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Association of exposure to phthalates and substitutes with infection risk among U.S. children

Yu Zhang1, Siqi Jin1, Zichuan Li2

  • 1MEEKL-AERM, College of Environmental Sciences and Engineering, and Center for Environment and Health, Peking University, Beijing, China.

Environmental Pollution (Barking, Essex : 1987)
|May 9, 2026
PubMed

Insights

Early exposure to di-isononyl phthalate (DiNP) increases infection risk in young children and adolescents. DiNP may not be a safe substitute for di(2-ethylhexyl) phthalate (DEHP) concerning immune health.

Area of Science:

  • Environmental Health
  • Toxicology
  • Pediatrics

Background:

  • Early-life exposure to di(2-ethylhexyl) phthalate (DEHP) is linked to immune system issues in children.
  • Data on the immune effects of DEHP substitutes like di-isononyl phthalate (DiNP), di-isononyl cyclohexane-1,2-dicarboxylate (DiNCH), and di(2-ethylhexyl) terephthalate (DEHTP) is limited.

Purpose of the Study:

  • To investigate the association between urinary phthalate metabolite concentrations and overall infection risk in U.S. children.
  • To assess the potential risks of DEHP substitutes compared to legacy phthalates.

Main Methods:

  • Analyzed urinary concentrations of 18 phthalate metabolites in 1,989 U.S. children aged 3-19 years.
  • Utilized logistic and mixture models to examine associations between phthalate exposure and infection risk across three age groups.
  • Included analysis of legacy phthalates and newer substitutes like DiNP, DiNCH, and DEHTP.

Main Results:

  • Higher infection risk was associated with DiNP metabolites (MONP, MCOP) in young children (3-5 years) and adolescents (12-19 years).
  • Adolescents exposed to other phthalate metabolites (e.g., mono-benzyl phthalate, mono-(3-carboxypropyl) phthalate) showed increased infection odds.
  • A mixture of phthalates was linked to higher infection risk in adolescents. DiNCH showed an isolated adverse association in 6-11-year-old boys.

Conclusions:

  • Specific phthalates and phthalate mixtures may heighten children's susceptibility to infections.
  • DiNP does not appear to be a safe alternative to DEHP for immune-related outcomes.
  • Further research, including longitudinal and toxicological studies, is needed for newer substitutes like DiNCH and DEHTP.

Keywords:
AlternativesChildrenDEHTPDINCHDi-isononyl phthalateImmuneInfectionPhthalatesVulnerable window

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