Comparing Levels of Urinary Phthalate Metabolites in Egyptian Children with Autism Spectrum Disorders and Healthy Control Children: Referring to Sources of Phthalate Exposure

Manal A. Shehata; Ebtissam M. Salah El-Din; Mai M.   Youssef; Mones M.  Abushady; Inas R. El-Alameey; Engy A. Ashaat; Amr S. Gouda; Walaa S. Nazim

doi:10.3889/oamjms.2021.7635

Authors

Manal A. Shehata Department of Child Health, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
Ebtissam M. Salah El-Din Department of Child Health, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
Mai M. Youssef Department of Child Health, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
Mones M. Abushady Department of Child Health, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
Inas R. El-Alameey Department of Child Health, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt; Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Saudi Arabia
Engy A. Ashaat Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Giza, Egypt
Amr S. Gouda Biochemical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Giza, Egypt
Walaa S. Nazim Biochemical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Giza, Egypt

DOI:

https://doi.org/10.3889/oamjms.2021.7635

Keywords:

Autism spectrum disorders, Children, Environmental risk factors, Phthalate exposure

Abstract

Background: Evidence supporting environmental risk factors of autism spectrum disorder (ASD) is rising. Phthalates are assumed to contribute to this risk due to their extensive use in daily life as plasticizers and additives in numerous customer products. Phthalates are also accused as a neurotoxic agent affecting brain development.

Aim: The main objective of this study is to compare the concentrations of urinary phthalate metabolites as biomarkers of phthalate exposure in children with autism to that of a healthy control group and to compare their exposure to suspected environmental sources of phthalate.

Methods: It was a case-control study; conducted over a period of one year. Thirty-eight children with ASD and 99 apparently healthy children comprised the control group, were enrolled in the study. Urinary concentrations of four phthalate metabolites were measured, using a combination of solid phase extraction, high pressure liquid chromatography, and tandem mass spectrometry.

Results: Children with ASD comprised 38 children (32 boys and 6 girls), their mean age was 8.95 + 4.17 years. There were significant higher levels of urinary Mono (2ethylhexyl) phthalate (MEHP), mono benzyl, and mono butyl phthalates in cases vs. controls with p value equals (0.006, 0.017 and <0.001) respectively. Regression analysis revealed that male gender and the level of mono butyl are the main predictors of ASD (p<0.001).

Conclusion: This study suggested a link between phthalates and ASD with higher urinary levels of phthalate metabolites in children with ASD. These high levels are either due to increased exposure or defective metabolism in children with ASD. The study declined any relationship of the studied sources of phthalate exposure to ASD except the exposure to wall painting with plastic.

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