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J Pediatr. 2013 Sep;163(3):747-53.e1. doi: 10.1016/j.jpeds.2013.03.072. Epub 2013 May 24.

Urinary phthalates are associated with higher blood pressure in childhood.

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Department of Pediatrics, New York University School of Medicine, New York, NY 10016, USA.



To examine associations of urinary phthalate levels with blood pressure (BP) and serum triglyceride and lipoprotein levels in children.


We performed a cross-sectional analysis of a subsample of US children aged 6-19 years who participated in the National Health and Nutrition Examination Survey between 2003 and 2008. We quantified exposure to 3 families of phthalates--low molecular weight, high molecular weight and di-2-ethylhexylphthalate (DEHP)--based on molar concentration of urinary metabolites. We assessed descriptive, bivariate, and multivariate associations with BP and lipid levels.


Controlling for an array of sociodemographic and behavioral factors, as well as diet and body mass index, levels of metabolites of DEHP, a phthalate commonly found in processed foods, were associated with higher age-, sex-, and height-standardized BP. For each log unit (roughly 3-fold) increase in DEHP metabolites, a 0.041 SD unit increase in systolic BP z-score was identified (P = .047). Metabolites of low molecular weight phthalates commonly found in cosmetics and personal care products were not associated with BP. Phthalate metabolites were not associated with triglyceride levels, high-density lipoprotein level, or prehypertension.


Dietary phthalate exposure is associated with higher systolic BP in children and adolescents. Further work is needed to confirm these associations, as well as to evaluate opportunities for intervention.


BMI; BP; Blood pressure; Body mass index; CDC; Centers for Disease Control and Prevention; DBP; DEHP; Di-2-ethylhexylphthalate; Diastolic BP; HDL; HMW; High molecular weight; High-density lipoprotein; LMW; Low molecular weight; MBP; MECPP; MEHHP; MEHP; MEOHP; MEP; Mono-(2-ethyl-5-carboxypentyl) phthalate; Mono-(2-ethyl-5-hydroxyhexyl) phthalate; Mono-(2-ethyl-5-oxohexyl) phthalate; Mono-(2-ethylhexyl) phthalate; Mono-ethyl phthalate; Mono-n-butyl-phthalate; NHANES; National Health and Nutrition Examination Survey; SBP; Systolic BP

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