Insulin resistance has been linked with diabetes and cardiovascular disease. In some groups of adolescents, the appearance of environmental chemicals called phthalates is associated with insulin resistance, according to the study, “Urinary Phthalates and Increased Insulin Resistance in Adolescents,” in the September 2013 Pediatrics (published online Aug. 19). Out of concern over the increasing diabetes rate (and other endocrine system issues) in youth worldwide and laboratory studies suggesting the possibility of a role for phthalates in insulin resistance, the researchers looked for an association between signs of phthalate exposure in the urine and insulin resistance among adolescents. They looked at 2003-2008 NHANES data for 766 people 12 to 19 years old, analyzing lab results for signs in the urine of exposure to one or more of three particular chemicals in the phthalate family, and also for the incidence of insulin resistance. In addition to analyzing the NHANES data, they surveyed the adolescents regarding ethnicity and lifestyle. They found higher levels of phthalates (or phthalate metabolites) in the urine of certain subsets of the study participants, including females and Mexican-American teens. Teens from higher-income households had lower concentrations of one particular chemical, called LMW, in their urine. Another chemical, called DEHP, was associated with increased insulin resistance in study participants. A significant source of exposure to phthalates is food packaging, although children and adolescents may be exposed through other consumer goods as well. There are alternatives to phthalate-containing plastics for food packaging, such as waxed paper and aluminum foil. It is not known whether insulin-resistant children and teens consume food with a higher phthalate content, or whether insulin-resistant children excrete more DEHP in their urine, but the authors recommend further investigation to determine the effects of dietary phthalate exposures.
Editor’s Note: This issue also includes the study, “Bisphenol A and Chronic Disease Risk Factors in U.S. Children,” and a related commentary, “Urine Chemical Content May Be a False Measure of Environmental Exposure.”
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.