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Journal Article 
Urinary Phthalates and Leukocyte Telomere Length: An Analysis of NHANES 1999-2002 
Scinicariello, F; Feroe, AG; Attanasio, R 
The International Agency for Research on Cancer classified the di-2-ethylhexyl phthalate (DEHP) as "possibly carcinogenic to humans". In vitro studies reported that phthalate exposure resulted in induction of several nuclear transcription factors that are activators of telomerase reverse transcriptase (TERT) and telomerase activity of the human telomerase complex. The objective of this study was to determine whether there is an association between urinary phthalate metabolites [mono-ethyl phthalate (MEP), mono-butyl phthalate (MBP), mono-(2-ethyl)-hexyl phthalate (MEHP), and mono-benzyl phthalate (MBzP) and leukocyte telomere length (LTL) in the adult population of the National Health and Nutrition Examination Survey (NHANES) 1999-2002 (n=2472). After adjustment for potential confounders, participants in the 3rd and 4th quartiles of urinary MEHP had statistically significantly longer LTL (5.34%, 95% CI: 1.31, 9.53; and 7.14%, 95% CI: 2.94, 11.63; respectively) compared to the lowest quartile, with evidence of a dose-response relationship (p-trend=0.01). The association remained when the analyses were stratified by age groups (20-39years, 40-59years, and 60years and older), and sex. Furthermore, MBP and MBzP were associated with higher LTL in older participants. The age independent association between longer LTL and MEHP (a metabolite of DEHP) might suggest a possible role of MEHP as tumor promoter. 
Adult; Cross-Sectional Studies; Dose-Response Relationship, Drug; Environmental Exposure/adverse effects; Middle Aged; Neoplasms/chemically induced/genetics/urine; Phthalic Acids/adverse effects/urine; Surveys and Questionnaires; Telomere Homeostasis/drug effects; Young Adult; Leukocyte telomere length; Mono-(2-ethyl)-hexyl phthalate; Phthalate esters: di-2-ethylhexyl phthalate 
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