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The importance of diet for uptake of phthalates in pregnant women

Kostens betydelse för upptag av ftalater hos gravida kvinnor

Anna Roos

Fakulteten för hälsa, natur och teknikvetenskap

Folkhälsovetenskap

Examensarbete i folkhälsovetenskap I (magister) 15 HP

Handledare: Carl-Gustaf Bornehag, Huan Shu

Examinator: Carl-Gustaf Bornehag

2017-05-24

SAMMANFATTNING

Bakgrund: Kemikalier med hormonstörande egenskaper (Endocrine Disruptor Chemicals) –

EDCs, är ämnen som kan påverka det naturliga hormonsystemet hos människor och djur.

Ftalater är industriproducerade kemikalier, flera av dem med misstänkt hormonstörande

egenskaper. Ftalater är vanligt förekommande i många olika typer av produkter. De sprids till

sin omgivning och förorenar miljön. De finns även i livsmedel. Genom att mäta biomarkörer i

urin, blod, bröstmjölk och fostervatten kan man konstatera att både gravida kvinnor och foster

är exponerade för ftalater. Detta är av stor oro då man vet att fosterstadiet är den period i livet

då exponering för kemikalier med hormonstörande egenskaper är som mest kritiskt, på grund

av negativa hälsoeffekter.

Syfte: Syftet med studien är att undersöka hur intag av mejeriprodukter, fett, kött och fisk

påverkar urinnivåer av ftalater hos gravida kvinnor.

Metod: Urinprov analyserade för innehåll av ftalater från 1,670 kvinnor deltagande i

SELMA-studien har använts för statistisk analys, tillsammans med enkätsvar angående

kostvanor besvarade av de 1,670 kvinnorna i vecka 25 av graviditeten.

Resultat: Mejeriprodukter och fett: Kostintag av grädde, standardmjölk, färskost, margarin

för matlagning, majonnäs och flytande margarin hade signifikant samband med högre nivåer

av mono-n-butyl ftalat (MnBP) och mono-benzyl ftalat (MBzP) i urinen hos gravida kvinnor.

Kött: Ett kostintag av bacon och påläggskorv hade significant samband med högre nivåer av

mono-n-butyl ftalat (MnBP) och mono-benzyl ftalat MBzP) i urinen hos gravida kvinnor.

Fisk: Kostintag av sill/makrill hade significant samband med högre nivåer av mono-n-butyl

ftalat (MnBP) och mono-benzyl ftalat (MBzP) i urinen hos gravida kvinnor. Kostintag av rökt

makrill/sill, “annan fisk”, och sötvattensfisk hade significant samband med högre nivåer av

di-2-ethylhexyl ftalat (DEHP) metaboliter i urinen hos gravida kvinnor.

Slutsats: Gravida kvinnor i Sverige är exponerade för ftalater. Resultat från detta arbete

indikerar att gravida kvinnor i Sverige får i sig ftalater genom ett kostintag av mejeriprodukter

med högre fetthalt, fett, kött med högre fetthalt, och fisk. Resultatet är så kallat råresultat och

vidare studier behövs för att komplettera dessa fynd.

Nyckelord: Kemikalier med hormonstörande egenskaper, kost, ftalat, graviditet, urinnivå

Roos A., 2017. Kostens betydelse för upptag av ftalater hos gravida kvinnor, Magisteruppsats

i folkhälsovetenskap, Karlstad Universitet

ABSTRACT

Background: Endocrine disruptor chemicals - EDCs are compounds which may interfere

with the natural hormone system in humans and animals. Phthalates are industrial chemicals

suspected of being EDCs. Phthalates are widely used in a wide range of consumer products.

They have therefore become environmental contaminants and are present in food and drinks.

By measuring biomarkers in urine, blood, breast milk, and amniotic fluid, it is shown that

pregnant women and fetuses are exposed to phthalates. Exposure for phthalates in pregnant

women are of great concern since it is known that the period when fetus is developing is the

most critical period for exposure due to related health risks.

Aim: The aim of this study is to examine how intake of dairy, fat, meat or fish is related to

urinary levels of phthalates in pregnant women.

Method: Urine samples analyzed for the content of phthalate metabolites from 1,670 women

participating in the SELMA-study has been used for statistical analysis, together with data

selected from questionnaires regarding diet answered by the 1,670 women in week 25 of

pregnancy.

Results: Dairy and fat: Diet of cream, full fat milk, cream cheese, margarine for cooking,

mayonnaise and liquid margarine for cooking was significantly associated with higher levels

of mono-n-butyl phthalate (MnBP) and mono-benzyl phthalate (MBzP) in pregnant women.

Meat: Diet of bacon and sausage cuts was associated with higher levels of mono-n-butyl

phthalate (MnBP) and mono-benzyl phthalate (MBzP). Fish: Diet of herring/mackerel was

associated with higher levels of mono-n-butyl phthalate (MnBP) and mono-benzyl phthalate

(MBzP). Diet of smoked mackerel/herring, “other fish”, and freshwater fish was associated

with higher levels of di-2-ethylhexyl phthalate (DEHP) metabolites in pregnant women.

Conclusion: Pregnant women in Sweden are exposed to phthalates. Results in the current

work indicate that pregnant women are exposed to phthalates via intake of high fat dairy, fat,

high fat meat, and fish. Results are crude and further studies are needed to complement these

findings.

Keywords: Endocrine disruptor chemicals, diet, phthalate, pregnancy, urinary levels

Roos A., 2017. The importance of diet for uptake of phthalates in pregnant women, Thesis in

public health sciences, Karlstad University

TACK

Till Carl-Gustaf Bornehag & Huan Shu.

För att jag fick ta del.

För att ni har lärt mig massor.

För ert tålamod då arbetet dragit ut på tiden.

För att jag inte hade klarat detta utan er!

TABLE OF CONTENTS

1. BACKGROUND ................................................................................................................... 1

1.1 Chemicals with endocrine disrupting properties (EDCs) ............................................... 1

1.1.1 Phthalates ..................................................................................................................... 1

1.1.2 EDCs in pregnant women ............................................................................................ 3

1.1.3 The Swedish Environmental Longitudinal, Mother and child, Asthma and allergy

(SELMA) - study .................................................................................................................... 4

1.2 Uptake of EDCs ............................................................................................................. 4

1.2.1 Phthalates in dairy, fat, meat and fish ................................................................. 5

1.3 Question at issue ............................................................................................................... 5

1.4 Aim ................................................................................................................................... 5

1.5 Expected use with this study ............................................................................................ 6

2. METHODS ........................................................................................................................... 6

2.1 Study population ............................................................................................................... 6

2.2 Urine collection and chemical analysis ............................................................................ 6

2.3 Food frequency questionnaire........................................................................................... 7

2.4 Bio statistical analysis ....................................................................................................... 8

3. Ethical approval ................................................................................................................... 9

4. Results ................................................................................................................................. 10

4.1 The study population ..................................................................................................... 10

4.2 Urinary levels of phthalate metabolites in pregnant women ......................................... 10

4.3 Descriptive data on food intake ..................................................................................... 11

4.4 Association between dietary intake and urinary levels of phthalate metabolites .......... 12

5. Discussion ............................................................................................................................ 16

5.1 Diet and uptake of phthalates in humans ........................................................................ 16

5.2 Method discussion .......................................................................................................... 19

5.3 Further studies ................................................................................................................ 20

6. Conclusion ........................................................................................................................... 20

References ........................................................................................................................... 21

Appendix 1 .......................................................................................................................... 26

Appendix 2 .......................................................................................................................... 31

1. BACKGROUND

1.1 Chemicals with endocrine disrupting properties

All human depends on a healthy functioning endocrine system for development and bodily

functions (Bergman et al., 2013). There are chemicals in our surroundings with endocrine

disrupting properties (EDCs), meaning they may interact with the endocrine system in

humans and animals with adverse health effects as a result. Endocrine disrupting chemicals

are used in a wide range of commonly used products. Since these chemicals may migrate into

the surrounding environment, they may also be found in food and drinks. Due to bio-

monitoring data of urine, blood, breast milk and amniotic fluid it is known that all humans are

exposed to chemicals, some of them suspected to disrupt the endocrine system (Fromme et al.,

2011; Frederiksen, Sorgensen, & Andersson, 2010; Wan et al., 2013; Wittassek, Koch,

Angerer & Bruning, 2011).

1.1.1 Phthalates

Phthalic acid esters (phthalates) are industrial chemicals suspected of being EDCs (Dodson,

Nishioka, Standley, Perovich, Brody & Rudel, 2012). In table 1 five commonly used

phthalates and their metabolites are presented. Phthalates (di-esters) are referred to as a parent

compound, which is broken down in to metabolites (mono-esters or oxidized products) as

described in table 1. Figure 1 describes the molecular formula and structure of 10 investigated

phthalate metabolites (ChemSrc, n.d.).

Table 1. Description of phthalates, including abbreviations and CAS no.

Parent compound Abb. CAS no Metabolite Abb. CAS no

Diethyl Phthalate DEP 84-66-2 Mono-ethyl phthalate MEP 2306-33-4

Dibutyl Phthalate DBP 84-74-2 Mono-n-butyl phthalate MnBP 131-70-4

Butylbenzyl Phthalate BBzP 85-68-7 Mono-benzyl phthalate MBzP 2528-16-7

Mono-(2-ethylhexyl) phthalate MEHP 4376-20-9

Mono-(2-ethyl-5-hydroxylhexyl) phthalate MEHHP 40321-99-1

Mono-(2-ethyl-5-oxohexyl) phthalate MEOHP 40321-98-0

Mono-(2-ethyl-5-carboxypentyl) phthalate MECPP 40809-41-4

Mono-(4-methyl-7-hydroxyloctyl)phthalate MHiNP 936021-98-6

Mono-(4-methyl-7-oxo octyl)phthalate MOiNP 936022-00-3

Mono-(4-methyl-7-carboxyheptyl)phthalate MCiOP 936022-02-5

Di-2-ethylhexyl Phthalate 117-81-7

Di-isononyl Phthalate 68515-48-0

DEHP

DiNP

2

1

Figure 1. Description of molecular formula and structure of 10 phthalate metabolites.

Phthalates are widely used in a wide range of consumer products (Dodson et al., 2012). Based

on molecular weight and chemical properties, they are divided into high- or low molecular

weight phthalates. High molecular weight phthalates such as DEHP, BBzP, and DiNP are

used in for example food packaging and food containers (Rudel et al., 2011; Tran & Miyake,

2017), flooring and wallcovering. Low molecular weight phthalates, such as DEP and DBP

are used in personal care products and coating of some medications (Tran & Miyake, 2017).

Phthalates are also used in plastics, cleaning products, building materials (Bornehag,

Lundgren, Weschler, Sigsgaard, Hagerhed-Engman, & Sundell, 2005), printings (on food

packaging’s) (Jarosowa, 2006), PVC tubing within milking industry (Cao, 2010; Fierens,

Holderbeke, Willems, Henauw & Sioen, 2012) and prepacked and processed food (Takaro et

al., 2010).

As phthalates migrates into the surroundings they have become environmental contaminants,

present all around us in indoor dust, air, water and in soil (Bergman et al., 2013; Langer et al.,

2014). Several studies confirm that pregnant women are exposed to phthalates; Casas et al.

(2011) used one spot urine samples from 120 pregnant women. Samples were analyzed for 11

phthalate metabolites. Result showed that phthalates (MECPP, MEHHP, MEOHP, and MEP)

were detected in all urine samples (Casas et al., 2011). Ye et al. (2008) reported

concentrations of phthalates in spot urine samples from 100 pregnant women. Those

phthalates which are used also in this thesis were detected in 96-100 % of samples (Ye et al.,

2008). The Swedish Environmental Longitudinal, Mother and child, Asthma and allergy

(SELMA)- study could identify metabolites from 5 phthalates in the urine of all 2,356

MnBP: C12H14O4 MEP: C10H10O4 MHiNP: C17H24O5 MOiNP: C17H22O5 MCiOP: C17H22O6

MBzP: C15H12O4 MEHP: C16H22O4 MEHHP: C16H22O5 MEOHP: C16H20O5 MECPP: C16H20O6

3

pregnant women conducting in the study (Shu et al., submitted). Several of the investigated

phthalates are EDCs.

1.1.2 EDCs in pregnant women

EDCs have been detected in amniotic fluid, indicating that these compounds are transferred

from the pregnant women to fetus (Jensen et al., 2012; Mose, Mortensen, Hedegaard &

Knudsen, 2007). This is a concern regarding health consequences for the unborn child

(Bergman et al., 2013). If the pregnant woman is repetitive exposed to phthalates during

pregnancy, it may lead to phthalates accumulation in the fetus. Mose et al. (2007) measured

levels of eight different phthalates in five placentas, which were dually perfused. During

perfusions, the concentration of phthalates (MEP, MnBP, and MEHP) increased in maternal

and fetal chamber in all five perfusions (Mose et al., 2007). It is known that when fetus is

developing is the most critical period for exposure to EDCs. It may affect the child’s health,

also later in life (Bergman et al., 2013; Takaro, Diamond, Gobas, Otton & Shu, 2010). EDCs

in pregnant women is more a health risk for the child, rather than the pregnant woman

(Bergman et al., 2012). Effects caused of EDCs in adults are likely to decrease when the EDC

is no longer present. That is unfortunately not the same with the unborn child. When fetus is

growing, tissues are developing in periods. Exposure to EDCs during such a period may lead

to changes in development. These changes are most often not visible when the baby is born.

Instead they may show from when the baby is a few months old until adulthood. Depending

on which tissue is developing, exposure to EDCs may have different effects. Some tissues

continue developing when the child is born and during childhood (Bergman et al., 2012). If

the mother is exposed to EDCs also after the baby is born she may continue to transfer EDCs

to the child via mother’s milk (Fromme et al., 2011). Jahreis et al. (2017) found a significant

association between exposure to MnBP in pregnant women, and increased risk of asthma in

children up to 6 years old (Jahreis et al., 2017). Exposure to phthalates in pregnant women has

also been investigated regarding association with obesity-related metabolic disturbances

(Perng, Watkins, Cantoral, Mercado-García, Meeker, Téllez-Rojo & Peterson, 2017),

neurodevelopmental disorders (Tran & Miyake, 2017) and anogenital distance (AGD) as a

biomarker of prenatal androgen exposure, in newborns (Swan et al., 2015). Exposure of EDCs

may also play a role in preterm birth and low birth weight of babies (Bergman et al., 2012;

Polánska, Ligocka, Sobala & Hanke, 2016).

4

1.1.3 The Swedish Environmental Longitudinal, Mother and child, Asthma and allergy

(SELMA)- study

The SELMA-study is a population-based, longitudinal pregnancy cohort study. The study is

conducted in the Swedish county of Värmland. The county has a population of about 270,000.

There are 16 municipalities of which Torsby is the largest by area. Karlstad is the biggest

town. The study started in September 2007 and aims to follow mothers from early pregnancy

until the children reach school age. The SELMA-study is a cooperation between Karlstad

University, the county council of Värmland, Lund University and several international

research teams. The overall aim with the project is to investigate the importance of maternal

and early life exposure to environmental- and lifestyle factors, and the risk of developing

asthma and allergy. Neurodevelopmental disorder and reproductive development are also

investigated (Bornehag et al., 2012; Selmastudien n.d).

1.2 Uptake of EDCs

Phthalates enters the body system through intake of foods and drinks, dermal contact and

inhalation. These chemicals are then rapidly metabolized and excreted from the body

(Jarosowa, 2006; Kato et al., 2004; Koch, Rossbach, Drexler & Angerera, 2003; Takaro et al.,

2010). Phthalates can be measured in urine, blood, amniotic fluid and breast milk

(Frederiksen et al., 2010; Fromme et al., 2011; Langer et al., 2014; Wan et al., 2013;

Wittassek et al., 2011). Concentrations of phthalates in urine samples may vary due to intake

of liquids etc. in the pregnant women. Creatinine adjusted urinary metabolite concentrations

correlate better with concentrations in blood, serum, or plasma than the unadjusted

concentrations. Creatinine adjustment involves dividing micrograms of phthalate per liter

urine, with grams of creatinine per liter urine (Barr, 2005).

If foods or drinks come in contact with phthalates during production, in industry, storing or

processing such as cooking at home, phthalates might migrate into foodstuff and drinks. Still

foodstuff may contain EDCs before being processed or packed, for example crops, meat, and

fish which are exposed to EDCs from their environment (Cao, 2010; Fierens et al., 2012;

Jarosowa, 2006; Montuori, Jover, Morgantini, Bayona & Triassi, 2008; Shu, 2010; Takaro et

al., 2010). Studies have shown that we are exposed to phthalates, mostly DEHP and its

5

metabolites, via dietary intake of dairy, fat, meat and fish (Cao, 2010; Fierens et al., 2012;

Schecter et al., 2013)

1.2.1 Phthalates in dairy, meat and fish

Dairy: Phthalate metabolites (DEHP) is most commonly exposed to humans via dietary intake

of fatty foods such as dairy (and meat) (Cao, 2010). Phthalates (DEHP) may be found in dairy

in the whole milk chain, from farm to retail (Fierens et al., 2012). Removing dairy products

from the diet may decrease levels of phthalate metabolites (MEP, MEOHP, and MEHHP) in

urine (Ji, Lim Kho, Park & Choi, 2010).

Meat: Consumption of poultry has been shown to be associated with phthalate metabolites

(metabolites of DEHP) in urine (Colacino, Harris & Schecter, 2010). Phthalates (DEHP) may

be found in various meats and meat products (especially pork) (Schecter et al., 2013).

Fish: Phthalate metabolites (DEHP) may be found in fish (Schecter et al., 2013).

1.3 Question at issue

It is known that pregnant women are exposed to phthalates via inhalation, dermal and dietary

pathways (Bergman et al., 2012; Kato et al., 2004; Takaro et al., 2010). However, knowledge

regarding specific food as sources for uptake is limited. Since maternal exposure is of concern

regarding adverse health consequences for the unborn child, it is of importance to identify

diets that is contributing to uptake of phthalates in pregnant women.

1.4 Aim

The aim of this study is to examine how intake of dairy, fat, meat or fish is related to urinary

levels of phthalates in pregnant women.

6

1.5 Expected use with this study

Results from this study gives crude information regarding phthalate exposure from intake of

dairy, fat, fish and meat. Complementary studies are needed to create evidence based dietary

advices for pregnant women, in order to reduce uptake of phthalates.

2. METHODS

2.1 Study population

Data is collected from pregnant women participating in the Swedish Environmental

Longitudinal, Mother and child, Asthma and allergy (SELMA) –study (Bornehag et al.,

2012). There are 25 antenatal care centers (ACCs) in Värmland. In Sweden, all pregnant

women (99.9%) regularly visit an ACC during their pregnancy. The first appointment is

around 10th week of pregnancy. All pregnant women visiting any of the 25 ACCs between

September 2007 and March 2010 were invited to participate in the SELMA study. Women

who planned to move outside Värmland, who had passed more than 22 weeks of pregnancy,

or did not speak Swedish, were excluded. It was voluntary to participate in the study and the

women were not prompted in any way. Of 6,658 women, 2,582 agreed to participate in the

study (39%). Bornehag et al. (2012) found a self-selection bias in the SELMA-study when

comparing those participating with those not participating. Data for example showed that

those participating more frequently had asthma and allergy symptoms within their family.

Mothers participating were also higher educated than those not participating. The authors

mean that these findings indicate that the participating families do not fully represent the

study population (Bornehag et al., 2012). Since the aim of current work is to investigate

associations between dietary intake and phthalate metabolites in urine, such self-selection bias

should not affect results. Using data from the SELMA-study provides a great opportunity to

use valuable information regarding dietary intake and urinary levels of phthalates from a large

study population of pregnant women. Of significant use when studying the importance of diet

for uptake of phthalates in pregnant women.

2.2 Urine collection and chemical analysis

Urinary samples analyzed for phthalates within the SELMA-study, from 1,670 women were

used within this study. SELMA-women had handed their urine sample at the antenatal care

center in week ten of pregnancy. Ahead of time they were instructed to use their first morning

7

void and to keep it in their refrigerator or below room temperature. Urine was then frozen (-

20°C) in a bio-bank at the central hospital in Karlstad (Bornehag et al., 2012).

“Aliquots of 0.2 mL of urine were added with 0.1 mL of ammonium acetate (pH

6.5) and 0.01 mL glucoronidase (E-coli) and thereafter incubated at 37°C in 30

min. Then 0.05 mL of a 50:50 (v:v) water and acetonitrile solution of labeled (3H

or 13C) internal standards of all analyzed compounds were added and then

analyzed by liquid chromatograph tandem mass spectrometry (LC-MS/MS). For

the analysis of phthalate and phenol metabolites, a C18 column (2.1 mm i.d. x 50

mm, Genesis Lightn; Grace, Deerfield, IL, USA) was used prior to the injector to

reduce the interferences of contaminants in the mobile phase. For analysis of

phthalate metabolites, the samples were injected on a C18 column (1.5 μm, 2.0

mm i.d. x 30 mm VisionHT; Grace, Deerfield, IL, USA). The mobile phases were

water and acetonitrile with 0.08% formic acid.” Analyze was performed in a

laboratory at Lund University (Shu et al., 2014, pp. manuscript in preparation).

2.3 Food frequency questionnaire

A food frequency questionnaire (FFQ) was used in mid pregnancy (25th week) in the

SELMA-study (Selmastudien, n.d.). Questionnaires from 1,670 SELMA-women, for which

there are urine analyzed, were used in the current study. The questionnaire includes questions

on food, health and lifestyle. The instruction is to assess a mean dietary intake of the different

foodstuffs. All data from the questionnaire used in the current work are shown in appendix 1.

Questions regarding dairy, fat, meat and fish are for example:

Dairy: Question no 26: “How much do You drink/eat the following?” Possible alternatives

regarding dairy are: skimmed milk/low-fat milk, semi-skimmed milk, full-fat milk, fruit

yoghurt, low fat sour milk/low-fat yoghurt, semi-skimmed sour milk, sour milk/yoghurt,

cream cheese-low fat, cream cheese, hard cheese-low fat, hard cheese, dessert cheese.

Instruction: “1 glass = 2 dl, 1 cup = 1.5 dl. Fill in each line per day or per week”.

Fat: The questionnaire also contains questions regarding fat intake, both used for cooking,

homemade dressing, on bread etc. For example, question no 30: “What types of fat do you

usually use a) for cooking? b) in homemade dressing? (multiple choice possible). Possible

8

alternatives are butter/Bregott, liquid butter, olive oil, corn oil or sunflower oil, margarine for

cooking, liquid margarine, rapeseed oil, other, none.

Meat: Question no 31 b) “How often on average do You eat the following? Fill in the number

of times per month or per week or day, that means only one cross per line”. Possible answers

for frequency are never, one-three times/month, one-two times/ week, three-four times/week or

five-six times/week, once a day, two times/day or more than three times/day. The meat

products in this question are beef, pork (sliced/in pot), meat of game animals, lamb, other

meat, minced beef dishes, lean sausage, Falukorv sausage, other sausage, black pudding/blood

sausage, liver/kidney, sliced meat such as ham or turkey, sausage cuts/salami, bacon/pork

belly.

Fish: Question no 31 c) “How often on average do You eat the following?” Instruction: Fill in

the number of times per month or per week or day, that means only one cross per line.

Possible answers for frequency are never, one-three times/month, one-two times/ week, three-

four times/week or five-six times/week, once a day, two times/day or more than three

times/day. The fish/bird/egg products in this question are smoked mackerel/herring/others,

herring/mackerel, salmon, cod/coalfish/saithe/fish fingers, tuna, freshwater fish, other fish,

spawn/lump fish, caviar/Kalles, seafood/shrimps/crabs, chicken/other birds, eggs/omelets.

2.4 Bio statistical analysis

All creatinine adjusted phthalate concentration from urine samples were log transformed for a

more normal distribution. The log transformation made highly skewed distributions less

skewed, which eased statistical analysis.

In the current work reported dietary intake of the different foodstuffs (dairy, fat, meat, fish)

was divided into two groups; those who did consume that specific foodstuff, and those who

did not consume that foodstuff. Data analyze was performed using SPSS version 21. Two

sample t-test were conducted for the two groups (consuming vs. not consuming) for each

phthalate metabolite level. A p-value less than 0.05 were used as a significant association

between intake of foodstuff and levels of phthalates in urine. When analyzing results dairy

was divided into full fat dairy and low fat dairy since results in current work indicated that

9

there were differences in impact on urinary levels of phthalates due to content of fat. Low fat

dairy was here seen as dairy products with lower fat content than the origin product.

A ratio of geometric mean (RGM) was calculated by dividing log transformed mean

concentrations of phthalate for those consuming, by log transformed mean concentrations of

phthalate with those not consuming the specific foodstuff. A table was constructed for each

phthalate metabolite inclosing p-value and RGM for each foodstuff (appendix 2). By

analyzing RGM-values it was possible to see how intake of the different foodstuffs were

affecting urinary levels of phthalates; If dietary intake of a specific foodstuff had for example

a RGM=1.26 regarding urinary concentrations of a phthalate metabolite, those who ate that

foodstuff had in mean 26 % higher log concentrations of investigated phthalate metabolite in

their urine, compared to those who did not eat that foodstuff. If intake of that foodstuff was

also significant associated with increased levels of investigated phthalate in urine, it was

assessed that intake of that foodstuff is contributing to exposure of investigated phthalate in

pregnant women.

3. Ethical approval

The SELMA-study is approved by the Ethical committee in Uppsala, Sweden (Dnr

2007/062). The women participating in the SELMA-study, from whom data is used in current

work, has during recruitment for the SELMA-study been informed of the overall aim with the

project – to investigate associations between environmental exposure in early life, and

incidence of asthma and allergy, and other chronical conditions, later in life (Selmastudien,

n.d.). The aim of the current work is in line with the overall aim of the SELMA-study.

Thereto no personal data of the SELMA-women has been used within the current work.

Nevertheless, result from current study may cause anxieties and concern among public

regarding chemicals in food and their investigated health consequences. Still, contributing

with knowledge regarding dietary uptake of phthalates in pregnant women is important for

public health and needs to be investigated.

10

4. RESULTS

4.1. The study population

The 1,670 SELMA-women – for which there are both questionnaire data on food habits and

urinary levels of phthalates, were all located in the county of Värmland in Sweden. Before the

women got pregnant most of them (89.1 %) had a diet including meat and fish. 3.7 % of the

women avoided meat but ate fish. 5.8 % avoided fish but ate meat. 1.3 % of the women were

vegetarians eating dairy and egg. 0.1 % of the women were vegetarians eating dairy. 0.1 % of

the women were vegans (Figure 2).

Figure 2. 1,670 SELMA-women’s diet before pregnancy.

Almost all (93.7 %) of the women had breakfast every day. Most women (83.2 %) had lunch

every day (12.3 % had lunch several times a week). Most women (89.1 %) had dinner/supper

every day (8.1 % had dinner/supper several times a week).

4.2 Urinary levels of phthalate metabolites in pregnant women

Phthalate metabolites was identified in all 1,670 urine samples used in the current study.

Limit of quantification (LOQ), minimum concentrations, percentiles and median

concentrations for phthalate metabolites in urine samples are shown in table 2.

89,1 %

3,7 % 5,8 %1,3 % 0,1 % 0,1 %

0

10

20

30

40

50

60

70

80

90

100

Eat meat and

fish

Avoid meat,

eat fish

Avoid fish, eat

meat

Vegetarian

eating dairy

and egg

Vegetarian

eating dairy

Vegan

Diet before pregnancy

11

Table 2. Distribution of phthalate metabolites in urine of 1,670 pregnant women in the current

study.

4.3 Descriptive data on food intake

Answers to the food frequency questionnaire are described in detail in appendix 1. Tables

were constructed for each phthalate metabolite with frequency and log mean for the two

groups (consuming vs. not consuming) for each foodstuff, p-value, ratio and RGM values

(appendix 2).

Dairy: SELMA-women preferred milk with lower fat content: Semi skimmed milk was the

most frequently consumed milk; 66.9 % of the women drank semi skimmed milk on a daily

basis. Low fat milk was preferred before full fat milk. When it comes to sour milk/yoghurt the

women instead preferred full fat before low fat sour milk/yoghurt: 76 % of the women ate full

fat sour milk/yoghurt and 60 % of the women ate full fat sour milk/yoghurt on a daily basis.

65.4 % of SELMA-women ate low fat sour milk/yoghurt and 42.9 % ate it daily (appendix 1,

table A1, A3, A4).

Fat: Olive oil, liquid margarine and rapeseed oil was preferred for cooking among SELMA-

women, before margarine or liquid butter: About half of the women used olive oil, and 24.7 %

of the women used margarine for cooking (appendix 1, table A2).

Meat: Meat was commonly consumed among majority of SELMA-women: 94.9 % of the

SELMA-women ate minced beef dishes, 91.6 % ate beef, 79.3 % ate pork, 85.8 % ate sliced

meat, 78.1 % ate bacon, 81.7 % ate Falukorv sausage and 52.2 % of SELMA-women ate

Metabolite/Compound %>LOQ

Min 25% Median 75% 95%

MEP (DEP) 100.0 2.779 29,59 59.98 135,10 479.12

MnBP (MnBP) 100.0 3.025 41,19 69.82 112,13 226.28

MBzP (BBzP) 100.0 0.406 8,05 16.38 31,97 94.16

MEHP (DEHP) 99.6 0.139 2,05 3.65 6,50 15.97

MEHHP (DEHP) 100.0 0.862 9,36 16.21 26,81 66.48

MEOHP (DEHP) 99.9 0.468 6,30 11.03 18,35 43.14

MECPP (DEHP) 100.0 0.734 8,93 15.36 25,72 63.16

MHiNP (DiNP) 99.9 0.059 2,76 5.89 12,64 53.73

MOiNP (DiNP) 100.0 0.049 1,42 2.70 5,37 19.23

MCiOP (DiNP) 100.0 0.329 4,74 8.85 16,63 74.75

Urine metabolites (ng/mL) N=1,670 SELMA-women

12

sausage cuts. Least commonly consumed meat products were liver/kidney (4.7 %), lamb

(12.8%), lean sausage, black pudding/blood sausage and meat of game (appendix 1, table A1,

A4).

Fish: Cod/saithe/fishfingers, salmon and herring/mackerel was preferred among SELMA-

women; 81.6 % ate cod/saithe/fishfingers, 72.9 % ate salmon, 63.8% ate herring/mackerel. A

third of the SELMA-women reported consumption of “other fish”. 16.9 % of SELMA-women

ate smoked mackerel/herring. 6.2 % of the SELMA-women reported that they ate freshwater

fish (appendix 1, table A1).

4.4 Association between dietary intake and urinary levels of phthalate metabolites

Table 3 below describes food items that were significantly associated with an increased level

of phthalate metabolites in prenatal urine. Intake of these food items had a RGM higher than

1.05, meaning those who ate these foodstuffs had in mean 5% (or more) higher concentrations

of investigated phthalate in their urine compared with those women who did not eat that

specific foodstuff (appendix 2). Table 4 are describing foods that were associated with lower

levels of phthalates in prenatal urine for those who ate, compared to those who did not eat that

specific food. These foods had negative significant associations and low RGM values (<0.95)

for marked phthalate (appendix 2.).

13

Table 3. Food items positively associated with an increased level of phthalate metabolites in

prenatal urine among 1,670 pregnant women in SELMA.

* FFD=Full fat dairy, V=Vegetable fats/Fats, M=Meat, F=Fish. Bold regarding FFD/V means the foodstuff; full

fat dairy or vegetable fats/fats, which had a significant association with marked phthalate, since they are grouped

together.

Dairy and fat: Full fat dairy and fat/vegetable fat were grouped together in table 3 and 4. As it

is shown in table 3 intakes of several full fat dairy products were associated with increased

levels of phthalate metabolites in prenatal urine, most often MnBP and MBzP. Those who ate

full fat milk every day had in mean 10 % higher concentrations of DBP metabolites (MnBP)

and in mean 15 % higher concentrations of BBzP metabolites (MBzP) than those who did not

consume full fat milk every day (appendix 2.). There was no low-fat dairy associated with an

increase of phthalate metabolites in urine. Instead, the consumption of low fat dairy products

showed association with lower levels of phthalate metabolites in urine. For example, intake of

low fat milk, low fat sour milk and semi skimmed sour milk were associated with lower levels

of MBzP in urine compared with those who did not eat these foods. When it comes to fat,

such as margarine, liquid margarine and mayonnaise, these foodstuffs were also associated

with increased levels of MnBP and MBzP in urine. Those who ate margarine for cooking had

in mean 12 % higher concentrations of DBP metabolites (MnBP) and in mean 26 % higher

concentrations of BBzP metabolites (MBzP) in urine than those who did not consume

margarine for cooking (appendix 2.). Still there were some vegetable high fat foods associated

with lower levels of phthalates in prenatal urine; Olive oil for homemade dressing and olive

Parent compound -> DEP DBP BBzP

Positive association and RGM>1.05 MEP MnBP MBzP MEHP MEHHP MEOHP MECPP MHiNP MOiNP MCiOP

Cream FFD/V

Full fat milk/day FFD/V FFD/V FFD/V

Full fat sour milk/day FFD/V

Margarine-for cooking FFD/V FFD/V

Mayonnaise FFD/V FFD/V

Cream cheese/week FFD/V FFD/V FFD/V FFD/V

Liquid margarine-for cooking FFD/V

Dessert cheese/week FFD/V

Liquid butter- for cooking FFD/V

Sausage cuts M

Bacon M M

Lamb M M M M M

Low fat liver pate/week M

Smoked mackerel/Herring/Others F

Freshwater fish F F F F

Other Fish F F F F

Herring/mackerel F

No fat in homemade dressing x x

DEHP DiNP

14

oil for cooking at home was associated with lower levels of MnBP and MBzP in urine (table

4).

Intake of full fat dairy products (cream cheese and dessert cheese) were also associated with

higher levels of MOiNP and MCiOP in urine (table 3).

Meat: As it is shown in table 3 intakes of meat was associated with higher levels of phthalate

metabolites in prenatal urine; bacon and sausage cuts were associated with higher levels of

MnBP and MBzP. Those who ate bacon had in mean 7 % higher concentrations of MnBP and

in mean 12 % higher concentrations of MBzP in their urine compared with those who did not

consume bacon. There are also meat products in results with high RGM values (but no

significant association). Meaning those women who ate these meat products had in mean

higher concentrations of MnBP and MBzP in their urine compared to those who did not.

These were mostly high fat meat products; Falukorv sausage and other sausage (appendix 2.).

Intake of lamb was associated with higher levels of DEHP metabolites (MEHP, MEHHP,

MEOHP, MECPP) in urine (table 3). Those who ate lamb had in mean 26 % higher

concentrations of MEHP and 17-20 % higher concentrations of MEHHP, MEOHP, MECPP

in their urine, compared to those who did not eat lamb (appendix 2.). There were several meat

products with no significant association but high RGM-values for DEHP metabolites,

meaning those who ate these foods had 5% (or more) higher concentrations of investigated

phthalate in their urine compared with those women who did not eat that specific food. For

example, sliced meat (MEHP, MEOHP), other meat (MEHHP, MEOHP) and liver/kidney

(MEHHP, MEOHP, MECPP) (appendix 2).

Meats (lamb and low fat liver pate) were also associated with higher levels of MCiOP in

prenatal urine (table 3).

There were no meats associated with decreased levels of phthalate metabolite in prenatal urine

(Table 4).

Fish: As it is shown in table 3 intakes of fish was associated with higher levels of phthalates

in prenatal urine; Intake of herring/mackerel was associated with higher levels of MBzP in

15

urine (Table 3). But as shown in table 4 there were other fish items associated with lower

levels of MnBP and MBzP such as salmon, spawn, seafood.

Intake of smoked mackerel/herring, “other fish”, and freshwater fish were all associated with

higher levels of DEHP metabolites (MEHP, MEHHP, MEOHP, MECPP) in urine. The fish

affecting urine concentrations of DEHP metabolites the most was freshwater fish. Those who

ate freshwater fish had in mean 20-26 % higher concentrations of DEHP metabolites in their

urine compared to those women who did not eat freshwater fish (appendix 2.). There were no

fish products associated with decreased levels of DEHP metabolites in prenatal urine (Table

4). The only fish products with low RGM-values for DEHP metabolites were spawn and

seafood, meaning those who ate these foods had 5% (or more) lower concentrations of

investigated phthalate in their urine compared to those women who did not eat that specific

food, although not significant (appendix 2).

There were no significant association between intake of fish and DiNP metabolites in urine.

Still intake of spawn had high RGM for all three DiNP metabolites in urine (appendix 2).

16

Table 4. Food items negatively associated with an increased level of phthalate metabolites in

prenatal urine among 1,670 pregnant women in SELMA.

* FFD=Full fat dairy, V=Vegetable fats/Fats, LFD=Low fat dairy, M=Meat, F=Fish. Bold regarding FFD/V

means the foodstuff; full fat dairy or vegetable fats/fats, which had a significant association with marked

phthalate, since they are grouped together.

5. DISCUSSION

5.1 Diet and uptake of phthalates in humans

Dairy and fat: Results of the current work showed that intake of several full fat dairy products

was associated with increased levels of phthalate metabolites in prenatal urine, most often

MnBP and MBzP (table 3.). In opposite, the consumption of low fat dairy products showed

association with lower levels of phthalate metabolites in urine (table 4.). When it comes to fat,

such as margarine, liquid margarine and mayonnaise, intake of these foods was also

associated with increased levels of MnBP and MBzP in urine (table 3.). Still, olive oil for

homemade dressing and olive oil for cooking at home was associated with lower levels of

MnBP and MBzP in urine (table 4.). Results of current work regarding increased levels of

MnBP in urine due to intake of dairy is in line with Schechter et al. (2013), who found DBP in

five of nine samples of dairy products other than milk in their study. Results in the current

work regarding dairy and MnBP is also to in line with Fierens et al. (2012), even if Fierens et

al. found phthalates in low fat dairy; Fierens et al. (2012) investigated phthalates in milk and

dairy products, from farm to retail. Low-fat milk available in retail contained metabolites of

Parent compound -> DEP DBP BBzP

Negative association and RGM<0.95 MEP MnBP MBzP MEHP MEHHP MEOHP MECPP MHiNP MOiNP MCiOP

Cottage cheese/day FFD/V

Low fat cream cheese/day LFD

Hard cheese/day FFD/V

Full fat milk/day FFD/V

Butter, Bregott-for cooking FFD/V FFD/V

Olive oil-for cooking FFD/V FFD/V

Olive oil-in homemade dressing FFD/V FFD/V

Low fat creme fraiche LFD LFD LFD LFD

Low fat sourmilk/yoghurt/day LFD

Semi-skimmed sour milk/day LFD

Liquid butter-for cooking FFD/V

Low fat milk/day LFD

Full fat fruit yoghurt/week FFD/V FFD/V

Sour cream FFD/V FFD/V FFD/V

Full fat sour milk/day FFD/V

Herring/mackerel F

Salmon F F

Spawn F

Seafood F

Eggs/Omelets x x x

DEHP DiNP

17

DnBP. Cheese available at retail contained metabolites of DnBP (Fierens et al., 2012). DnBP

is metabolized into MnBP why presence of DnBP in dairy indicate exposure to MnBP.

Results in current work also indicated that fat content in dairy products are decisive for

concentrations of phthalate metabolites (MnBP and MBzP) in urine. Further, results showed

that intake of fat was related to increased levels of MnBP and MBzP in urine. That was

expected since phthalates are lipophilic. Still, vegetable oil, which is also fat, was negatively

associated with concentrations of MnBP and MBzP in urine. Further studies are needed to

look upon differences in phthalate exposure between animal fat and vegetable fat. Further

studies may also include differences in processing and packaging for the different foodstuffs.

In the current work intake of full fat milk on a daily basis, was associated with increased

levels of DEHP metabolites (MEHP) in urine (Table 3). There were no other significant

association between intake of dairy and increased levels of DEHP metabolites in urine. Even

if full fat milk were associated with increased levels of DEHP metabolites results of current

work are not fully in line with other studies; Ji et al. (2010) did a pilot study (n=25) to see if a

diet change affected urinary levels of phthalates. The participants changed from a mixed diet

to a vegetarian diet for five days. Levels of phthalates was compared within an hour after

start, and within two hours before end of program. The participants reported dietary intake via

questionnaires. All phthalates analyzed were detected in all samples. Levels of phthalates

(MEP, MEOHP, and MEHHP) decreased during the program. The study made by Ji et al.

(2010) also showed that consumption of dairy increased urinary levels of phthalates (MEOHP

and MEHHP) (Ji, Lim Kho, Park & Choi, 2010). Fierens et al. (2012) investigated phthalates

in milk and dairy products, from farm to retail, and found phthalates (DEHP) in raw milk in

the dairy factory’s cooling tank. Probably due to contaminated feed. Low-fat milk available in

retail contained metabolites of DEHP. Phthalates (DEHP) was also found in butter packed in

foil (Fierens et al., 2012). Even if result of the current work showed that intake of dairy (full

fat milk) increased levels of DEHP metabolites in urine (table 3), there were more results

indicating association between intake of dairy and lower levels of DEHP metabolites in urine

(table 4), or no difference for DEHP metabolites in urine between those who consumed dairy

and those who did not (appendix 2). Results of current work regarding dairy and DEHP

metabolites is more in line with Serrano et al. (2014). They used data from the Infant

Development and Environment Study (TIDES). A cohort study with an aim to investigate

association between exposure to phthalates in pregnant women and infant reproductive

development. Serrano et al. (2014) used data from food frequency questionnaire and urine

18

samples from 656 pregnant women from US. Women reported number of servings per week

of peanut butter/nut butter, beef, seafood, poultry, other meats, spices, oils, fats, soy, and

dairy. Their result showed that intake of dairy was associated with lower concentrations of

DEHP metabolites in urine in pregnant women. According to the authors these results were

highly unexpected since foodstuff with higher fat content may contain higher weight

phthalates since they are more lipophilic, especially DEHP. The authors see a possible

explanation in the rapid metabolism of phthalates. They thereby advocate urine sample

collection 24-48 h after dietary report (Serrano et al., 2014). Weather the metabolism of

phthalates play a role in results of current work needs further investigation.

Meat: Results of the current work showed that MnBP and MBzP in urine was more associated

with intake of high fat meat/pork (table 3.). RGM values showed that women who ate high fat

meat/pork products had in mean higher concentrations of MnBP and MBzP in their urine

compared to those who did not (appendix 2.). When it comes to DEHP metabolites in urine,

result in current work indicated that these phthalates are more related to intake of other

meat/lean meat (table 3.). Dietary intake of lamb was the one meat product significant

associated with higher levels of all four DEHP metabolites in urine. RGM values showed that

women who ate meat products such as sliced meat, other meat, and liver/kidney had in mean

higher concentrations of metabolites of DEHP in their urine compared to those who did not

(appendix 2.). Results in current work for association between intake of meats (significant for

lamb and high RGM for other) and phthalates in urine is to extent in line with Schecter et al.

(2013) who examined phthalate concentrations in food. The different phthalates investigated

were found in a range from 6% to 74%. DEHP was the most frequent phthalate in all foods

tested except in beef. Pork had the highest concentration of total phthalates. Result in current

work for association between pork and MnBP and MBzP, before pork and DEHP metabolites,

is not in line with Colacino et al. (2010) who investigated associations between dietary intake

of meat and phthalate concentrations in urine. They analyzed data from the 2003–2004

National Health and Nutrition Examination Survey (NHANES) and found that metabolites of

DEHP were associated with the consumption of poultry (Colacino, Harris & Schecter, 2010).

According to Cao (2010), DEHP is most commonly exposed to humans via dietary intake of

fatty foods such as high fat meats. Still intake of several other high fat meats showed no

association with DEHP metabolites in urine in the current study. Also the strong association

between intake of lamb and all four DEHP metabolites in urine needs further investigation.

19

Fish: In the current work intake of herring/mackerel was associated with higher levels of

MBzP in urine (table 3). Still there were other fish items associated with lower levels of

MnBP and MBzP such as salmon, spawn, seafood (table 4). These results may indicate that

fat content is decisive for content of phthalates since herring and mackerel are fish with higher

fat content, and seafood has low fat content. Still salmon and spawn which were associated

with lower levels of MnBP and MBzP are higher in fat content (Livsmedelsverket, n.d.), why

further investigation is needed.

In the current work intake of fish was associated with higher levels of DEHP metabolites in

prenatal urine; Smoked mackerel/herring, “other fish”, and freshwater fish were all associated

with higher levels of DEHP metabolites (MEHP, MEHHP, MEOHP, MECPP) in urine (table

3.). The fish affecting urine concentrations of DEHP metabolites the most was freshwater

fish. Those who ate freshwater fish had in mean 20-26 % higher concentrations of DEHP

metabolites in their urine compared to those women who did not eat freshwater fish (appendix

2.). Results in current work is in line with results from Colacino et al. (2010), who found

associations between DEHP metabolites (MEHP) and fish consumption in their study. Results

are also in line with Schecter et al, (2013) who tested foods for different phthalates and found

that DEHP was most common and at the highest concentrations in fish (median

concentrations of 86 ng/g).

5.2 Method discussion

The questionnaire was answered by the SELMA-women fifteen weeks after urinary samples

were collected. Phthalate metabolites analyzed within this study are rapidly metabolized and

excreted through the body why urinary measurements of these compounds are best used to

assess recent exposure. The questionnaire asks for the woman’s dietary intake during

pregnancy. The instruction is to assess a mean dietary intake of the different foodstuffs. So,

the answers were more reflecting dietary habits during pregnancy, rather than dietary intake

for a specific day. Still it is possible that the pregnant women have changed their dietary

habits during this period. This time lap may be a bias. It is also possible that SELMA-women

were uncertain for example about the name of the fish they were consuming or whether it is

marine or freshwater.

20

Analysis in current work was done without adjustment for potential confounders which is a

limitation. Such confounding factors could be inhalation of household dust containing

phthalates, PVC-flooring, or dermal contact with products containing phthalates etc. Neither

was the result analyzed for dose-response associations.

5.3 Further studies

Results from this study gives crude information regarding phthalate exposure from intake of

dairy, fat, fish and meat. Complementary studies are needed to create evidence based dietary

advices for pregnant women, in order to reduce uptake of phthalates. Results in the current

work is based on differences between those consuming and those who don’t. Further studies

may include a dose-response analysis to see if urinary levels of investigated phthalate are

affected by higher or lower intake of different foodstuff. Analysis in current work is done

without adjustment for potential confounders which is a limitation, and further studies should

be controlled for confounders such as exposure for phthalates via inhalation and dermal

contact. The long-term aim is to identify diets reducing uptake of phthalates in pregnant

women.

6. Conclusion

Pregnant women in Sweden are exposed to phthalates. Results in the current work indicate

that pregnant women are exposed to phthalates via intake of high fat dairy, fat, high fat meat,

and fish. Additionally, results indicate that fat content is decisive for uptake of phthalates.

Still results are crude and further studies are needed to complement these findings.

21

REFRENCES

• Bergman, Å., Heindel, J. J., Kasten, T., Kidd, K. A., Jobling, S., Neira, M., …

Woodruff, T. J. (2013). The impact of endocrine disruption: a consensus statement on

the state of the science. Environ Health Perspectives, 121, 104 -106, doi:

10.1289/ehp.1205448

• Bornehag, C-G., Lundgren, B., Weschler, C. J., Sigsgaard, T., Hagerhed-Engman, L.,

& Sundell, J. (2005). Phthalates in indoor dust and their association with building

characteristics. Environmental Health Perspectives, 113(10), 1399–1404.

http://doi.org/10.1289/ehp.7809

• Bornehag, C-G., Moniruzzaman, S., Larsson, M., Lindström, C. B., Hasselgren, M.,

Bodin, A., von Kobyletzkic, L. B., Carlstedt, F., Lundin, F., Nånberg, E., Jönsson, B.

A. G., Sigsgaard, T. & Janson, S. (2012), The SELMA Study: A birth cohort study in

Sweden following more than 2000 mother–child pairs. Paediatric and Perinatal

Epidemiology, 26, 456–467. doi:10.1111/j.1365-3016.2012.01314.x

• Cao, X-L. (2010). Phthalate Esters in Foods: Sources, Occurrence, and Analytical

Methods. Comprehensive Reviews in Food Science and Food Safety, 9, 21–43. doi:

10.1111/j.1541-4337.2009.00093.x

• Casas, L., Fernández, M. F., Llop, S., Guxens, M., Ballester, F., Olea, N., Irurzun, M.

B., Rodríguez, L. S. M., Riaño, I., Tardón, A., Vrijheid, M., Calafat, A. M., & Sunyer,

J. (2011). Urinary concentrations of phthalates and phenols in a population of Spanish

pregnant women and children. Environment International, 37, 858–866 doi:

10.1016/j.envint.2011.02.012

• Colacino, J. A., Harris, T. R., & Schecter, A. (2010). Dietary intake is associated with

phthalate body burden in a nationally representative sample. Environmental Health

Perspectives, 118(7), 998–1003. http://doi.org/10.1289/ehp.0901712

• ChemSrc. n.d. Download 2017-06-16 from http://www.chemsrc.com/en/index.jsp

http://doi.org/10.1289/ehp.0901712

22

• Dodson, R. E., Nishioka, M., Standley, L. J., Perovich, L. J., Brody, J. G., & Rudel, R.

A. (2012). Endocrine disruptors and asthma-associated chemicals in consumer

products. Environmental Health Perspectives, 120(7), 935–943.

http://doi.org/10.1289/ehp.1104052

• Frederiksen, H., Jørgensen, N., & Andersson, A-M. (2010). Correlations between

phthalate metabolites in urine, serum, and seminal plasma from young danish men

determined by isotope dilution liquid chromatography tandem mass spectrometry.

J Anal Toxicol, 34 (7), 400-410. doi:10.1093/jat/34.7.400

• Fierens, T., Holderbeke, M., Willems, H., Henauw, S., & Sioen, I., (2012). Transfer of

eight phthalates through the milk chain — A case study. Environment International,

51, 1–7. doi: 10.1016/j.envint.2012.10.002

• Fromme, H., Gruber, L., Seckin, E., Raab, U., Zimmermann, S., Kiranoglu, M.,

Schlummer, M., Schwegler, U., Smolic, S., Völkel, W. (2011). Phthalates and their

metabolites in breast milk--results from the Bavarian monitoring of breast milk

(BAMBI). Environ International, 37(4),715-22. doi: 10.1016/j.envint.2011.02.008.

• Jahreis, S., Trump, S., Bauer, M., Bauer, T., Thürmann, L., Feltens, R., Wang, Q., Gu,

L., Grützmann, K., Röder, S., Averbeck, M., Weichenhan, D., Plass, C., Sack, U.,

Borte, M., Dubourg, V., Schüürmann, G., Simon, J., Bergen, M., Hackermüller, J.,

Eils, R., Lehmann, I., Polte, T. (2017). Maternal phthalate exposure promotes allergic

airway inflammation over 2 generations through epigenetic modifications. Journal of

Allergy and Clinical Immunology, doi.org/10.1016/j.jaci.2017.03.017.

• Jarošová, A. (2006). Phthalic acid esters (PAEs) in the food chain. Czech J. Food Sci.,

24, 223–231.

• Jensen, M. S., Nørgaard-Pedersen, B., Toft, G., Hougaard, D. M., Bonde, J. P., Cohen,

A., Jönsson, B. A. G. (2012). Phthalates and perfluorooctanesulfonic acid in human

amniotic fluid: temporal trends and timing of amniocentesis in pregnancy.

http://doi.org/10.1289/ehp.1104052

23

Environmental Health Perspectives, 120(6), 897–903.

http://doi.org/10.1289/ehp.1104522

• Ji, K., Lim Kho, Y., Park, Y., & Choi, K. (2010) Influence of a five-day vegetarian

diet on urinary levels of antibiotics and phthalate metabolites: a pilot study with

"Temple Stay" participants. Environ Research, 110,375–382.

• Kato, K., Silva, M. J., Reidy, J. A., Hurtz, D., Malek, N. A., Needham, L. L., …

Calafat, A. M. (2004). Mono(2-ethyl-5-hydroxyhexyl) phthalate and mono-(2-ethyl-5-

oxohexyl) phthalate as biomarkers for human exposure assessment to di-(2-

ethylhexyl) phthalate. Environmental Health Perspectives, 112(3), 327–330.

• Koch, H. M., Rossbach, B., Drexler, H., & Angerera, J. (2003). Internal exposure of

the general population to DEHP and other phthalates—determination of secondary and

primary phthalate monoester metabolites in urine. Environmental Research. 93, 177–

185.

• Langer, S., Bekö, G., Weschler, C. J., Brive, L. M., Toftum, J., Callesen, M., &

Clausen, G. (2014). Phthalate metabolites in urine samples from Danish children and

correlations with phthalates in dust samples from their homes and daycare centers. Int

J Hyg Environ Health Perspectives, 217,78–87.

• Livsmedelsverket. (n.d.). Download 2017-05-14, from

https://www.livsmedelsverket.se/livsmedel-och-innehall/mat-och-dryck/fisk-och-

skaldjur

• Mose, T., Mortensen, G. K., Hedegaard, M., & Knudsen, L. E. (2007). Phthalate

monoesters in perfusate from a dual placenta perfusion system, the placenta tissue and

umbilical cord blood. Reproductive Toxicology (Elmsford, N.Y.), 23(1), 83-91. doi:

10.1016/j.reprotox.2006.08.006

http://doi.org/10.1289/ehp.1104522

24

• Montuori, P., Jover, E., Morgantini, M., Bayona, J. M., & Triassi, M. (2008).

Assessing human exposure to phthalic acid and phthalate esters from mineral water

stored in polyethylene terephthalate and glass bottles. Food Additives &

Contaminants, Part A, 25:4, 511-518.

• Perng, W., Watkins, D. J., Cantoral, A., Mercado-García, A., Meeker, J. D., Téllez-

Rojo, M. M., & Peterson, K. E. (2017). Exposure to phthalates is associated with lipid

profile in peripubertal Mexican youth. Environmental Research, 154, 311–317.

http://doi.org/10.1016/j.envres.2017.01.033

• Polańska, K., Ligocka, D., Sobala, W., Hanke, W. (2016). Effect of environmental

phthalate exposure on pregnancy duration and birth outcomes. Int J Occup Med

Environ Health. 29(4):683-97. doi: 10.13075/ijomeh.1896.00691.

• Rudel, R. A., Gray, J. M., Engel, C. L., Rawsthorne, T. W., Dodson, R. E., Ackerman,

J. M., … Brody, J. G. (2011). Food packaging and bisphenol A and bis(2-Ethyhexyl)

phthalate exposure: findings from a dietary intervention. Environmental Health

Perspectives, 119(7), 914–920. http://doi.org/10.1289/ehp.1003170

• Schecter, A., Lorber, M., Guo, Y., Wu, Q., Yun, S. H., Kannan, K., … Birnbaum, L.

S. (2013). Phthalate concentrations and dietary exposure from food purchased in New

York State. Environmental Health Perspectives, 121(4), 473–479.

http://doi.org/10.1289/ehp.1206367

• Selmastudien. (n.d.). Download 2017-05-14, from http://www.selmastudien.se

• Serrano, S. E., Karr, C. J., Seixas, N. S., Nguyen, R. H. N., Barrett, E. S., Janssen, S.,

… Sathyanarayana, S. (2014). Dietary phthalate exposure in pregnant women and the

impact of consumer practices. International Journal of Environmental Research and

Public Health, 11(6), 6193–6215. http://doi.org/10.3390/ijerph110606193

• Shu, H., (2010). Phthalate exposure in a Canadian birth cohort at three months of

age: exposure sources and the influence of socioeconomic status. (B.A. Health

25

Sciences, Simon Fraser University). Download from url:

http://summit.sfu.ca/system/files/iritems1/12117/etd7095_HShu.pdf

• Shu, H., Jönsson, B., Genning, C., Lindh, C. H., Svensson, Å., Nånberg, E., Knutz,

M., Takaro, T. K., & Bornehag C-G. (Manuscript in preparation) Temporal trends in

phthalate exposures in the Swedish birth cohort SELMA study, 2007-2010.

• Swan, S. H., Sathyanarayana, S., Barrett, E. S., Janssen, S., Liu, F., Nguyen, R. H. N.,

… Alcedo, G. (2015). First trimester phthalate exposure and anogenital distance in

newborns. Human Reproduction (Oxford, England), 30(4), 963–972.

http://doi.org/10.1093/humrep/deu363

• Takaro, T.K., Diamond, M., Gobas, F., Otton, V., & Shu, H. (2010) Critical review of

phthalates in Canadian indoor environments. Health Canada, Safe Environments

Program, Ottawa, Ontario; March 31, 1–128.

• Tran, N. Q. V., & Miyake, K. (2017). Neurodevelopmental disorders and

environmental toxicants: Epigenetics as an underlying mechanism. International

Journal of Genomics, 2017, 7526592. http://doi.org/10.1155/2017/7526592

• Wan, HT., Leung, PY., Zhao, YG., Wei, X., Wong, MH., & Wong, CKC. (2013).

Blood plasma concentrations of endocrine disrupting chemicals in Hong Kong

populations. J Hazard Mater, 261, 763–769. doi: 10.1016/j.jhazmat.2013.01.034

• Wittassek, M., Koch, H. M., Angerer, J. & Brüning, T. (2011). Assessing exposure to

phthalates – The human biomonitoring approach. Molecular Nutrition & Food

Research., 55, 7–31. doi:10.1002/mnfr.201000121

• Ye, X., Pierik, F. H., Hauser, R., Duty, S., Angerer, J., Park, M. M., … Longnecker,

M. P. (2008). Urinary metabolite concentrations of organophosphorous pesticides,

bisphenol A, and phthalates among pregnant women in Rotterdam, the Netherlands:

The Generation R Study. Environmental Research, 108(2), 260–267.

http://doi.org/10.1016/j.envres.2008.07.014

26

Appendix 1.

Table A1. Distribution of answers on the food frequency questionnaire to 1,670 pregnant

women in SELMA. Question: “How often on average do You eat the Following?”.

Instruction: “Fill in the number of times per month or per week or per day, that means only

one cross per line. Put a cross in the 0-box if you rarely or never eat the commodity.”

Rarely/never 1-3 times/month 1-2 times/week3-4 times/week 5-6 times/week 1 times/day 2 times/day 3+times/day

MEAT no. no. no. no. no. no. no.

Beef 141 439 842 203 8 5 1

Pork slices/in pot 346 631 600 48 4 4 1

Meat of game animals 1053 382 134 43 8 3

Lamb 1457 137 28 3 1

Other meat 1103 230 161 24 4 2

Minced beef dishes 86 210 1132 192 14 3

Lean Sausage 1159 307 118 4

Falukorv sausage 306 781 525 14 2 1

Other sausage 608 732 255 8 1

Black pudding/blood sausage 1131 437 57 2 1

Liver/kidney 1592 26 5 2 2

Sliced meat 237 348 496 363 90 71 28 2

Sausage cuts 798 425 285 83 18 12 5 1

Bacon 366 911 332 21 3 2

FISH

Smoked mackerel/herring/others 1388 211 29 6

Herring mackerel 1065 503 55 13 1

Salmon 452 878 301 7 1 1

Cod/coalfish, saithe/fish fingers 308 906 419 6 1 1

Tuna 986 566 83 3 1

Freshwater fish 1567 55 7 1

Other fish 1119 384 90 3 2

Spawn 1386 235 5

Caviar (Kalles) 692 510 319 84 13 15

Seafood 461 992 180 5 2

Chicken/Other bird 89 479 961 110 7 2

Eggs/omelets 90 422 791 271 46 26 2

FAT/DAIRY

Icecream 165 795 522 143 17 7 1

Mayonnaise light/fat free 1298 307 29 1 1

Mayonnaise 1104 455 71 6 1

Creme fraiche light/fat free 509 426 552 137 11 1

Creme fraiche 645 543 374 63 10 3

Cream 414 713 412 95 8 4 2

Cooking cream 346 491 630 154 18 3

Sour cream 739 738 146 10 2 2

Coffee cream 1564 57 7 4 1 2

27


women in SELMA. Question: “What types of fat do You usually use? For cooking? In

homemade dressing? (multiple choice possible)”


women in SELMA. Question: “How much do You drink/eat the following?” Instruction: If

you do not drink/eat any of items fill in 0. 1 glass=2 dl, 1 cup=1.5 dl. Fill in each line per day

or per week.

Fat for cooking: No. do not use: No. usually use:

Butter, bregott 1175 489

Liquid butter 1263 401

Olive oil 835 828

Corn oil or sunflower oil 1421 242

Margarine for cooking 1258 406

Liquid margarine 979 685

Rape oil 1083 581

Fat in homemade dressing: No. do not use: No. usually use:

Olive oil 825 830

Corn oil or sunflower oil 1536 118

Rape oil 1238 417

Other oil 1605 50

None 1261 394

28

Quantity-> 0 0.5 0.75 1 1.5 2 2,3 2.5 3 3.5 3.75 4 4.5 5 6 7 7.5 8 9

Skimmed milk/Low-fat milk glass/d 995 1 115 4 107 2 49 15 7 4

Skimmed milk/Low-fat milk glass/w 618 1 27 35 1 34 15 15 7 7 3 1

Semi-skimmed milk glass/d 553 12 248 8 193 3 74 2 36 1 21 7 4

Semi-skimmed milk glass/w 313 49 1 92 1 74 42 37 18 39 1 6 4

Full-fat milk glass/d 1109 4 51 2 52 1 1 15 5 3 1 1 1

Full-fat milk glass/w 666 1 50 38 1 16 16 15 2 10 2 2

Fruit yoghurt glass/d 735 8 1 151 3 40 6 2

Fruit yoghurt glass/w 412 9 2 191 4 172 2 92 1 35 1 29 7 16 2

Low-fat sour milk/yoghurt glass/d 953 2 107 6 49 6 2 1 1

Low-fat sour milk/yoghurt glass/w 578 2 72 1 94 55 20 28 5 23 1

Semi-skimmed sour milk glass/d 1094 69 5 35 1 2 1 2

Semi-skimmed sour milk glass/w 701 39 1 39 13 1 16 23 8 8 1

Sour milk/yoghurt glass/d 668 6 1 180 15 66 1 17 4 3 2 3

Sour milk/yoghurt glass/w 401 1 2 126 2 157 2 99 1 47 1 42 19 24 3 1

Quantity-> 10 10.5 11 12 13 14 15 16 20 21 25 28 30 35 40 49 50 56

Skimmed milk/Low-fat milk glass/d

Skimmed milk/Low-fat milk glass/w 7 2 9 3 2 1

Semi-skimmed milk glass/d 2 1

Semi-skimmed milk glass/w 21 2 3 11 5 2 2 4 1 2 1 1 1 1

Full-fat milk glass/d 1

Full-fat milk glass/w 3 7 2 1 1 1 1

Fruit yoghurt glass/d 1

Fruit yoghurt glass/w 3 2 1 1

Low-fat sour milk/yoghurt glass/d

Low-fat sour milk/yoghurt glass/w 3 1 4 1 1 1

Semi-skimmed sour milk glass/d

Semi-skimmed sour milk glass/w 3 2 1

Sour milk/yoghurt glass/d 1

Sour milk/yoghurt glass/w 9 1 1 6 1 2

29


women in SELMA. Question: “How much do You drink/eat the following?” Instruction: If

you do not drink/eat any of items fill in 0. 1 glass=2 dl, 1 cup=1.5 dl. Fill in each line per day

or per week.

30

Quantity-> 0 0.25 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 6 6.5 7 8 9

Cottage cheese, kvarq tbsp/day 1019 1 7 1 14 3 6 2

Cottage cheese, kvarq tbsp/week 603 3 70 85 55 2 31 38 13 5 1

Cream cheese-low fat tbsp/d 1175 1 15 9 1 1

Cream cheese-low fat tbsp/w 766 1 29 26 15 1 10 5 2 1 1

Cream cheese tbsp/d 977 1 36 20 8 2 1 1

Cream cheese tbsp/w 621 4 114 97 42 1 32 17 4 4 2

Hard cheese-low fat slides/d 983 17 1 84 25 1 47 6 10 1 2

Hard cheese-low fat slides/w 652 6 27 12 27 23 20 5 5 1

Hard cheese slides/d 266 1 73 265 82 214 38 60 5 25 3

Hard cheese slides/w 182 13 38 31 70 62 62 24 37 3

Dessert cheese tbsp/d 1169 7 1

Dessert cheese tbsp/w 753 4 65 32 13 9 2 1

Liver pate-light tbsp/d 1221 7 2 1 1 1 1

Liver pate-light tbsp/w 795 12 13 5 7 7 3

Liver pate tbsp/d 632 4 64 2 55 1 20 10 2 3

Liver pate tbsp/w 380 1 3 170 202 110 2 74 58 26 9 10

Slice bread with butter/margarine/d 80 71 6 459 20 234 7 241 3 46 33 1 7 8

Slice bread with butter/margarine/w 50 1 7 1 15 10 38 19 22 23 23 8

Quantity-> 10 11 12 13 13.5 14 15 16 17 18 19 20 21 22 23 24 25

Cottage cheese, kvarq tbsp/day

Cottage cheese, kvarq tbsp/week 22 2 1 2 3

Cream cheese-low fat tbsp/d

Cream cheese-low fat tbsp/w 1

Cream cheese tbsp/d 1

Cream cheese tbsp/w 6 1

Hard cheese-low fat slides/d 1 1

Hard cheese-low fat slides/w 24 4 4 5 1 1 2

Hard cheese slides/d 16 2 4 1


Dessert cheese tbsp/d

Dessert cheese tbsp/w 1

Liver pate-light tbsp/d

Liver pate-light tbsp/w 1

Liver pate tbsp/d 2

Liver pate tbsp/w 22 1 7 4 3 2

Slice bread with butter/margarine/d 1 1 1

Slice bread with butter/margarine/w 49 2 11 3 42 10 11 6 11 1 12 9 1 1 2 4

Quantity-> 27 28 30 32 33 35 40 42 43 45 56 58 60 63 70 84

Cottage cheese, kvarq tbsp/day

Cottage cheese, kvarq tbsp/week 1

Cream cheese-low fat tbsp/d

Cream cheese-low fat tbsp/w

Cream cheese tbsp/d

Cream cheese tbsp/w

Hard cheese-low fat slides/d 1

Hard cheese-low fat slides/w 3 2 1

Hard cheese slides/d


Dessert cheese tbsp/d

Dessert cheese tbsp/w

Liver pate-light tbsp/d

Liver pate-light tbsp/w

Liver pate tbsp/d

Liver pate tbsp/w 1

Slice bread with butter/margarine/d

Slice bread with butter/margarine/w 1 7 7 2 1 5 2 1 1

31

Appendix 2.

Tables below show associations between SELMA-women’s reported dietary intake of foods,

and phthalates measured in their urine. Association’s marked light green has high RGM

values, those marked darker green has high RGM values (>1.05) and significant associations.

Association’s marked light red has low RGM values (<0.95), those marked darker red has low

RGM values and significant negative associations.

32

Freq. Log-Mean Freq. Log-MeanLiquid butter- for cooking 1263 1,55 401 1,62 0,01 1,05 1,17

Low fat creme fraiche 509 1,54 1161 1,58 0,12 1,03 1,10

Falukorv sausage 306 1,54 1364 1,57 0,28 1,02 1,07

Eggs/Omelets 90 1,54 1580 1,57 0,56 1,02 1,07

Low fat sourmilk/yoghurt/week 578 1,55 1092 1,58 0,23 1,02 1,07

Low fat cream cheese/week 766 1,55 904 1,58 0,26 1,02 1,07

Other meat 1103 1,56 567 1,59 0,25 1,02 1,07

Pizza 327 1,55 1343 1,57 0,51 1,01 1,05

Cod/Saithe/Fishfingers 308 1,55 1362 1,57 0,56 1,01 1,05

Ice cream 165 1,55 1505 1,57 0,57 1,01 1,05

Low fat milk/week 618 1,56 1052 1,58 0,67 1,01 1,05

Cream cheese/week 621 1,56 1049 1,58 0,36 1,01 1,05

Semi-skimmed milk/week 313 1,56 1357 1,57 0,66 1,01 1,02

Low fat hard cheese/week 652 1,56 1018 1,57 0,55 1,01 1,02

Low fat liverpate/week 795 1,56 875 1,57 0,72 1,01 1,02

Liquid margarine-for cooking 979 1,56 685 1,57 0,73 1,01 1,02

No fat in dressing 1261 1,56 394 1,57 0,73 1,01 1,02

Spawn 1386 1,57 284 1,58 0,61 1,01 1,02

Fruit yoghurt/week 412 1,57 1258 1,57 0,97 1,00 1,00

Low fat sourmilk/yoghurt/day 953 1,57 717 1,57 0,93 1,00 1,00

Semi-skimmed sour milk/week 701 1,57 969 1,57 0,83 1,00 1,00

Sour milk/week 401 1,57 1269 1,57 0,88 1,00 1,00

Cottage cheese/week 603 1,57 1067 1,57 0,78 1,00 1,00

Dessert cheese/week 753 1,57 917 1,57 0,98 1,00 1,00

Beef 141 1,57 1529 1,57 0,95 1,00 1,00

Pork 346 1,57 1324 1,57 0,83 1,00 1,00

Minced beef dishes 86 1,57 1584 1,57 0,99 1,00 1,00

Lean sausage 1159 1,57 511 1,57 0,96 1,00 1,00

Other sausage 608 1,57 1062 1,57 0,97 1,00 1,00

Liver/kidney 1592 1,57 78 1,57 0,96 1,00 1,00

Sliced meat 237 1,57 1433 1,57 0,91 1,00 1,00

Sausage cuts 798 1,57 872 1,57 0,98 1,00 1,00

Tuna 986 1,57 684 1,57 0,99 1,00 1,00

Other fish 1119 1,57 551 1,57 0,8 1,00 1,00

Seafood 461 1,57 1209 1,57 0,97 1,00 1,00

Cocking cream 346 1,57 1324 1,57 0,98 1,00 1,00

Sour cream 739 1,57 931 1,57 0,8 1,00 1,00

Olive oil-for cooking 835 1,57 828 1,57 0,93 1,00 1,00

Corn-/sunfloweroil-for cooking 1421 1,57 242 1,57 0,99 1,00 1,00

Olive oil-in dressing 825 1,57 830 1,57 0,94 1,00 1,00

Corn-/sunfloweroil-in dressing 1536 1,57 118 1,57 0,96 1,00 1,00

Low fat milk/day 995 1,57 675 1,56 0,54 0,99 0,98

Full fat milk/week 666 1,57 1004 1,56 0,71 0,99 0,98

Sour milk/day 668 1,57 1002 1,56 0,64 0,99 0,98

Low fat hard cheese/day 983 1,57 687 1,56 0,47 0,99 0,98

Game 1053 1,57 617 1,56 0,62 0,99 0,98

Lamb 1457 1,57 213 1,56 0,82 0,99 0,98

Rape oil-in dressing 1238 1,57 417 1,56 0,62 0,99 0,98

Hard cheese/week 182 1,59 1488 1,57 0,45 0,99 0,95

Buttered bread/week 50 1,59 1620 1,57 0,8 0,99 0,95

Chicken/other bird 89 1,59 1581 1,57 0,57 0,99 0,95

Semi-skimmed milk/day 553 1,58 1117 1,56 0,5 0,99 0,95

Fruit yoghurt/day 735 1,58 935 1,56 0,33 0,99 0,95

Liver pate/day 632 1,58 1038 1,56 0,31 0,99 0,95

Salmon 452 1,58 1218 1,56 0,42 0,99 0,95

Caviar-"Kalles" 692 1,58 978 1,56 0,46 0,99 0,95

Cream 414 1,58 1256 1,56 0,46 0,99 0,95

Black pudding 1131 1,57 539 1,55 0,39 0,99 0,95

Smoked mackerel/herring/others 1388 1,57 282 1,55 0,44 0,99 0,95

Margarine-for cooking 1258 1,57 406 1,55 0,52 0,99 0,95

Liver pate/week 380 1,59 1290 1,56 0,17 0,98 0,93

Creme fraiche 645 1,59 1025 1,56 0,21 0,98 0,93

Semi-skimmed sour milk/day 1094 1,58 576 1,55 0,23 0,98 0,93

Cream cheese/day 977 1,58 693 1,55 0,16 0,98 0,93

Low fat liver pate/day 1221 1,58 449 1,55 0,26 0,98 0,93

Rape oil-for cooking 1083 1,58 581 1,55 0,21 0,98 0,93

Freshwater fish 1567 1,57 103 1,54 0,42 0,98 0,93

Buttered bread/day 80 1,61 1590 1,57 0,37 0,98 0,91

Bacon 366 1,6 1304 1,56 0,16 0,98 0,91

Dessert cheese/day 1169 1,58 501 1,54 0,09 0,97 0,91

Herring/mackerel 1065 1,58 605 1,54 0,09 0,97 0,91

Mayonnaise 1104 1,58 566 1,54 0,08 0,97 0,91

Other oil-in dressing 1605 1,57 50 1,53 0,49 0,97 0,91

Panncakes 323 1,61 1347 1,56 0,04 0,97 0,89

Low fat cream cheese/day 1175 1,58 495 1,53 0,02 0,97 0,89

Coffee cream 1564 1,57 106 1,52 0,19 0,97 0,89

Hard cheese/day 266 1,62 1404 1,56 0,03 0,96 0,87

Full fat milk/day 1109 1,59 561 1,53 0,01 0,96 0,87

Cottage cheese/day 1019 1,59 651 1,53 0,01 0,96 0,87

Butter, Bregott-for cooking 1175 1,59 489 1,52 0,01 0,96 0,85

RGMFoods in relation with MEPDo not consume Does consume

P-Value Ratio

33

Freq. Log-Mean Freq. Log-Mean

Margarine-for cooking 1258 0,8 406 0,9 0 1,13 1,26

Other oil-for dressing 1605 0,83 50 0,92 0,13 1,11 1,23

No fat in dressing 1261 0,81 394 0,89 0 1,10 1,20

Full fat milk/day 1109 0,81 561 0,87 0 1,07 1,15

Bacon 366 0,79 1304 0,84 0,03 1,06 1,12


Mayonnaise 1104 0,81 566 0,86 0,01 1,06 1,12


Ice cream 165 0,79 1505 0,83 0,28 1,05 1,10

Pizza 327 0,8 1343 0,84 0,18 1,05 1,10


Sausage cuts 798 0,81 872 0,85 0,03 1,05 1,10

Freshwater fish 1567 0,83 103 0,87 0,28 1,05 1,10


Panncakes 323 0,81 1347 0,84 0,25 1,04 1,07


Coffee cream 1564 0,83 106 0,86 0,47 1,04 1,07

Corn-/sunfloweroil in dressing 1536 0,83 118 0,86 0,37 1,04 1,07

Eggs/omelets 90 0,81 1580 0,83 0,58 1,02 1,05

Other sausage 608 0,82 1062 0,84 0,27 1,02 1,05

Tuna 986 0,82 684 0,84 0,4 1,02 1,05



Cream 414 0,82 1256 0,83 0,65 1,01 1,02

Sour cream 739 0,82 931 0,83 0,61 1,01 1,02

Cream cheese/day 977 0,83 693 0,84 0,56 1,01 1,02

Other Fish 1119 0,83 551 0,84 0,52 1,01 1,02




Sour milk/day 668 0,83 1002 0,83 0,71 1,00 1,00

Sour milk/week 401 0,83 1269 0,83 0,63 1,00 1,00




Low fat liver pate/week 795 0,83 875 0,83 0,64 1,00 1,00

Liver pate/day 632 0,83 1038 0,83 0,97 1,00 1,00

Liver pate/week 380 0,83 1290 0,83 0,84 1,00 1,00


Pork 346 0,83 1324 0,83 0,84 1,00 1,00

Game 1053 0,83 617 0,83 0,88 1,00 1,00

Black pudding 1131 0,83 539 0,83 0,8 1,00 1,00

Sliced meat 237 0,83 1433 0,83 0,88 1,00 1,00

Smoked mackerel/Herring/others 1388 0,83 282 0,83 0,95 1,00 1,00

Caviar-"Kalles" 692 0,83 978 0,83 0,72 1,00 1,00

Creme fraiche 645 0,83 1025 0,83 0,75 1,00 1,00





Lean sausage 1159 0,83 511 0,82 0,53 0,99 0,98

Hard cheese/day 266 0,85 1404 0,83 0,48 0,98 0,95

Hard cheese/week 182 0,85 1488 0,83 0,55 0,98 0,95




Liver/kidney 1592 0,83 78 0,81 0,73 0,98 0,95


Beef 141 0,86 1529 0,83 0,44 0,97 0,93

Chicken/Other bird 89 0,86 1581 0,83 0,45 0,97 0,93

Low fat milk/week 618 0,85 1052 0,82 0,2 0,96 0,93






Other meat 1103 0,84 567 0,81 0,22 0,96 0,93

Lamb 1457 0,83 213 0,8 0,21 0,96 0,93

Cocking cream 346 0,86 1324 0,82 0,18 0,95 0,91



Spawn 1386 0,84 284 0,79 0,05 0,94 0,89

Seafood 461 0,87 1209 0,81 0,01 0,93 0,87

Low fat milk/day 995 0,85 675 0,79 0 0,93 0,87


Low fat creme fraiche 509 0,88 1161 0,81 0 0,92 0,85

Liquid butter-for cooking 1263 0,85 401 0,78 0,01 0,92 0,85

Salmon 452 0,89 1218 0,81 0 0,91 0,83

Olive oil-for cooking 835 0,87 828 0,79 0 0,91 0,83

Olive oil-in dressing 825 0,88 830 0,78 0 0,89 0,79

RGMFoods in relation with MBzPDoes not consume Does consume

P-Value Ratio

34

Freq. Log-Mean Freq. Log-MeanMargarine-for cookin 1258 1,5 406 1,55 0 1,03 1,12


Full fat milk/day 1109 1,5 561 1,54 0 1,03 1,10

Freshwater fish 1567 1,51 103 1,55 0,13 1,03 1,10

Bacon 366 1,49 1304 1,52 0,03 1,02 1,07

Eggs/Omelets 90 1,49 1580 1,52 0,41 1,02 1,07

Cream 414 1,49 1256 1,52 0,02 1,02 1,07

Sour milk/day 668 1,5 1002 1,53 0,02 1,02 1,07

Cream cheese/day 977 1,5 693 1,53 0,07 1,02 1,07

Mayonnaise 1104 1,5 566 1,53 0,03 1,02 1,07


Sour milk/week 401 1,5 1269 1,52 0,38 1,01 1,05


Hard cheese/day 266 1,5 1404 1,52 0,46 1,01 1,05

Other sausage 608 1,5 1062 1,52 0,18 1,01 1,05

Creme fraiche 645 1,5 1025 1,52 0,14 1,01 1,05

Liver/kidney 1592 1,51 78 1,53 0,53 1,01 1,05


Other Fish 1119 1,51 551 1,53 0,17 1,01 1,05

Coffee cream 1564 1,51 106 1,53 0,48 1,01 1,05







Panncakes 323 1,51 1347 1,52 0,55 1,01 1,02

Pizza 327 1,51 1343 1,52 0,53 1,01 1,02

Lamb 1457 1,51 213 1,52 0,82 1,01 1,02

Black pudding 1131 1,51 539 1,52 0,46 1,01 1,02

Sausage cuts 798 1,51 872 1,52 0,66 1,01 1,02

Smoked mackerel/Herring/Others 1388 1,51 282 1,52 0,55 1,01 1,02

Tuna 986 1,51 684 1,52 0,28 1,01 1,02

Sour cream 739 1,51 931 1,52 0,46 1,01 1,02


Low fat milk/week 618 1,51 1052 1,51 0,92 1,00 1,00


Semi-skimmer sour milk/day 1094 1,51 576 1,51 0,98 1,00 1,00






Other meat 1103 1,51 567 1,51 0,95 1,00 1,00


Sliced meat 237 1,51 1433 1,51 0,67 1,00 1,00

Ice cream 165 1,51 1505 1,51 0,66 1,00 1,00

Other oil-dressing 1605 1,51 50 1,51 0,95 1,00 1,00

Low fat milk/day 995 1,52 675 1,51 0,54 0,99 0,98






Liver pate/day 632 1,52 1038 1,51 0,76 0,99 0,98

Liver pate/week 380 1,52 1290 1,51 0,64 0,99 0,98

Pork 346 1,52 1324 1,51 0,71 0,99 0,98

Game 1053 1,52 617 1,51 0,76 0,99 0,98

Lean sausage 1159 1,52 511 1,51 0,65 0,99 0,98


Spawn 1386 1,52 284 1,51 0,62 0,99 0,98

Caviar-"Kalles" 692 1,52 978 1,51 0,45 0,99 0,98

Seafood 461 1,52 1209 1,51 0,39 0,99 0,98

Cocking cream 346 1,52 1324 1,51 0,46 0,99 0,98









Hard cheese/week 182 1,53 1488 1,5 0,36 0,98 0,93




Beef 141 1,55 1529 1,51 0,13 0,97 0,91

Salmon 452 1,54 1218 1,5 0,02 0,97 0,91



RGMFoods in relation with MnBPDoes not consume Does consume

P-Value Ratio

35

Freq. Log-Mean Freq. Log-MeanLamb 1457 0,14 213 0,24 0 1,71 1,26

Liver/kidney 1592 0,15 78 0,23 0,07 1,53 1,20

Freshwater fish 1567 0,15 103 0,23 0,04 1,53 1,20

Coffee cream 1564 0,15 106 0,22 0,07 1,47 1,17

Sliced meat 237 0,12 1433 0,16 0,15 1,33 1,10


Full fat milk/day 1109 0,14 561 0,18 0,01 1,29 1,10

Other Fish 1119 0,14 551 0,18 0,03 1,29 1,10


Eggs/Omelets 90 0,13 1580 0,16 0,55 1,23 1,07

Sausage cuts 798 0,14 872 0,17 0,17 1,21 1,07

Caviar-"Kalles" 692 0,14 978 0,17 0,5 1,21 1,07

Other meat 1103 0,15 567 0,18 0,1 1,20 1,07

Mayonnaise 1104 0,15 566 0,18 0,11 1,20 1,07


Sour milk/day 668 0,14 1002 0,16 0,28 1,14 1,05

Hard cheese/day 266 0,14 1404 0,16 0,32 1,14 1,05

Bacon 366 0,14 1304 0,16 0,51 1,14 1,05


Cream cheese/day 977 0,15 693 0,17 0,16 1,13 1,05

Lean sausage 1159 0,15 511 0,17 0,29 1,13 1,05












Beef 141 0,15 1529 0,16 0,78 1,07 1,02

Pork 346 0,15 1324 0,16 0,78 1,07 1,02


Black pudding 1131 0,15 539 0,16 0,64 1,07 1,02

Salmon 452 0,15 1218 0,16 0,8 1,07 1,02

Creme fraiche 645 0,15 1025 0,16 0,79 1,07 1,02

Cream 414 0,15 1256 0,16 0,5 1,07 1,02


Sour milk/week 401 0,16 1269 0,16 0,94 1,00 1,00




Liver pate/day 632 0,16 1038 0,16 0,99 1,00 1,00


Tuna 986 0,16 684 0,16 0,97 1,00 1,00


Cocking cream 346 0,16 1324 0,16 0,98 1,00 1,00




Light milk/day 995 0,16 675 0,15 0,49 0,94 0,98






Game 1053 0,16 617 0,15 0,77 0,94 0,98

Other sausage 608 0,16 1062 0,15 0,58 0,94 0,98




Low fat milk/week 618 0,17 1052 0,15 0,44 0,88 0,95



Liver pate/week 380 0,17 1290 0,15 0,3 0,88 0,95


Spawn 1386 0,16 284 0,14 0,46 0,88 0,95




Panncakes 323 0,18 1347 0,15 0,2 0,83 0,93

Seafood 461 0,18 1209 0,15 0,13 0,83 0,93


Hard cheese/week 182 0,19 1488 0,15 0,16 0,79 0,91

Pizza 327 0,19 1343 0,15 0,1 0,79 0,91

Ice cream 165 0,19 1505 0,15 0,29 0,79 0,91


Sour cream 739 0,18 931 0,14 0,03 0,78 0,91

RGMFoods in relation with MEHPDoes not consume Does consume

P-Value Ratio

36

Freq. Log-Mean Freq. Log-MeanFreshwater fish 1567 0,76 103 0,86 0,01 1,13 1,26

Lamb 1457 0,76 213 0,83 0,01 1,09 1,17

Other Fish 1119 0,75 551 0,8 0 1,07 1,12

Coffee cream 1564 0,77 106 0,81 0,26 1,05 1,10

Caviar-"Kalles" 692 0,75 978 0,78 0,09 1,04 1,07



Liver/kidney 1592 0,77 78 0,8 0,4 1,04 1,07




Full fat milk/day 1109 0,76 561 0,78 0,14 1,03 1,05

Other meat 1103 0,76 567 0,78 0,42 1,03 1,05

Sausage cuts 798 0,76 872 0,78 0,32 1,03 1,05


Mayonnaise 1104 0,76 566 0,78 0,32 1,03 1,05




Hard cheese/day 266 0,76 1404 0,77 0,59 1,01 1,02


Sliced meat 237 0,76 1433 0,77 0,51 1,01 1,02

Bacon 366 0,76 1304 0,77 0,56 1,01 1,02

Cream 414 0,76 1256 0,77 0,6 1,01 1,02

Black pudding 1131 0,77 539 0,78 0,46 1,01 1,02



Sour milk/day 668 0,77 1002 0,77 0,99 1,00 1,00

Sour milk/week 401 0,77 1269 0,77 0,93 1,00 1,00

Cream cheese/day 977 0,77 693 0,77 0,72 1,00 1,00




Liver pate/day 632 0,77 1038 0,77 0,73 1,00 1,00

Game 1053 0,77 617 0,77 0,93 1,00 1,00

Lean sausage 1159 0,77 511 0,77 0,97 1,00 1,00

Salmon 452 0,77 1218 0,77 0,92 1,00 1,00

Spawn 1386 0,77 284 0,77 0,85 1,00 1,00

Ice cream 165 0,77 1505 0,77 0,97 1,00 1,00

Creme fraiche 645 0,76 1025 0,76 0,39 1,00 1,00



Low fat milk/week 618 0,78 1052 0,77 0,56 0,99 0,98



Pork 346 0,78 1324 0,77 0,69 0,99 0,98


Seafood 461 0,78 1209 0,77 0,54 0,99 0,98

Eggs/Omelets 90 0,78 1580 0,77 0,86 0,99 0,98

Cocking cream 346 0,78 1324 0,77 0,66 0,99 0,98




Tuna 986 0,77 684 0,76 0,52 0,99 0,98



Beef 141 0,79 1529 0,77 0,41 0,97 0,95

Low fat milk/day 995 0,78 675 0,76 0,31 0,97 0,95









Hard cheese/week 182 0,8 1488 0,77 0,28 0,96 0,93




Liver pate/week 380 0,79 1290 0,76 0,11 0,96 0,93

Panncakes 323 0,79 1347 0,76 0,18 0,96 0,93

Pizza 327 0,79 1343 0,76 0,17 0,96 0,93

Other sausage 608 0,79 1062 0,76 0,14 0,96 0,93


Low fat Creme fraiche 509 0,8 1161 0,76 0,02 0,95 0,91

Sour cream 739 0,79 931 0,75 0,04 0,95 0,91




RGMFoods in relation with MEHHPDoes not consume Does consume

P-Value Ratio

37


Lamb 1457 0,59 213 0,67 0 1,14 1,20

Other Fish 1119 0,59 551 0,63 0,02 1,07 1,10


Liver/kidney 1592 0,6 78 0,64 0,32 1,07 1,10

Coffee cream 1564 0,6 106 0,64 0,22 1,07 1,10


Full fat milk/day 1109 0,6 561 0,63 0,06 1,05 1,07

Corn-/Sunfloweroil-in dressing 1536 0,6 118 0,63 0,31 1,05 1,07


Hard cheese/day 266 0,59 1404 0,61 0,41 1,03 1,05

Sliced meat 237 0,59 1433 0,61 0,42 1,03 1,05

Sausage cuts 798 0,59 872 0,61 0,28 1,03 1,05

Bacon 366 0,59 1304 0,61 0,53 1,03 1,05


Caviar-"Kalles" 692 0,59 978 0,61 0,11 1,03 1,05

Creme fraiche 645 0,59 1025 0,61 0,27 1,03 1,05

Other meat 1103 0,6 567 0,62 0,29 1,03 1,05



Mayonnaise 1104 0,6 566 0,62 0,21 1,03 1,05




Sour milk/day 668 0,6 1002 0,61 0,69 1,02 1,02

Cream cheese/day 977 0,6 693 0,61 0,74 1,02 1,02



Black pudding 1131 0,6 539 0,61 0,49 1,02 1,02

Cream 414 0,6 1256 0,61 0,6 1,02 1,02

Lean sausage 1159 0,6 511 0,6 0,87 1,00 1,00

Sour milk/week 401 0,6 1269 0,6 0,95 1,00 1,00


Liver pate/day 632 0,6 1038 0,6 0,92 1,00 1,00

Game 1053 0,6 617 0,6 0,99 1,00 1,00

Spawn 1386 0,6 284 0,6 0,97 1,00 1,00

Corn-/Sunfloweroil-for cooking 1421 0,6 242 0,6 0,86 1,00 1,00



Low fat milk/day 995 0,61 675 0,6 0,43 0,98 0,98

Low fat milk/week 618 0,61 1052 0,6 0,61 0,98 0,98



Semi-skimmed sourmilk/week 701 0,61 969 0,6 0,33 0,98 0,98








Pork 346 0,61 1324 0,6 0,58 0,98 0,98


Salmon 452 0,61 1218 0,6 0,87 0,98 0,98

Tuna 986 0,61 684 0,6 0,53 0,98 0,98

Eggs/Omelets 90 0,61 1580 0,6 0,84 0,98 0,98

Ice cream 165 0,61 1505 0,6 0,93 0,98 0,98

Cocking cream 346 0,61 1324 0,6 0,58 0,98 0,98


Panncakes 323 0,62 1347 0,6 0,24 0,97 0,95

Pizza 327 0,62 1343 0,6 0,26 0,97 0,95

Other sausage 608 0,62 1062 0,6 0,26 0,97 0,95

Seafood 461 0,62 1209 0,6 0,28 0,97 0,95

Semi-skimmed sourmilk/day 1094 0,61 576 0,59 0,25 0,97 0,95






Hard cheese/week 182 0,63 1488 0,6 0,34 0,95 0,93

Liver pate/week 380 0,63 1290 0,6 0,16 0,95 0,93

Beef 141 0,63 1529 0,6 0,35 0,95 0,93


Sour cream 739 0,62 931 0,59 0,08 0,95 0,93







RGMFoods in relation with MEO HPDoes not consume Does consume

P-Value Ratio

38


Lamb 1457 0,73 213 0,8 0 1,10 1,17

Liver/kidney 1592 0,73 78 0,78 0,2 1,07 1,12

Other Fish 1119 0,72 551 0,76 0,05 1,06 1,10


Coffee cream 1564 0,73 106 0,76 0,34 1,04 1,07



Caviar-"Kalles" 692 0,72 978 0,74 0,26 1,03 1,05

Creme fraiche 645 0,72 1025 0,74 0,27 1,03 1,05

Full fat milk/day 1109 0,73 561 0,75 0,19 1,03 1,05



Sour milk/week 401 0,73 1269 0,74 0,48 1,01 1,02





Hard cheese/day 266 0,73 1404 0,74 0,86 1,01 1,02

Other meat 1103 0,73 567 0,74 0,54 1,01 1,02

Black pudding 1131 0,73 539 0,74 0,82 1,01 1,02

Sliced meat 237 0,73 1433 0,74 0,6 1,01 1,02

Sausage cuts 798 0,73 872 0,74 0,37 1,01 1,02


Salmon 452 0,73 1218 0,74 0,75 1,01 1,02


Mayonnaise 1104 0,73 566 0,74 0,56 1,01 1,02

Cream 414 0,73 1256 0,74 0,75 1,01 1,02





Bacon 366 0,73 1304 0,73 0,93 1,00 1,00

Spawn 1386 0,73 284 0,73 0,94 1,00 1,00



Low fat milk/week 618 0,74 1052 0,73 0,93 0,99 0,98




Sour milk/day 668 0,74 1002 0,73 0,93 0,99 0,98




Cream cheese/day 977 0,74 693 0,73 0,84 0,99 0,98




Liver pate/day 632 0,74 1038 0,73 0,76 0,99 0,98

Game 1053 0,74 617 0,73 0,69 0,99 0,98

Lean sausage 1159 0,74 511 0,73 0,67 0,99 0,98

Tuna 986 0,74 684 0,73 0,46 0,99 0,98

Ice cream 165 0,74 1505 0,73 0,88 0,99 0,98


Corn-/Sunflower-for cooking 1421 0,74 242 0,73 0,82 0,99 0,98


Liver pate/week 380 0,75 1290 0,73 0,42 0,97 0,95

Panncakes 323 0,75 1347 0,73 0,26 0,97 0,95

Pork 346 0,75 1324 0,73 0,46 0,97 0,95


Seafood 461 0,75 1209 0,73 0,18 0,97 0,95

Eggs/Omelets 90 0,75 1580 0,73 0,64 0,97 0,95

Cocking cream 346 0,75 1324 0,73 0,33 0,97 0,95

Low fat milk/day 995 0,74 675 0,72 0,27 0,97 0,95






Pizza 327 0,76 1343 0,73 0,11 0,96 0,93


Other sausage 608 0,75 1062 0,72 0,07 0,96 0,93

Sour cream 739 0,75 931 0,72 0,04 0,96 0,93


Hard cheese/week 182 0,77 1488 0,73 0,11 0,95 0,91

Beef 141 0,77 1529 0,73 0,14 0,95 0,91

Low fat Creme fraiche 509 0,76 1161 0,72 0,03 0,95 0,91




RGMFoods in relation with MECPPDoes not consume Does consume

P-Value Ratio

39

Freq. Log-Mean Freq. Log-MeanMinced beef dishes 86 0,21 1584 0,34 0,06 1,62 1,35

Beef 141 0,25 1529 0,34 0,08 1,36 1,23

Sliced meat 237 0,28 1433 0,34 0,14 1,21 1,15

Cocking cream 346 0,28 1324 0,34 0,07 1,21 1,15

Bacon 366 0,29 1304 0,34 0,16 1,17 1,12

Lamb 1457 0,32 213 0,37 0,27 1,16 1,12

Spawn 1386 0,32 284 0,37 0,16 1,16 1,12


Pork 346 0,3 1324 0,34 0,2 1,13 1,10



Ice cream 165 0,3 1505 0,33 0,5 1,10 1,07




Low fat milk/day 995 0,32 675 0,35 0,21 1,09 1,07

Full fat milk/day 1109 0,32 561 0,35 0,31 1,09 1,07



Black pudding 1131 0,32 539 0,35 0,3 1,09 1,07


Panncakes 323 0,31 1347 0,33 0,46 1,06 1,05





Cream cheese/day 977 0,32 693 0,34 0,58 1,06 1,05


Other sausage 608 0,32 1062 0,34 0,52 1,06 1,05

Sausage cuts 798 0,32 872 0,34 0,37 1,06 1,05

Other Fish 1119 0,32 551 0,34 0,52 1,06 1,05


Low fat milk/week 618 0,32 1052 0,33 0,73 1,03 1,02


Liver pate/week 380 0,32 1290 0,33 0,58 1,03 1,02


Salmon 452 0,32 1218 0,33 0,81 1,03 1,02

cream 414 0,32 1256 0,33 0,55 1,03 1,02


Sour milk/week 401 0,33 1269 0,33 0,84 1,00 1,00

Cottage cheese/w 603 0,33 1067 0,33 0,81 1,00 1,00


Liver pate/day 632 0,33 1038 0,33 0,83 1,00 1,00

Pizza 327 0,33 1343 0,33 0,93 1,00 1,00

Liver/kidney 1592 0,33 78 0,33 0,99 1,00 1,00


Tuna 986 0,33 684 0,33 0,83 1,00 1,00

Caviar-"Kalles" 692 0,33 978 0,33 0,82 1,00 1,00

Mayonnaise 1104 0,33 566 0,33 0,8 1,00 1,00

Coffee cream 1564 0,33 106 0,33 0,99 1,00 1,00






Hard cheese/day 266 0,34 1404 0,33 0,66 0,97 0,98

Hard cheese/week 182 0,34 1488 0,33 0,73 0,97 0,98



Lean sausage 1159 0,33 511 0,32 0,53 0,97 0,98

Freshwater fish 1567 0,33 103 0,32 0,79 0,97 0,98






Sour cream 739 0,34 931 0,32 0,34 0,94 0,95



Seafood 461 0,35 1209 0,32 0,37 0,91 0,93

Creme fraiche 645 0,35 1025 0,32 0,31 0,91 0,93

Game 1053 0,34 617 0,31 0,19 0,91 0,93



Other meat 1103 0,34 567 0,3 0,14 0,88 0,91

Sour milk/day 668 0,36 1002 0,31 0,04 0,86 0,89




Eggs/Omelets 90 0,48 1580 0,32 0,01 0,67 0,69

RGMFoods in relation with MHiNPDoes not consume Does consume

P-Value Ratio

40

Freq. Log-Mean Freq. Log-MeanMinced beef dishes 86 -0,08 1584 0 0,18 0,00 1,20

Spawn 1386 -0,01 284 0,05 0,07 -5,00 1,15

Sliced meat 237 -0,04 1433 0,01 0,2 -0,25 1,12

Cocking cream 346 -0,04 1324 0,01 0,9 -0,25 1,12

Cream cheese/week 621 -0,03 1049 0,02 0,03 -0,67 1,12

Lamb 1457 -0,01 213 0,04 0,13 -4,00 1,12

Liver/kidney 1592 0 78 0,04 0,39 ######## 1,10

Beef 141 -0,04 1529 0 0,31 0,00 1,10

Dessert cheese/week 753 -0,02 917 0,02 0,01 -1,00 1,10

Low fat liver pate/week 795 -0,02 875 0,02 0,14 -1,00 1,10

Coffee cream 1564 0 106 0,03 0,48 ######## 1,07

Full fat milk/week 666 -0,02 1004 0,01 0,09 -0,50 1,07

Semi-skimmed sour milk/week 701 -0,02 969 0,01 0,11 -0,50 1,07

Low fat cream cheese/week 766 -0,02 904 0,01 0,16 -0,50 1,07

Bacon 366 -0,02 1304 0,01 0,37 -0,50 1,07

Cream 414 -0,02 1256 0,01 0,29 -0,50 1,07

Full fat milk/day 1109 -0,01 561 0,02 0,2 -2,00 1,07

Dessert cheese/day 1169 -0,01 501 0,02 0,35 -2,00 1,07

Low fat liver pate/day 1221 -0,01 449 0,02 0,32 -2,00 1,07

Black pudding 1131 -0,01 539 0,02 0,28 -2,00 1,07

Other Fish 1119 -0,01 551 0,02 0,31 -2,00 1,07

Ice cream 165 -0,02 1505 0 0,57 0,00 1,05

Low fat milk/day 995 -0,01 675 0,01 0,45 -1,00 1,05

Fruit yoghurt/day 735 -0,01 935 0,01 0,47 -1,00 1,05

Low fat sourmilk/yoghurt/day 953 -0,01 717 0,01 0,38 -1,00 1,05

Low fat sourmilk/yoghurt/week 578 -0,01 1092 0,01 0,39 -1,00 1,05

Cream cheese/day 977 -0,01 693 0,01 0,34 -1,00 1,05

Low fat hard cheese/day 983 -0,01 687 0,01 0,34 -1,00 1,05

Mayonnaise 1104 -0,01 566 0,01 0,43 -1,00 1,05

Liquid margarine-for cooking 979 -0,01 685 0,01 0,32 -1,00 1,05

Low fat cream cheese/day 1175 0 495 0,01 0,76 ######## 1,02

Liquid butter-for cooking 1263 0 401 0,01 0,81 ######## 1,02

Corn-/Sunfloweroil-in dressing 1536 0 118 0,01 0,8 ######## 1,02

Low fat milk/week 618 -0,01 1052 0 0,72 0,00 1,02

Semi-skimmed milk/week 313 -0,01 1357 0 0,83 0,00 1,02

Low fat hard cheese/week 652 -0,01 1018 0 0,58 0,00 1,02

Hard cheese/day 266 -0,01 1404 0 0,73 0,00 1,02

Hard cheese/week 182 -0,01 1488 0 0,77 0,00 1,02

Liver pate/week 380 -0,01 1290 0 0,61 0,00 1,02

Panncakes 323 -0,01 1347 0 0,53 0,00 1,02

Pork 346 -0,01 1324 0 0,7 0,00 1,02

Fruit yoghurt/week 412 0 1258 0 0,93 ######## 1,00

Semi-skimmed milk/day 1094 0 576 0 0,74 ######## 1,00

Sour milk/week 401 0 1269 0 0,9 ######## 1,00

Cottage cheese/week 603 0 1067 0 0,84 ######## 1,00

Liver pate/day 632 0 1038 0 0,78 ######## 1,00

Other sausage 608 0 1062 0 0,81 ######## 1,00

Sausage cuts 798 0 872 0 0,81 ######## 1,00

Tuna 986 0 684 0 0,99 ######## 1,00

Freshwater fish 1567 0 103 0 0,94 ######## 1,00

Chicken/Other bird 89 0 1581 0 0,93 ######## 1,00

Rape oil-for cooking 1083 0 581 0 0,86 ######## 1,00

Olive oil-in dressing 825 0 830 0 0,79 ######## 1,00

Cottage cheese/day 1019 0 651 -0,01 0,68 ######## 0,98

Lean sausage 1159 0 511 -0,01 0,69 ######## 0,98

Herring/mackerel 1065 0 605 -0,01 0,75 ######## 0,98

Butter, Bregott-for cooking 1175 0 489 -0,01 0,65 ######## 0,98

Corn-/Sunfloweroil-for cooking 1421 0 242 -0,01 0,66 ######## 0,98

No fat in dressing 1261 0 394 -0,01 0,79 ######## 0,98

Pizza 327 0,01 1343 0 0,63 0,00 0,98

Falukorv sausage 306 0,01 1364 0 0,78 0,00 0,98

Salmon 452 0,01 1218 0 0,75 0,00 0,98

Cod/Saithe/Fishfingers 308 0,01 1362 0 0,76 0,00 0,98

Caviar-"Kalles" 692 0,01 978 0 0,67 0,00 0,98

Semi-skimmed milk/day 553 0,01 1117 -0,01 0,4 -1,00 0,95

Game 1053 0,01 617 -0,01 0,4 -1,00 0,95

Other meat 1103 0,01 567 -0,01 0,4 -1,00 0,95

Low fat Creme fraiche 509 0,01 1161 -0,01 0,44 -1,00 0,95

Creme fraiche 645 0,01 1025 -0,01 0,54 -1,00 0,95

Sour cream 739 0,01 931 -0,01 0,41 -1,00 0,95

Smoked mackerel/Herring/Others 1388 0 282 -0,02 0,47 ######## 0,95

Sour milk/day 668 0,02 1002 -0,01 0,14 -0,50 0,93

Seafood 461 0,02 1209 -0,01 0,2 -0,50 0,93

Margarine-for cooking 1258 0,01 406 -0,02 0,38 -2,00 0,93

Rape oil-in dressing 1238 0,01 417 -0,02 0,33 -2,00 0,93

Other oil-in dressing 1605 0 50 -0,04 0,47 ######## 0,91

Olive oil-for cooking 835 0,02 828 -0,02 0,09 -1,00 0,91

Buttered bread/day 80 0,06 1590 0 0,3 0,00 0,87

Buttered bread/week 50 0,09 1620 0 0,26 0,00 0,81

Eggs/Omelets 90 0,15 1580 -0,01 0,01 -0,07 0,69

RGMFoods in relation with MO iNPDoest not consume Does consume

P-Value Ratio

41

Freq. Log-Mean Freq. Log-MeanMinced beef dishes 86 0,43 1584 0,51 0,11 1,19 1,20


Lamb 1457 0,5 213 0,56 0,05 1,12 1,15

Beef 141 0,46 1529 0,51 0,16 1,11 1,12

Sliced meat 237 0,47 1433 0,52 0,19 1,11 1,12

Cocking cream 346 0,47 1324 0,52 0,08 1,11 1,12

Semi-skimmed sourmilk/week 701 0,48 969 0,53 0,03 1,10 1,12



Spawn 1386 0,5 284 0,55 0,11 1,10 1,12

Panncakes 323 0,48 1347 0,52 0,19 1,08 1,10


Liver/kidney 1592 0,51 78 0,55 0,31 1,08 1,10

Ice cream 165 0,48 1505 0,51 0,33 1,06 1,07

Low fat milk/week 618 0,49 1052 0,52 0,13 1,06 1,07




Liver pate/week 380 0,49 1290 0,52 0,33 1,06 1,07

Pork 346 0,49 1324 0,52 0,26 1,06 1,07

Salmon 452 0,49 1218 0,52 0,39 1,06 1,07

Low fat milk/day 995 0,5 675 0,53 0,16 1,06 1,07




Full fat milk/day 1109 0,5 561 0,52 0,53 1,04 1,05


Semi-skimmed sourmilk/day 1094 0,5 576 0,52 0,36 1,04 1,05




Black pudding 1131 0,5 539 0,52 0,36 1,04 1,05


Sour milk/week 401 0,5 1269 0,51 0,55 1,02 1,02


Other sausage 608 0,5 1062 0,51 0,69 1,02 1,02

Bacon 366 0,5 1304 0,51 0,54 1,02 1,02

Cream 414 0,5 1256 0,51 0,57 1,02 1,02


Other Fish 1119 0,51 551 0,52 0,55 1,02 1,02




Cream cheese/day 977 0,51 693 0,51 0,76 1,00 1,00

Liver pate/day 632 0,51 1038 0,51 0,92 1,00 1,00

Lean sausage 1159 0,51 511 0,51 0,9 1,00 1,00

Sausage cuts 798 0,51 872 0,51 0,82 1,00 1,00




Mayonnaise 1104 0,51 566 0,51 0,97 1,00 1,00






Hard cheese/day 266 0,52 1404 0,51 0,76 0,98 0,98

Hard cheese/week 182 0,52 1488 0,51 0,7 0,98 0,98

Caviar-"Kalles" 692 0,52 978 0,51 0,66 0,98 0,98



Tuna 986 0,51 684 0,5 0,54 0,98 0,98

Freshwater fish 1567 0,51 103 0,5 0,86 0,98 0,98

Coffee cream 1564 0,51 106 0,5 0,89 0,98 0,98



Game 1053 0,52 617 0,5 0,29 0,96 0,95

Creme fraiche 645 0,52 1025 0,5 0,57 0,96 0,95

Sour cream 739 0,52 931 0,5 0,59 0,96 0,95



Pizza 327 0,53 1343 0,5 0,31 0,94 0,93

Seafood 461 0,53 1209 0,5 0,24 0,94 0,93

Other meat 1103 0,52 567 0,49 0,1 0,94 0,93



Sour milk/day 668 0,53 1002 0,49 0,07 0,92 0,91



Eggs/Omelets 90 0,63 1580 0,5 0,02 0,79 0,74

RGMFoods in relation with MCiO PDoes not consume Does consume

P-Value Ratio

42

43

44

Documents

The importance of diet for uptake of phthalates in ...kau.diva-portal.org/smash/get/diva2:1118482/FULLTEXT01.pdf · Holderbeke, Willems, Henauw & Sioen, 2012) and prepacked and processed