The associations between phthalate exposure and insulin resistance, β-cell function and blood glucose control in a population-based sample

In developed countries, phthalate exposure is ubiquitous. Previous studies have shown an association between phthalate levels and health effects. To test associations between phthalate exposures, estimated from urinary phthalate metabolites, and insulin resistance, beta-cell function and glucose control. Data were obtained from a cross-sectional, nationally representative study; the Canadian Health Measures Survey (CHMS, 2009-2011). Participants under the age of 12, those with diabetes, who were pregnant or who had not fasted overnight were excluded. Fasting blood glucose, insulin, and glycosylated hemoglobin (HbA(1C)) levels were measured in a subset of participants, and urine was collected for creatinine and phthalate metabolites. We tested associations between these variables using linear regression analysis. Of 4437 participants (12-79 years old), 2119 had fasting glucose measurements and at least one phthalate metabolite above detection limits. MBzP, MCPP, MEHP, MEHHP, MiBP, and the sum of DEHP metabolites were positively associated with increased HbA(1C) (p < 0.05). DEHP metabolites were positively associated with increased fasting glucose, insulin, HOMA-IR and HOMA-beta. An interquartile increase in the sum of log transformed DEHP metabolites was associated with increases in HOMA-IR and HOMA-beta of 0.15 (95% CI 0.04, 0.26) and 10.24 (95% CI 3.71, 16.77) respectively. Increased concentrations of all measured phthalate metabolites were associated with reduced blood glucose control. DEHP metabolites were also associated with increased glucose concentrations, and indicators of beta-cell function and insulin resistance. Our results suggest that exposure to phthalates may possibly impair control of blood glucose and thereby predispose to pre-diabetes. Crown Copyright (C) 2017 Published by Elsevier B.V. All rights reserved.