Some work environment factors can greatly affect human health. Negative effects are especially pronounced when workers are exposed to multifactorial conditions and noxious agents [1]. Phthalates —the esters of 1,2-benzenedicarboxylic acid, constitute a group of man-made chemicals having many industrial applications. As plasticizers, phthalates are additives which improve the flexibility, processability and softness of vinyl [2]. Phthalates are not bonded with covalent bonds to the polymer chains, but rather their molecules are embedded between the polymer chain molecules, so they can leach out or evaporate into air or become part of dust and airborne particles. Due to this fact, they have become one of the major indoor pollutants [3,4,5] and play a role as important environmental factors in the pathogenesis of negative health outcomes. Other possible routes of exposure are through contaminated foodstuffs, mainly through packaging materials, or dermal contact with cosmetics containing phthalates [6,7,8].

Phthalate exposure was found to be related to various adjuvant or inflammatory responses of inflammatory cells [9] and it was shown that phthalates may contribute to airway remodelling [10] or may affect respiratory health [4,11,12,13,14]. Some studies show that employment in the polyvinyl chloride (PVC) fabrication industry may be associated with both obstructive and restrictive ventilatory effects [15] and pointed to a potential toxicological effect of vinyl and PVC [16,17]. Exposure to the thermal degradation products of PVC and phthalic acid esters leads to symptoms affecting the eyes and upper airways, probably associated with the thermal degradation products of PVC. However no significant differences were found between exposed and control subjects with regard to spirometry [18].

Di(2-ethylhexyl) phthalate (DEHP) has been associated in epidemiological studies with the development of wheezing and allergic airway diseases [10,19,20]. At high concentrations, mono (2-ethylhexyl) phthalate (MEHP) can have acute airway irritant effects in mice [21]. In polyvinylchloride fabrication workers decreases in adjusted cross-shift ratio of forced expiratory volume in 1 s to forced vital capacity (FEV₁/FVC), pre shift FEV₁/FVC, and prevalence of chronic cough and chronic phlegm were observed [19]. The complete role of phthalates in respiratory diseases still remains to be established [14], but indoors emissions from plastic `materials may have adverse effects on the lower respiratory tract [17]. Increasing but limited evidence for the effects of phthalate exposure on respiratory health has demanded attention for further investigation [11,14,22]. Because of the presence of phthalates in a great number of materials and products incommon use, the opportunity of exposure in everyday life is high. This risk is considerably higher in waste management workers because they are exposed to a wide range of different plastic materials in mixtures of substances which can influence their leaching or evaporation. The aim of this work was to study the potential effect of exposure to phthalates and health-related outcomes in waste management workers.

The characteristics of subjects are described in Table 2. All participants (n = 30) were in permanent, full-time position in communal services in the Nitra region, Slovakia. Men had been employed on average 94.8 months (n = 20) and women 66.6 months (n = 10). The percentage of smokers and ex-smokers in the group was similar, 55% and 60%, respectively. Pack/year index (p/y) was much higher in men (21.95 ± 18.67) than in women (7.13 ± 8.31).

Spirometry results suggest a decrease of pulmonary functions (especially FEV₁ and FEV₁/FVC) associated with respiratory disease. We detected mild to severe COPD symptoms in 20% (n = 6; p/y = 24.08 ± 21.88) and symptoms of chronic bronchitis (CHB) in 50% (n = 15; p/y = 12.80 ± 10.96) of subjects.

Table 3 summarizes data on concentration of phthalate monoesters in urine of the 30 waste management workers collected during a day shift. We found that the concentration of the metabolite MEHP is the highest, followed by the metabolites MnBP, MEP and MiNP.

We observed several relationships between anthropometric and respiratory parameters not related to phthalate exposure. Thus, we observed a significant decrease of FEV₁/FVC associated to pack/year index (r = −0.425; p = 0.019) and sagittal chest diameter (r = −0.410; p = 0.025). The results of our study suggest significant associations between decreases in FVC % of predicted value with transverse chest diameter (r = −0.406; p = 0.026) and BMI (r = −0.385; p = 0.036). We only observed associations between decreases in FEV₁ % of predicted values with transverse chest diameter (r = −0.439; p = 0.015) and BMI (r = −0.375; p = 0.041).

We observed an association between FFMI and increased PEF % of PV (r = 0.362; p = 0.049). In agreement with the purpose of the study, we observed that the urinary concentration of MEHP was positively associated with FEV₁/FVC (r = 0.431; p = 0.018). Values of WHR were inversely associated with urinary levels of MEHP (r = −0.362; p = 0.049). We also found correlations between WHtR (r = −0.357; p = 0.057) and waist circumference (r = −0.347; p = 0.060) and decreasing concentration of MEHP. We observed association between FFMI and increase of MiNP concentration (r = 0.439; p = 0.015).

Table 4 summarizes the results of backward multiple linear regression analysis used for identification of factors associated with pulmonary function. We are presenting only regressions with significant results. The strongest predictor of pulmonary function was the p/y index. Smoking history predicted a decrease of the following pulmonary parameters: index FEV₁/FVC, FEV₁ % of PV and PEF % of PV. Unexpectedly, the concentration of two urinary phthalate metabolites, MEHP and MiNP, were positively associated with pulmonary function (in PEF % of PV and FEV₁/FVC). Anthropometric parameters FFMI, BMI and transversal chest diameter were associated with pulmonary function. BMI was inversely associated with pulmonary parameters in FEV₁ % of PV and in FVC % of PV while FFMI was positively associated with in PEF % of PV.

Many toxic substances encountered in the workplace can modify human health and quality of life. We have shown herein that there is still insufficient data on respiratory outcomes for adults exposed to phthalates. We detected that mean concentrations for urinary MEP, MnBP and MEHP are positively skewed, which means that in community services workers high levels prevail in the upper quantiles.

Urinary MEHP concentrations in our study (median 5.94 ng/mL) are comparable with workers in a factory with polymer moulding (pre-shift urine sample) and workers in DEHP manufacturing (post-shift urine sample). However they are lower than in other factories included [26]. In comparison with the environmentally exposed general population [2,27,28] we detected a higher concentration of MEHP in urine (median 5.94 ng/mL; 95th percentile 60.71 ng/mL). In other studies on the general population the median was higher but lower 95 percentile values of MEHP concentration (10.3 ng/mL; 37.9 ng/mL [29] and 7.6 ng/mL; 33.6 ng/mL [30]) were observed. However, the values from European countries remain higher than those reported by U.S. authors, which can be explained by substitution of DEHP by other phthalates (DiNP/DiDP) in the United States [30].

The concentration of MiNP was low and close to the detection limit, with detection frequencies of 10% (median < LOD; 95th percentile 14.89 ng/mL). It is comparable to results of the Canadian Health Measures Survey [31], but higher than concentration values in a Danish mother-child pairs study [32]. Exposure estimates based on the concentrations of monoester metabolites of DiNP and DiDP probably underestimates human exposure [33]. It also should be noted that MiNP is not the major metabolite of the parent phthalate as it is converted into several other secondary metabolites prior to excretion [34], so low MiNP detection frequencies do not necessarily suggest low population exposure level to DiNP.

The concentration of MnBP in our study (median 67.13 ng/mL; 95th percentile 130.04 ng/mL) is comparable with an analysis in adult German population [27], but higher than results realised on the general German population [28].

In contrast with the results of National Health and Nutrition Examination Survey (NHANES) [2,23] we recorded lower median and 95 percentile concentration values of MEP (49.20 ng/mL; 344.45 ng/mL), but comparable with investigations on the German general population [28]. Based on the questionnaire and the low socioeconomic status of waste management workers, lower urinary concentrations of MEP were not surprising, because MEP is commonly used in cosmetics, personal care and sun screen products.

Based on correlation analyses, in our study we found an association between phthalate exposure and respiratory health, in particular between MEHP and MiNP and PEF % of PV and FEV₁/FVC. This is not in agreement with data from Third National Health and Nutrition Examination Survey (NHANES III) [14], where no correlation was detected between MEHP and FEV₁/FVC or effects of MEHP on the respiratory tract. On the other hand, an association between urinary concentrations of the metabolites of DEP and of DnBP to decreased lung function was reported [14]. Based on associations found between PVC and bronchial obstruction [10] we assume that the presence of COPD and chronic bronchitis symptoms in our cohort could be associated to phthalate exposure, however it is crucial to take the effect of smoking into account. We speculated on possible modulatory role of phthalates as endocrine disrupting chemicals, which could affect body composition (especially lipid accumulation and fat distribution) and subsequently pulmonary functions. This speculation has yet to be examined in larger samples.

Our results agree with the Korean Elderly Environmental Panel (KEEP) study [35], in which no significant association was found between MnBP and any of the pulmonary function measurements. Urinary levels of MEHP and MiNP were positively associated with PEF % of PV and FEV₁/FVC, which is in contrast to the KEEP survey, where an inverse association between DEHP and FEV₁/FVC was detected. Nevertheless some differences in the analytical approach in the KEEP survey compared to us should be noted. They considered DEHP as the sum of the secondary metabolites mono-(2-ethyl-5-hydroxyhexyl) phthalate and mono-(2-ethyl-5-oxohexyl) phthalate, whereas we only evaluated the primary metabolite MEHP.

There is growing interest in the possibility that endocrine disrupting chemicals, such as phthalates, may affect obesity-related pathways [36]. Indeed, association of concentrations of several prevalent phthalate metabolites with abdominal obesity and insulin resistance was found in a cross-sectional study of US men [37]. In the National Health and Nutrition Examination Survey (NHANES 1999–2002) [38] MEHP was inversely related to BMI, while in our study BMI was inversely associated with WC, WHR and WHtR. We also found an association between increased MiNP concentrations and FFMI. This association would suggest that phthalates may contribute to the body composition.

Our study has several important limitations. The small number of participants (n = 30) could distort results. Another weakness of our study is also the great number of samples with concentration <LOD for MiNP which limited the statistical significance of our data. Further single spot-urine measurement of phthalates does not necessarily reflect the whole exposure history of each participant. Exposure sources may vary over time based on dietary intake, use of personal care products and other factors. A final limitation of study is that we measured only simple monoesters of DEHP and DiNP in urine however oxidative metabolites are much more sensitive biomarkers of phthalate exposure. In the future, special attention has to be paid to the analyses of the oxidative metabolites of long-chain phthalates (DEHP, DiNP) and new potential metabolites (DiNP) [39], which are more suitable to capture the average background exposure. The availability of a greater number of participants would have improved our results.

We have shown in a cross sectional study that waste management workers are exposed to a range of phthalates. Our results suggest that occupational exposure to phthalates as endocrine disrupting compounds, evaluated on the basis of urinary metabolites (MEHP and MiNP) on top of lifestyle factors, can modify pulmonary function (PEF % of PV and FEV₁/FVC) and body composition (FFMI, but not BMI).