Risk assessment for phthalate exposures in the elderly: A repeated biomonitoring study

Recent studies indicated that exposure to phthalates affects the development of a variety of diseases in the elderly population. However, limited information was available about the variability of phthalate daily intakes (DIs) and the proportion of the population that is highly exposed to phthalates. Therefore, we measured the levels of three phthalate metabolites, mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-n-butyl phthalate (MnBP) in 4014 urine samples repeatedly collected from 1646 elderly people. The DIs of di(2-ethylhexyl) phthalate (DEHP) and di-n-butyl phthalate (DnBP) were calculated using urinary MEHHP, MEOHP, and MnBP levels, and then the proportion of the population that was highly exposed to DEHP and DnBP was calculated. The intra-class correlation (ICC) for MEHHP, MEOHP, and MnBP levels was 0.07, 0.02, and 0.03, respectively, and exposures to DEHP and DnBP were strongly correlated with each other (correlation coefficient=0.89 and p-value<0.0001). The geometric mean of estimated DI was 8.8μg/kg_body-weight/day (range 0.005-3382.0) for DEHP and 1.5μg/kg_body-weight/day (range 0.0002-1076.8) for DnBP. The percentages of urine samples with DEHP > reference dose (RfD, 20μg/kg_body-weight/day) and DnBP > tolerable daily intake (TDI, 10μg/kg_body-weight/day) were 20.2% and 3.6%, respectively. The Korean elderly were co-exposed to DEHP and DnBP, and the variation of DEHP and DnBP metabolite levels was mainly attributed to intra-individual variation, rather than inter-individual variation. Furthermore, Korean elderly were exposed to the hazards of DEHP and DnBP based on the high level of the exceedance rate over TDI or RfD for DEHP and DnBP. Since the elderly are very susceptible to environmental pollutants, the harmful effects of DEHP and DnBP in the elderly population should be further studied in the future.