabolites AND biomonitoring OR epidemiological studies, restricted to publications between 2000 and 2018.
  • The review summarizes biomonitoring of phthalate diesters and their monoester and oxidative metabolites in urine, serum, breast milk, semen, saliva, amniotic fluid, and nails, plus selected epidemiological studies linking exposure to health outcomes. Main analysis is narrative synthesis; no meta-analysis is reported.

Limitations

  • Paper-stated: there is a lack of biomonitoring data on phthalate exposures in developing countries in Africa and South America; lack of analytical standards hinders identification of intermediate biological transformation products; the relevance of matrices such as blood, breast milk, semen, and nails remains largely unknown; and observed associations between phthalate exposure and disease outcomes are exploratory and preliminary.
  • Paper-stated: studies reporting partitioning of phthalates among tissues and organs at steady-state exposure conditions are not available, and interactions of phthalate metabolites with other contaminants should be considered in future investigations.
  • Evident from the text: as a narrative review, it does not report a formal systematic-review protocol, risk-of-bias assessment, or quantitative pooled effect estimates, so causal inference from the cited exposure–health associations is limited.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/toxics7020021

Cites

207 of 207 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Chemical structures of major phthalates and their metabolites studied in the literature.
Figure 1 Chemical structures of major phthalates and their metabolites studied in the literature.CC BY · PubMed Central
Figure 2 Metabolic pathways of phthalate esters in humans.
Figure 2 Metabolic pathways of phthalate esters in humans.CC BY · PubMed Central
Figure 3 Urinary concentrations of phthalate metabolites reported in adults (general population) from several countries (MDEHP: Sum of DEHP metabolites; biomonitoring data published after 2000; median concentration is presented).
Figure 3 Urinary concentrations of phthalate metabolites reported in adults (general population) from several countries (MDEHP: Sum of DEHP metabolites; biomonitoring data published after 2000; median concentration is presented).CC BY · PubMed Central
Figure 4 Urinary concentrations of phthalate metabolites reported in children (general population) from several countries (MDEHP: Sum of DEHP metabolites; biomonitoring data published after 2000, median concentration is presented).
Figure 4 Urinary concentrations of phthalate metabolites reported in children (general population) from several countries (MDEHP: Sum of DEHP metabolites; biomonitoring data published after 2000, median concentration is presented).CC BY · PubMed Central

Verification

Claims the paper makes

31 No full text of the sources · 27 Partly supported · 23 No basis given · 17 Own interpretation · 11 Supported · 5 Not checked yet · 1 Not supported · 1 Sources not found · 1 Own method · accuracy not yet measured

Verify all 1 references — free account

Show all 75 claims

  • It may state two separate claims as one. 26
  • Probably not a substantial claim. 18
  • The quote only partly states this claim. 2
42 of 42
  • The paper relies on this without support.

    Food intake is the main source of phthalate exposure for high molecular weight phthalates.

    “Food intake is the main source of phthalate exposure (for high molecular weight phthalates).”
  • The paper relies on this without support.

    Humans are exposed to thousands of harmful chemicals.

    “Because humans are exposed to thousands of harmful chemicals”
  • The paper relies on this without support.

    Biomonitoring studies of human phthalate exposure have been based on urinary concentrations of phthalate metabolites.

    “The biomonitoring studies of human phthalate exposure have been based on urinary concentrations of phthalate metabolites.”
  • The paper relies on this without support.

    Urine is a preferred matrix of choice for biomonitoring studies.

    “a preferred matrix of choice for biomonitoring studies”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

4 of 4

Citations

Cites

Show all 212 references

Research works printed but not linked: 1

  1. Sapozhnikova, 2019, Suspect screening of chemicals in food packaging film by comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry, LCGC N. Am., 37, 52

Cited by

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Items 701–755 of 755

Metadata

Authors
Wang, Y., Zhu, H., & Kannan, K.
Affiliations
New York State Department of Health (US)
Corresponding author
Kannan, Kurunthachalam
Venue
Toxics
Publisher
MDPI AG
Published
2019-04-05
Volume
7
Issue
2
Pages
21
ISSN
2305-6304 (ISSN-L)
OpenAlex
W2929721361
Cited by
755
References
212
Citations by year
2026: 74 · 2025: 101 · 2024: 156 · 2023: 120 · 2022: 122 · 2021: 115 · 2020: 62 · 2019: 3
FWCI
29.94
Type
journal article
Language
en
Open access
Locations
  • Toxics (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Effects and risks of endocrine disrupting chemicals
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pesticide Exposure and Toxicity
Keywords
phthalates, human biomonitoring, urinary phthalate metabolites, DEHP, dibutyl phthalate, diisobutyl phthalate, endocrine disruption, reproductive toxicity, exposure trends, children's exposure, type 2 diabetes, insulin resistance, obesity, asthma, allergy, plasticizers

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