Abstract
Background: Phthalates esters are widely used commercially and can leach from a food container or food packaging. Few studies have been conducted in Asia regarding food processed to varying levels and human phthalate exposure. This study aimed to evaluate the association between unprocessed and ultra-processed food intake and urinary phthalate metabolite levels in the Taiwanese adult population.Methods: A total of 516 participant data were extracted from the cross-sectional 1993–1996 and 2005–2008 Nutrition and Health Survey in Taiwan of those aged over 18 years, where urinary measures and one 24-h dietary recall were collected. Urinary concentrations of dimethyl phthalate, diethyl phthalate, dibutyl phthalate, butyl benzyl phthalate, and di-(2-ethylhexyl) phthalate metabolites including monomethyl phthalate, monoethyl phthalate (MEP), monobutyl phthalate (MBP), monobenzyl phthalate, mono-(2-ethylhexyl) phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, and mono-(2-ethyl-5-oxohexyl) phthalate were measured in spot urine samples. The NOVA food processing classification system was applied to divide all consumed foods into four mutually exclusive groups including unprocessed or minimally processed, processed culinary ingredients, processed and ultra-processed food. Generalized linear models were employed to examine the associations between the percentage quartiles (Qs) of unprocessed and ultra-processed foods in the total weight of food and the urinary phthalate metabolites.Results: Compared with participants in the lowest quartiles (Q1) of ultra-processed food intake, highest ultra-processed food intake (Q4) had 65.7% (95% confidence interval [CI]: 4.83, 162) higher urinary concentrations of MEP after adjusted for covariates. In contrast, the higher unprocessed food consumption was inversely associated with urinary concentrations of MEP and MBP (P for trend = 0.03). When compared to the lowest unprocessed food consumers (Q1), higher consumers (Q4) presented 38.6% (95% CI: −61.3, −2.59) lower MEP concentrations and 23.1% (95% CI: −38.5, −3.71) lower MBP concentrations.Conclusion: Ultra-processed food consumption was associated with increased concentrations of urinary MEP. Conversely, consuming unprocessed food was associated with lower concentrations of MEP and MBP in the Asian Taiwanese adult population.
Highlights
NOVA classification system defines ultra-processed food as industrial formulations manufactured from substances derived from whole foods and that typically contain cosmetic additives such as added flavors and colors [1]
Highmolecular-weight (HMW) phthalates, such as di-(2-ethylhexyl) phthalate (DEHP), are mainly used for food containers, food packaging, and the polyvinyl chloride (PVC) gloves worn for food preparation [8]
Those with the highest unprocessed food intake (Q4) tended to be older (>65 years, 17.1 vs. 1.55%), had a lower education level and total energy intake (1,545 vs. 1,886 kcal), and higher protein (41.9 vs. 37.0 g/1,000 kcal), dietary fiber (11.1 vs. 6.15 g/1,000 kcal), calcium (275 vs. 195 mg/1,000 kcal) and magnesium (140 vs. 112 mg/1,000 kcal) intake compared with the lowest group (Q1; all P < 0.05)
Summary
NOVA classification system defines ultra-processed food as industrial formulations manufactured from substances derived from whole foods and that typically contain cosmetic additives such as added flavors and colors [1]. Most ultra-processed foods, such as ready-to-eat meals, sugar-sweetened beverages, and packaged snack products, contain little or no nutrients but high levels of calories, fat, sugar, and additives. Ultra-processed food consumption has been associated with an increased risk of obesity [2], type 2 diabetes [3], cardiovascular disease [4], cancer [5], and premature death [6]. This is a concerning health issue globally. This study aimed to evaluate the association between unprocessed and ultra-processed food intake and urinary phthalate metabolite levels in the Taiwanese adult population
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