{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:23:15Z","timestamp":1787725395347,"version":"build-2784847793"},"reference-count":90,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Environ Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Phthalates are a group of industrial chemicals widely used in everyday products including cosmetics, food packaging and containers, plastics, and building materials. Previous studies have indicated that urinary phthalate metabolites are associated with metabolic effects including those on lipid metabolism, but the results are mixed. Furthermore, whether thyroid function mediates the association between phthalate exposure and lipid metabolism remains unclear. In the present study, we explored whether changes in thyroid function markers mediate the associations between phthalate exposure and lipid metabolism indicators in Taiwanese adults. The cross-sectional data were obtained from the Taiwan Environmental Survey for Toxicants conducted in 2013. Levels of 11 urinary phthalate metabolites, levels of 5 thyroid hormones, and 8 indicators of lipid metabolism were assessed in 222 Taiwanese adults. The relationships of urinary phthalate metabolite levels with serum thyroid hormone levels and lipid metabolism indicators were explored using multiple regression models. Mediation analysis was conducted to evaluate the role of thyroid function in the association between phthalate exposure and lipid metabolism. The metabolite of di(\u2212\u20092-ethylhexyl) phthalate (\u2211DEHPm) exhibited a significant positive association with the lipid metabolite indicator of high-density lipoprotein cholesterol (HDL-C; \u03b2\u2009=\u20090.059, 95% confidence interval [CI]\u2009=\u20090.009, 0.109) in adults, and the thyroid function indicator thyroxine (T<jats:sub>4<\/jats:sub>) had a significant negative association with the metabolite \u2211DEHPm (\u03b2\u2009=\u2009\u2212\u20090.059, 95% CI\u2009=\u2009\u2212\u20090.101, \u2212\u20090.016) and a significant negative association with HDL-C (\u03b2\u2009=\u2009\u2212\u20090.284, 95% CI\u2009=\u2009\u2212\u20090.440, \u2212\u20090.128). The T<jats:sub>4<\/jats:sub> indirect effect was 0.015 (95% CI\u2009=\u2009\u2212\u20090.0087, 0.05), and the mediation effect was 32.2%. Our results support the assumption that exposure to phthalates influences the homeostasis of lipid metabolism by interfering with thyroid function.<\/jats:p>","DOI":"10.1186\/s12940-022-00873-9","type":"journal-article","created":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T06:02:42Z","timestamp":1656655362000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Mediation effects of thyroid function in the associations between phthalate exposure and lipid metabolism in adults"],"prefix":"10.1186","volume":"21","author":[{"given":"Han-Bin","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Keng","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Ying","family":"Siao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-Ting C.","family":"Lo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Chun","family":"Chou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Chin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,7,1]]},"reference":[{"key":"873_CR1","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.1016\/j.kjms.2012.05.005","volume":"28","author":"JH Li","year":"2012","unstructured":"Li JH, Ko YC. Plasticizer incident and its health effects in Taiwan. Kaohsiung J Med Sci. 2012;28:S17\u201321.","journal-title":"Kaohsiung J Med Sci"},{"issue":"2","key":"873_CR2","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1080\/10937400902729226","volume":"12","author":"MA Kamrin","year":"2009","unstructured":"Kamrin MA. Phthalate risks, phthalate regulation, and public health: a review. J Toxicol Environ Health, Part B. 2009;12(2):157\u201374.","journal-title":"J Toxicol Environ Health, Part B"},{"issue":"5\u20136","key":"873_CR3","doi-asserted-by":"publisher","first-page":"172","DOI":"10.2298\/MPNS1406172B","volume":"67","author":"I Bajkin","year":"2014","unstructured":"Bajkin I, Bjelica A, I\u010din T, Dobri\u0107 V, Kova\u010dev-Zavi\u0161i\u0107 B, Medi\u0107-Stojanoska M. Effects of phthalic acid esters on fetal health. Med Pregl. 2014;67(5\u20136):172\u20135.","journal-title":"Med Pregl"},{"issue":"11","key":"873_CR4","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/oem.2004.017590","volume":"62","author":"R Hauser","year":"2005","unstructured":"Hauser R, Calafat AM. Phthalates and human health. Occup Environ Med. 2005;62(11):806\u201318.","journal-title":"Occup Environ Med"},{"issue":"5","key":"873_CR5","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1530\/eje.1.02128","volume":"154","author":"M Boas","year":"2006","unstructured":"Boas M, Feldt-Rasmussen U, Skakkeb\u00e6k NE, Main KM. Environmental chemicals and thyroid function. Eur J Endocrinol. 2006;154(5):599\u2013611.","journal-title":"Eur J Endocrinol"},{"issue":"16","key":"873_CR6","doi-asserted-by":"publisher","first-page":"12711","DOI":"10.1007\/s11356-015-4567-7","volume":"22","author":"C Liu","year":"2015","unstructured":"Liu C, Zhao L, Wei L, Li L. DEHP reduces thyroid hormones via interacting with hormone synthesis-related proteins, deiodinases, transthyretin, receptors, and hepatic enzymes in rats. Environ Sci Pollut Res. 2015;22(16):12711\u20139.","journal-title":"Environ Sci Pollut Res"},{"issue":"1\u20132","key":"873_CR7","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.mce.2009.02.018","volume":"304","author":"F Gr\u00fcn","year":"2009","unstructured":"Gr\u00fcn F, Blumberg B. Endocrine disrupters as obesogens. Mol Cell Endocrinol. 2009;304(1\u20132):19\u201329.","journal-title":"Mol Cell Endocrinol"},{"issue":"1\u20132","key":"873_CR8","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.mce.2009.02.017","volume":"304","author":"B Desvergne","year":"2009","unstructured":"Desvergne B, Feige JN, Casals-Casas C. PPAR-mediated activity of phthalates: a link to the obesity epidemic? Mol Cell Endocrinol. 2009;304(1\u20132):43\u20138.","journal-title":"Mol Cell Endocrinol"},{"issue":"7","key":"873_CR9","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1289\/ehp.9852","volume":"115","author":"JD Meeker","year":"2007","unstructured":"Meeker JD, Calafat AM, Hauser R. Di (2-ethylhexyl) phthalate metabolites may alter thyroid hormone levels in men. Environ Health Perspect. 2007;115(7):1029\u201334.","journal-title":"Environ Health Perspect"},{"issue":"10","key":"873_CR10","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1289\/ehp.1103582","volume":"119","author":"JD Meeker","year":"2011","unstructured":"Meeker JD, Ferguson KK. Relationship between urinary phthalate and bisphenol a concentrations and serum thyroid measures in US adults and adolescents from the National Health and nutrition examination survey (NHANES) 2007\u20132008. Environ Health Perspect. 2011;119(10):1396\u2013402.","journal-title":"Environ Health Perspect"},{"key":"873_CR11","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.envres.2016.11.014","volume":"153","author":"HB Huang","year":"2017","unstructured":"Huang HB, Pan WH, Chang JW, Chiang HC, Guo YL, Jaakkola JJ, et al. Does exposure to phthalates influence thyroid function and growth hormone homeostasis? The Taiwan environmental survey for toxicants (TEST) 2013. Environ Res. 2017a;153:63\u201372.","journal-title":"Environ Res"},{"key":"873_CR12","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1016\/j.scitotenv.2016.06.146","volume":"579","author":"W Wu","year":"2017","unstructured":"Wu W, Zhou F, Wang Y, Ning Y, Yang JY, Zhou YK. Exposure to phthalates in children aged 5\u20137 years: associations with thyroid function and insulin-like growth factors. Sci Total Environ. 2017;579:950\u20136.","journal-title":"Sci Total Environ"},{"key":"873_CR13","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1016\/j.scitotenv.2017.01.144","volume":"584","author":"C Park","year":"2017","unstructured":"Park C, Choi W, Hwang M, Lee Y, Kim S, Yu S, et al. Associations between urinary phthalate metabolites and bisphenol a levels, and serum thyroid hormones among the Korean adult population-Korean National Environmental Health Survey (KoNEHS) 2012\u20132014. Sci Total Environ. 2017;584:950\u20137.","journal-title":"Sci Total Environ"},{"key":"873_CR14","doi-asserted-by":"publisher","first-page":"S10","DOI":"10.1097\/EDE.0000000000000722","volume":"28","author":"HB Huang","year":"2017","unstructured":"Huang HB, Chuang CJ, Su PH, Sun CW, Wang CJ, Wu MT, et al. Prenatal and childhood exposure to phthalate diesters and thyroid function in a 9-year follow-up birth cohort study: Taiwan maternal and infant cohort study. Epidemiology. 2017b;28:S10\u20138.","journal-title":"Epidemiology"},{"issue":"1","key":"873_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/srep30589","volume":"6","author":"HJ Tsai","year":"2016","unstructured":"Tsai HJ, Wu CF, Tsai YC, Huang PC, Chen ML, Wang SL, et al. Intake of phthalate-tainted foods and serum thyroid hormones in Taiwanese children and adolescents. Sci Rep. 2016;6(1):1\u20139.","journal-title":"Sci Rep"},{"key":"873_CR16","doi-asserted-by":"publisher","first-page":"511","DOI":"10.3389\/fendo.2018.00511","volume":"9","author":"LH Duntas","year":"2018","unstructured":"Duntas LH, Brenta G. A renewed focus on the association between thyroid hormones and lipid metabolism. Front Endocrinol. 2018;9:511.","journal-title":"Front Endocrinol"},{"issue":"4","key":"873_CR17","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/j.jacl.2012.05.002","volume":"6","author":"PP T\u00f3th","year":"2012","unstructured":"T\u00f3th PP, Potter D, Ming EE. Prevalence of lipid abnormalities in the United States: the National Health and nutrition examination survey 2003-2006. J Clin Lipidol. 2012;6(4):325\u201330.","journal-title":"J Clin Lipidol"},{"issue":"20","key":"873_CR18","doi-asserted-by":"publisher","first-page":"3066","DOI":"10.1161\/CIRCULATIONAHA.105.539528","volume":"112","author":"PW Wilson","year":"2005","unstructured":"Wilson PW, D\u2019Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005;112(20):3066\u201372.","journal-title":"Circulation"},{"issue":"2","key":"873_CR19","doi-asserted-by":"publisher","first-page":"153","DOI":"10.2174\/1570161115666171010115119","volume":"17","author":"MA Abdul-Ghani","year":"2019","unstructured":"Abdul-Ghani MA, Jayyousi A, DeFronzo RA, Asaad N, Al-Suwaidi J. Insulin resistance the link between T2DM and CVD: basic mechanisms and clinical implications. Curr Vasc Pharmacol. 2019;17(2):153\u201363.","journal-title":"Curr Vasc Pharmacol"},{"issue":"4","key":"873_CR20","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.12.033","volume":"28","author":"X Zhou","year":"2019","unstructured":"Zhou X, Zhang D, Zhou Y, Wang F, Zhu X. Microembolic signals is associated with insulin resistance among acute ischemic stroke patients. J Stroke Cerebrovasc Dis. 2019;28(4):1070\u20137.","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"873_CR21","doi-asserted-by":"publisher","first-page":"116799","DOI":"10.1016\/j.envpol.2021.116799","volume":"278","author":"HB Huang","year":"2021","unstructured":"Huang HB, Siao CY, Lo YTC, Shih SF, Lu CH, Huang PC. Mediation effects of thyroid function in the associations between phthalate exposure and glucose metabolism in adults. Environ Pollut. 2021;278:116799.","journal-title":"Environ Pollut"},{"issue":"7","key":"873_CR22","doi-asserted-by":"publisher","first-page":"e0133782","DOI":"10.1371\/journal.pone.0133782","volume":"10","author":"PC Huang","year":"2015","unstructured":"Huang PC, Tsai CH, Liang WY, Li SS, Pan WH, Chiang HC. Age and gender differences in urinary levels of eleven phthalate metabolites in general Taiwanese population after a DEHP episode. PLoS One. 2015;10(7):e0133782.","journal-title":"PLoS One"},{"key":"873_CR23","doi-asserted-by":"publisher","first-page":"113414","DOI":"10.1016\/j.ijheh.2019.10.009","volume":"224","author":"JW Chang","year":"2020","unstructured":"Chang JW, Liao KW, Huang CY, Huang HB, Chang WT, Jaakkola JJ, et al. Phthalate exposure increased the risk of early renal impairment in Taiwanese without type 2 diabetes mellitus. Int J Hyg Environ Health. 2020;224:113414.","journal-title":"Int J Hyg Environ Health"},{"key":"873_CR24","doi-asserted-by":"publisher","first-page":"105751","DOI":"10.1016\/j.envint.2020.105751","volume":"140","author":"PC Huang","year":"2020","unstructured":"Huang PC, Waits A, Chen HC, Chang WT, Jaakkola JJ, Huang HB. Mediating role of oxidative\/nitrosative stress biomarkers in the associations between phthalate exposure and thyroid function in Taiwanese adults. Environ Int. 2020a;140:105751.","journal-title":"Environ Int"},{"issue":"1","key":"873_CR25","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1002\/mnfr.201000121","volume":"55","author":"M Wittassek","year":"2011","unstructured":"Wittassek M, Koch HM, Angerer J, Br\u00fcning T. Assessing exposure to phthalates\u2013the human biomonitoring approach. Mol Nutr Food Res. 2011;55(1):7\u201331.","journal-title":"Mol Nutr Food Res"},{"key":"873_CR26","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1016\/j.scitotenv.2017.11.048","volume":"619","author":"HB Huang","year":"2018","unstructured":"Huang HB, Kuo PL, Chang JW, Jaakkola JJ, Liao KW, Huang PC. Longitudinal assessment of prenatal phthalate exposure on serum and cord thyroid hormones homeostasis during pregnancy-Tainan birth cohort study (TBCS). Sci Total Environ. 2018;619:1058\u201365.","journal-title":"Sci Total Environ"},{"issue":"1","key":"873_CR27","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1080\/1047322X.1990.10389587","volume":"5","author":"RW Hornung","year":"1990","unstructured":"Hornung RW, Reed LD. Estimation of average concentration in the presence of nondetectable values. Appl Occup Environ Hyg. 1990;5(1):46\u201351.","journal-title":"Appl Occup Environ Hyg"},{"key":"873_CR28","doi-asserted-by":"publisher","first-page":"114648","DOI":"10.1016\/j.envpol.2020.114648","volume":"264","author":"PC Huang","year":"2020","unstructured":"Huang PC, Chang WH, Wu MT, Chen ML, Wang IJ, Shih SF, et al. Characterization of phthalate exposure in relation to serum thyroid and growth hormones, and estimated daily intake levels in children exposed to phthalate-tainted products: a longitudinal cohort study. Environ Pollut. 2020b;264:114648.","journal-title":"Environ Pollut"},{"key":"873_CR29","doi-asserted-by":"publisher","first-page":"109863","DOI":"10.1016\/j.envres.2020.109863","volume":"188","author":"A Waits","year":"2020","unstructured":"Waits A, Chen HC, Kuo PL, Wang CW, Huang HB, Chang WH, et al. Urinary phthalate metabolites are associated with biomarkers of DNA damage and lipid peroxidation in pregnant women\u2013Tainan birth cohort study (TBCS). Environ Res. 2020;188:109863.","journal-title":"Environ Res"},{"key":"873_CR30","first-page":"757","volume":"5","author":"J Mill\u00e1n","year":"2009","unstructured":"Mill\u00e1n J, Pint\u00f3 X, Mu\u00f1oz A, Z\u00fa\u00f1iga M, Rubi\u00e9s-Prat J, Pallardo LF, et al. Lipoprotein ratios: physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag. 2009;5:757.","journal-title":"Vasc Health Risk Manag"},{"issue":"8","key":"873_CR31","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1016\/j.amjcard.2017.01.008","volume":"119","author":"G Harari","year":"2017","unstructured":"Harari G, Green MS, Magid A, Zelber-Sagi S. Usefulness of non\u2013high-density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men in 22-year follow-up. Am J Cardiol. 2017;119(8):1193\u20138.","journal-title":"Am J Cardiol"},{"issue":"3","key":"873_CR32","first-page":"359","volume":"3","author":"S Bhardwaj","year":"2013","unstructured":"Bhardwaj S, Bhattacharjee J, Bhatnagar MK, Tyagi S, Delhi N. Atherogenic index of plasma, Castelli risk index and atherogenic coefficient-new parameters in assessing cardiovascular risk. Int J Pharm Biol Sci. 2013;3(3):359\u201364.","journal-title":"Int J Pharm Biol Sci"},{"issue":"1","key":"873_CR33","doi-asserted-by":"publisher","first-page":"11","DOI":"10.30554\/archmed.20.1.3534.2020","volume":"20","author":"M Salcedo-Cifuentes","year":"2020","unstructured":"Salcedo-Cifuentes M, Belalcazar S, Acosta EY, Medina-Murillo JJ. Conventional biomarkers for cardiovascular risks and their correlation with the Castelli risk index-indices and TG\/HDL-C. Archivos de Medicina (Manizales). 2020;20(1):11\u201322.","journal-title":"Archivos de Medicina (Manizales)"},{"issue":"1","key":"873_CR34","doi-asserted-by":"publisher","first-page":"6","DOI":"10.5551\/jat.11.6","volume":"11","author":"CJ Packard","year":"2004","unstructured":"Packard CJ, Saito Y. Non\u2212 HDL cholesterol as a measure of atherosclerotic risk. J Atheroscler Thromb. 2004;11(1):6\u201314.","journal-title":"J Atheroscler Thromb"},{"issue":"4","key":"873_CR35","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.jacl.2008.06.013","volume":"2","author":"MJ Blaha","year":"2008","unstructured":"Blaha MJ, Blumenthal RS, Brinton EA, Jacobson TA, National Lipid Association Taskforce, on Non-HDL Cholesterol. The importance of non\u2013HDL cholesterol reporting in lipid management. J Clin Lipidol. 2008;2(4):267\u201373.","journal-title":"J Clin Lipidol"},{"issue":"10","key":"873_CR36","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1289\/ehp.0901331","volume":"118","author":"M Boas","year":"2010","unstructured":"Boas M, Frederiksen H, Feldt-Rasmussen U, Skakkeb\u00e6k NE, Heged\u00fcs L, Hilsted L, et al. Childhood exposure to phthalates: associations with thyroid function, insulin-like growth factor I, and growth. Environ Health Perspect. 2010;118(10):1458\u201364.","journal-title":"Environ Health Perspect"},{"key":"873_CR37","volume-title":"Modern epidemiology","author":"KJ Rothman","year":"2008","unstructured":"Rothman KJ, Greenland S, Lash TL. Modern epidemiology, vol. 3. Philadelphia: Wolters Kluwer Health\/Lippincott Williams & Wilkins; 2008."},{"issue":"2","key":"873_CR38","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1289\/ehp.1509693","volume":"124","author":"KM O\u2019Brien","year":"2016","unstructured":"O\u2019Brien KM, Upson K, Cook NR, Weinberg CR. Environmental chemicals in urine and blood: improving methods for creatinine and lipid adjustment. Environ Health Perspect. 2016;124(2):220\u20137.","journal-title":"Environ Health Perspect"},{"issue":"3","key":"873_CR39","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1093\/biostatistics\/kxu058","volume":"16","author":"JF Bobb","year":"2015","unstructured":"Bobb JF, Valeri L, Claus HB, Christiani DC, Wright RO, Mazumdar M, et al. Bayesian kernel machine regression for estimating the health effects of multi-pollutant mixtures. Biostatistics. 2015;16(3):493\u2013508.","journal-title":"Biostatistics"},{"key":"873_CR40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v059.i05","volume":"59","author":"D Tingley","year":"2014","unstructured":"Tingley D, Yamamoto T, Hirose K, Keele L, Imai K. Mediation: R package for causal mediation analysis. J Stat Softw. 2014;59:1\u201338.","journal-title":"J Stat Softw"},{"key":"873_CR41","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.ecoenv.2012.02.023","volume":"80","author":"L Olsen","year":"2012","unstructured":"Olsen L, Lind L, Lind PM. Associations between circulating levels of bisphenol a and phthalate metabolites and coronary risk in the elderly. Ecotoxicol Environ Saf. 2012;80:179\u201383.","journal-title":"Ecotoxicol Environ Saf"},{"key":"873_CR42","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.envres.2017.01.033","volume":"154","author":"W Perng","year":"2017","unstructured":"Perng W, Watkins DJ, Cantoral A, Mercado-Garc\u00eda A, Meeker JD, T\u00e9llez-Rojo MM, et al. Exposure to phthalates is associated with lipid profile in peripubertal Mexican youth. Environ Res. 2017;154:311\u20137.","journal-title":"Environ Res"},{"issue":"6","key":"873_CR43","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1038\/ijo.2015.8","volume":"39","author":"L Yaghjyan","year":"2015","unstructured":"Yaghjyan L, Sites S, Ruan Y, Chang SH. Associations of urinary phthalates with body mass index, waist circumference and serum lipids among females: National Health and nutrition examination survey 1999\u20132004. Int J Obes. 2015;39(6):994\u20131000.","journal-title":"Int J Obes"},{"key":"873_CR44","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/j.envint.2018.09.028","volume":"121","author":"R Dong","year":"2018","unstructured":"Dong R, Chen J, Zheng J, Zhang M, Zhang H, Wu M, et al. The role of oxidative stress in cardiometabolic risk related to phthalate exposure in elderly diabetic patients from Shanghai. Environ Int. 2018;121:340\u20138.","journal-title":"Environ Int"},{"issue":"2","key":"873_CR45","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1210\/jc.2006-1718","volume":"92","author":"A Roos","year":"2007","unstructured":"Roos A, Bakker SJ, Links TP, Gans RO, Wolffenbuttel BH. Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab. 2007;92(2):491\u20136.","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"873_CR46","doi-asserted-by":"publisher","first-page":"540","DOI":"10.3346\/jkms.2011.26.4.540","volume":"26","author":"SB Park","year":"2011","unstructured":"Park SB, Choi HC, Joo NS. The relation of thyroid function to components of the metabolic syndrome in Korean men and women. J Korean Med Sci. 2011;26(4):540\u20135.","journal-title":"J Korean Med Sci"},{"issue":"6","key":"873_CR47","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1111\/j.1365-2265.2011.04328.x","volume":"76","author":"AC Waring","year":"2012","unstructured":"Waring AC, Rodondi N, Harrison S, Kanaya AM, Simonsick EM, Miljkovic I, et al. Thyroid function and prevalent and incident metabolic syndrome in older adults: the health, ageing and body composition study. Clin Endocrinol. 2012;76(6):911\u20138.","journal-title":"Clin Endocrinol"},{"issue":"11","key":"873_CR48","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1089\/thy.2014.0103","volume":"24","author":"L Mehran","year":"2014","unstructured":"Mehran L, Amouzegar A, Tohidi M, Moayedi M, Azizi F. Serum free thyroxine concentration is associated with metabolic syndrome in euthyroid subjects. Thyroid. 2014;24(11):1566\u201374.","journal-title":"Thyroid"},{"issue":"4","key":"873_CR49","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1111\/cen.12311","volume":"80","author":"R Ren","year":"2014","unstructured":"Ren R, Jiang X, Zhang X, Guan Q, Yu C, Li Y, et al. Association between thyroid hormones and body fat in euthyroid subjects. Clin Endocrinol. 2014;80(4):585\u201390.","journal-title":"Clin Endocrinol"},{"issue":"2","key":"873_CR50","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1089\/thy.2013.0314","volume":"24","author":"GL Roef","year":"2014","unstructured":"Roef GL, Rietzschel ER, Van Daele CM, Taes YE, De Buyzere ML, Gillebert TC, et al. Triiodothyronine and free thyroxine levels are differentially associated with metabolic profile and adiposity-related cardiovascular risk markers in euthyroid middle-aged subjects. Thyroid. 2014;24(2):223\u201331.","journal-title":"Thyroid"},{"issue":"4","key":"873_CR51","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1111\/cen.13095","volume":"85","author":"S Temizkan","year":"2016","unstructured":"Temizkan S, Balaforlou B, Ozderya A, Avci M, Aydin K, Karaman S, et al. Effects of thyrotrophin, thyroid hormones and thyroid antibodies on metabolic parameters in a euthyroid population with obesity. Clin Endocrinol. 2016;85(4):616\u201323.","journal-title":"Clin Endocrinol"},{"issue":"1","key":"873_CR52","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12902-019-0383-2","volume":"19","author":"R Xu","year":"2019","unstructured":"Xu R, Huang F, Zhang S, Lv Y, Liu Q. Thyroid function, body mass index, and metabolic risk markers in euthyroid adults: a cohort study. BMC Endocr Disord. 2019;19(1):1\u20139.","journal-title":"BMC Endocr Disord"},{"issue":"3","key":"873_CR53","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.maturitas.2009.01.007","volume":"62","author":"HT Park","year":"2009","unstructured":"Park HT, Cho GJ, Ahn KH, Shin JH, Hong SC, Kim T, et al. Thyroid stimulating hormone is associated with metabolic syndrome in euthyroid postmenopausal women. Maturitas. 2009;62(3):301\u20135.","journal-title":"Maturitas"},{"key":"873_CR54","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1530\/EJE-10-0312","volume":"163","author":"J de Jesus Garduno-Garcia","year":"2010","unstructured":"de Jesus Garduno-Garcia J, Alvirde-Garcia U, Lopez-Carrasco G, Mendoza MEP, Mehta R, Arellano-Campos O, et al. TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects. Eur J Endocrinol. 2010;163:273\u20138.","journal-title":"Eur J Endocrinol"},{"issue":"4","key":"873_CR55","doi-asserted-by":"publisher","first-page":"349","DOI":"10.7150\/ijms.7104","volume":"11","author":"KY Chin","year":"2014","unstructured":"Chin KY, Ima-Nirwana S, Mohamed IN, Aminuddin A, Johari MH, Ngah WZW. The relationships between thyroid hormones and thyroid-stimulating hormone with lipid profile in euthyroid men. Int J Med Sci. 2014;11(4):349.","journal-title":"Int J Med Sci"},{"issue":"3","key":"873_CR56","first-page":"147","volume":"40","author":"M Gutch","year":"2017","unstructured":"Gutch M, Rungta S, Kumar S, Agarwal A, Bhattacharya A, Razi SM. Thyroid functions and serum lipid profile in metabolic syndrome. Biom J. 2017;40(3):147\u201353.","journal-title":"Biom J"},{"issue":"1","key":"873_CR57","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12902-017-0215-1","volume":"17","author":"BH Wolffenbuttel","year":"2017","unstructured":"Wolffenbuttel BH, Wouters HJ, Slagter SN, van Waateringe RP, Kobold ACM, van Vliet-Ostaptchouk JV, et al. Thyroid function and metabolic syndrome in the population-based LifeLines cohort study. BMC Endocr Disord. 2017;17(1):1\u201311.","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"873_CR58","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.dsx.2017.08.001","volume":"12","author":"ML Hamlaoui","year":"2018","unstructured":"Hamlaoui ML, Ayachi A, Dekaken A, Gouri A. Relationship of metabolic syndrome and its components with thyroid dysfunction in Algerian patients. Diabetes Metab Syndr. 2018;12(1):1\u20134.","journal-title":"Diabetes Metab Syndr"},{"issue":"2","key":"873_CR59","doi-asserted-by":"publisher","first-page":"311","DOI":"10.3803\/EnM.2016.31.2.311","volume":"31","author":"HJ Kim","year":"2016","unstructured":"Kim HJ, Bae JC, Park HK, Byun DW, Suh K, Yoo MH, et al. Triiodothyronine levels are independently associated with metabolic syndrome in euthyroid middle-aged subjects. Endocrinol Metab. 2016;31(2):311\u20139.","journal-title":"Endocrinol Metab"},{"issue":"5","key":"873_CR60","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1530\/EJE-12-0447","volume":"167","author":"G Roef","year":"2012","unstructured":"Roef G, Lapauw B, Goemaere S, Zmierczak HG, Toye K, Kaufman JM, et al. Body composition and metabolic parameters are associated with variation in thyroid hormone levels among euthyroid young men. Eur J Endocrinol. 2012;167(5):719.","journal-title":"Eur J Endocrinol"},{"key":"873_CR61","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.chemosphere.2017.09.123","volume":"190","author":"A Pradhan","year":"2018","unstructured":"Pradhan A, Olsson PE, Jass J. Di (2-ethylhexyl) phthalate and diethyl phthalate disrupt lipid metabolism, reduce fecundity and shortens lifespan of Caenorhabditis elegans. Chemosphere. 2018;190:375\u201382.","journal-title":"Chemosphere"},{"issue":"4","key":"873_CR62","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1038\/nm1025","volume":"10","author":"RM Evans","year":"2004","unstructured":"Evans RM, Barish GD, Wang YX. PPARs and the complex journey to obesity. Nat Med. 2004;10(4):355\u201361.","journal-title":"Nat Med"},{"issue":"41","key":"873_CR63","doi-asserted-by":"publisher","first-page":"11468","DOI":"10.1021\/acs.jafc.0c05077","volume":"68","author":"Y Zhao","year":"2020","unstructured":"Zhao Y, Ma DX, Wang HG, Li MZ, Talukder M, Wang HR, et al. Lycopene prevents Dehp-induced liver lipid metabolism disorder by inhibiting the Hif-1\u03b1-induced Ppar\u03b1\/Ppar\u03b3\/Fxr\/Lxr system. J Agric Food Chem. 2020;68(41):11468\u201379.","journal-title":"J Agric Food Chem"},{"key":"873_CR64","doi-asserted-by":"publisher","first-page":"112029","DOI":"10.1016\/j.fct.2021.112029","volume":"149","author":"W Zhang","year":"2021","unstructured":"Zhang W, Li JY, Wei XC, Wang Q, Yang JY, Hou H, et al. Effects of dibutyl phthalate on lipid metabolism in liver and hepatocytes based on PPAR\u03b1\/SREBP-1c\/FAS\/GPAT\/AMPK signal pathway. Food Chem Toxicol. 2021;149:112029.","journal-title":"Food Chem Toxicol"},{"issue":"3","key":"873_CR65","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1007\/s00204-014-1446-9","volume":"90","author":"HC Chiang","year":"2016","unstructured":"Chiang HC, Kuo YT, Shen CC, Lin YH, Wang SL, Tsou TC. Mono (2-ethylhexyl) phthalate accumulation disturbs energy metabolism of fat cells. Arch Toxicol. 2016;90(3):589\u2013601.","journal-title":"Arch Toxicol"},{"key":"873_CR66","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1289\/ehp.824541","volume":"45","author":"FP Bell","year":"1982","unstructured":"Bell FP. Effects of phthalate esters on lipid metabolism in various tissues, cells and organelles in mammals. Environ Health Perspect. 1982;45:41\u201350.","journal-title":"Environ Health Perspect"},{"issue":"1","key":"873_CR67","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.tox.2011.02.007","volume":"289","author":"Y Hayashi","year":"2011","unstructured":"Hayashi Y, Ito Y, Yamagishi N, Yanagiba Y, Tamada H, Wang D, et al. Hepatic peroxisome proliferator-activated receptor \u03b1 may have an important role in the toxic effects of di (2-ethylhexyl) phthalate on offspring of mice. Toxicology. 2011;289(1):1\u201310.","journal-title":"Toxicology"},{"key":"873_CR68","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.tox.2013.04.010","volume":"309","author":"R Nakashima","year":"2013","unstructured":"Nakashima R, Hayashi Y, Md K, Jia X, Wang D, Naito H, et al. Exposure to DEHP decreased four fatty acid levels in plasma of prepartum mice. Toxicology. 2013;309:52\u201360.","journal-title":"Toxicology"},{"issue":"1","key":"873_CR69","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.bbrc.2011.05.057","volume":"410","author":"R Kimura","year":"2011","unstructured":"Kimura R, Takahashi N, Murota K, Yamada Y, Niiya S, Kanzaki N, et al. Activation of peroxisome proliferator-activated receptor-\u03b1 (PPAR\u03b1) suppresses postprandial lipidemia through fatty acid oxidation in enterocytes. Biochem Biophys Res Commun. 2011;410(1):1\u20136.","journal-title":"Biochem Biophys Res Commun"},{"issue":"32","key":"873_CR70","doi-asserted-by":"publisher","first-page":"2566","DOI":"10.1093\/eurheartj\/ehs227","volume":"34","author":"S Colin","year":"2013","unstructured":"Colin S, Briand O, Touche V, Wouters K, Baron M, Pattou F, et al. Activation of intestinal peroxisome proliferator-activated receptor-\u03b1 increases high-density lipoprotein production. Eur Heart J. 2013;34(32):2566\u201374.","journal-title":"Eur Heart J"},{"issue":"2","key":"873_CR71","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1093\/toxsci\/kfg145","volume":"74","author":"CH Hurst","year":"2003","unstructured":"Hurst CH, Waxman DJ. Activation of PPAR\u03b1 and PPAR\u03b3 by environmental phthalate monoesters. Toxicol Sci. 2003;74(2):297\u2013308.","journal-title":"Toxicol Sci"},{"key":"873_CR72","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.toxlet.2017.05.028","volume":"277","author":"A Engel","year":"2017","unstructured":"Engel A, Buhrke T, Imber F, Jessel S, Seidel A, V\u00f6lkel W, et al. Agonistic and antagonistic effects of phthalates and their urinary metabolites on the steroid hormone receptors ER\u03b1, ER\u03b2, and AR. Toxicol Lett. 2017;277:54\u201363.","journal-title":"Toxicol Lett"},{"issue":"41","key":"873_CR73","doi-asserted-by":"publisher","first-page":"37731","DOI":"10.1074\/jbc.R100034200","volume":"276","author":"ED Rosen","year":"2001","unstructured":"Rosen ED, Spiegelman BM. PPAR\u03b3: a nuclear regulator of metabolism, differentiation, and cell growth. J Biol Chem. 2001;276(41):37731\u20134.","journal-title":"J Biol Chem"},{"issue":"5","key":"873_CR74","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1038\/nrendo.2018.10","volume":"14","author":"RA Sinha","year":"2018","unstructured":"Sinha RA, Singh BK, Yen PM. Direct effects of thyroid hormones on hepatic lipid metabolism. Nat Rev Endocrinol. 2018;14(5):259\u201369.","journal-title":"Nat Rev Endocrinol"},{"issue":"9","key":"873_CR75","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1089\/thy.2018.0664","volume":"29","author":"RA Sinha","year":"2019","unstructured":"Sinha RA, Bruinstroop E, Singh BK, Yen PM. Nonalcoholic fatty liver disease and hypercholesterolemia: roles of thyroid hormones, metabolites, and agonists. Thyroid. 2019;29(9):1173\u201391.","journal-title":"Thyroid"},{"issue":"2","key":"873_CR76","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1002\/hep.31296","volume":"72","author":"MJ Ritter","year":"2020","unstructured":"Ritter MJ, Amano I, Hollenberg AN. Thyroid hormone signaling and the liver. Hepatology. 2020;72(2):742\u201352.","journal-title":"Hepatology"},{"issue":"6","key":"873_CR77","first-page":"383","volume":"78","author":"GC Ness","year":"1991","unstructured":"Ness GC. Thyroid hormone. Basis for its hypocholesterolemic effect. The. J Fla Med Assoc. 1991;78(6):383\u20135.","journal-title":"J Fla Med Assoc"},{"issue":"6","key":"873_CR78","doi-asserted-by":"publisher","first-page":"E1140","DOI":"10.1152\/ajpendo.00516.2005","volume":"290","author":"TT Antunes","year":"2006","unstructured":"Antunes TT, Gagnon A, Chen B, Pacini F, Smith TJ, Sorisky A. Interleukin-6 release from human abdominal adipose cells is regulated by thyroid-stimulating hormone: effect of adipocyte differentiation and anatomic depot. Am J Physiol Endocrinol Metab. 2006;290(6):E1140\u20134.","journal-title":"Am J Physiol Endocrinol Metab"},{"issue":"1","key":"873_CR79","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.toxlet.2009.05.004","volume":"189","author":"M Ghisari","year":"2009","unstructured":"Ghisari M, Bonefeld-Jorgensen EC. Effects of plasticizers and their mixtures on estrogen receptor and thyroid hormone functions. Toxicol Lett. 2009;189(1):67\u201377.","journal-title":"Toxicol Lett"},{"issue":"1","key":"873_CR80","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.toxlet.2009.07.019","volume":"191","author":"O Shen","year":"2009","unstructured":"Shen O, Du G, Sun H, Wu W, Jiang Y, Song L, et al. Comparison of in vitro hormone activities of selected phthalates using reporter gene assays. Toxicol Lett. 2009;191(1):9\u201314.","journal-title":"Toxicol Lett"},{"issue":"4","key":"873_CR81","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1089\/10507250252949405","volume":"12","author":"LH Duntas","year":"2002","unstructured":"Duntas LH. Thyroid disease and lipids. Thyroid. 2002;12(4):287\u201393.","journal-title":"Thyroid"},{"issue":"1","key":"873_CR82","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s42003-019-0624-y","volume":"2","author":"CF Cheng","year":"2019","unstructured":"Cheng CF, Ku HC, Cheng JJ, Chao SW, Li HF, Lai PF, et al. Adipocyte browning and resistance to obesity in mice is induced by expression of ATF3. Commun Biol. 2019;2(1):1\u201318.","journal-title":"Commun Biol"},{"key":"873_CR83","doi-asserted-by":"publisher","first-page":"111487","DOI":"10.1016\/j.fct.2020.111487","volume":"142","author":"JW Hsu","year":"2020","unstructured":"Hsu JW, Nien CY, Yeh SC, Tsai FY, Chen HW, Lee TS, et al. Phthalate exposure causes browning-like effects on adipocytes in vitro and in vivo. Food Chem Toxicol. 2020;142:111487.","journal-title":"Food Chem Toxicol"},{"key":"873_CR84","doi-asserted-by":"publisher","first-page":"112439","DOI":"10.1016\/j.fct.2021.112439","volume":"156","author":"JW Hsu","year":"2021","unstructured":"Hsu JW, Nien CY, Chen HW, Tsai FY, Yeh SC, Kao YH, et al. Di (2-ethylhexyl) phthalate exposure exacerbates metabolic disorders in diet-induced obese mice. Food Chem Toxicol. 2021;156:112439.","journal-title":"Food Chem Toxicol"},{"issue":"2","key":"873_CR85","first-page":"225","volume":"20","author":"SH Tu","year":"2011","unstructured":"Tu SH, Chen C, Hsieh YT, Chang HY, Yeh CJ, Lin YC, et al. Design and sample characteristics of the 2005-2008 nutrition and health survey in Taiwan. Asia Pac J Clin Nutr. 2011;20(2):225\u201337.","journal-title":"Asia Pac J Clin Nutr"},{"issue":"2","key":"873_CR86","first-page":"238","volume":"20","author":"WH Pan","year":"2011","unstructured":"Pan WH, Wu HJ, Yeh CJ, Chuang SY, Chang HY, Yeh NH, et al. Diet and health trends in Taiwan: comparison of two nutrition and health surveys from 1993-1996 and 2005-2008. Asia Pac J Clin Nutr. 2011;20(2):238\u201350.","journal-title":"Asia Pac J Clin Nutr"},{"issue":"17","key":"873_CR87","doi-asserted-by":"publisher","first-page":"1734","DOI":"10.1289\/ehp.7212","volume":"112","author":"R Hauser","year":"2004","unstructured":"Hauser R, Meeker JD, Park S, Silva MJ, Calafat AM. Temporal variability of urinary phthalate metabolite levels in men of reproductive age. Environ Health Perspect. 2004;112(17):1734\u201340.","journal-title":"Environ Health Perspect"},{"issue":"2","key":"873_CR88","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.envres.2007.09.010","volume":"106","author":"SL Teitelbaum","year":"2008","unstructured":"Teitelbaum SL, Britton JA, Calafat AM, Ye X, Silva MJ, Reidy JA, et al. Temporal variability in urinary concentrations of phthalate metabolites, phytoestrogens and phenols among minority children in the United States. Environ Res. 2008;106(2):257\u201369.","journal-title":"Environ Res"},{"issue":"3","key":"873_CR89","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1210\/jcem.87.3.8165","volume":"87","author":"S Andersen","year":"2002","unstructured":"Andersen S, Pedersen KM, Bruun NH, Laurberg P. Narrow individual variations in serum T4 and T3 in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab. 2002;87(3):1068\u201372.","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"873_CR90","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1089\/105072502761016494","volume":"12","author":"MB Zimmermann","year":"2002","unstructured":"Zimmermann MB, K\u00f6hrle J. The impact of iron and selenium deficiencies on iodine and thyroid metabolism: biochemistry and relevance to public health. Thyroid. 2002;12(10):867\u201378.","journal-title":"Thyroid"}],"container-title":["Environmental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12940-022-00873-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12940-022-00873-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12940-022-00873-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T02:07:46Z","timestamp":1668478066000},"score":1,"resource":{"primary":{"URL":"https:\/\/ehjournal.biomedcentral.com\/articles\/10.1186\/s12940-022-00873-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,1]]},"references-count":90,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["873"],"URL":"https:\/\/doi.org\/10.1186\/s12940-022-00873-9","relation":{},"ISSN":["1476-069X"],"issn-type":[{"value":"1476-069X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,1]]},"assertion":[{"value":"2 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the National Health Research Institutes\u2019 Research Ethics Committee at Taiwan (no. EC1020206). All participants gave written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"61"}}