(ASPOT38) Endocrine disrupting chemicals associated health hazards from polyethylene terephthalates used in edible packaging: A Systematic review of clinical studies

Background: The endocrine-disrupting chemicals and the associated toxicities in humans from polyethylene terephthalate (PET) which is a common material used for food and beverages packaging warrants health safety considerations. Much more research and evidences are needed to clarify the endocrine-disrupting chemicals from PET in beverages and packaging containers and its associated health hazards and effects.

Objectives: This review aimed to address the endocrine toxicity associated with the PET and its biproducts.

Methods: A systematic review of primary studies accessed through PubMed/Medline, Scopus, and Embase was conducted in January 2024 through preferred reporting items for systematic reviews and meta-analysis (PRISMA). The primary studies evaluating endocrine toxicity and associated health hazard associated with the exposure to PET or its biproducts from beverages and food products were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for analytical cross-sectional studies was used for methodological quality assessment. A narrative synthesis was performed to collate the evidence and to present the findings. The study selection, data extraction, and quality assessment was performed by two independent reviewers and any discrepancies were settled through mutual discussion or consulting another reviewer in the team.

Results: A total of 9 studies out of 367 articles were considered for this systematic review. Majority (n=6) of studies were published from Iran and remaining each study from Greece, United States and Austria. Various metabolites such as DEHP, DEP, DMP, DnBP, 4-NP and 4-t-OP are present in water bottles, fruit juice and pickled vegetable packs. These metabolites pose a health safety concern through estrogenic risks in adults and children, though overall hazard quotient indicates these products are safe to consume. The PET metabolites in milk bottles demonstrate low estrogenic activity and pose no risk to consumers even when milk consumption is routine and high amount. Additionally, PET metabolites contributed to an age dependent risk in lowering the testosterone production among male aged above 20 years. Other health hazards such as lower infant birth weight, skin reactions, and diarrhea were observed with DEPH, DEHP, and MEP, respectively.

Conclusions: While minimal endocrine risks are linked to PET and its metabolites in beverages and food packaging, comprehensive long-term clinical studies are lacking. Conducting well-designed observational studies are essential for a more accurate risk assessment of PET in humans.