Objectve Phthalates (PAEs) have been reported to have hepatotoxicity. Several studies have assessed the health risks of exposure to PAEs in general populaton, but not in patents diagnosed with type 2 diabetes mellitus (T2DM) which would be aggravated by liver damage. In this study, we aim to evaluate the levels of cumulatve exposure to PAEs in elder T2DM patents and assess the health risk of liver damage related to the exposure.
Methods A cross-sectional study was conducted. A total of 300 spot urine samples were collected from elder T2DM patents from a community health service center of Huangpu District, Shanghai in 2016. Liquid chromatography-tandem mass spectrometry was used to determine 10 metabolites of 6 kinds of PAEs in urine. Estmated daily intake (EDI) was calculated based on the creatnine-adjusted concentratons of the 10 metabolites. Hazard index (HI) as a measure of health risk assessment was used to assess the liver damage induced by cumulatve exposure to PAEs. The associatons of demographic characteristc with hazard quotent (HQ) and HI of PAEs were analyzed using linear regression.
Results Except mono-methyl phthalate (MMP), mono-benzyl phthalate (MBzP), and mono-2-carboxymethyl-hexyl phthalate (MCMHP), the detection rates of the other 7 metabolites were 100% positive in urine samples of T2DM patients. Mono-ethyl phthalate (MEP), mono-n-butyl phthalate (MnBP), and monoisobutyl phthalate (MiBP) showed highest levels, with the medians of creatnine-adjusted concentrations being 137.13, 265.73, and 381.53 μg/g, respectively. Comparatively, the positive detection rate (88.3%) and the concentraton (median:3.70 μg/g) of MBzP were the lowest. The EDI of di-isobutyl phthalate (DiBP) was much higher than those of the others, with a median of 12.95 μg/(kg·d). The HQs of di-2-ethylhexyl phthalate (DEHP), DiBP, and di-n-butyl phthalate (DnBP) were much higher than those of di-ethyl phthalate (DEP) and butyl-benzyl phthalate (BBP), with medians of 0.169 4, 0.129 5, and 0.081 8, respectvely. The partcipants (n=55) with HI≥ 1 accounted for 18.33% of total study partcipants. Having a family history of diabetes was positvely associated with the HQs of DEP, DiBP, and BBP (P < 0.05).
Conclusion The exposure to PAEs may be a risk factor of liver damage among elder T2DM patents from Shanghai, and DEHP plays a dominant role.
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