This study explores the association between phthalates and total vitamin D levels and the link between phthalates exposure and subclinical inflammation using monocyte percentage to high-density lipoprotein cholesterol ratio (MHR), utilizing three National Health and Nutrition Examination Survey (NHANES) survey cycles 2013-2018. This study is cross-sectional, utilizing one-time urine samples from randomly selected NHANES participants to assess phthalate metabolites. An inverse association between vitamin D and all Di(2-ethylhexyl) phthalate (DEHP) metabolites was found. The molar sum of DEHP metabolites was inversely associated with vitamin D (β -2.329; 95% CI -3.937,-0.720). An inverse association was observed between monocarboxynonyl phthalate and vitamin D (β -0.0278; 95% CI -0.0527,-0.00298). A similar relationship was found between monocarboxyoctyl phthalate and vitamin D (β -0.0160; 95% CI -0.0242,-0.00775). There was no association between phthalate metabolites and MHR. Stratified analysis showed that the association between phthalate metabolites and MHR may vary according to vitamin D status.
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