This study investigated the association between co-exposure to phthalate esters (PAEs) and organophosphate esters (OPEs) and diabetes, the modifying effect of dietary antioxidants, and potential mechanisms. Using data from NHANES 2011-2018, a higher environmental risk score (ERS) for PAEs and OPEs was significantly associated with increased diabetes risk. This association interacted with dietary antioxidant intake, with a stronger association observed in individuals with low antioxidant intake. Quantile g-computation confirmed the positive association between combined exposure and diabetes, which was attenuated by the addition of dietary antioxidants. Adverse outcome pathway (AOP) analysis implicated TCPP and TCEP as key chemicals affecting glucose metabolism and insulin signaling, leading to diabetes.

Yang Yang, Cheng Zhang, Hui Gao