Uses and occurrences of five major alternative plasticizers, and their exposure and related endocrine outcomes in humans: A systematic review

Non-phthalate plasticizers are being increasingly used in commercial and consumer products, to replace phthalates. Among major non-phthalate plasticizer groups, we chose five alternative plasticizers of DEHA, DINCH, DEHTP, ATBC, and TOTM, and conducted a systematic literature review for current knowledge on their use and occurrences in major sources, and their exposure and endocrine outcomes in humans. Relevant articles published between January 2000 and December 2022 were identified from PubMed and Scopus search and analyzed. For occurrence, biomonitoring, and endocrine-related outcomes, 79, 73, and 14 studies were finally identified, respectively. The alternative plasticizers were widely used in food packaging, children’s products, hygiene products, medical devices, and construction materials, and frequently detected in indoor dust. Food packaging materials and children’s products were major sources of direct exposure to humans. Human exposure to alternative plasticizers is reported mostly via biomonitoring of urine. Urinary levels of DEHTP and DINCH metabolites were higher among infants, children, and pregnant women than in general adults. In humans, DEHTP, DINCH, or ATBC exposure were associated with sex hormone disruption and reproductive outcomes, but these associations varied by sex and age. This review showed that the use of and exposure to these alternative plasticizers have increased over time. Their potential health implications, especially among susceptible humans, warrant greater attention and further investigation.</p