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•A major public health issue in Taiwan in 2011 involved phthalate-tainted foods.•This cohort study followed three waves in affected children over five years.•Past daily DEHP intake ...from DEHP-tainted foods and time had significant effects on urinary ACR, with negative interactions.•Urinary melamine levels increased urinary ACR and oxidative stress over time.•Impact of DEHP-tainted foods on urinary ACR was highest in the first wave and diminished gradually.
In 2011, phthalates, mainly di-(2-ethylhexyl) phthalate (DEHP), were found to have been added to a variety of foods in Taiwan, increasing the risk of microalbuminuria in children. Exposure to melamine perhaps modifies that risk. This prospective cohort study investigates whether renal injury resulting from exposure to DEHP-tainted foods from the 2011 Taiwan Food Scandal is reversed over time. The temporal and interactive effects of past daily DEHP intake, current daily DEHP intake, and urinary melamine levels on oxidative stress and renal injury were also examined.
Two hundred possibly DEHP-affected children (aged < 18 years) were enrolled in the first survey wave (August 2012–January 2013), with 170 and 159 children in the second (July 2014–February 2015) and third waves (May 2016–October 2016), respectively. The first wave comprised questionnaires that were used to collect information about possible past daily DEHP intake from DEHP-tainted foods. One-spot first morning urine samples were collected to measure melamine levels, phthalate metabolites, and markers indicating oxidative stress (malondialdehyde and 8-oxo-2′-deoxyguanosine), and renal injury (albumin/creatinine ratio (ACR) and N-acetyl-beta-D-glucosaminidase) in all three waves. Generalized estimating equation (GEE) modeling revealed that both past daily DEHP intake and time might affect urinary ACR. However, most interactions were negative and significant correlation was observed only during the second wave (P for interaction = 0.014) in the group with the highest past daily DEHP intake (>50 μg/kg/day). Urinary melamine levels were found to correlate significantly with both urinary ACR and oxidative stress markers. The highest impact associated with exposure to DEHP-tainted foods in increasing urinary ACR of children was observed during the first wave, and the effect may partially diminish over time. These results suggest that continuous monitoring of renal health and other long-term health consequences is required in individuals who were affected by the scandal in 2011.
A major threat to public health involving phthalate-tainted foodstuffs occurred in Taiwan in 2011. Phthalates, mainly di-(2-ethylhexyl) phthalate (DEHP), were intentionally added to several ...categories of food commonly consumed by children. This study investigated the relationship between intake of the phthalate-tainted foods and renal function in children.
Children aged ≤10years with possible phthalate exposure were enrolled in this study between August 2012 and January 2013. Questionnaires were used to collect details of exposure to phthalate-tainted foodstuffs, and blood and urine samples were collected for clinical biochemical workup. The clinical biomarkers of renal injury, including urinary microalbumin, N-acetyl-beta-d-glucosaminidase (NAG), and β2-microglobulin were measured. Exposure was categorized based on recommended tolerable daily intake level defined by the U.S. Environmental Protection Agency (0.02mg/kg/day) and the European Food Safety Authority (0.05mg/kg/day).
We analyzed intake and renal function of 184 children whose intake of DEHP-tainted foods was known. Higher DEHP exposure to DEHP-tainted foods was significantly associated with increase of urine albumin/creatinine ratio (ACR). Children in the high-exposed group (daily DEHP intake (DDI)>0.05mg/kg/day) had 10.395 times the risk of microalbuminuria than the low-exposed group (DDI≤0.02 and >0mg/kg/day) and no-exposed group combined after adjustment (95% CI=1.096–98.580, P=0.04).
Intake of DEHP from phthalate-tainted foods may be a potential risk factor for microalbuminuria, a marker of glomerular injury in children.
•A major health threat from phthalate-tainted foodstuffs occurred in Taiwan in 2011.•DEHP-tainted food intake increases the excretion of urinary ACR in children.•DEHP-tainted food intake may increase the risk of microalbuminuria.
Phthalate exposure may reduce intellectual development in young children. In 2011, numerous Taiwanese children had been reported to have consumed phthalate-tainted products. We investigated the ...effects of phthalate exposure on the intellectual development of these children after the 2011 Taiwan di-2-ethylhexyl phthalate (DEHP) episode.
We recruited 204 children, aged 3–12 y, from 3 hospitals in Taiwan between 2012 and 2013. First-morning urine samples were collected for analyzing 5 phthalate metabolites. We applied a Bayesian model to estimate the past DEHP exposure (estDEHPADD) of each participant before the 2011 DEHP episode. Demographic information, consumption of phthalate-tainted products, and maternal education, of each participant were obtained using a questionnaire. We used the Wechsler intelligence evaluation tools for assessing the children's and maternal intelligence quotient.
The median levels of mono-2-ethylhexyl phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate, mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-n-butyl phthalate, and mono-iso-butyl phthalate in the children were 9.97, 45.8, 32.2, 46.2, and 24.3μg/g creatinine, respectively. Using the aforementioned urinary phthalate metabolites, we found that the children's verbal comprehension index (N =98) was significantly negatively associated with urinary log10 MEOHP (β, −11.92; SE, 5.33; 95%CI, −22.52~ −1.33; P=0.028) and log10 ΣDBP metabolites (β, −10.95; SE, 4.93; 95%CI, −20.74~ −1.16; P=0.029) after adjustment for age, gender, maternal IQ and education, passive smoking, estDEHPADD, active and passive smoking during pregnancy. Through a tolerable daily intake-based approach, we only found a significant negative association between past estimate DEHPADD and VIQ≥3-<6 in preschool children whereas no correlation was observed between current DEHP exposure and IQ≥3-<6 score with/ without estimate DEHPADD adjustment. It revealed that the effect of past high-DEHP exposure on verbal-related neurodevelopment of younger child are more sensitive.
Our results are consistent with the hypothesis that exposure to DEHP and DnBP affects intellectual development in preschool and school-aged children, particularly their language learning or expression ability.
•We evaluated the past/current phthalate exposure in children exposed to di-2-ethylhexyl phthalate (DEHP)-tainted products.•We used Wechsler intelligence tools to assess the intellectual development of children exposed to DEHP-tainted products.•Verbal comprehension index of school-aged children are senetive to current DEHP and DBP metabolites.•Verbal-related neurodevelopment of preschool children are sensitive to the past DEHP exposure index.•We concluded that DEHP and DBP exposure affect verbal-related development in preschool and school-aged children.
Abstract A literature search reveals no studies concerning simultaneous identification of commonly abused drugs, benzodiazepines, and new psychoactive substances in urine by liquid chromatography ...tandem mass spectrometry (LC–MS/MS). We developed and validated an LC–MS/MS method for simultaneous identification of multiple abused drugs, benzodiazepines, and new psychoactive substances in urine from suspected drug abusers. The instrument was operated in multiple-reaction monitoring using an electrospray ionization mode. Chromatograms were separated using an ACE5 C18 column on a gradient of acetonitrile. After liquid–liquid extraction, samples were passed through a 0.22-μm polyvinylidene difluoride filter before injection into the LC–MS/MS. The limits of quantitation ranged from 0.5 ng/mL to 31.3 ng/mL. The linearity ranged from 0.5 ng/mL to 200 ng/mL. The precision results were below 15.4% (intraday) and 18.7% (interday). The intraday accuracy ranged from 85.9% to 121.0%; interday accuracy ranged from 66.1% to 128.7%. The proposed method was applied to 769 urine samples. The most common three drugs identified were ketamine, amphetamine, and opiates. The drug positive rate for one or more drugs was 79.6%. Our results demonstrate the suitability of the LC–MS/MS method for simultaneous identification of multiple abused drugs, benzodiazepines, and new psychoactive substances in urine.
This study aims to examine whether behavior intervention can decrease total urinary melamine excretion. A total of 16 healthy subjects were recruited from two university buildings (eight subjects ...each). By using a stepped-wedge cluster randomized and controlled trial design, we randomly assigned eight subjects from the same building to the serial steps of either control–intervention–intervention or control–control–intervention. Each step lasted for 3 days. Subjects in the intervention step carried one bag containing stainless steel tableware as meal boxes and used them for each meal during the trial, whereas those in the control step carried one empty bag. The 24 h urine samples for 9 consecutive days were collected. In the control–intervention–intervention group, after excluding two subjects with missing data, the median absolute difference of the total 3 day melamine excretion between the seventh to the ninth day and from the first to the third day was −19.9 μg (a range from −160.6 to −7.2 μg, p = 0.028, n = 6). The median protection percent of the total 3 day melamine exposure (the amount from the seventh to the ninth day minus the amount from the first to the third day, divided by the amount from the first to the third day) was 68.4%, ranging from 41.8% to 91.8%. Regular use of stainless steel-made meals boxes can mitigate melamine exposure from melamine tableware.
ABSTRACT
Self‐management among adolescents with type 1 diabetes (T1D) is poorer than in other age groups during childhood. A valid and reliable short‐form scale to measure self‐management in ...adolescents with T1D is prudent for enhancing their self‐management in clinical settings. We used a cross‐sectional design to develop a short‐form Chinese version of the Self‐Management of Type 1 Diabetes for Adolescents Scale (C‐SMOD‐A) and test its psychometric characteristics. Two hundred adolescents with T1D were recruited from four hospitals in Taiwan through convenience sampling. Content validity, exploratory factor analysis, and corrected item‐total correlations were used to shorten the 52‐item C‐SMOD‐A. Confirmatory factor analysis, criterion‐related validity, and reliability testing were used to examine the psychometric characteristics of the short‐form C‐SMOD‐A. Finally, the 23‐item C‐SMOD‐A (C‐SMOD‐A‐23) with five inter‐correlated factors was developed. Glycated hemoglobin levels were significantly associated with each subscale of the C‐SMOD‐A‐23 with correlation coefficients ranging from −0.18 to −0.31. The composite reliability and test–retest reliability of the five subscales ranged from 0.70 to 0.88 and from 0.78 to 0.93 respectively. Accordingly, the C‐SMOD‐A‐23 has acceptable validity and reliability to measure five specific domains of self‐management for adolescents with T1D. Health‐care providers could use the C‐SMOD‐A‐23 as a clinical reference to assess specific domains of self‐management and provide interventions to enhance self‐management for adolescents with T1D.
In this study the recently developed technique of thermal desorption electrospray ionization/mass spectrometry (TD–ESI/MS) was applied to the rapid analysis of multiple controlled substances. With ...the reallocation of mass spectral resources from a standard ESI source coupled with liquid chromatography (LC) to an ambient TD–ESI source, this direct-analysis technique allows the identification of a wider range of illicit drugs through a dual-working mode (pretreatment-free qualitative screening/conventional quantitative confirmation). Through 60-MRM (multiple reaction monitoring) analysis—in which the MS/MS process was programmed to sequentially scan 60 precursor ion/product ion transitions and, thereby, identify 30 compounds (two precursor/product ion transitions per compound)—of a four-component (drug) standard, the signal intensity ratios of each drug transition were comparable with those obtained through 8-MRM analysis, demonstrating the selectivity of TD–ESI/MS for the detection of multiple drugs. The consecutive analyses of tablets containing different active components occurred with no cross-contamination or interference from sample to sample, demonstrating the reliability of the TD–ESI/MS technique for rapid sampling (two samples min−1). The active ingredients in seized drug materials could be detected even when they represented less than 2 mg g−1 of the total sample weight, demonstrating the sensitivity of TD–ESI/MS. Combining the ability to rapidly identify multiple drugs with the “plug-and-play” design of the interchangeable ion source, TD–ESI/MS has great potential for use as a pretreatment-free qualitative screening tool for laboratories currently using LC–MS/MS techniques to analyze illicit drugs.
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•Mass spectrometer featuring two interchangeable ion sources operating in a dual-working mode.•Qualitative screening assay/quantitative confirmation analysis after switching the ion source.•Applications using seized illicit street drugs.
The present study assessed the association between phthalate exposure and mitochondrial DNA (mtDNA) polymerase γ (POLG) methylation along with the potential effect on the characteristics of body fat ...in children. A total of 152 children were enrolled. The urinary concentrations of phthalate metabolites were measured using ultraperformance liquid chromatography-tandem mass spectrometry. Genomic DNA was extracted from the buffy coat, and bisulfite-treated DNA was subjected to a pyrosequencing assay. In total, 17 CpG sites in the exon 2 region of POLG were included in the analysis. A multivariable regression model was applied to determine whether characteristics of body fat were associated with phthalate exposure and methylation of POLG. After adjustment for covariates, male children with a ten-fold increase in mono-methyl phthalate (MMP) or mono-benzyl phthalate (MBzP) concentrations had significantly higher measurements for total body fat (MMP: β = 6.47%; MBzP: β = 3.54%), and trunk fat (MMP: β = 6.67%; MBzP: β = 3.90%). Male children who had hypermethylation at the 2nd CpG site in exon 2 of POLG also had high measurements for BMI (β = 1.66 kg/m2), waist (β = 4.49 cm) and hip (β = 4.81 cm) circumference, total body fat (β = 5.48%), and trunk fat (β = 6.21%). A dose-response relationship existed between methylation at the 2nd CpG site in exon 2 of POLG and characteristics of body fat (p for trend<0.01). This study suggested that male children who are exposed to phthalic acid esters have high body weight, BMI, and body and trunk fat percentages. Methylation of the exon 2 region of POLG is a possible mechanism behind the causal effect of endocrine-disrupting substances.
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•Mono-methyl phthalate (MMP) exposure level was associated with hypermethylation in exon 2 of polymerase γ (POLG) in children.•The dose-response relationship existed between methylation at the 2nd CpG site in exon 2 of POLG and body fat percentage.•The association between MMP exposure or hypermethylation of POLG and body fat percentage in male children was observed.
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