Percentage fractions of urinary di(2-ethylhexyl) phthalate metabolites: Association with obesity and insulin resistance in Korean girls

PLoS One. 2018 Nov 27;13(11):e0208081. doi: 10.1371/journal.pone.0208081. eCollection 2018.


Objective: We assessed the associations of percentage fractions of urinary di(2-ethylhexyl) phthalate (DEHP) metabolites with obesity and insulin resistance in Korean girls.

Methods: In total, 137 girls, aged 6 to 13 years (65 overweight cases and 72 controls), were recruited. Anthropometric indices and the homeostatic model assessment of insulin resistance (HOMA-IR) index were determined. Four major urinary DEHP metabolites were analyzed in spot urine samples by gas chromatography-tandem mass spectrometry, including mono(2-ethylhexyl) phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono(2-ethyl-5-carboxypentyl) phthalate.

Results: There were no significant differences in the urinary concentrations of the DEHP metabolites between the overweight and control groups. The percentage fraction of MEHHP (MEHHP%) among all DEHP metabolites was significantly higher in the overweight prepubertal girls than in the controls (P = 0.035). MEHHP% was positively associated with the body mass index percentile, waist circumference, body fat percentage, and HOMA-IR index in the prepubertal girls. After adjusting for covariates, the prepubertal girls in a higher MEHHP% quartile were found to have a higher odds ratio for central obesity than those in a lower quartile (odds ratios: 5.05 for quartile 3; 7.30 for quartile 4). The relative rate of MEHHP oxidation to MEOHP was negatively associated with the body mass index percentile and waist circumference in the prepubertal girls. However, no such association was observed in the pubertal girls.

Conclusions: MEHHP% was positively associated with obesity and insulin resistance in prepubertal girls. Further studies are necessary to elucidate the causal links between altered phthalate metabolism and increased susceptibility to insulin resistance in children.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biomarkers / urine
  • Child
  • Cross-Sectional Studies
  • Diethylhexyl Phthalate / metabolism*
  • Female
  • Humans
  • Insulin Resistance / physiology*
  • Obesity / urine*
  • Phthalic Acids / urine
  • Republic of Korea


  • Biomarkers
  • Phthalic Acids
  • mono(2-ethyl-5-hydroxyhexyl) phthalate
  • mono(2-ethyl-5-oxohexyl)phthalate
  • Diethylhexyl Phthalate

Grant support

This work was supported by a grant (to SHK, 2013) from the Korean Diabetes Association. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.