Prenatal exposure to phthalate and decreased body mass index of children: a systematic review and meta-analysis

Abstract

Phthalates are well-known endocrine-disrupting chemicals. Many detrimental health effects of phthalates were investigated, but studies on the association of phthalates with obesity in children showed inconsistent results. Thus, this systematic review and meta-analysis were performed to clarify whether prenatal and postnatal exposures to phthalates are associated with physical growth disturbances in children. We performed the systematic review and meta-analysis following the PRISMA 2020 statement guidelines, and found 39 studies that met our inclusion criteria, including 22 longitudinal and 17 cross-sectional studies. We observed a significant negative association between the prenatal exposure to DEHP and the body mass index (BMI) z-score of the offspring (β = − 0.05; 95% CI: − 0.10, − 0.001) in the meta-analysis, while no significant association between the prenatal exposure to DEHP and the body fat percentage of the offspring was observed (β = 0.01; 95% CI: − 0.41, 0.44). In the systematic review, studies on the association between phthalates exposure in childhood and obesity were inconsistent. Prenatal exposure to phthalates was found to be associated with decreased BMI z-score in children, but not associated with body fat percentage. Our findings suggest that phthalates disturb the normal muscle growth of children, rather than induce obesity, as previous studies have hypothesized.

Report of the Scientific Committee of the Spanish Agency for Food Safety and Nutrition (AESAN) on the available evidence in relation to the potential obesogenic activity of certain chemical compounds that may be present in foods

“…The authors conclude that prenatal exposure to phthalates is associated with a decrease in BMI in children but is not related to body fat percentage. These findings suggest that phthalates may disrupt children's normal muscle development, rather than inducing obesity, as had been raised in other studies (Lee et al, 2022). Therefore, from an epidemiological point of view, although some studies show a relationship between phthalate exposure and obesity, it is still unclear and more prospective studies confirming this trend are needed (Aaseth et al, 2022).…”

“…Four of these studies have shown a positive relationship between exposure to phthalates and obesity. In a very recent literature review, Lee et al (2022) studied whether prenatal or postnatal exposure to phthalates is associated with physical growth disorders in children. The authors conclude that prenatal exposure to phthalates is associated with a decrease in BMI in children but is not related to body fat percentage.…”

The Role of Endocrine Disruptors Bisphenols and Phthalates in Obesity: Current Evidence, Perspectives and Controversies

“…Similarly, conflicting results appear in prospective studies investigating the effects of intrauterine exposure to phthalates (based on concentrations in maternal urine during pregnancy) and infantile obesity, with some demonstrating an adverse relationship between maternal exposure and offspring weight gain [ 206 ], some demonstrating neutral [ 210 ] or even beneficial effects [ 210 , 211 ] and others demonstrating phthalate-compound-specific effects [ 209 ]. A recent meta-analysis indicated an overall association of prenatal exposure to the most broadly used di-(2-ethylhexyl)-phthalate with decreased BMI z-scores in infants but no impact on fat mass, suggesting that the correlation between phthalate exposure and BMI is mediated by decreased muscle growth [ 227 ].…”

Endocrine Disrupting Chemicals’ Effects in Children: What We Know and What We Need to Learn?

“…Change in auxological data (height, weight, and BMI) in children was reported to be longitudinally induced by phthalates exposure during mother pregnancy [ 140 , 141 ]. However, a recent systematic review and meta-analysis including 22 longitudinal and 17 cross-sectional studies demonstrated that prenatal exposure to DEHP was associated with decreased BMI z-score in children [ 142 ].…”