Occupational exposure to phthalate esters and systemic clinical changes in municipal sanitation workers: Human...

Continuous exposure to products containing phthalate acid esters (PAEs) has generated concerns regarding their impact on human health. This study was aimed at evaluating occupational exposure to PAEs metabolites among 90 municipal waste collection workers compared to 90 staff involved in janitorial duties across academic, administrative, and institutional areas (as a control group). Blood serum samples were analyzed to quantify multiple PAEs metabolites, alongside assessments of hematological, biochemical, inflammatory, oxidative stress, liver, thyroid, and kidney function biomarkers. Results showed significantly higher PAEs metabolite levels in exposed workers (total PAEs mean ± standard deviation: 25.66 ± 12.81 μg/L vs. 15.03 ± 5.14 μg/L, p < 0.001), accompanied by alterations in blood indices-including decreased white blood cells (WBC) and hemoglobin (HB), elevated red blood cells (RBC) and eosinophils-and elevated liver enzymes, thyroid hormones, and inflammatory markers such as the inflammatory cytokines tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). The findings suggest that PAEs' metabolite levels are largely unaffected by demographic and lifestyle factors, highlighting occupational exposure as the predominant source in this group. Network analysis revealed that occupational exposure to PAEs, including Mono(2-ethylhexyl) phthalate (MEHP), in municipal sanitation workers is associated with significant alterations in neutrophils, 8-hydroxy-2'-deoxyguanosine, (OHdG8), thyroid parameters (triiodothyronine (T3) and thyroxine (T4), prothrombin time)PT(.), and hematological factors (albumin, mean corpuscular hemoglobin concentration)MCHC(.), and partial thromboplastin time (PTT)). These findings highlight the impact of occupational PAEs exposure on multiple physiological systems and underscore the need for preventive measures and continuous health monitoring in this population.