Association between Phthalate Metabolites and Risk of Endometriosis: A Meta-Analysis

Cai, Wei; Yang, Jule; Liu, Yini; Bi, Yang; Wang, Hong

doi:10.3390/ijerph16193678

Cited by 41 publications

(19 citation statements)

References 40 publications

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“…Bisphenol A (BPA), a chemical used primarily in the production of polycarbonate plastics and epoxy resins, for example, in food and drink packaging, was found to be a risk factor for diabetes [ 64 ] and obesity in adults [ 64 ] ( Table 8 ). Women’s exposure to mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) has been found as a risk factor for endometriosis [ 65 ] ( Table 8 ). MEHHP is a metabolite of phthalate acid esters (PAEs).…”

Section: Resultsmentioning

confidence: 99%

Environmental Risk Factors and Health: An Umbrella Review of Meta-Analyses

Rojas-Rueda

Morales-Zamora

Alsufyani

et al. 2021

IJERPH

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Background: Environmental health is a growing area of knowledge, continually increasing and updating the body of evidence linking the environment to human health. Aim: This study summarizes the epidemiological evidence on environmental risk factors from meta-analyses through an umbrella review. Methods: An umbrella review was conducted on meta-analyses of cohort, case-control, case-crossover, and time-series studies that evaluated the associations between environmental risk factors and health outcomes defined as incidence, prevalence, and mortality. The specific search strategy was designed in PubMed using free text and Medical Subject Headings (MeSH) terms related to risk factors, environment, health outcomes, observational studies, and meta-analysis. The search was limited to English, Spanish, and French published articles and studies on humans. The search was conducted on September 20, 2020. Risk factors were defined as any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or death. The environment was defined as the external elements and conditions that surround, influence, and affect a human organism or population’s life and development. The environment definition included the physical environment such as nature, built environment, or pollution, but not the social environment. We excluded occupational exposures, microorganisms, water, sanitation and hygiene (WASH), behavioral risk factors, and no-natural disasters. Results: This umbrella review found 197 associations among 69 environmental exposures and 83 diseases and death causes reported in 103 publications. The environmental factors found in this review were air pollution, environmental tobacco smoke, heavy metals, chemicals, ambient temperature, noise, radiation, and urban residential surroundings. Among these, we identified 65 environmental exposures defined as risk factors and 4 environmental protective factors. In terms of study design, 57 included cohort and/or case-control studies, and 46 included time-series and/or case-crossover studies. In terms of the study population, 21 included children, and the rest included adult population and both sexes. In this review, the largest body of evidence was found in air pollution (91 associations among 14 air pollution definitions and 34 diseases and mortality diagnoses), followed by environmental tobacco smoke with 24 associations. Chemicals (including pesticides) were the third larger group of environmental exposures found among the meta-analyses included, with 19 associations. Conclusion: Environmental exposures are an important health determinant. This review provides an overview of an evolving research area and should be used as a complementary tool to understand the connections between the environment and human health. The evidence presented by this review should help to design public health interventions and the implementation of health in all policies approach aiming to improve populational health.

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Section: Resultsmentioning

confidence: 99%

Environmental Risk Factors and Health: An Umbrella Review of Meta-Analyses

Rojas-Rueda

Morales-Zamora

Alsufyani

et al. 2021

IJERPH

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“…Prenatal phthalate exposure has also been associated with reduced risk of PCOS in adolescent female offspring [ 98 ], which is consistent with their antiandrogenic effects. Endometriosis has been linked with higher levels of some phthalates in a meta-analysis [ 99 ], but none of the relevant studies involved prenatal exposures. Taken together, these studies of DES, BPA and phthalates strongly support the hypothesis that prenatal exposures to evolutionarily novel antiandrogenic and estrogenic chemicals increase risk of endometriosis.…”

Section: Mechanismsmentioning

confidence: 99%

The evolutionary biology of endometriosis

Dinsdale

Nepomnaschy

Crespi

2021

Evolution, Medicine, and Public Health

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We provide the first analysis and synthesis of the evolutionary and mechanistic bases for risk of endometriosis in humans, structured around Niko Tinbergen's four questions about phenotypes: phylogenetic history, development, mechanism, and adaptive significance. Endometriosis, which is characterized by the proliferation of endometrial tissue outside of the uterus, has its phylogenetic roots in the evolution of three causally-linked traits: (1) highly-invasive placentation, (2) spontaneous rather than implantation-driven endometrial decidualization, and (3) frequent extensive estrogen-driven endometrial proliferation and inflammation, followed by heavy menstrual bleeding. Endometriosis is potentiated by these traits, and appears to be driven, proximately, by relatively low levels of prenatal and postnatal testosterone. Testosterone affects the developing HPO (hypothalamic-pituitary-ovarian) axis and at low levels it can result in an altered trajectory of reproductive and physiological phenotypes that in extreme cases can mediate the symptoms of endometriosis. Polycystic ovary syndrome, by contrast, is known from previous work to be caused primarily by high prenatal and postnatal testosterone, and it demonstrates a set of phenotypes opposite to those found in endometriosis. The hypothesis that endometriosis risk is driven by low prenatal testosterone, and involves extreme expression of some reproductive phenotypes, is supported by a suite of evidence from genetics, development, endocrinology, morphology and life history. The hypothesis also provides insights into why these two diametric, fitness-reducing disorders are maintained at such high frequencies in human populations. Finally, the hypotheses described and evaluated here lead to numerous testable predictions, and have direct implications for the treatment and study of endometriosis.

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“…Meta-analyses [ 14 , 82 ], as well as the systematic reviews [ 80 , 83 ] present in literature, fail to identify elements with a clear correlation. For some metabolites of DEHP, higher risk indices have been suggested, but various methodological limits have been claimed as involved.…”

Section: Discussionmentioning

confidence: 99%

From Environmental to Possible Occupational Exposure to Risk Factors: What Role Do They Play in the Etiology of Endometriosis?

Caporossi

Capanna

Viganò

et al. 2021

IJERPH

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Endometriosis is a gynecological disorder characterized by the presence of endometrial stroma and glands outside the uterine cavity. A systematic review of the literature was conducted to clarify, starting from environmental exposure data, whether possible occupational risk factors may correlate with the onset of the disease. The guidelines for reporting systematic reviews of the “PRISMA” statement were followed and two databases, Scopus and PubMed, were used. Of the 422 studies selected with specific keywords, 32 publications were eligible, 28 of which referred to chemical agents and 4 related to night work. Conflicting data emerged among these studies. Although some compounds seemed to be more involved than others in the onset of endometriosis. Association with exposure to organochlorine compounds is the most supported by the epidemiological data, while other pesticide exposure did not show any clear correlation. Likewise, the hypothesis of a correlation with perfluoroalkyls exposure is not currently supported by data. The involvement of metals as risk factors has not been confirmed, while the role of night work, in the case of long service, seems to play an etiological role. In order to clarify the potential occupational risk of endometriosis development, well-designed studies are needed to evaluate the potential association between chemical compounds and disease etiology.

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Association between Phthalate Metabolites and Risk of Endometriosis: A Meta-Analysis

Cited by 41 publications

References 40 publications

Environmental Risk Factors and Health: An Umbrella Review of Meta-Analyses

Environmental Risk Factors and Health: An Umbrella Review of Meta-Analyses

The evolutionary biology of endometriosis

From Environmental to Possible Occupational Exposure to Risk Factors: What Role Do They Play in the Etiology of Endometriosis?

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