{"paper_id":"0f485ff3-795c-482f-b390-471657e0fbb1","body_text":"Exposure to obesogenic endocrine disruptors in childhood. 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Impact on biomarkers of metabolic status. Ana Pilar Nso-Roca, Luis Tortajada-Genaro, Natividad Pons-Fernández, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7058500/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2026 Read the published version in Exposure and Health → Version 1 posted 5 You are reading this latest preprint version Abstract Childhood obesity is an escalating global health concern, partly driven by environmental factors such as endocrine disruptors (EDs), which can alter metabolism and promote adiposity. This case-control study examined the association between exposure to obesogenic EDs (bisphenols, parabens and benzophenones) and body composition in 72 children aged 3 to 15 years (53 with obesity and 19 normal-weight controls) recruited from two hospitals in Spain. Metabolic status, body composition and urinary levels of EDs were evaluated using tandem mass spectrometry. The findings, which are pioneering in evaluating combined exposure to chemicals, reveal that EDs were present in 100% of the participants, with parabens the most frequently detected. Higher methylparaben levels were observed in the group with obesity. Correlational analyses revealed positive associations between specific EDs and adiposity parameters, including triponderal mass index and visceral fat percentage. These results suggest that exposure to EDs may contribute to the development of childhood obesity. The massive and early exposure to EDs underscores the urgent need for preventive policies and longitudinal studies to evaluate their combined effects. These findings provide critical insights for developing effective strategies to combat childhood obesity. Childhood obesity Endocrine disruptors Metabolic risk Chemical exposure Figures Figure 1 Figure 2 Introduction Childhood obesity has become a serious public health issue, with its prevalence rising to pandemic proportions in recent years. In 2016, an estimated 650 million adults and 381 million children and adolescents worldwide were classified as overweight or obese.(World Health Organization 2022 ) Notably, 41 million were children under the age of five.(Ball et al. 2019 ) In Spain, the prevalence of childhood overweight is 23.3%, while childhood obesity affects 18.6% and continues to rise.(World Health Organization 2022 ) Obesity is also an important risk factor for numerous diseases such as diabetes, dyslipidemia, hypertension, metabolic syndrome and cardiovascular disease.(Kumar and Kelly 2017 ) A high-calorie diet and lack of physical activity are primary contributors to the development and progression of obesity. In pediatric populations, therapeutic strategies are limited to lifestyle interventions, such as recommending healthy, low-calorie diets and regular physical exercise. While these approaches can help control obesity, the effectiveness is often limited, resulting in only modest and temporary weight loss.(Vermeiren et al. 2021 ) In this context, identifying novel factors involved in the regulation of energy metabolism is crucial for developing more effective strategies to combat obesity. Recent research has highlighted the potential role of exposure to chemicals that affect the endocrine system.(Thoene et al. 2020 ) These compounds are known as endocrine disruptors (EDs), chemical substances foreign to the affected organism that can alter its hormonal balance or that of its offspring.(Damstra et al. 2002 ) They can mimic the effect of natural hormones disrupting homeostasis and interfering with normal physiological functions. EDs are commonly found in pesticides, plastics, and cosmetic products, among other sources, leading to universal and often unnoticed human exposure.(Velmurugan et al. 2017 ) EDs are responsible for the increased incidence of certain metabolic diseases such as obesity, but their mechanisms of action are diverse and complex.(Li et al. 2021 ) Many of these compounds are considered persistent organic pollutants, characterized by their long-lasting nature, bioaccumulation, toxicity at very low doses, and biomagnification through the food chain.(Nadal et al. 2017 ) Substances that have been clearly identified as EDs include the following: Bisphenols are used in the production of polycarbonate plastics and epoxy resins, and primarily enter the body through the digestive tract. Common sources of exposure include tin cans, water bottles, kitchen utensils, paints, fabrics, car seats and various plastics. Among the most recognized bisphenols are bisphenol A (BPA) and bisphenol S (BPS).(Le Fol et al. 2017 ) Phthalates and parabens are used to enhance the flexibility and durability of plastics. Similar to bisphenols, they are often present in food coatings and can be ingested through the diet. They are also found in products such as toys and cosmetics, where exposure can occur through inhalation.(Xu et al. 2022 ) Polybrominated diphenyl ethers have been used for several decades in industry for their flame-retardant properties. The peculiarity of these substances is that they do not bind chemically with the products to which they are added (such as furniture), facilitating their release and allowing their introduction into the human body by various routes: inhalation through the air, ingestion of contaminated water or oils or even food (especially those rich in fat).(Vuong et al. 2019 ) Pesticides, biocides and herbicides , such as organophosphates, pyrethrins and pyrethroids can be found in both food and gardening products. Polychlorinated biphenyls are used as coolants and lubricants in transformers, condensers, plasticizers, ink solvents and electrical equipment. Metals and metalloids (lead, cadmium, nickel, mercury, arsenic, etc.) are present in food (fish and seafood) and in varnishes in construction materials, costume jewelry, batteries, toys, etc. Perfluoroalkyl substances are one of the most widely used groups of chemicals in industry today. Their properties include stability at elevated temperatures and the ability to act as water and grease repellents. They are present in a multitude of everyday objects such as clothing, furniture, kitchen utensils, food packaging and non-stick surfaces. Benzophenones are organic compounds of the ketone class, known for their ability to absorb ultraviolet radiation. They are widely used as ultraviolet filters in sunscreens, cosmetics, hair and nail care products, and are also found in plastic packaging, paints and coatings to protect against degradation caused by sunlight. The effects of these substances depend on the hormonal system they impact and the timing of exposure, primarily affecting the estrogen or thyroid systems. Among their numerous metabolic effects, many of these substances have recently been identified as obesogenic, as they have been shown to interfere with how the body stores and processes fat, as well as with mechanisms regulating appetite and satiety.(Nadal et al. 2017 ) The most common obesogenic EDs are parabens, bisphenols and benzophenones.(Caporossi and Papaleo 2017 ) Nevertheless, there is limited information regarding exposure in infancy and childhood and its relationship with the development of obesity in children, whether occurring during gestation(Højsager et al. 2021 ) or in the postnatal stage.(Aktağ et al. 2021 ) Eighty percent of children with obesity will be adults with obesity and the metabolic complications of obesity begin in childhood.(Ball et al. 2019 ) Therefore, understanding the impact of exposure to EDs as early as infancy is essential. The vast majority of studies investigating the interaction between EDs and the development of obesity have focused on exposure to individual chemicals. Research on the effects of simultaneous exposure to multiple chemicals in humans is scarce, and even more so in pediatric populations. For this reason, we designed a study to investigate the potential association between body composition in pediatric patients and exposure to key EDs (bisphenols, parabens and benzophenones) that may have obesogenic effects. Material and Methods Study design and participants This prospective case-control study was conducted by the Pediatric Endocrinology service at two secondary-level hospitals in Spain. The study subjects were 36 boys and 36 girls with obesity between 3 and 15 years of age, who voluntarily chose to participate in the study and whose parents or legal guardians provided written informed consent. Patients were consecutively recruited from a childhood obesity clinic between October 2023 and October 2024. Nineteen healthy controls, with normal weight, were selected from routine health check-ups. Exclusion criteria included pre-existing metabolic diseases, endogenous obesity, or obesity secondary to other conditions. Characterization of metabolic status Obesity was defined using BMI percentiles, with values above the 95th percentile (age- and sex-specific) classified as obesity (Spanish Longitudinal Study of Growth 2017(Carrascosa et al. 2018 )). Weight was recorded without clothes or shoes with a DC-430 scale (Tanita®: Middlesex, United Kingdom) (error +/±0.1 kg) and height with a 213 stadiometer, (Seca®: Birmingham, United Kingdom) (error +/±0.5 cm). BMI was calculated from anthropometric data and BMI Z-score was calculated using the Seinaptracker® program (Medicalsoft Intercath SL, University of Barcelona, Spain 2007–2008). Waist circumference was measured with a non-elastic tape at the midpoint between the lower costal margin and the iliac crest. Blood analysis included glucose, insulin, HOMA-IR, lipid profile, liver profile, uric acid, and HbA1c. Body composition was assessed via the InBody S10 (InBody Co., Ltd., South Korea), following manufacturer guidelines under controlled conditions. Procedure Exposure to obesogenic EDs was assessed via tandem mass spectrometry (UHPLC-MS/MS) to determine urinary phenol concentrations. Non-fasting urine samples were collected in 10 ml polypropylene tubes at the initial visit, between 9:00 and 11:00 a.m., and immediately stored at -80°C. For analysis, the samples were thawed at room temperature, centrifuged, and an enzymatic solution of β-glucuronidase/sulfatase in 1 M ammonium acetate/acetic acid buffer solution (pH 5.0) was prepared. Each sample was enriched with 50 µL of enzyme solution to determine the total amounts (free and conjugated) of BPA, BPF, and BPS in urine and incubated for 24 h at 37◦C and supplemented with a standard replacement solution (5 mg/L EP-13C6, 2 mg/L BPA-D16 and 2 mg/L BP-d10) and 10% aqueous NaCl (pH 2.0, adjusted with 0.5 M HCl). Samples were mixed with acetone (dispersion solvent) and trichloromethane (extraction solvent), manually shaken and centrifuged. The sediment phase was transferred to a glass vial and the organic phase was evaporated under a stream of nitrogen. The residue was dissolved with acetonitrile/water and analyzed by UHPLC-MS/MS. The detection limit was defined as the minimum detectable amount of analyte with a signal-to-noise ratio ≥ 3 and was set at 0.1 ng/mL. Dietary quality was evaluated with the KidMed Mediterranean diet adherence scale.(López-Gajardo et al. 2022 ) Physical activity was estimated using the Krece Plus(Roman-Viñas et al. 2003 ) test, which evaluates weekly sports activity outside of school hours and daily screen time. Scores range from 0 to 5 points. The maximum test value is 10 and the minimum is 0. According to the overall test score, individuals are classified into three categories: Good (test value 9–10 for boys and 8–10 for girls), Fair (6 to 8 for boys and 5 to 7 for girls) and Poor (less than or equal to 5 for boys and less than or equal to 4 for girls).(Roman-Viñas et al. 2003 ) Data collection and analysis Data extraction was performed after obtaining informed consent. Variables were stored in a database, respecting confidentiality in accordance with the European General Data Protection Regulation (GDPR EU 2016/679). A database was created to accurately capture the content of the data collection notebook. The data entry matrix was designed to include the possible ranges or values and to establish the various consistency rules between variables. The quality of the information received was controlled through an exploratory analysis to detect outliers, out-of-range values, or missing data. This analysis also provides insights into variable distributions and gives guidance on potential transformations. A descriptive analysis was conducted based on BMI categorization (obese vs. non-obese), incorporating univariate regressions. For quantitative variables, results were presented as mean ± standard deviation, median with interquartile range, and minimum-maximum values. Hypothesis testing was performed using the Wilcoxon-Mann-Whitney or Kruskal-Wallis tests, depending on the number of grouping categories. In the latter case, post-hoc pairwise comparisons were conducted using the Wilcoxon-Mann-Whitney test, with P -values adjusted using the Benjamini-Hochberg method. For qualitative variables, frequency and proportions were calculated, with hypothesis testing performed using the χ² test with P -value simulation (2000 replicates). In all cases, statistical significance was set at α = 0.05. All analyses were performed in R (R Core Team, 2023). Similarly, STAMP® (Statistical Analysis of Metagenomic Profiles), a Python-based bioinformatics tool, was used statistical analysis and graph generation from large biological datasets. Results Anthropometric characteristics Between October 2023 and October 2024, 72 participants were included in the study (50% girls) with a mean age of 10.7 years (5.4–15.7 years). Of these, 53 had BMI compatible with obesity for their sex and age, and the remaining 19 were healthy children with normal weight. Their anthropometric characteristics are detailed in Table 1 . Table 1 Anthropometric and analytical characteristics of the study participants Total participants (N = 72) Normal weight (N = 19) Obese (N = 53) P -value Mean age (years) 10.76 (3.19) 10.31 (3.87) 10.93 (2.94) 0.5 Mean weight (kg) 61.62 (24.74) 41.31 (21.94) 68.90 (21.54) < 0.001 Mean height (cm) 148.68 (18.92) 142.31 (24.53) 150.96 (16.13) 0.091 Mean waist circumference (cm) 85.73 (16.65) 65.92 (12.69) 92.84 (11.30) 0.001 Mean waist circumference (SDS) 3.52 (2.19) 0.55 (1.37) 4.51 (1.36) < 0.001 Mean fat mass (kg) 22.16 (12.94) 8.26 (6.63) 26.97 (10.97) < 0.001 Mean fat-free mass (kg) 40.14 (15.10) 34.62 (16.67) 42.05 (14.19) 0.077 Skeletal muscle mass (kg) 21.95 (9.07) 18.57 (10.01) 23.12 (8.51) 0.071 Body fat percentage 33.63 (12.08) 17.93 (7.92) 39.06 (7.71) < 0.001 Mean BMI (kg/cm 2 ) 26.56 (6.37) 18.68 (4.02) 29.38 (4.36) 0.003 Mean TMI (kg/cm 3 ) 17.81 (3.50) 13.10 (1.33) 19.50 (2.25) 0.016 Mean percentile of SBP 74.76 (26.00) 65.83 (27.27) 77.79 (25.09) 0.1 Mean percentile of DBP 61.68 (20.54) 56.28 (21.81) 63.51 (19.98) 0.2 TSH (µU/mL) 2.39 (1.05) 2.65 (0.91) 2.31 (1.08) 0.3 Total cholesterol (mg/dL) 145.82 (32.84) 154.31 (31.63) 143.21 (33.06) 0.2 HDL (mg/dL) 46.29 (9.18) 53.64 (9.15) 44.31 (8.20) 0.002 LDL (mg/dL) 88.91 (24.83) 94.43 (20.94) 87.36 (25.79) 0.3 Triglycerides (mg/dL) 76.82 (41.72) 66.88 (24.45) 79.88 (45.50) 0.3 Glucose (mg/dL) 88.30 (7.16) 86.88 (7.24) 88.75 (7.15) 0.3 Insulin (µU/dL) 12.61 (8.58) 8.05 (6.05) 13.90 (8.79) 0.026 HOMA 2.78 (1.95) 1.76 (1.49) 3.07 (1.98) 0.031 HbA1c (%) 5.29 (0.25) 5.28 (0.25) 5.29 (0.25) 0.9 GOT (U/L) 26.55 (10.29) 28.31 (12.19) 26.00 (9.70) 0.4 GPT (U/L) 21.87 (11.03) 17.31 (6.69) 23.27 (11.75) 0.075 GGT (U/L) 16.38 (11.02) 13.64 (2.31) 17.14 (12.30) 0.2 Uric acid (mg/dL) 5.26 (1.32) 4.61 (1.17) 5.40 (1.32) 0.08 Cortisol 10.49 (3.63) 10.82 (2.07) 10.45 (3.80) 0.8 SDS, standard deviation; BMI, body mass index; TMI, triponderal mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TSH, thyroxine stimulating hormone; HDL, high-density lipoprotein; LDL, low density lipoprotein; HOMA, insulin resistance index; HbA1c, glycosylated hemoglobin; GOT, aspartate aminotransferase; GPT, glutamic-pyruvic transaminase; GGT, gamma-glutamyl transferase. Mediterranean diet adherence scale scores showed no statistically significant differences between cases and controls. However, Krece Plus scores were lower in cases (3.93 vs. 6.21, P = 0.002), and screen time was higher (3.02 vs. 1.8 hours, P = 0.008). Urinary biomarker concentrations are presented in Table 1 . Body composition Body composition analysis was conducted for all participants (Table 2 ). The visceral fat area was significantly higher in cases than in controls ( P < 0.001), as was the total body water/fat-free mass index ( P 0.003). Table 2 Body composition characteristics of the study participants assessed by electrical bioimpedance Total participants (N = 72) Normal weight (N = 19) Obese (N = 53) P -value Intracellular water (L) 18.36 (6.95) 15.77 (7.68) 19.26 (6.53) 0.072 Extracellular water (L) 11.04 (4.11) 9.47 (4.48) 11.59 (3.87) 0.063 Total body water (L) 29.40 (11.05) 25.24 (12.15) 30.84 (10.38) 0.068 Extracellular water/total body water (L) 0.38 (0.01) 0.38 (0.01) 0.38 (0.01) 0.6 Body cell mass (Kg) 26.30 (9.96) 22.58 (10.98) 27.58 (9.36) 0.071 Bone mineral content (Kg) 2.30 (0.91) 2.14 (1.02) 2.36 (0.87) 0.4 Arm circumference (cm) 30.31 (5.86) 23.76 (5.09) 32.58 (4.17) < 0.001 Arm muscle circumference (cm) 23.38 (4.66) 20.04 (4.54) 24.54 (4.15) < 0.001 Waist circumference (cm) 78.98 (17.40) 64.26 (13.54) 84.07 (15.67) < 0.001 Visceral fat area (cm 2 ) 95.17 (57.25) 31.83 (28.03) 117.10 (47.60) < 0.001 Basal metabolic rate (Kcal/d) 1,236.73 (326.19) 1,117.61 (360.10) 1,277.96 (306.58) 0.077 Total body water/fat free mass (L/kg) 73.32 (0.51) 72.97 (0.57) 73.44 (0.43) 0.003 Phase angle (º) 5.82 (1.27) 5.52 (0.67) 5.92 (1.42) 0.2 The correlation between body fat, waist circumference and analytical markers of lipid and glycemic profile was analyzed using Pearson’s test. A positive correlation was observed between waist circumference and total body fat, particularly perivisceral fat, while body fat showed a negative correlation with HDL levels (Table 3 ). Table 3 Pearson correlation analysis between body composition and metabolic parameters Fat mass Visceral fat area (cm 2 ) Total body water/fat free mass (L/kg) Waist circumference (cm) 0.5821* 2.3059* 0.0055 HDL (mg/dL) -0.1981* -0.9191* -0.0034 HOMA -0.8904 -2.5229 0.0862 Insulin (µU/dL) 0.3886 1.7505 -0.0244 HDL, high-density lipoprotein; HOMA, insulin resistance index. The * indicate that the correlation is significant. Endocrine disruptors in urine Urine samples were analyzed for 10 phenolic EDs: BPA, BPS, bisphenol F (BPF), methylparaben (MPB), ethylparaben (EPB), propylparaben (PPB), butylparaben (BPB), benzophenone-1 (BP-1), benzophenone-3 (BP-3), and 4-hydroxy benzophenone (4-OH-BP). At least one ED was detected in 100% of the participants. Sex-specific differences in detection rates are shown in Fig. 1 . Overall, levels were higher in girls, except for BPA and MPB, which were more elevated in boys. The number of detected EDs per participant ranged from six to nine. The most commonly detected phenols were BPA, MPB, and BP3, which were present in 100% of the participants. The detection of BPB and 4-OH-BP was higher in children with excess weight. The mean urinary phenol blood levels were as follows: BPB, 2.77 ng/ml; BPS, 0.92 ng/ml; BPF, 0.58 ng/ml; MPB, 59.87 ng/ml; EPB, 2.05 ng/ml; PPB, 4.01 ng/ml; BP-1, 1.89 ng/ml; BP-3, 5.14 ng/ml; and 4-OH-BP, 86.1 ng/ml. Box-plot diagrams were obtained for the ED concentrations studied revealed no significant differences between participants with normal weight and those with obesity, a finding confirmed by Student’s t -test with a 95% confidence level. For phenols, and many environmental pollutants, clinically significant levels or reference values have not been established. The phenol concentrations found in our urine samples were similar to those reported in other studies in children(Apel et al. 2017 ), except for MPB, which was notably elevated in the group with obesity (mean concentration 71.55 ng/ml, range 0.11-774.72 ng/ml) compared to controls (mean concentration 27.27 ng/ml, range 0.43-346.67 ng/ml). The relationship between ED levels and anthropometric characteristics is shown in Table 4 . Table 4 Correlation analysis between anthropometric parameters and detection of endocrine disruptors in urine BPA BPS BPF MPB EPB PPB BP-1 BP-3 4-OH-BP BMI (kg/cm 2 ) -18.6799* 0.7507 -0.8319 -30.1459 -0.392 -4.0041 -3.6713* -11.9589* -0.1255 TMI (kg/cm 3 ) 22.7333* -1.1554 1.1671 44.0535* 0.9991 6.6575* 4.9864* 17.824* -0.1152 Waist circumference (cm) 5.015* -0.2312 0.1505 3.7536 -0.0212 1.487 1.0078* 3.583* 0.0073 Fat mass (%) 2.639* -0.0956 0.1016 3.259 1.0791* -0.3024 0.5084* 0.7097 0.0987 BPA, bisphenol A; BPS, bisphenol S; BPF, bisphenol F; MPB, methylparaben; EPB, ethylparaben; PPB, propylparaben; BP-1, benzophenone 1; BP-3, benzophenone 3; 4-OH-BP, 4-hydroxybenzophenone. Data in bold represent those with statistical significance ( P < 0.05). Combined effect of ED in urine An analysis of correlations between all possible ED pairs was performed (Fig. 2 ). Figure 2 A shows Pearson’s correlation coefficients, ranging from − 1 to + 1, indicating the strength of the linear relationships between the variables. Strong correlations were seen between MPB and PPB, MPB and BPB, EPB and BPB, and BP-1 and BP-3, suggesting related behavior. The dendogram further these higher correlations, particular between MPB and PPB and BP-1 and BP-3 (Fig. 2 B). The correlation between urinary ED levels and anthropometric and body composition parameters was analyzed (Table 4 ). A positive, statistically significant correlation was detected between BPA, MPB, PPB, BP-1, and BP-3 levels and the triponderal mass index (TMI), as well as between BPA, EPB, and BP-1 levels and fat mass percentage. Conversely, a statistically significant negative correlation was identified between BPA, BP-1, and BP-3 levels and body mass index. Discussion Our study is the first to investigate the presence of obesogenic EDs in a population of children, revealing the presence of EDs in all the participants. Paraben levels were particularly high and have been linked to excess weight in cases of prenatal exposure.(Starling 2020 ) Childhood obesity is a growing public health concern due to its many short- and long-term consequences for children’s physical, emotional, and social well-being. Obesity is associated with an increased risk of chronic diseases such as type 2 diabetes, hypertension, and cardiovascular disorders, as well as psychological and self-esteem issues. Understanding the role of ED exposure in obesity is critical for developing targeted interventions and public health strategies. Environmental health encompasses all external physical, chemical, and biological factors affecting an individual. According to the World Health Organization, environmental factors contribute to 24% of the global disease burden and 23% of mortality.(Tardón 2022 ) Exposure to EDs during childhood is common yet often unnoticed. The potential effects are multifaceted, including weight gain. In 2015, the Parma consensus broadened the term obesogen to include EDs that influence metabolic conditions associated with obesity, such as insulin resistance, hypertension, dyslipidemia, and hyperglycemia, ultimately contributing to the development of metabolic syndrome.(Heindel et al. 2015 ) Our study includes participants spanning a broad range of childhood ages, which is particularly valuable given the limited research analyzing how the early-life environment influences obesity development. The similar proportion of boys and girls in our cohort ensures that the results are representative of both sexes. Furthermore, by comparing data from children both with normal weight and with overweight, our study provides more robust evidence regarding metabolic changes and their association with BMI. The classification into cases (children with obesity) and controls (normal-weight children) was appropriate, as both groups exhibited significantly different characteristics, not only in anthropometric parameters but also in body composition. No significant differences were found in Mediterranean diet adherence, likely due to the study population residing in the Mediterranean basin. However, daily screen time was significantly higher in children with overweight, indicating a more sedentary lifestyle. Prolonged screen use is linked to weight gain through reduced physical activity, increased consumption of unhealthy foods, and exposure to high-calorie food advertising. Excessive screen time can also disrupt sleep patterns, increasing obesity risk. The American Academy of Pediatrics and the WHO recommend complete avoidance of screen use in children under 2 years of age, limiting screen time to less than 1 hour in children aged 2 to 5 years and to less than 2 hours between the ages of 5 and 17 years. However, most children, especially children with obesity, do not adhere to these guidelines.(Cartanyà-Hueso et al. 2022 ) Similar findings were described by Wolf(Wolf et al. 2018 ) and Kolovos(Kolovos et al. 2021 ), who found an overall daily average of 2 hours and 19 minutes of screen exposure in children aged 0 to 8 years and 3 hours in children aged 10 to 18 years. The children in the case group had moderate obesity and exhibited metabolic alterations, including elevated insulin levels, higher HOMA index, and worse lipid profiles, indicating increased susceptibility to metabolic disorders. These findings underscore the seriousness of childhood obesity and the need for early interventions. Body composition also differed between groups, with the case group showing greater perivisceral fat accumulation. This central fat distribution was significantly associated with waist circumference, reinforcing its value as an anthropometric measure of fat mass in children. Our study’s strength lies in the simultaneous analysis of a wide range of EDs commonly encountered through ingestion, inhalation, and skin absorption. Assessing multiple EDs helps understand the cumulative effects of combined exposure, particularly in childhood obesity, and identifies potential synergistic interactions that may amplify adverse health outcomes. This comprehensive approach is essential for designing more effective prevention strategies and public health policies to protect vulnerable populations, including children, from the risks associated with combined ED exposure. All the participants in our study had at least one detectable disruptor in urine, with most showing a combination of bisphenols and parabens, reflecting findings from previous research.(Nadal et al. 2017 ) This widespread exposure, even at early ages, underscores the importance of studies like ours that assess the impact of these chemicals on children’s health. Few publications have analyzed exposure to multiple EDs during childhood and/or adolescence and their association with various obesity markers.(Heindel et al. 2022 ) Research on BPA has identified a positive association between BPA levels and obesity.(Mustieles et al. 2019 ) Studies such as Menale et al.(Menale et al. 2017 ) comparing patients with obesity with and without metabolic syndrome, have demonstrated significantly higher urinary BPA levels in patients with metabolic syndrome or insulin resistance. Various mechanisms have been described by which bisphenols alter energy storage and metabolism such as dysregulation of messenger RNA and microRNA,(Verbanck et al. 2017 ) alterations in the hypothalamic-pituitary-gonadal axis,(Yang et al. 2017 ) disruption of adiponectin synthesis and secretion,(Liu et al. 2019 ) promotion of preadipocyte differentiation, inhibiting the peroxisome proliferator-activated receptor gamma (PPARγ),(Zheng et al. 2016 ) and downregulating of uncoupling protein 1 expression,(Verbanck et al. 2017 ) among others.(Nadal et al. 2017 ) The maximum urinary BPA levels in our sample were close to the safe limit established by the Commission on Human Biomonitoring.(Apel et al. 2017 ) While BPA concentrations were higher in the case group than in controls, the difference was not statistically significant. This may be due to lower exposure levels compared to previous studies, likely due to BPA use restrictions.(Liu et al. 2019 ) As BPA is replaced by BPF and BPS, both of which have been linked to increased obesity risk in children and adolescents,(Liu et al. 2019 ; Thoene et al. 2020 ) a critical question remains regarding the cumulative effects of these bisphenols. Notably, some studies have reported adverse effects even at exposure levels lower than those detected in our study.(Verbanck et al. 2017 , 2021) Indeed, many scientists have advocated a “zero threshold” approach to ED exposure,(Rochester and Bolden 2015 ) as the in vitro effects of high doses do not always reliably predict the safety of low doses.(Apel et al. 2017 ) Regarding parabens, the levels in our participants with excess weight were higher than the limits described by other authors(Apel et al. 2017 ) and established as safe. The literature supports a positive association between paraben levels and the increase in childhood obesity,(Højsager et al. 2021 ) particularly with increased BMI and body fat percentage. This is in agreement with previous studies,(Højsager et al. 2021 ) and is explained through the action of parabens on leptin and proopiomelanocortin. An epigenetic modification is produced that reduces proopiomelanocortin levels, altering some of its usual functions such as the induction of satiety in the hypothalamus.(Leppert et al. 2020 ) Additionally, parabens promote adipocyte differentiation through the PPARγ pathway, increasing adiposity, especially butylparaben, as reported by Hu et al.(Hu et al. 2017 ) The relationship between chemical levels and body composition showed that at least one compound from each phenol group (bisphenols, parabens, benzophenones) was associated with excess adiposity. The negative correlation between the ED levels and BMI may stem from the limitations of BMI in estimating body composition, as it does not account for body mass distribution. TMI, in contrast, has been proposed as a more accurate adiposity predictor in children and adolescents because it is less affected by height and has a more linear relationship with body fat.(De Lorenzo et al. 2019 ) Certain EDs may also alter metabolism in ways that promote fat redistribution, favoring visceral fat storage without necessarily increasing total body weight.(Amato et al. 2021 ) Moreover, in pediatric populations, a child with a lower BMI but a higher TMI may have a lower relative weight due to lower lean mass, but a higher proportion of body fat.(Niu et al. 2023 ) The benzophenone group showed a statistically significant correlation with higher TMI, waist circumference, and body fat percentage. While these chemicals have been more commonly associated with neurodevelopmental disorders, male infertility, and intrauterine growth restriction,(Long et al. 2019 ) they have also been linked to potential obesogenic effects, as reflected in our findings.(Thoene et al. 2020 ) The individual analysis of endocrine disruptors has several limitations, particularly as it does not account for interactions between different molecules in the body, which may amplify or mitigate biological effects. Therefore, simultaneously measuring multiple EDs provides a more comprehensive and realistic assessment of total exposure to these compounds, better reflecting real-world conditions and detecting interactions that may influence biological outcomes. This allows for the evaluation of both synergistic and inhibitory effects, providing a more accurate picture of their combined impact on health. Our findings emphasize the growing concern about obesogenic substance exposure, especially in children and adolescents. These stages involve the maturation of key endocrine systems that are vulnerable to chemical exposure. This increased susceptibility calls for enhanced surveillance and prevention efforts to reduce exposure to EDs and their health impacts. The strong link between ED exposure and obesity prevalence underscores the need to assess these chemicals in patient samples during obesity consultations, as such exposure is often overlooked in medical history assessments. Studies are also needed to evaluate the impact of industrial, governmental, and domestic measures aimed at reducing exposure to environmental pollutants, particularly in vulnerable populations like children. A limitation of our study is the small sample size, which, while comparable to previous studies, may reduce the statistical power to detect significant differences. Additionally, as an observational study, it cannot establish causality. The reliance on a single urine sample may not fully capture exposure levels; however, it is more likely to underestimate rather than overestimate exposure. Despite these limitations, our study is valuable as it provides data on exposure to multiple disruptors, reflecting real-world environmental exposure. We also analyzed body composition, rather than relying solely on anthropometric data, adding value to the findings. To our knowledge, this is the first study in our setting to focus on the pediatric population and the effects of ED exposure during this critical stage of development. The presence of EDs affected all the participants in our study, highlighting the ubiquity of these compounds and the need to evaluate their effects in the pediatric population. A deeper understanding of the interactions between obesogenic EDs and metabolism can undoubtedly guide the design of strategies to minimize exposure to these chemicals, optimizing health outcomes. Additionally, it may contribute to the identification of new biomarkers for the early diagnosis of complications associated with the disease and its prognosis in adulthood. This knowledge will enable the development of more targeted and effective preventive and therapeutic strategies, ultimately improving the quality of life for future generations. In conclusion, exposure to EDs in childhood is massive and universal, with indications of potential obesogenic effects from exposure to bisphenols, parabens and benzophenones in the pediatric age group. Given the ubiquitous and universal nature of ED exposure, as well as the challenges regulatory authorities face in controlling it, investigating the interactions between environmental factors and health is essential. For condition such as childhood obesity—characterized by severe medium- and long-term consequences and limited therapeutic options—reducing exposure to EDs presents a promising avenue for innovative therapeutic strategies. Declarations Funding information : Research grants in medical sciences Fundación Bienvenida Navarro Luciano Tripodi, 2021. Acknowledgments : The authors thank Maria Repice for her help with the English version of the manuscript. Ethics approval: The study was approved by the Research Ethics Committee, code 21/039. This study was performed in line with the principles of the Declaration of Helsinki. Consent to participate: Informed consent was obtained from the parents or legal guardians. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article. Acknowledgments: This research was supported by a medical sciences research grant provided by Fundación Bienvenida Navarro Luciano Tripodi-2021. The funder has played no role in the research. The authors thank Maria Repice for her help with the English version of the manuscript. Author contributions: APNR: Study concept and design; study supervision; statistical analysis; interpretation of results; drafting and critical revision of the manuscript. LATG: laboratory analyses; data analysis and quality control; input on the discussion section. NPF: data visualization; literature search; interpretation of findings; review and revision of the manuscript for important intellectual content. FSF: participant recruitment and clinical data collection; coordination of hospital collaborations; review of the manuscript for accuracy and coherence. Statements Funding information: This research was supported by a medical sciences research grant provided by Fundación Bienvenida Navarro Luciano Tripodi-2021. The funder has played no role in the research. Conflicts of Interest: The authors declare no conflicts of interest. Author contributions: APNR: Study concept and design; study supervision; statistical analysis; interpretation of results; drafting and critical revision of the manuscript. LATG: laboratory analyses; data analysis and quality control; input on the discussion section. NPF: data visualization; literature search; interpretation of findings; review and revision of the manuscript for important intellectual content. FSF: participant recruitment and clinical data collection; coordination of hospital collaborations; review of the manuscript for accuracy and coherence. Data Availability Statement: The data that support the findings of this study are available on request from the corresponding author. Ethics approval: The study was approved by the Research Ethics Committee (approval code: 21/039) and conducted in accordance with the Declaration of Helsinki. It also complies with the ethical policies of Public Health Challenges. Consent to participate: Informed consent was obtained from the parents or legal guardians. Permission to Reproduce Material from Other Sources: The authors declare that all material included in this manuscript is original and does not require permission for reproduction from other sources. References Aktağ E, Yurdakök K, Yalçın SS, Kandemir N (2021) Urinary bisphenol A levels in prepubertal children with exogenous obesity according to presence of metabolic syndrome. J Pediatr Endocrinol Metab 34:495–502. https://doi.org/10.1515/jpem-2020-0371 Amato AA, Wheeler HB, Blumberg B (2021) Obesity and endocrine-disrupting chemicals. Endocr Connect 10:R87–R105. https://doi.org/10.1530/EC-20-0578 Apel P, Angerer J, Wilhelm M, Kolossa-Gehring M (2017) New HBM values for emerging substances, inventory of reference and HBM values in force, and working principles of the German Human Biomonitoring Commission. Int J Hyg Environ Health 220:152–166. https://doi.org/10.1016/j.ijheh.2016.09.007 Ball GDC, Savu A, Kaul P (2019) Changes in the prevalence of overweight, obesity, and severe obesity between 2010 and 2017 in preschoolers: A population‐based study. Pediatr Obes 1–5. https://doi.org/10.1111/ijpo.12561 Caporossi L, Papaleo B (2017) Bisphenol A and Metabolic Diseases: Challenges for Occupational Medicine. Int J Environ Res Public Health 14:959. https://doi.org/10.3390/ijerph14090959 Carrascosa A, Yeste D, Moreno-Galdó A, et al (2018) [Body mass index and tri-ponderal mass index of 1,453 healthy non-obese, non-undernourished millennial children. The Barcelona longitudinal growth study]. An Pediatr Barc Spain 2003 89:137–143. https://doi.org/10.1016/j.anpedi.2017.12.016 Cartanyà-Hueso À, Lidón-Moyano C, Martín-Sánchez JC, et al (2022) Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2-14 years. An Pediatr 97:333–341. https://doi.org/10.1016/j.anpede.2021.09.004 Damstra T, Barlow S, Bergman A, et al (2002) Global assessment of the state-of-the-science of endocrine disruptors. WHOpublication No WHOPCSEDC022 180 De Lorenzo A, Romano L, Di Renzo L, et al (2019) Triponderal mass index rather than body mass index: An indicator of high adiposity in Italian children and adolescents. Nutrition 60:41–47. https://doi.org/10.1016/j.nut.2018.09.007 Heindel JJ, Howard S, Agay-Shay K, et al (2022) Obesity II: Establishing causal links between chemical exposures and obesity. Biochem Pharmacol 199:115015. https://doi.org/10.1016/j.bcp.2022.115015 Heindel JJ, Vom Saal FS, Blumberg B, et al (2015) Parma consensus statement on metabolic disruptors. Environ Health 14:54. https://doi.org/10.1186/s12940-015-0042-7 Højsager FD, Kyhl HB, Frederiksen H, et al (2021) Prenatal Exposure to Butyl Paraben Is Associated With Fat Percentage in 7-Year-Old Boys. J Clin Endocrinol Metab 106:e2633–e2638. https://doi.org/10.1210/clinem/dgab167 Hu P, Overby H, Heal E, et al (2017) Methylparaben and butylparaben alter multipotent mesenchymal stem cell fates towards adipocyte lineage. Toxicol Appl Pharmacol 329:48–57. https://doi.org/10.1016/j.taap.2017.05.019 Kolovos S, Jimenez-Moreno AC, Pinedo-Villanueva R, et al (2021) Association of sleep, screen time and physical activity with overweight and obesity in Mexico. Eat Weight Disord 26:169–179. https://doi.org/10.1007/s40519-019-00841-2 Kumar S, Kelly AS (2017) Review of Childhood Obesity. Mayo Clin Proc 92:251–265. https://doi.org/10.1016/j.mayocp.2016.09.017 Le Fol V, Aït-Aïssa S, Sonavane M, et al (2017) In vitro and in vivo estrogenic activity of BPA, BPF and BPS in zebrafish-specific assays. Ecotoxicol Environ Saf 142:150–156. https://doi.org/10.1016/j.ecoenv.2017.04.009 Leppert B, Strunz S, Seiwert B, et al (2020) Maternal paraben exposure triggers childhood overweight development. Nat Commun 11:561. https://doi.org/10.1038/s41467-019-14202-1 Li N, Li J, Zhang Q, et al (2021) Effects of endocrine disrupting chemicals in host health: Three-way interactions between environmental exposure, host phenotypic responses, and gut microbiota. Environ Pollut 271:. https://doi.org/10.1016/j.envpol.2020.116387 Liu B, Lehmler H-J, Sun Y, et al (2019) Association of Bisphenol A and Its Substitutes, Bisphenol F and Bisphenol S, with Obesity in United States Children and Adolescents. Diabetes Metab J 43:59. https://doi.org/10.4093/dmj.2018.0045 Long J, Xia W, Li J, et al (2019) Maternal urinary benzophenones and infant birth size: Identifying critical windows of exposure. Chemosphere 219:655–661. https://doi.org/10.1016/j.chemosphere.2018.11.190 López-Gajardo MA, Leo FM, Sánchez-Miguel PA, et al (2022) KIDMED 2.0, An update of the KIDMED questionnaire: Evaluation of the psychometric properties in youth. Front Nutr 9:. https://doi.org/10.3389/fnut.2022.945721 Menale C, Grandone A, Nicolucci C, et al (2017) Bisphenol A is associated with insulin resistance and modulates adiponectin and resistin gene expression in obese children. Pediatr Obes 12:380–387. https://doi.org/10.1111/ijpo.12154 Mustieles V, Casas M, Ferrando-Marco P, et al (2019) Bisphenol A and adiposity measures in peripubertal boys from the INMA-Granada cohort. Environ Res 173:443–451. https://doi.org/10.1016/j.envres.2019.03.045 Nadal A, Quesada I, Tudurí E, et al (2017) Endocrine-disrupting chemicals and the regulation of energy balance. Nat Rev Endocrinol 13:536–546. https://doi.org/10.1038/nrendo.2017.51 Niu Y, Zhang Y, Sheng J, et al (2023) Tri-ponderal mass index as a screening tool for obesity prediction in children aged 6–9 years. Front Endocrinol 14:1277125. https://doi.org/10.3389/fendo.2023.1277125 Rochester JR, Bolden AL (2015) Bisphenol S and F: A Systematic Review and Comparison of the Hormonal Activity of Bisphenol A Substitutes. Environ Health Perspect 123:643–650. https://doi.org/10.1289/ehp.1408989 Roman-Viñas B, Serra-Majem L, Ribas-Barba L, et al (2003) Crecicimiento y desarrollo: actividad física. Estimación del nivel de actividad física mediante el Test Corto Krece Plus. Resultados en la población española. Crecim Desarro Estud Enkid Krece Plus 4:57–74 Starling S (2020) Maternal paraben exposure and childhood weight gain. Nat Rev Endocrinol 16:257. https://doi.org/10.1038/s41574-020-0343-y Tardón A (2022) Compuestos orgánicos persistentes y salud Persistent organic compounds and health. Rev Esp Endocrinol Pediatr 13:. https://doi.org/10.3266/RevEspEndocrinolPediatr.pre2022.Apr.732 Thoene M, Dzika E, Gonkowski S, Wojtkiewicz J (2020) Bisphenol S in Food Causes Hormonal and Obesogenic Effects Comparable to or Worse than Bisphenol A: A Literature Review. Nutrients 12:532. https://doi.org/10.3390/nu12020532 Velmurugan G, Ramprasath T, Gilles M, et al (2017) Gut Microbiota, Endocrine-Disrupting Chemicals, and the Diabetes Epidemic. Trends Endocrinol Metab 28:612–625. https://doi.org/10.1016/j.tem.2017.05.001 Verbanck M, Canouil M, Leloire A, et al (2017) Low-dose exposure to bisphenols A, F and S of human primary adipocyte impacts coding and non-coding RNA profiles. PLOS ONE 12:e0179583. https://doi.org/10.1371/journal.pone.0179583 Vermeiren E, Bruyndonckx L, De Winter B, et al (2021) The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies. Nutr Metab Cardiovasc Dis NMCD 31:2575–2586. https://doi.org/10.1016/j.numecd.2021.05.020 Vuong AM, Braun JM, Wang Z, et al (2019) Exposure to polybrominated diphenyl ethers (PBDEs) during childhood and adiposity measures at age 8 years. Environ Int 123:148–155. https://doi.org/10.1016/j.envint.2018.11.050 Wolf C, Wolf S, Weiss M, Nino G (2018) Children’s environmental health in the digital era: Understanding early screen exposure as a preventable risk factor for obesity and sleep disorders. Children 5:. https://doi.org/10.3390/children5020031 World Health Organization (2022) WHO European regional obesity report 2022. World Health Organization, [Copenhagen] Xu X, Wu H, Terry PD, et al (2022) Impact of Paraben Exposure on Adiposity-Related Measures: An Updated Literature Review of Population-Based Studies. Int J Environ Res Public Health 19:16268. https://doi.org/10.3390/ijerph192316268 Yang Q, Yang X, Liu J, et al (2017) Effects of BPF on steroid hormone homeostasis and gene expression in the hypothalamic–pituitary–gonadal axis of zebrafish. Environ Sci Pollut Res 24:21311–21322. https://doi.org/10.1007/s11356-017-9773-z Zheng S, Shi J, Hu J, et al (2016) Chlorination of bisphenol F and the estrogenic and peroxisome proliferator-activated receptor gamma effects of its disinfection byproducts. Water Res 107:1–10. https://doi.org/10.1016/j.watres.2016.10.048 (2021) Fourth national report on human exposure to environmental chemicals. National Center for Environmental Health Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2026 Read the published version in Exposure and Health → Version 1 posted Reviewers agreed at journal 22 Oct, 2025 Reviewers invited by journal 16 Oct, 2025 Editor invited by journal 15 Jul, 2025 Editor assigned by journal 09 Jul, 2025 First submitted to journal 06 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Patients = 72\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7058500/v1/dd90925a9bc20ded58210f5b.png\"},{\"id\":105224866,\"identity\":\"c17c82dc-7b06-471c-ac28-2c38cb76bb46\",\"added_by\":\"auto\",\"created_at\":\"2026-03-23 16:16:51\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1470326,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7058500/v1/2b19b25d-0aae-47cd-82eb-b5ab18dca6c6.pdf\"}],\"financialInterests\":\"\",\"formattedTitle\":\"Exposure to obesogenic endocrine disruptors in childhood. Impact on biomarkers of metabolic status.\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eChildhood obesity has become a serious public health issue, with its prevalence rising to pandemic proportions in recent years. In 2016, an estimated 650\\u0026nbsp;million adults and 381\\u0026nbsp;million children and adolescents worldwide were classified as overweight or obese.(World Health Organization \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e) Notably, 41\\u0026nbsp;million were children under the age of five.(Ball et al. \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) In Spain, the prevalence of childhood overweight is 23.3%, while childhood obesity affects 18.6% and continues to rise.(World Health Organization \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eObesity is also an important risk factor for numerous diseases such as diabetes, dyslipidemia, hypertension, metabolic syndrome and cardiovascular disease.(Kumar and Kelly \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) A high-calorie diet and lack of physical activity are primary contributors to the development and progression of obesity. In pediatric populations, therapeutic strategies are limited to lifestyle interventions, such as recommending healthy, low-calorie diets and regular physical exercise. While these approaches can help control obesity, the effectiveness is often limited, resulting in only modest and temporary weight loss.(Vermeiren et al. \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eIn this context, identifying novel factors involved in the regulation of energy metabolism is crucial for developing more effective strategies to combat obesity. Recent research has highlighted the potential role of exposure to chemicals that affect the endocrine system.(Thoene et al. \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e) These compounds are known as endocrine disruptors (EDs), chemical substances foreign to the affected organism that can alter its hormonal balance or that of its offspring.(Damstra et al. \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e2002\\u003c/span\\u003e) They can mimic the effect of natural hormones disrupting homeostasis and interfering with normal physiological functions. EDs are commonly found in pesticides, plastics, and cosmetic products, among other sources, leading to universal and often unnoticed human exposure.(Velmurugan et al. \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eEDs are responsible for the increased incidence of certain metabolic diseases such as obesity, but their mechanisms of action are diverse and complex.(Li et al. \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e) Many of these compounds are considered persistent organic pollutants, characterized by their long-lasting nature, bioaccumulation, toxicity at very low doses, and biomagnification through the food chain.(Nadal et al. \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eSubstances that have been clearly identified as EDs include the following:\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eBisphenols\\u003c/b\\u003e are used in the production of polycarbonate plastics and epoxy resins, and primarily enter the body through the digestive tract. Common sources of exposure include tin cans, water bottles, kitchen utensils, paints, fabrics, car seats and various plastics. Among the most recognized bisphenols are bisphenol A (BPA) and bisphenol S (BPS).(Le Fol et al. \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePhthalates and parabens\\u003c/b\\u003e are used to enhance the flexibility and durability of plastics. Similar to bisphenols, they are often present in food coatings and can be ingested through the diet. They are also found in products such as toys and cosmetics, where exposure can occur through inhalation.(Xu et al. \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePolybrominated diphenyl ethers\\u003c/b\\u003e have been used for several decades in industry for their flame-retardant properties. The peculiarity of these substances is that they do not bind chemically with the products to which they are added (such as furniture), facilitating their release and allowing their introduction into the human body by various routes: inhalation through the air, ingestion of contaminated water or oils or even food (especially those rich in fat).(Vuong et al. \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePesticides, biocides and herbicides\\u003c/b\\u003e, such as organophosphates, pyrethrins and pyrethroids can be found in both food and gardening products.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePolychlorinated biphenyls\\u003c/b\\u003e are used as coolants and lubricants in transformers, condensers, plasticizers, ink solvents and electrical equipment.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eMetals and metalloids\\u003c/b\\u003e (lead, cadmium, nickel, mercury, arsenic, etc.) are present in food (fish and seafood) and in varnishes in construction materials, costume jewelry, batteries, toys, etc.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePerfluoroalkyl substances\\u003c/b\\u003e are one of the most widely used groups of chemicals in industry today. Their properties include stability at elevated temperatures and the ability to act as water and grease repellents. They are present in a multitude of everyday objects such as clothing, furniture, kitchen utensils, food packaging and non-stick surfaces.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eBenzophenones\\u003c/b\\u003e are organic compounds of the ketone class, known for their ability to absorb ultraviolet radiation. They are widely used as ultraviolet filters in sunscreens, cosmetics, hair and nail care products, and are also found in plastic packaging, paints and coatings to protect against degradation caused by sunlight.\\u003c/p\\u003e\\u003cp\\u003eThe effects of these substances depend on the hormonal system they impact and the timing of exposure, primarily affecting the estrogen or thyroid systems. Among their numerous metabolic effects, many of these substances have recently been identified as obesogenic, as they have been shown to interfere with how the body stores and processes fat, as well as with mechanisms regulating appetite and satiety.(Nadal et al. \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) The most common obesogenic EDs are parabens, bisphenols and benzophenones.(Caporossi and Papaleo \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) Nevertheless, there is limited information regarding exposure in infancy and childhood and its relationship with the development of obesity in children, whether occurring during gestation(H\\u0026oslash;jsager et al. \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e) or in the postnatal stage.(Aktağ et al. \\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eEighty percent of children with obesity will be adults with obesity and the metabolic complications of obesity begin in childhood.(Ball et al. \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) Therefore, understanding the impact of exposure to EDs as early as infancy is essential. The vast majority of studies investigating the interaction between EDs and the development of obesity have focused on exposure to individual chemicals. Research on the effects of simultaneous exposure to multiple chemicals in humans is scarce, and even more so in pediatric populations.\\u003c/p\\u003e\\u003cp\\u003eFor this reason, we designed a study to investigate the potential association between body composition in pediatric patients and exposure to key EDs (bisphenols, parabens and benzophenones) that may have obesogenic effects.\\u003c/p\\u003e\"},{\"header\":\"Material and Methods\",\"content\":\"\\u003cp\\u003e\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eStudy design and participants\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis prospective case-control study was conducted by the Pediatric Endocrinology service at two secondary-level hospitals in Spain. The study subjects were 36 boys and 36 girls with obesity between 3 and 15 years of age, who voluntarily chose to participate in the study and whose parents or legal guardians provided written informed consent. Patients were consecutively recruited from a childhood obesity clinic between October 2023 and October 2024. Nineteen healthy controls, with normal weight, were selected from routine health check-ups. Exclusion criteria included pre-existing metabolic diseases, endogenous obesity, or obesity secondary to other conditions.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eCharacterization of metabolic status\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eObesity was defined using BMI percentiles, with values above the 95th percentile (age- and sex-specific) classified as obesity (Spanish Longitudinal Study of Growth 2017(Carrascosa et al. \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e2018\\u003c/span\\u003e)). Weight was recorded without clothes or shoes with a DC-430 scale (Tanita\\u0026reg;: Middlesex, United Kingdom) (error +/\\u0026plusmn;0.1 kg) and height with a 213 stadiometer, (Seca\\u0026reg;: Birmingham, United Kingdom) (error +/\\u0026plusmn;0.5 cm). BMI was calculated from anthropometric data and BMI Z-score was calculated using the Seinaptracker\\u0026reg; program (Medicalsoft Intercath SL, University of Barcelona, Spain 2007\\u0026ndash;2008). Waist circumference was measured with a non-elastic tape at the midpoint between the lower costal margin and the iliac crest. Blood analysis included glucose, insulin, HOMA-IR, lipid profile, liver profile, uric acid, and HbA1c. Body composition was assessed via the InBody S10 (InBody Co., Ltd., South Korea), following manufacturer guidelines under controlled conditions.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eProcedure\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eExposure to obesogenic EDs was assessed via tandem mass spectrometry (UHPLC-MS/MS) to determine urinary phenol concentrations. Non-fasting urine samples were collected in 10 ml polypropylene tubes at the initial visit, between 9:00 and 11:00 a.m., and immediately stored at -80\\u0026deg;C. For analysis, the samples were thawed at room temperature, centrifuged, and an enzymatic solution of β-glucuronidase/sulfatase in 1 M ammonium acetate/acetic acid buffer solution (pH 5.0) was prepared. Each sample was enriched with 50 \\u0026micro;L of enzyme solution to determine the total amounts (free and conjugated) of BPA, BPF, and BPS in urine and incubated for 24 h at 37◦C and supplemented with a standard replacement solution (5 mg/L EP-13C6, 2 mg/L BPA-D16 and 2 mg/L BP-d10) and 10% aqueous NaCl (pH 2.0, adjusted with 0.5 M HCl). Samples were mixed with acetone (dispersion solvent) and trichloromethane (extraction solvent), manually shaken and centrifuged. The sediment phase was transferred to a glass vial and the organic phase was evaporated under a stream of nitrogen. The residue was dissolved with acetonitrile/water and analyzed by UHPLC-MS/MS. The detection limit was defined as the minimum detectable amount of analyte with a signal-to-noise ratio\\u0026thinsp;\\u0026ge;\\u0026thinsp;3 and was set at 0.1 ng/mL.\\u003c/p\\u003e\\u003cp\\u003eDietary quality was evaluated with the KidMed Mediterranean diet adherence scale.(L\\u0026oacute;pez-Gajardo et al. \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e) Physical activity was estimated using the Krece Plus(Roman-Vi\\u0026ntilde;as et al. \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e2003\\u003c/span\\u003e) test, which evaluates weekly sports activity outside of school hours and daily screen time. Scores range from 0 to 5 points. The maximum test value is 10 and the minimum is 0. According to the overall test score, individuals are classified into three categories: Good (test value 9\\u0026ndash;10 for boys and 8\\u0026ndash;10 for girls), Fair (6 to 8 for boys and 5 to 7 for girls) and Poor (less than or equal to 5 for boys and less than or equal to 4 for girls).(Roman-Vi\\u0026ntilde;as et al. \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e2003\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eData collection and analysis\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eData extraction was performed after obtaining informed consent. Variables were stored in a database, respecting confidentiality in accordance with the European General Data Protection Regulation (GDPR EU 2016/679).\\u003c/p\\u003e\\u003cp\\u003eA database was created to accurately capture the content of the data collection notebook. The data entry matrix was designed to include the possible ranges or values and to establish the various consistency rules between variables.\\u003c/p\\u003e\\u003cp\\u003eThe quality of the information received was controlled through an exploratory analysis to detect outliers, out-of-range values, or missing data. This analysis also provides insights into variable distributions and gives guidance on potential transformations.\\u003c/p\\u003e\\u003cp\\u003eA descriptive analysis was conducted based on BMI categorization (obese vs. non-obese), incorporating univariate regressions. For quantitative variables, results were presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation, median with interquartile range, and minimum-maximum values. Hypothesis testing was performed using the Wilcoxon-Mann-Whitney or Kruskal-Wallis tests, depending on the number of grouping categories. In the latter case, post-hoc pairwise comparisons were conducted using the Wilcoxon-Mann-Whitney test, with \\u003cem\\u003eP\\u003c/em\\u003e-values adjusted using the Benjamini-Hochberg method. For qualitative variables, frequency and proportions were calculated, with hypothesis testing performed using the χ\\u0026sup2; test with \\u003cem\\u003eP\\u003c/em\\u003e-value simulation (2000 replicates). In all cases, statistical significance was set at α\\u0026thinsp;=\\u0026thinsp;0.05.\\u003c/p\\u003e\\u003cp\\u003eAll analyses were performed in R (R Core Team, 2023). Similarly, STAMP\\u0026reg; (Statistical Analysis of Metagenomic Profiles), a Python-based bioinformatics tool, was used statistical analysis and graph generation from large biological datasets.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAnthropometric characteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eBetween October 2023 and October 2024, 72 participants were included in the study (50% girls) with a mean age of 10.7 years (5.4\\u0026ndash;15.7 years). Of these, 53 had BMI compatible with obesity for their sex and age, and the remaining 19 were healthy children with normal weight. Their anthropometric characteristics are detailed in Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eAnthropometric and analytical characteristics of the study participants\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003eTotal participants\\u003c/p\\u003e\\n \\u003cp\\u003e(N\\u0026thinsp;=\\u0026thinsp;72)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003eNormal weight\\u003c/p\\u003e\\n \\u003cp\\u003e(N\\u0026thinsp;=\\u0026thinsp;19)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003eObese\\u003c/p\\u003e\\n \\u003cp\\u003e(N\\u0026thinsp;=\\u0026thinsp;53)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e-value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean age (years)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e10.76 (3.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e10.31 (3.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e10.93 (2.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean weight (kg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e61.62 (24.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e41.31 (21.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e68.90 (21.54)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean height (cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e148.68 (18.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e142.31 (24.53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e150.96 (16.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.091\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean waist circumference (cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e85.73 (16.65)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e65.92 (12.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e92.84 (11.30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean waist circumference (SDS)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e3.52 (2.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e0.55 (1.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e4.51 (1.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean fat mass (kg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e22.16 (12.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e8.26 (6.63)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e26.97 (10.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean fat-free mass (kg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e40.14 (15.10)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e34.62 (16.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e42.05 (14.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.077\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSkeletal muscle mass (kg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e21.95 (9.07)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e18.57 (10.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e23.12 (8.51)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.071\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBody fat percentage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e33.63 (12.08)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e17.93 (7.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e39.06 (7.71)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean BMI (kg/cm\\u003c/strong\\u003e\\u003csup\\u003e\\u003cstrong\\u003e2\\u003c/strong\\u003e\\u003c/sup\\u003e\\u003cstrong\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e26.56 (6.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e18.68 (4.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e29.38 (4.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.003\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean TMI (kg/cm\\u003c/strong\\u003e\\u003csup\\u003e\\u003cstrong\\u003e3\\u003c/strong\\u003e\\u003c/sup\\u003e\\u003cstrong\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e17.81 (3.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e13.10 (1.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e19.50 (2.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.016\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean percentile of SBP\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e74.76 (26.00)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e65.83 (27.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e77.79 (25.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean percentile of DBP\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 11.5331%;\\\"\\u003e\\n \\u003cp\\u003e61.68 (20.54)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 8.041%;\\\"\\u003e\\n \\u003cp\\u003e56.28 (21.81)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e63.51 (19.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTSH (\\u0026micro;U/mL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e2.39 (1.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e2.65 (0.91)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e2.31 (1.08)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal cholesterol (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e145.82 (32.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e154.31 (31.63)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e143.21 (33.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHDL (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e46.29 (9.18)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e53.64 (9.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e44.31 (8.20)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.002\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLDL (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e88.91 (24.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e94.43 (20.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e87.36 (25.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTriglycerides (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e76.82 (41.72)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e66.88 (24.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e79.88 (45.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGlucose (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e88.30 (7.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e86.88 (7.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e88.75 (7.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eInsulin (\\u0026micro;U/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e12.61 (8.58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e8.05 (6.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e13.90 (8.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.026\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHOMA\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e2.78 (1.95)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e1.76 (1.49)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e3.07 (1.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.031\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHbA1c (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e5.29 (0.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e5.28 (0.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e5.29 (0.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGOT (U/L)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e26.55 (10.29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e28.31 (12.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e26.00 (9.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGPT (U/L)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e21.87 (11.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e17.31 (6.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e23.27 (11.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.075\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGGT (U/L)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e16.38 (11.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e13.64 (2.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e17.14 (12.30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eUric acid (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e5.26 (1.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e4.61 (1.17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e5.40 (1.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 16.8172%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCortisol\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 7.6734%;\\\"\\u003e\\n \\u003cp\\u003e10.49 (3.63)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" style=\\\"width: 11.9007%;\\\"\\u003e\\n \\u003cp\\u003e10.82 (2.07)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" style=\\\"width: 7.4437%;\\\"\\u003e\\n \\u003cp\\u003e10.45 (3.80)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 3.9516%;\\\"\\u003e\\n \\u003cp\\u003e0.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\" style=\\\"width: 48.6136%;\\\"\\u003eSDS, standard deviation; BMI, body mass index; TMI, triponderal mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TSH, thyroxine stimulating hormone; HDL, high-density lipoprotein; LDL, low density lipoprotein; HOMA, insulin resistance index; HbA1c, glycosylated hemoglobin; GOT, aspartate aminotransferase; GPT, glutamic-pyruvic transaminase; GGT, gamma-glutamyl transferase.\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMediterranean diet adherence scale scores showed no statistically significant differences between cases and controls. However, Krece Plus scores were lower in cases (3.93 vs. 6.21, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.002), and screen time was higher (3.02 vs. 1.8 hours, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.008). Urinary biomarker concentrations are presented in Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBody composition\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eBody composition analysis was conducted for all participants (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). The visceral fat area was significantly higher in cases than in controls (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), as was the total body water/fat-free mass index (\\u003cem\\u003eP\\u003c/em\\u003e 0.003).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\" style=\\\"margin-right: calc(13%); width: 87%;\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eBody composition characteristics of the study participants assessed by electrical bioimpedance\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003eTotal participants\\u003c/p\\u003e\\n \\u003cp\\u003e(N\\u0026thinsp;=\\u0026thinsp;72)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003eNormal weight\\u003c/p\\u003e\\n \\u003cp\\u003e(N\\u0026thinsp;=\\u0026thinsp;19)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 20.6297%;\\\"\\u003e\\n \\u003cp\\u003eObese\\u003c/p\\u003e\\n \\u003cp\\u003e(N\\u0026thinsp;=\\u0026thinsp;53)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 5.4545%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e-value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIntracellular water (L)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e18.36 (6.95)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e15.77 (7.68)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e19.26 (6.53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e0.072\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eExtracellular water (L)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e11.04 (4.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e9.47 (4.48)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e11.59 (3.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e0.063\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal body water (L)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e29.40 (11.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e25.24 (12.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e30.84 (10.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e0.068\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eExtracellular water/total body water (L)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e0.38 (0.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e0.38 (0.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e0.38 (0.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e0.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBody cell mass (Kg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e26.30 (9.96)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e22.58 (10.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e27.58 (9.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e0.071\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBone mineral content (Kg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e2.30 (0.91)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e2.14 (1.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e2.36 (0.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eArm circumference (cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e30.31 (5.86)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e23.76 (5.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e32.58 (4.17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eArm muscle circumference (cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e23.38 (4.66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e20.04 (4.54)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e24.54 (4.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eWaist circumference (cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e78.98 (17.40)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e64.26 (13.54)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e84.07 (15.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVisceral fat area (cm\\u003c/strong\\u003e\\u003csup\\u003e\\u003cstrong\\u003e2\\u003c/strong\\u003e\\u003c/sup\\u003e\\u003cstrong\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e95.17 (57.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e31.83 (28.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e117.10 (47.60)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBasal metabolic rate (Kcal/d)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e1,236.73 (326.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e1,117.61 (360.10)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e1,277.96 (306.58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e0.077\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal body water/fat free mass (L/kg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e73.32 (0.51)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e72.97 (0.57)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e73.44 (0.43)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.003\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 22.9091%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePhase angle (\\u0026ordm;)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 29.1273%;\\\"\\u003e\\n \\u003cp\\u003e5.82 (1.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 27.7091%;\\\"\\u003e\\n \\u003cp\\u003e5.52 (0.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 9.7091%;\\\"\\u003e\\n \\u003cp\\u003e5.92 (1.42)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 10.9091%;\\\"\\u003e\\n \\u003cp\\u003e0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe correlation between body fat, waist circumference and analytical markers of lipid and glycemic profile was analyzed using Pearson\\u0026rsquo;s test. A positive correlation was observed between waist circumference and total body fat, particularly perivisceral fat, while body fat showed a negative correlation with HDL levels (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003ctable id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003ePearson correlation analysis between body composition and metabolic parameters\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 11.0839%;\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 17.7126%;\\\"\\u003e\\n \\u003cp\\u003eFat mass\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 9.943%;\\\"\\u003e\\n \\u003cp\\u003eVisceral fat area (cm\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" style=\\\"width: 16.9253%;\\\"\\u003e\\n \\u003cp\\u003eTotal body water/fat free mass (L/kg)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 11.0839%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eWaist circumference (cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 17.7126%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.5821*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 14.7786%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2.3059*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 13.9093%;\\\"\\u003e\\n \\u003cp\\u003e0.0055\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 11.0839%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHDL (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 17.7126%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e-0.1981*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 14.7786%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e-0.9191*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 13.9093%;\\\"\\u003e\\n \\u003cp\\u003e-0.0034\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 11.0839%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHOMA\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 17.7126%;\\\"\\u003e\\n \\u003cp\\u003e-0.8904\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 14.7786%;\\\"\\u003e\\n \\u003cp\\u003e-2.5229\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 13.9093%;\\\"\\u003e\\n \\u003cp\\u003e0.0862\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 11.0839%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eInsulin (\\u0026micro;U/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 17.7126%;\\\"\\u003e\\n \\u003cp\\u003e0.3886\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 14.7786%;\\\"\\u003e\\n \\u003cp\\u003e1.7505\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" style=\\\"width: 13.9093%;\\\"\\u003e\\n \\u003cp\\u003e-0.0244\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" style=\\\"width: 57.4844%;\\\"\\u003eHDL, high-density lipoprotein; HOMA, insulin resistance index.\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" style=\\\"width: 57.4844%;\\\"\\u003eThe * indicate that the correlation is significant.\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEndocrine disruptors in urine\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eUrine samples were analyzed for 10 phenolic EDs: BPA, BPS, bisphenol F (BPF), methylparaben (MPB), ethylparaben (EPB), propylparaben (PPB), butylparaben (BPB), benzophenone-1 (BP-1), benzophenone-3 (BP-3), and 4-hydroxy benzophenone (4-OH-BP).\\u003c/p\\u003e\\n\\u003cp\\u003eAt least one ED was detected in 100% of the participants. Sex-specific differences in detection rates are shown in Fig.\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Overall, levels were higher in girls, except for BPA and MPB, which were more elevated in boys.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe number of detected EDs per participant ranged from six to nine. The most commonly detected phenols were BPA, MPB, and BP3, which were present in 100% of the participants. The detection of BPB and 4-OH-BP was higher in children with excess weight. The mean urinary phenol blood levels were as follows: BPB, 2.77 ng/ml; BPS, 0.92 ng/ml; BPF, 0.58 ng/ml; MPB, 59.87 ng/ml; EPB, 2.05 ng/ml; PPB, 4.01 ng/ml; BP-1, 1.89 ng/ml; BP-3, 5.14 ng/ml; and 4-OH-BP, 86.1 ng/ml.\\u003c/p\\u003e\\n\\u003cp\\u003eBox-plot diagrams were obtained for the ED concentrations studied revealed no significant differences between participants with normal weight and those with obesity, a finding confirmed by Student\\u0026rsquo;s \\u003cem\\u003et\\u003c/em\\u003e-test with a 95% confidence level.\\u003c/p\\u003e\\n\\u003cp\\u003eFor phenols, and many environmental pollutants, clinically significant levels or reference values have not been established. The phenol concentrations found in our urine samples were similar to those reported in other studies in children(Apel et al. \\u003cspan class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e), except for MPB, which was notably elevated in the group with obesity (mean concentration 71.55 ng/ml, range 0.11-774.72 ng/ml) compared to controls (mean concentration 27.27 ng/ml, range 0.43-346.67 ng/ml). The relationship between ED levels and anthropometric characteristics is shown in Table \\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003ctable id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eCorrelation analysis between anthropometric parameters and detection of endocrine disruptors in urine\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBPA\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBPS\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBPF\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMPB\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEPB\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePPB\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBP-1\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBP-3\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4-OH-BP\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBMI (kg/cm\\u003c/strong\\u003e\\u003csup\\u003e\\u003cstrong\\u003e2\\u003c/strong\\u003e\\u003c/sup\\u003e\\u003cstrong\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e-18.6799*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.7507\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-0.8319\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-30.1459\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-0.392\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-4.0041\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e-3.6713*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e-11.9589*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-0.1255\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTMI (kg/cm\\u003c/strong\\u003e\\u003csup\\u003e\\u003cstrong\\u003e3\\u003c/strong\\u003e\\u003c/sup\\u003e\\u003cstrong\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e22.7333*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-1.1554\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.1671\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e44.0535*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.9991\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e6.6575*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e4.9864*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e17.824*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-0.1152\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eWaist circumference (cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e5.015*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-0.2312\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.1505\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3.7536\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-0.0212\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.487\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1.0078*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e3.583*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.0073\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFat mass (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2.639*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-0.0956\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.1016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3.259\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1.0791*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-0.3024\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.5084*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.7097\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.0987\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"10\\\"\\u003eBPA, bisphenol A; BPS, bisphenol S; BPF, bisphenol F; MPB, methylparaben; EPB, ethylparaben; PPB, propylparaben; BP-1, benzophenone 1; BP-3, benzophenone 3; 4-OH-BP, 4-hydroxybenzophenone.\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"10\\\"\\u003eData in bold represent those with statistical significance (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCombined effect of ED in urine\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAn analysis of correlations between all possible ED pairs was performed (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Figure \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003eA shows Pearson\\u0026rsquo;s correlation coefficients, ranging from \\u0026minus;\\u0026thinsp;1 to +\\u0026thinsp;1, indicating the strength of the linear relationships between the variables. Strong correlations were seen between MPB and PPB, MPB and BPB, EPB and BPB, and BP-1 and BP-3, suggesting related behavior. The dendogram further these higher correlations, particular between MPB and PPB and BP-1 and BP-3 (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003eB).\\u003c/p\\u003e\\n\\u003cp\\u003eThe correlation between urinary ED levels and anthropometric and body composition parameters was analyzed (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). A positive, statistically significant correlation was detected between BPA, MPB, PPB, BP-1, and BP-3 levels and the triponderal mass index (TMI), as well as between BPA, EPB, and BP-1 levels and fat mass percentage. Conversely, a statistically significant negative correlation was identified between BPA, BP-1, and BP-3 levels and body mass index.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eOur study is the first to investigate the presence of obesogenic EDs in a population of children, revealing the presence of EDs in all the participants. Paraben levels were particularly high and have been linked to excess weight in cases of prenatal exposure.(Starling \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eChildhood obesity is a growing public health concern due to its many short- and long-term consequences for children\\u0026rsquo;s physical, emotional, and social well-being. Obesity is associated with an increased risk of chronic diseases such as type 2 diabetes, hypertension, and cardiovascular disorders, as well as psychological and self-esteem issues. Understanding the role of ED exposure in obesity is critical for developing targeted interventions and public health strategies. Environmental health encompasses all external physical, chemical, and biological factors affecting an individual. According to the World Health Organization, environmental factors contribute to 24% of the global disease burden and 23% of mortality.(Tard\\u0026oacute;n \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eExposure to EDs during childhood is common yet often unnoticed. The potential effects are multifaceted, including weight gain. In 2015, the Parma consensus broadened the term obesogen to include EDs that influence metabolic conditions associated with obesity, such as insulin resistance, hypertension, dyslipidemia, and hyperglycemia, ultimately contributing to the development of metabolic syndrome.(Heindel et al. \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eOur study includes participants spanning a broad range of childhood ages, which is particularly valuable given the limited research analyzing how the early-life environment influences obesity development. The similar proportion of boys and girls in our cohort ensures that the results are representative of both sexes. Furthermore, by comparing data from children both with normal weight and with overweight, our study provides more robust evidence regarding metabolic changes and their association with BMI. The classification into cases (children with obesity) and controls (normal-weight children) was appropriate, as both groups exhibited significantly different characteristics, not only in anthropometric parameters but also in body composition.\\u003c/p\\u003e\\u003cp\\u003eNo significant differences were found in Mediterranean diet adherence, likely due to the study population residing in the Mediterranean basin. However, daily screen time was significantly higher in children with overweight, indicating a more sedentary lifestyle. Prolonged screen use is linked to weight gain through reduced physical activity, increased consumption of unhealthy foods, and exposure to high-calorie food advertising. Excessive screen time can also disrupt sleep patterns, increasing obesity risk. The American Academy of Pediatrics and the WHO recommend complete avoidance of screen use in children under 2 years of age, limiting screen time to less than 1 hour in children aged 2 to 5 years and to less than 2 hours between the ages of 5 and 17 years. However, most children, especially children with obesity, do not adhere to these guidelines.(Cartany\\u0026agrave;-Hueso et al. \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e) Similar findings were described by Wolf(Wolf et al. \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e2018\\u003c/span\\u003e) and Kolovos(Kolovos et al. \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e), who found an overall daily average of 2 hours and 19 minutes of screen exposure in children aged 0 to 8 years and 3 hours in children aged 10 to 18 years.\\u003c/p\\u003e\\u003cp\\u003eThe children in the case group had moderate obesity and exhibited metabolic alterations, including elevated insulin levels, higher HOMA index, and worse lipid profiles, indicating increased susceptibility to metabolic disorders. These findings underscore the seriousness of childhood obesity and the need for early interventions.\\u003c/p\\u003e\\u003cp\\u003eBody composition also differed between groups, with the case group showing greater perivisceral fat accumulation. This central fat distribution was significantly associated with waist circumference, reinforcing its value as an anthropometric measure of fat mass in children.\\u003c/p\\u003e\\u003cp\\u003eOur study\\u0026rsquo;s strength lies in the simultaneous analysis of a wide range of EDs commonly encountered through ingestion, inhalation, and skin absorption. Assessing multiple EDs helps understand the cumulative effects of combined exposure, particularly in childhood obesity, and identifies potential synergistic interactions that may amplify adverse health outcomes. This comprehensive approach is essential for designing more effective prevention strategies and public health policies to protect vulnerable populations, including children, from the risks associated with combined ED exposure.\\u003c/p\\u003e\\u003cp\\u003eAll the participants in our study had at least one detectable disruptor in urine, with most showing a combination of bisphenols and parabens, reflecting findings from previous research.(Nadal et al. \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) This widespread exposure, even at early ages, underscores the importance of studies like ours that assess the impact of these chemicals on children\\u0026rsquo;s health.\\u003c/p\\u003e\\u003cp\\u003eFew publications have analyzed exposure to multiple EDs during childhood and/or adolescence and their association with various obesity markers.(Heindel et al. \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e) Research on BPA has identified a positive association between BPA levels and obesity.(Mustieles et al. \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) Studies such as Menale et al.(Menale et al. \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) comparing patients with obesity with and without metabolic syndrome, have demonstrated significantly higher urinary BPA levels in patients with metabolic syndrome or insulin resistance. Various mechanisms have been described by which bisphenols alter energy storage and metabolism such as dysregulation of messenger RNA and microRNA,(Verbanck et al. \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) alterations in the hypothalamic-pituitary-gonadal axis,(Yang et al. \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) disruption of adiponectin synthesis and secretion,(Liu et al. \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) promotion of preadipocyte differentiation, inhibiting the peroxisome proliferator-activated receptor gamma (PPARγ),(Zheng et al. \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e2016\\u003c/span\\u003e) and downregulating of uncoupling protein 1 expression,(Verbanck et al. \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) among others.(Nadal et al. \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eThe maximum urinary BPA levels in our sample were close to the safe limit established by the Commission on Human Biomonitoring.(Apel et al. \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) While BPA concentrations were higher in the case group than in controls, the difference was not statistically significant. This may be due to lower exposure levels compared to previous studies, likely due to BPA use restrictions.(Liu et al. \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) As BPA is replaced by BPF and BPS, both of which have been linked to increased obesity risk in children and adolescents,(Liu et al. \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e; Thoene et al. \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e) a critical question remains regarding the cumulative effects of these bisphenols. Notably, some studies have reported adverse effects even at exposure levels lower than those detected in our study.(Verbanck et al. \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e, 2021) Indeed, many scientists have advocated a \\u0026ldquo;zero threshold\\u0026rdquo; approach to ED exposure,(Rochester and Bolden \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e) as the in vitro effects of high doses do not always reliably predict the safety of low doses.(Apel et al. \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eRegarding parabens, the levels in our participants with excess weight were higher than the limits described by other authors(Apel et al. \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e) and established as safe. The literature supports a positive association between paraben levels and the increase in childhood obesity,(H\\u0026oslash;jsager et al. \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e) particularly with increased BMI and body fat percentage. This is in agreement with previous studies,(H\\u0026oslash;jsager et al. \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e) and is explained through the action of parabens on leptin and proopiomelanocortin. An epigenetic modification is produced that reduces proopiomelanocortin levels, altering some of its usual functions such as the induction of satiety in the hypothalamus.(Leppert et al. \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e) Additionally, parabens promote adipocyte differentiation through the PPARγ pathway, increasing adiposity, especially butylparaben, as reported by Hu et al.(Hu et al. \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eThe relationship between chemical levels and body composition showed that at least one compound from each phenol group (bisphenols, parabens, benzophenones) was associated with excess adiposity. The negative correlation between the ED levels and BMI may stem from the limitations of BMI in estimating body composition, as it does not account for body mass distribution. TMI, in contrast, has been proposed as a more accurate adiposity predictor in children and adolescents because it is less affected by height and has a more linear relationship with body fat.(De Lorenzo et al. \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) Certain EDs may also alter metabolism in ways that promote fat redistribution, favoring visceral fat storage without necessarily increasing total body weight.(Amato et al. \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e) Moreover, in pediatric populations, a child with a lower BMI but a higher TMI may have a lower relative weight due to lower lean mass, but a higher proportion of body fat.(Niu et al. \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e2023\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eThe benzophenone group showed a statistically significant correlation with higher TMI, waist circumference, and body fat percentage. While these chemicals have been more commonly associated with neurodevelopmental disorders, male infertility, and intrauterine growth restriction,(Long et al. \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) they have also been linked to potential obesogenic effects, as reflected in our findings.(Thoene et al. \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eThe individual analysis of endocrine disruptors has several limitations, particularly as it does not account for interactions between different molecules in the body, which may amplify or mitigate biological effects. Therefore, simultaneously measuring multiple EDs provides a more comprehensive and realistic assessment of total exposure to these compounds, better reflecting real-world conditions and detecting interactions that may influence biological outcomes. This allows for the evaluation of both synergistic and inhibitory effects, providing a more accurate picture of their combined impact on health.\\u003c/p\\u003e\\u003cp\\u003eOur findings emphasize the growing concern about obesogenic substance exposure, especially in children and adolescents. These stages involve the maturation of key endocrine systems that are vulnerable to chemical exposure. This increased susceptibility calls for enhanced surveillance and prevention efforts to reduce exposure to EDs and their health impacts. The strong link between ED exposure and obesity prevalence underscores the need to assess these chemicals in patient samples during obesity consultations, as such exposure is often overlooked in medical history assessments. Studies are also needed to evaluate the impact of industrial, governmental, and domestic measures aimed at reducing exposure to environmental pollutants, particularly in vulnerable populations like children.\\u003c/p\\u003e\\u003cp\\u003eA limitation of our study is the small sample size, which, while comparable to previous studies, may reduce the statistical power to detect significant differences. Additionally, as an observational study, it cannot establish causality. The reliance on a single urine sample may not fully capture exposure levels; however, it is more likely to underestimate rather than overestimate exposure.\\u003c/p\\u003e\\u003cp\\u003eDespite these limitations, our study is valuable as it provides data on exposure to multiple disruptors, reflecting real-world environmental exposure. We also analyzed body composition, rather than relying solely on anthropometric data, adding value to the findings. To our knowledge, this is the first study in our setting to focus on the pediatric population and the effects of ED exposure during this critical stage of development.\\u003c/p\\u003e\\u003cp\\u003eThe presence of EDs affected all the participants in our study, highlighting the ubiquity of these compounds and the need to evaluate their effects in the pediatric population. A deeper understanding of the interactions between obesogenic EDs and metabolism can undoubtedly guide the design of strategies to minimize exposure to these chemicals, optimizing health outcomes. Additionally, it may contribute to the identification of new biomarkers for the early diagnosis of complications associated with the disease and its prognosis in adulthood. This knowledge will enable the development of more targeted and effective preventive and therapeutic strategies, ultimately improving the quality of life for future generations.\\u003c/p\\u003e\\u003cp\\u003eIn conclusion, exposure to EDs in childhood is massive and universal, with indications of potential obesogenic effects from exposure to bisphenols, parabens and benzophenones in the pediatric age group. Given the ubiquitous and universal nature of ED exposure, as well as the challenges regulatory authorities face in controlling it, investigating the interactions between environmental factors and health is essential. For condition such as childhood obesity\\u0026mdash;characterized by severe medium- and long-term consequences and limited therapeutic options\\u0026mdash;reducing exposure to EDs presents a promising avenue for innovative therapeutic strategies.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eFunding information\\u003c/strong\\u003e: Research grants in medical sciences Fundaci\\u0026oacute;n Bienvenida Navarro Luciano Tripodi, 2021.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e: The authors thank Maria Repice for her help with the English version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval:\\u0026nbsp;\\u003c/strong\\u003eThe study was approved by the Research Ethics Committee, code 21/039. This study was performed in line with the principles of the Declaration of Helsinki.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent to participate:\\u003c/strong\\u003e Informed consent was obtained from the parents or legal guardians.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u0026nbsp;\\u003c/strong\\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments:\\u0026nbsp;\\u003c/strong\\u003eThis research was supported by a medical sciences research grant provided by Fundaci\\u0026oacute;n Bienvenida Navarro Luciano Tripodi-2021. The funder has played no role in the research. The authors thank Maria Repice for her help with the English version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions:\\u003c/strong\\u003e APNR: Study concept and design; study supervision; statistical analysis; interpretation of results; drafting and critical revision of the manuscript. LATG: laboratory analyses; data analysis and quality control; input on the discussion section. NPF: data visualization; literature search; interpretation of findings; review and revision of the manuscript for important intellectual content. FSF: participant recruitment and clinical data collection; coordination of hospital collaborations; review of the manuscript for accuracy and coherence.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eStatements\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003eFunding information: This research was supported by a medical sciences research grant provided by Fundaci\\u0026oacute;n Bienvenida Navarro Luciano Tripodi-2021. The funder has played no role in the research.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eConflicts of Interest: The authors declare no conflicts of interest.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eAuthor contributions: APNR: Study concept and design; study supervision; statistical analysis; interpretation of results; drafting and critical revision of the manuscript. LATG: laboratory analyses; data analysis and quality control; input on the discussion section. NPF: data visualization; literature search; interpretation of findings; review and revision of the manuscript for important intellectual content. FSF: participant recruitment and clinical data collection; coordination of hospital collaborations; review of the manuscript for accuracy and coherence.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eData Availability Statement: The data that support the findings of this study are available on request from the corresponding author.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eEthics approval: The study was approved by the Research Ethics Committee (approval code: 21/039) and conducted in accordance with the Declaration of Helsinki. It also complies with the ethical policies of Public Health Challenges.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eConsent to participate: Informed consent was obtained from the parents or legal guardians.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003ePermission to Reproduce Material from Other Sources: The authors declare that all material included in this manuscript is original and does not require permission for reproduction from other sources.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eAktağ E, Yurdak\\u0026ouml;k K, Yal\\u0026ccedil;ın SS, Kandemir N (2021) Urinary bisphenol A levels in prepubertal children with exogenous obesity according to presence of metabolic syndrome. J Pediatr Endocrinol Metab 34:495\\u0026ndash;502. https://doi.org/10.1515/jpem-2020-0371\\u003c/li\\u003e\\n \\u003cli\\u003eAmato AA, Wheeler HB, Blumberg B (2021) Obesity and endocrine-disrupting chemicals. Endocr Connect 10:R87\\u0026ndash;R105. https://doi.org/10.1530/EC-20-0578\\u003c/li\\u003e\\n \\u003cli\\u003eApel P, Angerer J, Wilhelm M, Kolossa-Gehring M (2017) New HBM values for emerging substances, inventory of reference and HBM values in force, and working principles of the German Human Biomonitoring Commission. Int J Hyg Environ Health 220:152\\u0026ndash;166. https://doi.org/10.1016/j.ijheh.2016.09.007\\u003c/li\\u003e\\n \\u003cli\\u003eBall GDC, Savu A, Kaul P (2019) Changes in the prevalence of overweight, obesity, and severe obesity between 2010 and 2017 in preschoolers: A population‐based study. Pediatr Obes 1\\u0026ndash;5. https://doi.org/10.1111/ijpo.12561\\u003c/li\\u003e\\n \\u003cli\\u003eCaporossi L, Papaleo B (2017) Bisphenol A and Metabolic Diseases: Challenges for Occupational Medicine. Int J Environ Res Public Health 14:959. https://doi.org/10.3390/ijerph14090959\\u003c/li\\u003e\\n \\u003cli\\u003eCarrascosa A, Yeste D, Moreno-Gald\\u0026oacute; A, et al (2018) [Body mass index and tri-ponderal mass index of 1,453 healthy non-obese, non-undernourished millennial children. The Barcelona longitudinal growth study]. An Pediatr Barc Spain 2003 89:137\\u0026ndash;143. https://doi.org/10.1016/j.anpedi.2017.12.016\\u003c/li\\u003e\\n \\u003cli\\u003eCartany\\u0026agrave;-Hueso \\u0026Agrave;, Lid\\u0026oacute;n-Moyano C, Mart\\u0026iacute;n-S\\u0026aacute;nchez JC, et al (2022) Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2-14 years. An Pediatr 97:333\\u0026ndash;341. https://doi.org/10.1016/j.anpede.2021.09.004\\u003c/li\\u003e\\n \\u003cli\\u003eDamstra T, Barlow S, Bergman A, et al (2002) Global assessment of the state-of-the-science of endocrine disruptors. WHOpublication No WHOPCSEDC022 180\\u003c/li\\u003e\\n \\u003cli\\u003eDe Lorenzo A, Romano L, Di Renzo L, et al (2019) Triponderal mass index rather than body mass index: An indicator of high adiposity in Italian children and adolescents. Nutrition 60:41\\u0026ndash;47. https://doi.org/10.1016/j.nut.2018.09.007\\u003c/li\\u003e\\n \\u003cli\\u003eHeindel JJ, Howard S, Agay-Shay K, et al (2022) Obesity II: Establishing causal links between chemical exposures and obesity. Biochem Pharmacol 199:115015. https://doi.org/10.1016/j.bcp.2022.115015\\u003c/li\\u003e\\n \\u003cli\\u003eHeindel JJ, Vom Saal FS, Blumberg B, et al (2015) Parma consensus statement on metabolic disruptors. Environ Health 14:54. https://doi.org/10.1186/s12940-015-0042-7\\u003c/li\\u003e\\n \\u003cli\\u003eH\\u0026oslash;jsager FD, Kyhl HB, Frederiksen H, et al (2021) Prenatal Exposure to Butyl Paraben Is Associated With Fat Percentage in 7-Year-Old Boys. J Clin Endocrinol Metab 106:e2633\\u0026ndash;e2638. https://doi.org/10.1210/clinem/dgab167\\u003c/li\\u003e\\n \\u003cli\\u003eHu P, Overby H, Heal E, et al (2017) Methylparaben and butylparaben alter multipotent mesenchymal stem cell fates towards adipocyte lineage. Toxicol Appl Pharmacol 329:48\\u0026ndash;57. https://doi.org/10.1016/j.taap.2017.05.019\\u003c/li\\u003e\\n \\u003cli\\u003eKolovos S, Jimenez-Moreno AC, Pinedo-Villanueva R, et al (2021) Association of sleep, screen time and physical activity with overweight and obesity in Mexico. Eat Weight Disord 26:169\\u0026ndash;179. https://doi.org/10.1007/s40519-019-00841-2\\u003c/li\\u003e\\n \\u003cli\\u003eKumar S, Kelly AS (2017) Review of Childhood Obesity. Mayo Clin Proc 92:251\\u0026ndash;265. https://doi.org/10.1016/j.mayocp.2016.09.017\\u003c/li\\u003e\\n \\u003cli\\u003eLe Fol V, A\\u0026iuml;t-A\\u0026iuml;ssa S, Sonavane M, et al (2017) In vitro and in vivo estrogenic activity of BPA, BPF and BPS in zebrafish-specific assays. Ecotoxicol Environ Saf 142:150\\u0026ndash;156. https://doi.org/10.1016/j.ecoenv.2017.04.009\\u003c/li\\u003e\\n \\u003cli\\u003eLeppert B, Strunz S, Seiwert B, et al (2020) Maternal paraben exposure triggers childhood overweight development. Nat Commun 11:561. https://doi.org/10.1038/s41467-019-14202-1\\u003c/li\\u003e\\n \\u003cli\\u003eLi N, Li J, Zhang Q, et al (2021) Effects of endocrine disrupting chemicals in host health: Three-way interactions between environmental exposure, host phenotypic responses, and gut microbiota. Environ Pollut 271:. https://doi.org/10.1016/j.envpol.2020.116387\\u003c/li\\u003e\\n \\u003cli\\u003eLiu B, Lehmler H-J, Sun Y, et al (2019) Association of Bisphenol A and Its Substitutes, Bisphenol F and Bisphenol S, with Obesity in United States Children and Adolescents. Diabetes Metab J 43:59. https://doi.org/10.4093/dmj.2018.0045\\u003c/li\\u003e\\n \\u003cli\\u003eLong J, Xia W, Li J, et al (2019) Maternal urinary benzophenones and infant birth size: Identifying critical windows of exposure. Chemosphere 219:655\\u0026ndash;661. https://doi.org/10.1016/j.chemosphere.2018.11.190\\u003c/li\\u003e\\n \\u003cli\\u003eL\\u0026oacute;pez-Gajardo MA, Leo FM, S\\u0026aacute;nchez-Miguel PA, et al (2022) KIDMED 2.0, An update of the KIDMED questionnaire: Evaluation of the psychometric properties in youth. Front Nutr 9:. https://doi.org/10.3389/fnut.2022.945721\\u003c/li\\u003e\\n \\u003cli\\u003eMenale C, Grandone A, Nicolucci C, et al (2017) Bisphenol A is associated with insulin resistance and modulates adiponectin and resistin gene expression in obese children. Pediatr Obes 12:380\\u0026ndash;387. https://doi.org/10.1111/ijpo.12154\\u003c/li\\u003e\\n \\u003cli\\u003eMustieles V, Casas M, Ferrando-Marco P, et al (2019) Bisphenol A and adiposity measures in peripubertal boys from the INMA-Granada cohort. Environ Res 173:443\\u0026ndash;451. https://doi.org/10.1016/j.envres.2019.03.045\\u003c/li\\u003e\\n \\u003cli\\u003eNadal A, Quesada I, Tudur\\u0026iacute; E, et al (2017) Endocrine-disrupting chemicals and the regulation of energy balance. Nat Rev Endocrinol 13:536\\u0026ndash;546. https://doi.org/10.1038/nrendo.2017.51\\u003c/li\\u003e\\n \\u003cli\\u003eNiu Y, Zhang Y, Sheng J, et al (2023) Tri-ponderal mass index as a screening tool for obesity prediction in children aged 6\\u0026ndash;9 years. Front Endocrinol 14:1277125. https://doi.org/10.3389/fendo.2023.1277125\\u003c/li\\u003e\\n \\u003cli\\u003eRochester JR, Bolden AL (2015) Bisphenol S and F: A Systematic Review and Comparison of the Hormonal Activity of Bisphenol A Substitutes. Environ Health Perspect 123:643\\u0026ndash;650. https://doi.org/10.1289/ehp.1408989\\u003c/li\\u003e\\n \\u003cli\\u003eRoman-Vi\\u0026ntilde;as B, Serra-Majem L, Ribas-Barba L, et al (2003) Crecicimiento y desarrollo: actividad f\\u0026iacute;sica. Estimaci\\u0026oacute;n del nivel de actividad f\\u0026iacute;sica mediante el Test Corto Krece Plus. Resultados en la poblaci\\u0026oacute;n espa\\u0026ntilde;ola. Crecim Desarro Estud Enkid Krece Plus 4:57\\u0026ndash;74\\u003c/li\\u003e\\n \\u003cli\\u003eStarling S (2020) Maternal paraben exposure and childhood weight gain. Nat Rev Endocrinol 16:257. https://doi.org/10.1038/s41574-020-0343-y\\u003c/li\\u003e\\n \\u003cli\\u003eTard\\u0026oacute;n A (2022) Compuestos org\\u0026aacute;nicos persistentes y salud Persistent organic compounds and health. Rev Esp Endocrinol Pediatr 13:. https://doi.org/10.3266/RevEspEndocrinolPediatr.pre2022.Apr.732\\u003c/li\\u003e\\n \\u003cli\\u003eThoene M, Dzika E, Gonkowski S, Wojtkiewicz J (2020) Bisphenol S in Food Causes Hormonal and Obesogenic Effects Comparable to or Worse than Bisphenol A: A Literature Review. Nutrients 12:532. https://doi.org/10.3390/nu12020532\\u003c/li\\u003e\\n \\u003cli\\u003eVelmurugan G, Ramprasath T, Gilles M, et al (2017) Gut Microbiota, Endocrine-Disrupting Chemicals, and the Diabetes Epidemic. Trends Endocrinol Metab 28:612\\u0026ndash;625. https://doi.org/10.1016/j.tem.2017.05.001\\u003c/li\\u003e\\n \\u003cli\\u003eVerbanck M, Canouil M, Leloire A, et al (2017) Low-dose exposure to bisphenols A, F and S of human primary adipocyte impacts coding and non-coding RNA profiles. PLOS ONE 12:e0179583. https://doi.org/10.1371/journal.pone.0179583\\u003c/li\\u003e\\n \\u003cli\\u003eVermeiren E, Bruyndonckx L, De Winter B, et al (2021) The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies. Nutr Metab Cardiovasc Dis NMCD 31:2575\\u0026ndash;2586. https://doi.org/10.1016/j.numecd.2021.05.020\\u003c/li\\u003e\\n \\u003cli\\u003eVuong AM, Braun JM, Wang Z, et al (2019) Exposure to polybrominated diphenyl ethers (PBDEs) during childhood and adiposity measures at age 8 years. Environ Int 123:148\\u0026ndash;155. https://doi.org/10.1016/j.envint.2018.11.050\\u003c/li\\u003e\\n \\u003cli\\u003eWolf C, Wolf S, Weiss M, Nino G (2018) Children\\u0026rsquo;s environmental health in the digital era: Understanding early screen exposure as a preventable risk factor for obesity and sleep disorders. Children 5:. https://doi.org/10.3390/children5020031\\u003c/li\\u003e\\n \\u003cli\\u003eWorld Health Organization (2022) WHO European regional obesity report 2022. World Health Organization, [Copenhagen]\\u003c/li\\u003e\\n \\u003cli\\u003eXu X, Wu H, Terry PD, et al (2022) Impact of Paraben Exposure on Adiposity-Related Measures: An Updated Literature Review of Population-Based Studies. Int J Environ Res Public Health 19:16268. https://doi.org/10.3390/ijerph192316268\\u003c/li\\u003e\\n \\u003cli\\u003eYang Q, Yang X, Liu J, et al (2017) Effects of BPF on steroid hormone homeostasis and gene expression in the hypothalamic\\u0026ndash;pituitary\\u0026ndash;gonadal axis of zebrafish. Environ Sci Pollut Res 24:21311\\u0026ndash;21322. https://doi.org/10.1007/s11356-017-9773-z\\u003c/li\\u003e\\n \\u003cli\\u003eZheng S, Shi J, Hu J, et al (2016) Chlorination of bisphenol F and the estrogenic and peroxisome proliferator-activated receptor gamma effects of its disinfection byproducts. Water Res 107:1\\u0026ndash;10. https://doi.org/10.1016/j.watres.2016.10.048\\u003c/li\\u003e\\n \\u003cli\\u003e(2021) Fourth national report on human exposure to environmental chemicals. National Center for Environmental Health\\u003cstrong\\u003e\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":true,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"exposure-and-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"wqeh\",\"sideBox\":\"Learn more about [Exposure and Health](https://www.springer.com/journal/12403)\",\"snPcode\":\"12403\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12403/3\",\"title\":\"Exposure and Health\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"Childhood obesity, Endocrine disruptors, Metabolic risk, Chemical exposure\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7058500/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7058500/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eChildhood obesity is an escalating global health concern, partly driven by environmental factors such as endocrine disruptors (EDs), which can alter metabolism and promote adiposity. This case-control study examined the association between exposure to obesogenic EDs (bisphenols, parabens and benzophenones) and body composition in 72 children aged 3 to 15 years (53 with obesity and 19 normal-weight controls) recruited from two hospitals in Spain. Metabolic status, body composition and urinary levels of EDs were evaluated using tandem mass spectrometry. The findings, which are pioneering in evaluating combined exposure to chemicals, reveal that EDs were present in 100% of the participants, with parabens the most frequently detected. Higher methylparaben levels were observed in the group with obesity. Correlational analyses revealed positive associations between specific EDs and adiposity parameters, including triponderal mass index and visceral fat percentage. These results suggest that exposure to EDs may contribute to the development of childhood obesity. The massive and early exposure to EDs underscores the urgent need for preventive policies and longitudinal studies to evaluate their combined effects. These findings provide critical insights for developing effective strategies to combat childhood obesity.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Exposure to obesogenic endocrine disruptors in childhood. Impact on biomarkers of metabolic status.\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-30 12:04:28\",\"doi\":\"10.21203/rs.3.rs-7058500/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"reviewerAgreed\",\"content\":\"\",\"date\":\"2025-10-22T06:27:59+00:00\",\"index\":0,\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-10-16T12:54:14+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"Exposure and Health\",\"date\":\"2025-07-15T05:57:16+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-07-09T14:19:33+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Exposure and Health\",\"date\":\"2025-07-06T10:43:58+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"exposure-and-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"wqeh\",\"sideBox\":\"Learn more about [Exposure and Health](https://www.springer.com/journal/12403)\",\"snPcode\":\"12403\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12403/3\",\"title\":\"Exposure and Health\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"cb29d920-8332-48e6-bfe0-caee16641438\",\"owner\":[],\"postedDate\":\"October 30th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-23T16:15:29+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7058500\",\"link\":\"https://doi.org/10.1007/s12403-026-00764-1\",\"journal\":{\"identity\":\"exposure-and-health\",\"isVorOnly\":false,\"title\":\"Exposure and Health\"},\"publishedOn\":\"2026-03-18 15:58:50\",\"publishedOnDateReadable\":\"March 18th, 2026\"},\"versionCreatedAt\":\"2025-10-30 12:04:28\",\"video\":\"\",\"vorDoi\":\"10.1007/s12403-026-00764-1\",\"vorDoiUrl\":\"https://doi.org/10.1007/s12403-026-00764-1\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7058500\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7058500\",\"identity\":\"rs-7058500\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}