. 2020 Jun 21;10(6):e033509. doi: 10.1136/bmjopen-2019-033509

Table 3.

Human studies addressing exposure to OC compounds and obesity (n = 25)

Authors, year	Country	Study design, quality	Study objective	Source population	Sex and age	Sample size	Sample, compounds (DR) and method	Outcomes	Adjustment for confounding factors	Main findings
Hue et al, 2007⁸⁹	Canada	Cross-sectional, 5	To investigate the association between [plasma OC compounds] and obesity	NS	Male and female, steady body weight, control 38.8±9.4 years (n=16), obese 38.6±7.6 years (n=19), morbidly obese 44.3±9.2 years (n=18)	53	Plasma 14 PCBs (28, 52, 99, 101, 105, 118, 128, 138, 153, 156, 170, 180, 183, 187) (NS) 11 chlorinated pesticides (β-HCH, HCB, p, p’-DDE, trans-nonachlor, oxychlordane, cis-nonachlor, aldrin, α-chlordane, γ-chlordane) (NS) p, p’-DDT (7.5%) mirex (22.4%) GC-MS	BMI	Age	[Total plasma OC compounds] not correlated with BMI
Dhooge et al, 2010⁵³	Belgium	Cross-sectional, 6	To investigate the association between exposure to pollutants and body size	Selection from a stratified clustered multistage design, as a random sample of adolescents and adults residing in the study area	Male and female, 14–15 years and 50–65 years	1679 adolescents, 1583 adults	Serum PCB 118, 138, 153, 180, HCB, p, p-DDE, CALUX analysis of the dioxin fraction of dioxin-like activity in plasma (NS) GC-ECD	BMI	Adolescents: blood lipids, age, height of father and mother, smoking, sexual maturation (Tanner), food intake. Adults: blood lipids, age, smoking, food intake	[Serum HCB, sum PCB 118, 153, 180] negatively associated with BMI, and [PCB118] positively associated with BMI in adolescents [Serum sum PCB 138, 153, 180] negatively associated with BMI, and [serum HCB, p, p’-DDE and PCB118, dioxin fraction] positively associated with BMI in adult men [Sum PCB138, 153, 180] negatively associated with BMI, and [HCB, p, p’-DDE and PCB118] positively associated with BMI in adult women
Elobeid et al, 2010²³	USA	Cross-sectional, 5	To investigate the association between [serum OC compounds] and BMI/WC	General population, NHANES 1999–2002	Male and female, 6 years to > 40 years	2464	Serum HpCDD, OcDD, oxychlordane, trans-nonachlor, p, p’-DDT (NS) GC-MS	BMI, WC	Serum TC and TG	[Serum p, p’-DDT] positively associated with WC in all subjects [Serum oxychlordane and HpCDD] positively associated with WC in subjects with detectable levels of these compounds [Serum OcDD] increased with higher WC and BMI [Serum trans-nonachlor] decreased with higher BMI
Dirinck et al, 2011⁵⁴	Belgium	Cross-sectional, 4	To investigate the association between [serum OC compounds] and BMI, WC, fat mass and HOMA-IR	Outpatients from the weight management clinic of the Department of Endocrinology, Diabetology and Metabolism of the Antwerp University Hospital (obese); hospital staff and volunteers (normal-weight controls)	Male and female, 21–60 years (median 40 years)	144	Serum PCB (153, 138, 180, 170, sum PCB), pp-DDE, b-HCH (NS) GC-MS	BMI, WC, FM (total abdominal, visceral abdominal, subcutaneous abdominal), FM%	None	[Serum PCB 153, 180, 180, sum PCB] negatively correlated with BMI, WC, FM%, total and subcutaneous abdominal adipose tissue [Serum b-HCH] positively correlated with BMI, WC, FM%, and total and subcutaneous abdominal adipose tissue
Lee et al, 2011²⁴	USA	Cohort, 7	To investigate the association between [serum OC compounds] and adiposity, dyslipidaemia, and insulin resistance over 18 years	Non-diabetic controls from the Coronary Artery Risk Development in Young Adults study	Male and female, 18–30 years at baseline (27.2±3.3 years)	90	Serum 9°C pesticides (44%–100%), 35 PCB congeners (7%–100%) GC/ID-HRMS	BMI	Age, sex, race, TG, TC, HDL-C, HOMA-IR, baseline BMI	[Serum p, p’-DDE] and PCBs with > 7 chlorines predicted higher BMI after 18 years (inverted U-shaped curve across quartiles)
Twum et al, 2011²⁵	USA	Cross-sectional, 6	To investigate the association between [urinary OC compounds] and obesity	General population, NHANES 2003–2004, NHANES 2005–2006	Male and female, 6–19 years	6770	Urine 2,4-DCP (92%), 2,5-DCP (99%), ortho-phenylphenol (<40%) HPLC-MS	BMI, obesity (BMI > p95 for sex and age)	Age, gender, race, income, total fat intake	[Urinary 2,5-DCP] associated with childhood obesity
Lee et al, 2012⁵⁵	Sweden	Cross-sectional, 6, and prospective, 7	To investigate the association between [plasma POPs] and prevalent abdominal obesity, cross-sectionally and prospectively	Participants from the Prospective Investigation of the Vasculature in Uppsala Seniors	Male and female, 70 years (at baseline)	970 (cross-sectional) 511 (prospective)	Plasma 17 PCB (98.7%–100%) 5°C pesticides (p, p’-DDE, trans-nonachlor, HCB, chlordane, cis-chlordane(3.4–100%)) HRGC-HRMS	WC, abdominal obesity (WC > 102 cm for men and > 88 cm for women)	Total calorie intake, exercise, smoking, alcohol consumption, TG, TC	[Plasma less chlorinated PCBs, p, p’-DDE and dioxin] associated with abdominal obesity (inverted U-shape relation, particularly in women) [Plasma highly chlorinated PCB] inversely associated with abdominal obesity Similar but weaker associations between [plasma POPs] and development of abdominal obesity after 5 years
Arrebola et al, 2012⁸⁷	Bolivia	Cross-sectional, 3	To describe [serum and adipose tissue OC compounds] in an urban adult population from Bolivia and its association with demographic characteristics	Subjects undergoing non-cancer-related surgery at a general hospital in Santa Cruz de la Sierra	Male and female, >16 years (31.4±12.6 years)	112	Serum and adipose tissue p, p’-DDT (50%), p, p’-DDE (93%), HCB (21%), PCB congeners 138,153,180 (56%–80%) GC-ECD	BMI	None	[Serum and adipose tissue OC compounds] not correlated with BMI
Ben et al, 2013⁸⁸	Tunisia	Cross-sectional, 4	To describe [serum OC compounds] in the general population of Bizerte, Tunisia, and investigate its association with age, gender and BMI	Subjects visiting the Regional Hospital of Bizerte, in Tunisia	Male and female, >18 years, not pregnant and without critical or heart disease	113	Serum HCB, p, p’-DDE, PCB 153, PCB 180 (100%) Dieldrin, heptachlor, PCB 18, 28, 31, 52, 44 (0%) b-HCH, lindane, p, p’-DDD, p, p’-DDT, PCB congeners 101, 149, 118, 138, 194 (1.7%–95.6%) GC-MS	BMI	Serum lipids	[Serum OCPs and PCB congeners 153, 138, 180 and sum PCB] not associated with BMI
Lankester et al., 2013⁴³	USA	Cross-sectional, 7	To investigate the association between [urinary TCS] and BMI	General population, NHANES 2003–2003	Male and female, >20 years	4037	Urine TCS (75%) HPLC-MS/MS	BMI	Survey year, sex, age, race, poverty index ratio, urinary BPA, urinary cotinine	[Urinary TCS] positively associated with increased BMI
Roos et al, 2013⁶⁰	Sweden	Cross-sectional, 6	To investigate the association between [plasma OC compounds] and abdominal obesity	Subjects aged 70 years randomly chosen from the register of community living from Uppsala, Sweden	Male and female, 70 years	1016	Plasma 16 PCBs, p, p’-DDE, HCB, TNC (>95.5%); OcDD (80.6%); cis-chlordane, trans-chlordane (<10%) HRGC-HRMS	BMI, VAT/SAT ratio (determined by MRI)	Gender, education, exercise habits, smoking	[Plasma less chlorinated PCBs, p, p’-DDE, HCB, TNC] positively associated with both VAT and SAT [Plasma highly chlorinated PCBs] inversely related to both VAT and SAT [Plasma PCB189] correlated with VAT/SAT ratio in an inverted U-shaped manner
Buser et al, 2014²⁶	USA	Cross-sectional, 7	To investigate the association between [urinary POP] and BMI z-score, WC and obesity	General adult population, NHANES 2007–2008 and 2009–2010	Male and female, 6–19 years (mean 12.56±0.1 years)	1298	Urine 2,5-DCP (98.5%), 2,4-DCP (90%), TCS (79%) HRGC-HRMS	BMI z-score, WC, overweight (BMI p85–p95), obesity (BMI > p95)	Age, sex, race/ethnicity, calorie intake, television and video game and computer usage (6–11 years), physical activity (12–19 years), serum cotinine, poverty income ratio, urinary creatinine	[Urinary 2,4-DCP, 2,5-DCP] positively associated with BMI z-score, WC and obesity. After stratification for age, the associations remained significant only in adolescents.
Wei et al, 2014²⁷	USA	Cross-sectional, 7	To investigate the association between [urinary POP] and obesity	General adult population, NHANES 2005–2006, NHANES 2007–2008	Male and female, 20–85 years	2931	Urine 2,4-DCP (92.6%), 2,5-DCP (99%) HPLC-MS	BMI, obesity (BMI > 30 kg/m²), non-obese (< 30 kg/m²)	Age, gender, race, income, education, total fat intake, physical activity, urinary creatinine	[Urinary 2,5-DCP] positively associated with obesity
Li et al, 2015⁴⁴	USA	Cross-sectional, 6	To investigate the association between [urinary TCS] and obesity traits	General adult population, NHANES 2003–2010	Female and male, children (6–19 years) and adults (>20 years)	2898 children 2066 adults	Urine TCS (77%–79%) ID-HPLC-MS/MS	BMI and WC	Race/ethnicity, socioeconomic status, serum cotinine, (urinary BPA)	[Urinary TCS] inversely associated with BMI and WC in children and adults
Zong et al, 2015⁴⁵	USA	Cross-sectional, 7	To investigate the association between [serum OC compounds] and body fat	General adult population, NHAES 1999–2004	Female and male, >20 years	2358	Serum p, p’-DDE, p, p’-DDT, b-HCH, HxCDD, OcDD, HpCDF, PCB (126, 138, 153, 169, 170, 180, 187, 194, 196,199) (30%–69%) HRGC-HRMS	FM% (DXA)	Serum lipids, gender, age, ethnicity, education, physical activity, smoking status, alcohol consumption, history of parity and lactation	[Serum b-HCH, HpCDF, OcDD, PCB126] positively associated with trunk FM% (correlations stronger in subjects >40 years); [serum PCB 138, 153, 169, 170, 180, 187, 194, 196] inversely correlated with FM%
Tang-Péronard et al, 2015⁵⁶	Denmark	Cohort, 7	To investigate the association between [serum POP] at 8–10 years of age and changes in measures of obesity at 14–16 years and 20–22 years	Children form the European Youth Heart Study, Danish component	Male and female, 8-10 years at baseline	392	Serum PCB sum (PCB 138, 153, 180), p, p’-DDE, HCB (NS) GC	BMI z-score, WC, %BF	Baseline obesity, breast feeding, maternal educational level, maternal smoking, maternal BMI, pubertal status, physical fitness (maximal work test), dietary intake	[Serum POP] not associated with subsequent changes in measures of obesity
Geens et al, 2015⁴⁹	Belgium	Cross-sectional, 6	To investigate the association between [urinary TCS] and anthropometric data and serum thyroid hormones, to evaluate the dynamics of [urinary TCS] during 1 year of weight loss, to estimate daily TCS intake and investigate daily intake differences during weight loss and to evaluate variations in exposure sources according to treatment method for weight loss (bariatric surgery/diet)	OW and obese adults from the Endorup trial (Antwerp University Hospital); lean controls from hospital staff and volunteers	Female and male, >18 years	194	Urine TCS (>90%) HPLC-MS	BMI, WC	Age, gender, weight loss, urinary creatinine	No difference between [urinary TCS] in obese and lean subjects at baseline No significant change of [urinary TCS] during weight loss
Xue et al, 2015⁷¹	India	Cross-sectional, 6	To investigate the association between [urinary POPs] and obesity	Endocrinology Outpatient Department of the Amrita Institute of Medical Sciences, Kochi, India	Male and female, 2–14 years	103 (49 OW or obese and 27 normal-weight healthy controls)	Urine TCS (100%) LC-MS	BMI (OW defined by BMI > p85 and obesity defined by BMI > p95)	Age, sex, family income, parent education, physical activity, urinary creatinine	(Urinary TCS) not associated with obesity
Lee et al, 2016⁷⁴	South Korea	Cohort, 8	To investigate the association between [serum OC compounds] and prospective change of metabolic components of metabolic syndrome	Subjects from the Ewha Birth & Growth Cohort study	Female and male, 7–9 years	214 (158 completed follow-up)	Serum PCB (52, 101, 118, 138, 153, 156, 180), marker PCB (sum 28, 52, 101, 138, 153, 180), dioxin-like PCB (sum 77, 81, 114, 105, 126, 123, 156, 157, 169, 167, 189), nonachlor, HCB, b-HCH, p, p’-DDT, p, p’-DDE) (61.68%–99.53%) PCB (1, 3, 4, 15, 19, 28, 37, 77, 81, 104, 105, 114, 123, 126, 155, 157, 167, 169, 188, 189, 202, 205, 206, 208), oxychlordane, chlordane, heptachlor, heptachlor epoxide, a-HCH, g-HCH, d-HCH, o, p’-DDT, p, p’-DDD, o, p’-DDD, o, p’-DDE (NS) GC-MS	BMI, BMI z-score	Gender, age, monthly household income, baseline BMI, serum lipids	No association between (serum OC compounds) and change in BMI after 1 year
Deierlein et al, 2017³⁶	USA	Cohort, 9	To investigate the association between [urinary EDCs] and changes in adiposity measurements after 8 years, in elementary-school-aged girls	Subjects from the puberty cohort studies of the Breast Cancer and Environment Research Programme	Female, 6–8 years	1017	Urine 2,5-DCP (>80%) TCS (>80%) HPLC-MS	BMI, WC, BF% (bioelectrical impedance analysis)	Age, urinary creatinine, race/ethnicity, site of study, caregiver education, early puberty, baseline weight	(Urinary 2,5-DCP and TCS) associated with increase in adiposity measurements after 8 years
Harmouche et al, 2017⁸⁰	Lebanon	Cross-sectional, 6	To investigate serum levels of six indicator PCBs and differences in PCBs levels by gender, age and BMI	Students and employees of Saint Joseph University	Female and male, 17–65 years	316	Serum PCB 28, 52, 101, 138, 153, 180 (50%–60%) GC-ECD	BMI, BF% (bioelectrical impedance analyser)	Total serum lipids, age, gender, smoking status, dairy product, fish and shellfish consumption	(Serum sum PCB) associated with OW and OB in and inverted-U shaped manner
Henriquez-Hernandez et al, 2017⁶¹	Spain	Cross-sectional, 4	To investigate the association between exposure to POPs and OB and type two diabetes	Subjects from the Canary Islands Nutrition Survey	Female and male, >18 years	429	Serum p, p′-DDT (<50%), DDE (<50%), DDD (<50%), p, p′-DDE (85.8%), p, p′-DDD (<50%), aldrin (64.1%), dieldrin (<50%), endrin (68.3%), HCHα (88.1%), HCHβ (<50%), HCHδ (<50%), HCHγ (55.7%) PCBs 153 (77.2%), 180 (85.1%), 28, 52, 77, 81, 101, 105, 114, 118, 123, 126, 138, 153, 156, 157, 167, 169, 180, 189 (<50%) GC-ECD (OCPs), GC-MS (PCBs)	BMI, waist-to-hip ratio	None	(Serum p, p’-DDE) higher among OW and OB subjects
Karlsen et al, 2017⁶²	Denmark	Cross-sectional, 6	To investigate the association between [POPs] and obesity	Subjects from the National Hospital of the Farol Islands	Female and male, 5 years	349	Serum sum PCB 138, 153, 180 (100%), HCB (100%), p, p’DDE (100%) GC-ECD	BMI z-score, OW (> p85)	Serum lipids, maternal nationality, age at delivery, prepregnancy BMI, smoking during pregnancy, child’s gender, exclusive breastfeeding duration, child’s fish intake at age 5 years	(Serum OC compounds) inversely associated with BMI z-score
Parastar et al, 2017⁸¹	Iran	Cross-sectional, 2	To investigate the association between [urinary pesticides] and obesity in children and adolescents	Selection from households in different areas of Isfahan, Iran	Male and female, 6–18 years	242	Urine 2,4-DCP (94.6%), 2,5-DCP (95%), 2,4,5-TCP (85.1%), 2,4,6-TCP (38%) GC-MS	BMI, BMI z-score, WC	Urinary creatinine, physical activity, fasting blood sugar, blood pressure, TC, HDL-C, LDL-C	[Urinary 2,5-DCP] positively associated with BMI z-score and WC; [urinary 2,4,5-TCP] positively associated with WC; [urinary 2,5-DCP] associated with obesity
Kalloo et al, 2018⁴²	USA	Cross-sectional, 8, and prospective, 8	To investigate the association between [urinary TCS] and adiposity in children	Participants from the Health Outcomes and Measures of the Environment Study, Cincinnati	Male and female, <8 years	218	Urine TCS (NS) HPLC-MS/MS	BMI, WC, %BF	Maternal variables: race, age, education, marital status, household income, age at delivery, BMI, prenatal vitamin use, delivery method, breast feeding, parity, gestational diabetes, hypertensive disorders, urinary cotinine Child variables: age, screen time, diet, physical activity	No association between [urinary TCS] at the ages of 1–5 and 8 and measures of adiposity at the age of 8 years

AT, adipose tissue; BF, body fat; BMI, body mass index; BPA, bisphenol A; CALUX, chemical activated luciferase gene expression; DCP, dichlorophenol; DDD, dichlorodiphenyldichloroethane; DDE, dichlorodiphenyldichloroethylene; DDT, dichlorodiphenyltrichloroethane; DR, detection rate; DXA, dual-energy X-ray absorptiometry; EDC, endocrine disrupting chemical; FM, fat mass; GC-ECD, gas chromatography–electron capture detector; GC-ID/HMRS, gas chromatography–isotope dilution/high-resolution mass spectrometer; GC-MS, gas chromatography–mass spectrometry; HCB, hexachlorobenzene; HCH, hexachlorohexane; HDL-C, high-density lipoprotein cholesterol; HOMA-IR, homeostatic model assessment-insulin resistance; HpCDD, heptachlorodibenzo-p-dioxin; HpCDF, heptachlorodibenzofuran; HPLC-MS, high-performance liquid chromatography–mass spectrometry; HPLC-MS/MS, high-performance liquid chromatography-tandem mass spectrometry; HRGC-HRMS, high-resolution gas chromatography–high-resolution mass spectrometry; HxCDD, hexachlorodibenzo-p-dioxin; HxCDF, hexachlorodibenzofuran; ID-HPLC-MS/MS, isotope dilution-high-performance liquid chromatography-tandem mass spectrometry; LC-MS, liquid chromatography-mass spectrometry; LDL-C, low density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Survey; NS, not stated; OB, obesity; OC, organochlorine; OcDD, octachlorodibenzo-p-dioxin; OCP, organochlorine pesticide; OW, overweight; PCB, polychlorinated biphenyl; PeCDF, pentachlorodibenzofuran; POPs, persistent organic pollutant; SAT, subcutaneous adipose tissue; TC, total cholesterol; TCP, trichlorophenol; TCS, triclosan; TG, triglyceride; TNC, transnonachlordane; VAT, visceral adipose tissue; W, weight; WC, waist circumference.