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We combined metabolites into molar sums that represent similar sources and similar biological activity, LMWP metabolites [[SIGMA]LMWPs, the creatinine-corrected molar sum of MEP, MnBP, and MiBP (expressed as MEP, molecular weight 194)], HMWP metabolites [[SIGMA]HMWPs, the creatinine-corrected molar sum of MBzP, MEHP, MEOHP, MEHHP, MECPP, excluding MCOP and MCNP (expressed as MEHP, molecular weight 278)], and the sum of four DEHP metabolites [[SIGMA]DEHP, the creatinine-corrected molar sum of DEHP metabolites: MEHP, MEOHP, MEHHP, MECPP (expressed as MEHP, molecular weight 278)] (Teitelbaum et al.
High-molecular-weight phthalates (HMWPs), including di(2-ethylhexyl) phthalate (DEHP), are used primarily as plasticizers to increase the flexibility of vinyl plastic, which is used in many consumer products, such as pharmaceuticals, medical devices, and food packaging (Schettler 2006).
We observed effect modification by BMI for MEOHP ([P.sub.Interaction] = 0.04), MEHHP ([P.sub.Interaction] = 0.04), MECPP ([P.sub.Interaction] = 0.01), the sum of the HMWPs ([P.sub.Interaction] = 0.01), and the sum of DEPH metabolites ([P.sub.Interaction] = 0.02).
Furthermore, we observed inverse associations between MEOHP and MEHHP, and MEHPP and the sum of HMWPs and the sum of DEHP phthalates and BC-specific mortality among women with BMI [greater than or equal to] 25.0kg/[m.sup.2], but not among women with BMI <25.0kg/[m.sup.2].
We calculated the molar sums of individual metabolites (in micromoles per liter) of DEHP because they occur from the same parent phthalate, and also of HMWP and LMWP, as they represent similar sources of exposure and they are moderately to highly correlated ([SIGMA]DEHPm, [SIGMA]HMWPm, and [SIGMA]LMWPm, hereafter) (Valvi et al.
Associations between sums of HMWP or MEHP separately and BMI in children and/or adolescents were positive in a Chinese population (Wang et al.
We found that prenatal HMWP exposure is associated with lower early weight gain in infancy and lower BMI z-scores later in childhood, up to 7 years of age in boys, and some suggestion that HMWP exposure may be associated with higher BMI z-scores in girls.