Dietary sources of cumulative phthalates exposure among the US general population in NHANES 2005-2014

Background: Anti-androgenic phthalates are reproductive toxicants that may have additive effects on male development. Diet is the primary exposure source for most phthalates, which contaminate the food supply through food contact materials and industrialized production. Objective: To compare dietary sources of cumulative phthalates exposure between "food at home" (e.g. food consumed from a grocery store) and "food away from home" (e. g. food consumed from fast food/restaurants and cafeterias) in the U.S. general population. Methods: We estimated cumulative phthalates exposure by calculating daily intake from metabolite concentrations in urinary spot samples for 10,253 participants (>= 6 years old) using National Health and Nutrition Examination Survey (NHANES, 2005-2014) data. We constructed a biologically relevant metric of phthalates daily intake (Sigma androgen-disruptor, mu g/kg/day) by converting phthalates into anti-androgen equivalent terms prior to their summation. Particular foods and the percent of total energy intake (TEI) consumed from multiple dining out sources were ascertained from 24-h recall surveys. Associations with Sigma androgen-disruptor levels were estimated for children, adolescents, and adults using multivariable linear regression. Results: We observed a consistent positive association between dining out and Sigma androgen-disruptor levels across the study population (p-trend< 0.0001). Among adolescents, high consumers of foods outside the home had 55% (95% CI: 35%, 78%) higher Sigma androgen-disruptor levels compared to those who only consumed food at home. The contribution of specific dining out sources to Sigma androgen-disruptor levels varied by age group. For example, cafeteria food was associated with 15% (95% CI: 4.0%, 28%) and 64% (95% CI: 40%, 92%) higher Sigma androgen-disruptor levels in children and adults, respectively. Particular foods, especially sandwiches (i.e. cheeseburgers), were associated with increased Sigma androgen-disruptor levels only if they were purchased away from home (p < 0.01). Conclusion: Dining out may be an important source of biologically relevant cumulative phthalates exposure among the U.S. population. Future studies should evaluate modifiable production practices that remove phthalates from the food supply in addition to the efficacy of interventions that promote eating fresh foods prepared at home.