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Modification of the association by sex between the prenatal exposure to di(2-ethylhexyl) phthalate and fat percentage in a cohort of Mexicans schoolchildren



Children’s overweight and obesity are global public health problems, children with obesity have grater obesity risk as adults, thus leading to develop cardiometabolic diseases. Previous studies have found positive and significant associations between the exposure to phthalates and body mass index and body composition.


To evaluate the modification of the association by sex between DEHP exposure during pregnancy and the percentage of body fat in a cohort of Mexican schoolchildren.

Material and methods

The sample was comprised by children which had previously participated in a POSGRAD longitudinal study. A subsample of 190 mother–children binomials were included. Mothers’ DEHP concentrations and its metabolites had been measured in the second trimester of pregnancy: Mono-2-ethylhexyl phthalate (MEHP), Mono-2-ethyl-5-carboxypentyl phthalate (MECPP), Mono-2-ethyl-5-hidroxyhexyl phthalate (MEHHP), and Mono-2-ethyl-5-oxohexyl phthalate (MEOHP). The children’s adipose mass was measured at age 8, 9, and 10. Longitudinal data were analyzed using the mixed effects linear regression model, with intercept and random slope, adjusted by important confounders and stratified by sex.


We found a differentiated effect by sex, the exposure to DEHP during pregnancy significantly increases the adipose mass in boys. The average increase was 0.058% (p = 0.02) for every 1% variation in MECPP; 0.047% (p = 0.04) in MEHHP; 0.051% (p = 0.03) in MEOHP, and 0.066% (p = 0.007) in MECPP.


The results suggest an effect differentiated by sex; with boys being the main ones affected by the prenatal exposure to phthalates. However, we cannot rule out effects in girls.

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Supported by the Consejo Nacional de Ciencia y Tecnología (grant 202062 and 233903) and the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development grant R01HD058818.

Author information




LHC directed the writing of the manuscript and approved the final version. JOAM prepared the first draft and adjusted the analysis of body composition data and the formal analysis, ABV coordinated the study and with IR organized the original study protocol and obtained funding. DBB acquired data about exposure and interpreted results, KCM data: substantive contributions in the statistical methods, review and edition of the article. All authors participated in the design of the study protocol, helped to draft the manuscript, read and approved the final manuscript.

Corresponding author

Correspondence to Leticia Hernández Cadena.

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The authors declare no competing interests.

Ethics approval

Both women and infants signed an agreement letter adjacent to the consent letter from parents or tutors. The protocol was approved by Instituto Nacional de Salud Pública and Instituto Mexicano del Seguro Social Ethical Committee in Cuernavaca, Morelos, Mexico.

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Montes, J.O.A., Villarreal, A.B., Romieu, I. et al. Modification of the association by sex between the prenatal exposure to di(2-ethylhexyl) phthalate and fat percentage in a cohort of Mexicans schoolchildren. Int J Obes (2021).

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