Association between Exposure to p,p'-DDT and Its Metabolite p,p'-DDE with Obesity: Integrated Systematic Review and Meta-Analysis

Environ Health Perspect. 2017 Sep 18;125(9):096002. doi: 10.1289/EHP527.


Background: The prevalence of obesity is increasing in all countries, becoming a substantial public health concern worldwide. Increasing evidence has associated obesity with persistent pollutants such as the pesticide DDT and its metabolite p,p'-DDE.

Objectives: Our objective was to systematically review the literature on the association between exposure to the pesticide DDT and its metabolites and obesity to develop hazard identification conclusions.

Methods: We applied a systematic review-based strategy to identify and integrate evidence from epidemiological, in vivo, and in vitro studies. The evidence from prospective epidemiological studies was quantitatively synthesized by meta-analysis. We rated the body of evidence and integrated the streams of evidence to systematically develop hazard identification conclusions.

Results: We identified seven epidemiological studies reporting prospective associations between exposure to p,p'-DDE and adiposity assessed by body mass index (BMI) z-score. The results from the meta-analysis revealed positive associations between exposure to p,p'-DDE and BMI z-score (β=0.13 BMI z-score (95% CI: 0.01, 0.25) per log increase of p,p'-DDE). Two studies constituted the primary in vivo evidence. Both studies reported positive associations between exposure to p,p'-DDT and increased adiposity in rodents. We identified 19 in vivo studies and 7 in vitro studies that supported the biological plausibility of the obesogenic effects of p,p'-DDT and p,p'-DDE.

Conclusions: We classified p,p'-DDT and p,p'-DDE as "presumed" to be obesogenic for humans, based on a moderate level of primary human evidence, a moderate level of primary in vivo evidence, and a moderate level of supporting evidence from in vivo and in vitro studies.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • DDT / metabolism*
  • Dichlorodiphenyl Dichloroethylene / metabolism*
  • Environmental Exposure / statistics & numerical data*
  • Environmental Pollutants / metabolism*
  • Humans
  • Obesity / epidemiology*


  • Environmental Pollutants
  • Dichlorodiphenyl Dichloroethylene
  • DDT