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Endocrine disruptors and child healths

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Endocrine Endocrine Disruptors: Disruptors: Child healths Child healths Vichit Supornsilchai, MD, PhD Vichit Supornsilchai, MD, PhD Endocrine Unit, Department of Endocrine Unit, Department of Pediatric, Pediatric, Faculty of Medicine, Faculty of Medicine, King Chulalongkorn Memor King Chulalongkorn Memor ia ia l l Hospital Hospital
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Page 1: Endocrine disruptors and child healths

Endocrine Disruptors: Endocrine Disruptors:

Child healthsChild healths

Vichit Supornsilchai, MD, PhDVichit Supornsilchai, MD, PhD

Endocrine Unit, Department of Pediatric,Endocrine Unit, Department of Pediatric,

Faculty of Medicine, Faculty of Medicine,

King Chulalongkorn MemorKing Chulalongkorn Memoriaial Hospitall Hospital

Page 2: Endocrine disruptors and child healths

Overview Background animal experiences evidences in human Definition and classification of EDs Routes of human exposure The effects of EDs on the reproductive systems The effects of Bisphenol A (BPA) on PP and

obesity in Thai’s children and adolescents

Page 3: Endocrine disruptors and child healths

Background: Animal experiences

Outbreak of infertility in Australian sheep (1940s) Outbreak of infertility in Australian sheep (1940s) ingestion of large amount of subterranean clover ingestion of large amount of subterranean clover estrogenic effects of phytoestrogens in the Clover estrogenic effects of phytoestrogens in the Clover

(Clover disease)(Clover disease)

Reproductive dysfunction in the bald eagle Reproductive dysfunction in the bald eagle and other wild birdsand other wild birds exposure of high doses of DDT and other chemicalsexposure of high doses of DDT and other chemicals development of thin-shelled, nonviable eggs development of thin-shelled, nonviable eggs

Murkies AL et al., J Cli Endocrinol Metab, 1998, 83, 297-303Murkies AL et al., J Cli Endocrinol Metab, 1998, 83, 297-303

Garcelon DK et al., J Wildl Dis, 1997, 33, 299-303Garcelon DK et al., J Wildl Dis, 1997, 33, 299-303

Page 4: Endocrine disruptors and child healths

BackgroundBackground: : Animal experiencesAnimal experiences

Edwards TM et al., International Journal of Andrology 2006, 29, 109-121

Reproductive dysfunction in Reproductive dysfunction in young male alligators in Lake young male alligators in Lake Apopka, Florida (1970s) Apopka, Florida (1970s)

small phallus sizesmall phallus size decreased serum testosterone decreased serum testosterone

levelslevels abnormal gonadal morphologyabnormal gonadal morphologyAssociate with elevated level of Associate with elevated level of

DDT metabolitesDDT metabolites Guillette LT et al., Environ Health Perspect, 1994, 102, 680-688Guillette LT et al., Environ Health Perspect, 1994, 102, 680-688

Page 5: Endocrine disruptors and child healths

Background: Background: Evidences in humansEvidences in humans

DiethylstilbestrolDiethylstilbestrol (DES)(DES) is a prototype in is a prototype in humanhuman

exposed exposed male male offspringoffspring hypospadiashypospadias micropenismicropenis cryptorchidismcryptorchidism decreased fertilitydecreased fertility

exposed exposed femalefemale offspring offspring reproductive organ dysfunctionreproductive organ dysfunction decreased pregnancy ratedecreased pregnancy rate decreased fertility decreased fertility

Bibbo M et al., Obstet Gynecol, 1997, 49, 1-7

Page 6: Endocrine disruptors and child healths

Background: Background: Epidemiological evidences in humansEpidemiological evidences in humans

Fisher JS, Reproduction 2004, 127, 305-315 Fisher JS, Reproduction 2004, 127, 305-315

Carlsen et al., Environ Health Perspect 1995, 103, 137-139Carlsen et al., Environ Health Perspect 1995, 103, 137-139

Sperm countSperm count

Paulozzi, Environ Healthe Perspect 1999, 107, 297-302Paulozzi, Environ Healthe Perspect 1999, 107, 297-302

Page 7: Endocrine disruptors and child healths

Definition of EDs

An exogenous substance, either anthropogenic or natural, that can alter endocrine functions by

a variety of different mechanisms; By acting as either agonists or antagonists By altering the synthesis, transport and/or

catabolism of endogenous hormones By modifying the levels of expression

and/or functioning of hormone receptors

Page 8: Endocrine disruptors and child healths

ClassificationClassification

Estrogenic activity: Estrogenic activity: Dichlorodiphenyltrichloroethane (DDT)Dichlorodiphenyltrichloroethane (DDT) Phytoestrogens (at high concs)Phytoestrogens (at high concs) Polychlorinated biphenyls (PCBs)Polychlorinated biphenyls (PCBs) Bisphenol ABisphenol AAnti-androgenic activity: Anti-androgenic activity: AR antagonist:AR antagonist: vinclozolin, procymidone, vinclozolin, procymidone,

linuron, pp’ DDElinuron, pp’ DDE Reduce androgen synthesis:Reduce androgen synthesis: phthalate phthalate

estersesters

Page 9: Endocrine disruptors and child healths

Classification Classification

Anti-estrogenic activity:Anti-estrogenic activity: dioxin (TCDD), dioxin (TCDD), PCBs, phytoestrogens (at low concs)PCBs, phytoestrogens (at low concs)

Androgenic activity: Androgenic activity: Testosterone, Testosterone, Trembolone acetate Trembolone acetate

Thyroid hormonal effectsThyroid hormonal effects

Evidences were mostly from animal experimentsEvidences were mostly from animal experiments

Identified EDs are just a tip of icebergIdentified EDs are just a tip of iceberg

Page 10: Endocrine disruptors and child healths

Other mechanismsOther mechanisms

nonnuclear steroid hormone receptor nonnuclear steroid hormone receptor i.e.i.e. membrane receptormembrane receptor

nonsteroid receptors nonsteroid receptors i.e.i.e. neurotransmitter receptors neurotransmitter receptors (serotonin receptor, dopamine (serotonin receptor, dopamine receptor)receptor)

orphan receptor orphan receptor i.e.i.e. Aryl-hydrocarbon receptor (AhR) Aryl-hydrocarbon receptor (AhR)

direct effect on the enzymes in steroidogenesisdirect effect on the enzymes in steroidogenesis

Page 11: Endocrine disruptors and child healths

Routes of human exposureRoutes of human exposure

Timing of exposure is critical !

Page 12: Endocrine disruptors and child healths

Factors of endocrine Factors of endocrine disruption of EDsdisruption of EDs

Age at exposureAge at exposure Latency from exposureLatency from exposure Importance of mixturesImportance of mixtures Nontraditional dose-response dynamicsNontraditional dose-response dynamics Transgenerational epigenetic effectsTransgenerational epigenetic effects

Evanthia DK et.al. Endocrine Review 2009; 30: 293-342Evanthia DK et.al. Endocrine Review 2009; 30: 293-342

Page 13: Endocrine disruptors and child healths

The effects of EDs on reproductive systems

Male reproductive system Genital malformations and the TDS

(Testicular dysgenesis syndrome)

Female reproductive system Early and precocious puberty

Page 14: Endocrine disruptors and child healths

Asklund C, BJU international 2004, 93, 6-11Asklund C, BJU international 2004, 93, 6-11

First introduced by Skakkebaek (Denmark) First introduced by Skakkebaek (Denmark)

Genital malformations and the TDS Genital malformations and the TDS (Testicular (Testicular dysgenesis syndrome)dysgenesis syndrome)

Reproductive disease in adult men may result from disruptionReproductive disease in adult men may result from disruption of embryonic programming and fetal gonadal developmentof embryonic programming and fetal gonadal development

Page 15: Endocrine disruptors and child healths

Early and precocious pubertyEarly and precocious puberty

The onset of puberty trend to be earlier, The onset of puberty trend to be earlier, particularly in girlparticularly in girl

The precise trigger for the onset of The precise trigger for the onset of puberty is not known, but it is believed to puberty is not known, but it is believed to be a complex interaction between be a complex interaction between genetics, hormones, and environmental genetics, hormones, and environmental influences influences

EDs may play an important role in timing EDs may play an important role in timing and disturbance of normal pubertyand disturbance of normal puberty

Page 16: Endocrine disruptors and child healths

Exposure-outcome relationshipExposure-outcome relationship ExposureExposure ReferencesReferences

Advanced pubertyAdvanced puberty

Earlier menarche and pubarcheEarlier menarche and pubarche PBBPBB Blanck et al., 2000Blanck et al., 2000

Earlier thelarcheEarlier thelarche pesticides, pesticides, phthalatesphthalates

Colon et al., 2000Colon et al., 2000

Earlier menarcheEarlier menarche DDEDDE Vasiliu et al., 2004Vasiliu et al., 2004

Central precocious pubertyCentral precocious puberty DDEDDE Krstevska-Konstantinova Krstevska-Konstantinova et al., 2001et al., 2001

Earlier age at menarcheEarlier age at menarche DDTDDT Ouyang et al., 2005Ouyang et al., 2005

PBBs: Polybrominated biphenyls; DDE: Dichlorodiphenyldichloroethylene; DDT: Dichlorodiphenyltrichloroethane; PCBs: Polychlorinated biphenyls; PCDFs: Polychlorinated dibenzofurans; PCDDs: Polychlorinated dibenzodioxins)

Page 17: Endocrine disruptors and child healths

The literatures: outbreaks of The literatures: outbreaks of early puberty in sub-populationearly puberty in sub-population

Related to exposure to exogenous Related to exposure to exogenous hormones or hormone-like chemicalshormones or hormone-like chemicals

High frequency of CPP in a region with High frequency of CPP in a region with high exposure to the estrogenic high exposure to the estrogenic mycotoxin zearalenone mycotoxin zearalenone (Massart et.al., J Pediatr 2008; 152: 690-95)(Massart et.al., J Pediatr 2008; 152: 690-95)

Premature thelarche in 4 pre-pubertal Premature thelarche in 4 pre-pubertal girls after consumption of tea containing girls after consumption of tea containing a phytoestrogen (a phytoestrogen (Foeniculum vulgareFoeniculum vulgare) ) (Turkyilmaz et.al., J Peddiatr Surg 2008; 43: 2109-11)(Turkyilmaz et.al., J Peddiatr Surg 2008; 43: 2109-11)

Page 18: Endocrine disruptors and child healths

Evidences of PP and poultryEvidences of PP and poultry

An epidemic outburst of premature An epidemic outburst of premature breast development and ovarian cyst breast development and ovarian cyst in 2716 girls from Peurto Rico (1990-in 2716 girls from Peurto Rico (1990-1995) with unknown cause, 1995) with unknown cause, environmental factors (EDs: soy-environmental factors (EDs: soy-based formula, meat products) were based formula, meat products) were suspected. suspected. (Larriuz-Serrano et.al., P R Health Sci J 2001; 20:13-18)(Larriuz-Serrano et.al., P R Health Sci J 2001; 20:13-18)

Page 19: Endocrine disruptors and child healths

Evidences of PP and poultryEvidences of PP and poultry US Department of Agriculture and Puerto US Department of Agriculture and Puerto

Rico Department of Health reported that Rico Department of Health reported that there was no abnormal levels of the there was no abnormal levels of the suspected chemicals found in the suspected chemicals found in the approximately 800 samples of meat and approximately 800 samples of meat and dairy products that were analysed dairy products that were analysed (unpublished data)(unpublished data)

Early breast development in both sexes Early breast development in both sexes in Northern Italy due to estrogen in Northern Italy due to estrogen exposure through poultry and beef from exposure through poultry and beef from school cafeteria school cafeteria (Scaglioni et.al. Lancet 1978; 1: 551-2) (Scaglioni et.al. Lancet 1978; 1: 551-2)

Page 20: Endocrine disruptors and child healths

Neuroendocrine systemNeuroendocrine system

Hypothalamus (GnRH neurons)-pituitary-Hypothalamus (GnRH neurons)-pituitary-target organtarget organ

Highly complexHighly complex HPG axis: GnRH neurons express steroid HPG axis: GnRH neurons express steroid

hormone receptorshormone receptors Other cells in the brain also express steroid Other cells in the brain also express steroid

hormone receptors and can regulate GnRH hormone receptors and can regulate GnRH i.e. neurotransmitters (Noradrenergic, i.e. neurotransmitters (Noradrenergic, serotonergic, dopaminergic etc.) serotonergic, dopaminergic etc.)

Page 21: Endocrine disruptors and child healths

Bisphenol A (BPA)Bisphenol A (BPA)

synthetic estrogen (Xenoestrogen)synthetic estrogen (Xenoestrogen)

Dose-dependent effectsDose-dependent effects Low dose: interacts with both ERLow dose: interacts with both ER and and

ERERββ Higher dose: antiandrogenic activity Higher dose: antiandrogenic activity

Page 22: Endocrine disruptors and child healths

Chemical structureChemical structure

Bisphenol A

Estrogen

phenol group: bind to ER

Page 23: Endocrine disruptors and child healths

One of the hightest volume chemicals One of the hightest volume chemicals produced worldwideproduced worldwide

Epoxy resins and polycarbonate plastic Epoxy resins and polycarbonate plastic containers (hard, clean plastic)containers (hard, clean plastic)

Page 24: Endocrine disruptors and child healths

Plastic use Plastic use considerationsconsiderations

Page 25: Endocrine disruptors and child healths

Plastic use Plastic use considerationsconsiderations

Page 26: Endocrine disruptors and child healths

Sources of BPA exposureSources of BPA exposure

Canned

products

Polycarbonate plastics

Thermal paper products

Food Most plastics with recycling code 07

Sales receipts

Soda Intravenous tubing and medical equipments

Lottery tickets

Liquid infant formula (versus powder, which typically has no detectable BPA)

Bottles, toys, pacifier shields, dental sealants

Fax paper, recycling paper products (paper

towels, toilet paper, pizza boxes)

Factors that increase BPA

migration from containers

Increased temperature

Damaged surfaces (scratches)

Increased acidity

Page 27: Endocrine disruptors and child healths

Polycarbonate plasticsPolycarbonate plastics

Page 28: Endocrine disruptors and child healths

Canned Canned productsproducts

Thermal paper Thermal paper productsproducts

Page 29: Endocrine disruptors and child healths

BPA-free productsBPA-free products

Page 30: Endocrine disruptors and child healths

Routes of exposureRoutes of exposure

Dietary:Dietary: majority (99%) majority (99%) Monomers of BPA: hydrolyse and leach Monomers of BPA: hydrolyse and leach

from epoxy resins and polycarbonate from epoxy resins and polycarbonate plastics into food and liquids in contact plastics into food and liquids in contact

with the containerwith the container Factors: thermal, acidic and basic Factors: thermal, acidic and basic

conditionsconditions

Page 31: Endocrine disruptors and child healths

The primary source of BPA exposure in The primary source of BPA exposure in - - children age and adult: children age and adult:

oral intake from canned foodoral intake from canned food

- - infant: infant:

breastmilk and polycarbonate feeding bottlesbreastmilk and polycarbonate feeding bottles Young children have higher urinary BPA Young children have higher urinary BPA

concentration than adults: reflect higher food concentration than adults: reflect higher food intake per kilogram of body massintake per kilogram of body mass

Page 32: Endocrine disruptors and child healths

Nondietary exposureNondietary exposure Cashiers (Cashiers (occupational exposure)occupational exposure), industries , industries

using BPA Human exposure to BPA is using BPA Human exposure to BPA is widespread, small adverse effects of BPA widespread, small adverse effects of BPA could have large public health implicationscould have large public health implications

Infants in NICU have higher BPA exposure Infants in NICU have higher BPA exposure than the general poppulation due to intensive than the general poppulation due to intensive medical interventions and proceduresmedical interventions and procedures

Page 33: Endocrine disruptors and child healths

ประเทศแคนาดาออกกฎหมายห�ามการผลิ�ตแลิะประเทศแคนาดาออกกฎหมายห�ามการผลิ�ตแลิะจำ�าหน�ายผลิ�ตภั�ณฑ์�ท� ม�สาร จำ�าหน�ายผลิ�ตภั�ณฑ์�ท� ม�สาร BPA BPA ม�ผลิต�#งแต� ม�ผลิต�#งแต� 19 19 เมษายน เมษายน 2551 2551 เป&นต�นไปเป&นต�นไป

ประเทศสหร�ฐอเมร�กาออกกฎหมายห�ามการผลิ�ตประเทศสหร�ฐอเมร�กาออกกฎหมายห�ามการผลิ�ตแลิะจำ�าหน�ายผลิ�ตภั�ณฑ์�ท� ม�สาร แลิะจำ�าหน�ายผลิ�ตภั�ณฑ์�ท� ม�สาร BPA BPA ท� ใช้�ส�าหร�บท� ใช้�ส�าหร�บเด,ก ม�ผลิต�#งแต� เด,ก ม�ผลิต�#งแต� 1 1 ธั�นวาคม ธั�นวาคม 2553 2553 เป&นต�นไปเป&นต�นไป

กระทรวงสาธัารณส/ขจำ�น ประกาศห�ามใช้�สาร กระทรวงสาธัารณส/ขจำ�น ประกาศห�ามใช้�สาร BPA BPA ในการผลิ�ตขวดนมส�าหร�บเด,ก ม�ผลิต�#งแต� ในการผลิ�ตขวดนมส�าหร�บเด,ก ม�ผลิต�#งแต� 1 1 ม�ถุ/นายน ม�ถุ/นายน 2554 2554 เป&นต�นไป เป&นต�นไป

BPA regulationsBPA regulations

Page 34: Endocrine disruptors and child healths

BPA exposure in childrenBPA exposure in children

In the US population, in the 2003-2004 National Health and Nutrition Examination Survey (NHANES) data, •92.6% Age > 6 years expose BPA (Urine BPA mean 2.6 ug/g.cr, P10 0.9ug/g cr, P95 11.2ug/g cr).•High level BPA in female, young age (6-11yrs), low annual household income (<$20,000), Mexican American

Environ Health. 2012 Oct 19;11:79.

Country Sample size(male/female)

Age (yr)

Sampling date

(year)

Detectionfrequency

Ur BPA level(ng/mL)

U.S. 314715

6-11 12-19

2003-2004 92.6% for all GM 3.5GM 3.7

U.S. 356702

6-1112-19

2005-2006 92.9% for all GM 2.9GM 2.5

Canada 1031(524/507) 945(489/456)

6-1112-19

2007-2009 93.20%93.80%

GM 1.30GM 1.50

German 599 3-14 2003-2006 98.60% GM 2.66

Spanish 30 boys 4 2005-2006 96.70% Median 4.2

China 17(10/7) ≤19 2010 94.3% for all GM 1.65

Egypt 57 girls 10-13 2009 79% GM 0.84

Thai (adults) 2340 18-94 2011 52.8% Median 0.33

Thai (children) 376 4-18 2013 75.3% Mean 0.68

Page 35: Endocrine disruptors and child healths

Effect of BPAEffect of BPA

Current Opinion in Pediatrics 2011 ;23: 233-9Endocr Rev 2009 ;30: 75-95

Mutat Res. 2012 ;743: 83-90

Effect of BPA

Human

Cancer Breast cancer had higher median serum BPA than without breast cancer

Metabolic Cardiovascular disease, T2DM

Pubertal development

No significant association

Neurodevelopment

Externalizing behaviors (aggression and hyperactivity)

Reproductive system

semen quality, increased sperm DNA damage serum E2, oocyte in women undergoing in-vitro fertilization (IVF)

Page 36: Endocrine disruptors and child healths

BPA and obesityBPA and obesity

Page 37: Endocrine disruptors and child healths

Authors Country Year N Age(yr)

Method 

LOD(ng/mL)

BPA(ng/mL)

Obesity (%)

OW(%)

ResultBPA (ng/mL) and

obesity

P-value

2012: Trasande L, et al

USA 2003-2008

2838 6-19 LCMS 

0.3 2.8(median)

17.8 34.1 1st Q (BPA ≤1.5)2nd Q (1.5-2.7)3rd Q (2.8-5.5)4th Q (>5.6)OR 2.08-2.57

< 0.001

2012:Bhandari R, et al

USA 

2003-2008

2200 

6-18 LCMS 

0.3 4.8 17.7 

16.7 1st Q (BPA ≤1.5)2nd Q (1.5-2.7)3rd Q (2.8-5.4)4th Q (>5.4)OR 1.78-2.55

0.002

2012:Wang H, et al

China 2011 259 8-15 LCMS  

0.07 0.45 GM

31.7 20.4 Normal BPA 0.33Obesity BPA

0.57

0.018

2013:Li D, et al

China 2011 1,326 4-12 HPL/FD    

0.31 NA 18.3 Girl: associated with overweight

Significant, 95%CI

Thai children

Thailand

2013-2014

376 3-18 LCMS 

0.05 0.68(median)

11.3 9.0 OR 3.42 (NL vs. obese)

0.02

LOD: Lower limit of detection, OR: Odds ratio, LCMS: Liquid chromatography mass spectrometry

Page 38: Endocrine disruptors and child healths

BMIUrine BPA

(ng/mL)Urine adjusted BPA (ug/g Cr.)

Estimated daily intake (ug/day)

Median (IQR) Median (IQR) Median (IQR)

Normal weightOverweightObesity

 0.67 (0-1.48)0.62 (0-1.13)

0.87 (0.39-1.70)

 0.51 (0-1.09)0.36 (0-0.76)

0.71 (0.20-1.16)

 0.50 (0-1.32)0.45 (0-1.03)

0.65 (0.30-2.04)

IQR: Interquatile range

Page 39: Endocrine disruptors and child healths

 BMI OR 95% Confident interval for OR P-value

Normal weight Overweight Obesity

 1.001.123.42

  

0.48-2.621.18 -9.95

 1.000.790.02*

OR: Odds ratio

Page 40: Endocrine disruptors and child healths

BPA and pubertyBPA and puberty

Page 41: Endocrine disruptors and child healths

15/04/23Vichit Supornsilchai, MD 41

Integration of timing of Integration of timing of puberty influenced by both puberty influenced by both genetic and environmental genetic and environmental factorsfactors

Page 42: Endocrine disruptors and child healths

BPA and pubertal onsetBPA and pubertal onset

Pubertal developmentPubertal development No association between urine BPA conc No association between urine BPA conc

at 6-8 yrs of age and breast or pubic hair at 6-8 yrs of age and breast or pubic hair development 1 yr later (Wolff et al): development 1 yr later (Wolff et al): prospective cohort study, n= 1151prospective cohort study, n= 1151

No association between urine BPA and No association between urine BPA and pubertal develpoment (Wolff et al): cross pubertal develpoment (Wolff et al): cross sectional study, n= 192sectional study, n= 192

Page 43: Endocrine disruptors and child healths

Study Year Country Number

patients/

control

 Specimen/

Analysis

method

BPA  

Statistic

significant

patients control

Sun Woo

Lee et al

2009 Korea 30/30 Serum/

GCMS

11.2 ± 10.3 16.2 ± 12.5 No

Yunje Kim

et al

2013 Korea 150/90 Serum/

GCMS

7.56 ± 5.6

(N.D.-29.53)

ng/mL

3.53 ± 4.11

(0.39-26.16)

 ng/mL

no

Cai D et al 2010 China 110/100 Serum/

HPLC

40.9% 2% yes

Durmaz

et al

2014 Turkey 28 Urine/

HPLC

8.34

(median;

0.84-67.35)

µg/g Cr

1.62

(median;

0.3-25.79)

µg/g Cr

OR 8.68

95% CI:

2.03-32.72

Thai 2014 Thailand 29a/12b/43c

a:precocious

puberty,

b:early puberty

c:control

Urine/

LCMSMS

1.62 (0.68, 3)/

0.54 (0, 1.22)

(median)

µg/g Cr

0.59 (0, 0.97)

(median) µg/g

Cr

 

yes

BPA and precocious pubertyBPA and precocious puberty

Page 44: Endocrine disruptors and child healths
Page 45: Endocrine disruptors and child healths
Page 46: Endocrine disruptors and child healths

Kiss1 neuron

Kiss1 neuron

Kiss1 neuron

“Kiss network”

GnRH neuron

RFRP3 neuron

TTF1

EAP1

YY1 AVP/PeN

ARC

MeAPituitary

FSH, LH

Puberty

++

GnRH

stimulator

inhibitor

?

+

+

GPR54

GPR14

7/G

PR74

+

-

-

-

-

--

BPA

BPABPA

Page 47: Endocrine disruptors and child healths

How to reduce the endocrine How to reduce the endocrine

disruptors exposuredisruptors exposure Eliminate any pesticide, herbicide and Eliminate any pesticide, herbicide and

insecticide use (recommend organic insecticide use (recommend organic products)products)

Wash non-organic fruits and vegetablesWash non-organic fruits and vegetables Make as much of your diet organic as Make as much of your diet organic as

possible. This will eliminate the toxic, possible. This will eliminate the toxic, hormone-disrupting chemicals that are hormone-disrupting chemicals that are sprayed on fruits and vegetables. sprayed on fruits and vegetables.

15/04/23Vichit Supornsilchai, MD 47

Page 48: Endocrine disruptors and child healths

How to reduce the endocrine How to reduce the endocrine disruptors exposuredisruptors exposure

Use organic personal care products Use organic personal care products (shampoos, sunscreens, skin (shampoos, sunscreens, skin care, body care)care, body care)

Page 49: Endocrine disruptors and child healths

How to reduce the endocrine How to reduce the endocrine disruptors exposuredisruptors exposure

Teach your children to wash their hands Teach your children to wash their hands frequently and not to lick their fingers or frequently and not to lick their fingers or bite their nails. bite their nails.

Avoid buying canned foods or foods Avoid buying canned foods or foods wrapped in plastic. Make sure you wrapped in plastic. Make sure you remove foods from packaging as soon as remove foods from packaging as soon as possible. Use glassware for oven cooking possible. Use glassware for oven cooking

Page 50: Endocrine disruptors and child healths

How to reduce the endocrine How to reduce the endocrine disruptors exposuredisruptors exposure

Carefully read the labels of foods, Carefully read the labels of foods, personal care products, household personal care products, household cleaners, cosmetics etc.cleaners, cosmetics etc.

Install a water filter (pesticides, other Install a water filter (pesticides, other chemicals and other debris combine in chemicals and other debris combine in drinking water and heavy metals from drinking water and heavy metals from household pipes and plumbing)household pipes and plumbing)

15/04/23Vichit Supornsilchai, MD 50

Page 51: Endocrine disruptors and child healths

How to reduce the endocrine How to reduce the endocrine disruptors exposuredisruptors exposure

Don't let children chew on soft plastic Don't let children chew on soft plastic toys. Phthalates are added to soften PVC toys. Phthalates are added to soften PVC plastic toys. These plastic toys also retain plastic toys. These plastic toys also retain any pesticides sprayed in the house for any pesticides sprayed in the house for up to two weeks. up to two weeks.

Page 52: Endocrine disruptors and child healths

Problems in the study of EDs Problems in the study of EDs

difficult to compare the results from each studydifficult to compare the results from each study are the environmental levels sufficient to are the environmental levels sufficient to

induce reproductive tract abnormalities?induce reproductive tract abnormalities? the mixture effects in the environments the mixture effects in the environments

(additive or synergistic manner) (additive or synergistic manner) organ specific effectsorgan specific effects

Page 53: Endocrine disruptors and child healths

15/04/23Vichit Supornsilchai, MD 53

Thank Thank youyoufor for

your your attentionattention


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