By Lea Borgi, MD
April 24, 2018
Restaurant meals have more calories, salt, and fat than meals consumed at home.1 Additionally, eating out has been associated with an increased risk of obesity and hypertension.2
A recently published study found that there is even more reason for concern when it comes to food prepared away from home.3 Indeed, in an analysis of participants in the National Health and Nutrition Examination (NHANES), dining out was associated with a higher exposure to phthalate, an endocrine disrupting chemical (EDC).3 Phthalates, also called plasticizers, are found in several products, including food packaging and personal care products.4 By measuring urinary phthalate metabolites, authors were able to estimate individuals’ cumulative phthalate exposure.
Daily phthalate intake was found to be higher amongst participants who reported dining out the day prior when compared to those who ate at home (for example, 55% higher metabolite concentration in adolescents who reported eating out).3 Eating in fast food restaurants, full-service restaurants, or school cafeterias was found to be associated with an increased phthalate exposure, most likely because these foods are subjected to additional processing and packaging. When individual foods were analyzed, burgers and sandwiches consumed away from home were linked with the highest phthalate consumption, while abiding by dietary guidelines for fruit and vegetable consumption was linked with lower phthalate levels.3
Phthalate exposure has been associated with several diseases; first, because of its endocrine altering properties, phthalates have been linked with decreased sperm motility and concentration in males.5,6 Second, in a previous NHANES analysis, women with higher levels of phthalates had a higher risk of developing diabetes with an odds ratio of 1.96 (95% CI: 1.11-3.47).7 Finally, EDC, including phthalates, were found to play a role in the progression of obesity.8
In conclusion, while eating at home is recommended to curb the extra calories and unwanted fat and sugar, it is also important to address exposure to known detrimental environmental chemicals, especially those linked with adverse health outcomes. Partnering with the food industry to find safer processing and packaging practices would help decrease the consumption of EDCs, including phthalates.
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1. Cohen DA, Story M. Mitigating the Health Risks of Dining Out: The Need for Standardized Portion Sizes in Restaurants. Am J Public Health. 2014;104(4):586-590. doi:10.2105/AJPH.2013.301692.
2. McGuire S, Todd JE, Mancino L. et al. The Impact of Food Away from Home on Adult Diet Quality. ERR-90, U.S. Department of Agriculture, Econ. Res. Serv., February 2010. Advances in Nutrition. 2011;2(5):442-443. doi:10.3945/an.111.000679.
3. Varshavsky JR, Morello-Frosch R, Woodruff TJ, et al. Dietary sources of cumulative phthalates exposure among the U.S. general population in NHANES 2005–2014. Environment International. 2018, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2018.02.029.
4. Centers for Disease Control and Prevention. (2017). National Biomonitoring Program. Phthalates Factsheet. Retrieved from https://www.cdc.gov/biomonitoring/Phthalates_FactSheet.html
5. Swan SH. Environmental phthalate exposure in relation to reproductive outcomes and other health endpoints in humans. Environ Res. 2008;108(2):177-184. doi:10.1016/j.envres.2008.08.007.
6. Giulivo M, Lopez de Alda M, Capri E, et al. Human exposure to endocrine disrupting compounds: Their role in reproductive systems, metabolic syndrome and breast cancer. A review. Environ Res. Volume 151, 2016, Pages 251-264, ISSN 0013-9351, https://doi.org/10.1016/j.envres.2016.07.011.
7. James-Todd T, Stahlhut R, Meeker JD, et al. Urinary Phthalate Metabolite Concentrations and Diabetes among Women in the National Health and Nutrition Examination Survey (NHANES) 2001–2008. Environ Health Perspect. 2012;120(9):1307-1313. doi:10.1289/ehp.1104717.
8. Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, et al. Endocrine-disrupting chemicals: an endocrine society scientific statement. Endocr. Rev. 30 (2009), pp. 293-342
Dr. Borgi’s clinic research focuses on the link between nutrition and chronic diseases, such as hypertension and kidney disease. Dr. Borgi is also interested in food policy, and is completing a Master in Nutrition Sciences and Policy at the Friedman School of Nutrition Science and Policy at Tufts University. Dr. Borgi is currently interested in the recent changes made in food government programs regarding the inclusion of potatoes in food stamps.