Phthalate Replacements May Contribute to High Blood Pressure in Youth Interview with:
Teresa M. Attina, MD, PhD, MPH and
Leonardo Trasande, MD, MPP

Department of Pediatrics
NYU Langone Medical Center

Medical Research: What is the background for this study?

Response: Phthalates are environmental chemicals widely used in consumer and personal care products, and often found in plastic to increase flexibility. Di-2-ethylhexylphthalate (DEHP) is of particular interest because industrial processes to produce food frequently use plastic products containing DEHP. Because recognition of potential health risks related to DEHP exposure has increased, DEHP is being replaced by di-isononyl phthalate (DINP) and di-isodecyl phthalate (DIDP), two phthalates with similar chemical properties. Specifically, DINP is used in plastic products for food packaging, and DIDP is used in furnishings, cookware, medications, and several other consumer products. These alternatives have not been substantially studied for toxicity in laboratory studies because these studies are not required for regulatory approval: unlike the EU, in the US the current regulatory framework assumes that chemicals are safe until proven toxic.

Medical Research: What are the main findings?

Response: We examined DINP and DIDP levels in urine samples from children and adolescents (6 to 19 years old) who participated in the National Health and Nutrition Examination Survey between 2009 and 2012, to assess if these levels were associated with blood pressure measurements. Diet, physical activity, gender, race/ethnicity, income, and other factors that can contribute to increased blood pressure were also included in the analysis. A significant association was found between high blood pressure and DINP/DIDP levels in study participants. This is not a cause-and-effect relationship but it suggests that phthalates may contribute to increased blood pressure.

Medical Research: What should clinicians and patients take away from your report?

Response: Children and adolescents exposed to DIDP and DINP, currently used as DHEP replacements, have significantly increased blood pressure. This adds to the increasing body of evidence on the harmful effects of these environmental chemicals. Simple steps that could be taken to limit exposure include not microwaving food in plastic containers or covered by plastic wraps, and avoiding using the dishwasher for plastic food containers: high temperatures make more likely for these chemicals to leach into food. Plastic containers labeled with the numbers 3, 6 or 7 (inside the recycle symbol usually at the bottom of the container) should also be avoided, as these codes indicate the presence of phthalates.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Further studies are required to identify the underlying mechanisms and to investigate the long-term effects of exposure to these chemicals. This is particularly important during pregnancy and early childhood, and might reveal different and/or more persistent effects on health. There are ample opportunities for policy prevention in the current regulatory void, and these studies will form the basis for much needed regulatory interventions to limit exposure to ubiquitous environmental chemicals with the potential to increase cardiovascular risk.


Leonardo Trasande and Teresa M. Attina. Association of Exposure to Di-2-Ethylhexylphthalate Replacements With Increased Blood Pressure in Children and Adolescents. Hypertension, July 2015 DOI: 10.1161/HYPERTENSIONAHA.115.05603

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Leonardo Trasande, MD, MPP (2015). Phthalate Replacements May Contribute to High Blood Pressure in Youth