Low-plastic diet and urinary levels of plastic-associated phthalates and bisphenols: the randomized controlled PERTH Trial

The everyday use of plastic products exposes us to plastic-associated chemicals (PACs), which have been associated with risks to human health. We present the results of the Plastic Exposure Reduction Transforms Health Trial, with an observational cohort of 211 Australian participants and a 7-day pilot randomized controlled trial in 60 participants. Intervention groups received combinations of plastic-free kitchenware, low-plastic personal-care products and food sourced from more than 100 producers that minimized all plastic touchpoints from paddock to plate, while the control group received no intervention. The primary trial outcome was a reduction in urinary plastics-associated chemicals levels. In the cohort study, highly processed, plastic-packaged and canned foods were important modifiable factors for urinary PAC metabolite levels. Additionally, we observed negative associations between cardiometabolic biomarkers and higher urinary di(2-ethylhexyl) phthalate metabolites. Our randomized controlled dietary intervention maintained participants' daily energy intake while decreasing plastic exposure (P < 0.001) and urinary levels of mono-n-butyl phthalate, monobenzyl phthalate and bisphenol A by 37.5% (95% confidence interval (CI): -55.6, -12.0; P = 0.007), 53.5% (95% CI: -72.7, -20.6; P = 0.005) and 59.7% (95% CI: -82.5, -6.87; P = 0.033), respectively. Intervention groups provided with foods that had minimal to no contact with plastic had the broadest effect on PAC excretion, and replacing low-plastic personal-care products alone led to an independent decrease in urinary mono-n-butyl phthalate, compared to no intervention. Despite constant plastic exposures, limiting food plastics touchpoints decreases select PACs in 7 days. Australian and New Zealand Clinical Trials Registry: ACTRN12622001252707 .

Authors

Institutions

Publication Details

Journal
Nature Medicine
Published
2026-04-21
DOI
https://doi.org/10.1038/s41591-026-04324-7
Citations
1
Primary Topic
Effects and risks of endocrine disrupting chemicals
Type
article
Field-Weighted Citation Impact
18.28
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Low-plastic diet and urinary levels of plastic-associated phthalates and bisphenols: the randomized controlled PERTH Trial

Davide Chiarugi, Dick C. Chan, Jacob Warger, Alex H. Liu et al.
1 citations
Nature Medicine
Effects and risks of endocrine disrupting chemicals
18.28
article

Low-plastic diet and urinary levels of plastic-associated phthalates and bisphenols: the randomized controlled PERTH Trial

Davide Chiarugi, Dick C. Chan, Jacob Warger, Alex H. Liu, Rishabh Kulkarni, Kevin Victor Thomas, Kathryn L. Linge, Sam Salman, Christos Symeonides, Lelinh Duong, Bhedita J. Seewoo, Tony Smith, Kevin Murray, Michelle Trevenen, Gerald F. Watts, Silvana Gaudieri, Anna Henry, Amelia J. Harray, Ahmed Elagali, Michaela Lucas, Zaheerah Haywood, Andrew D. Lucas, S R Dunlop, Hannah Papendorf, Andrea Vermeersch, Tamsin Johnson, Kim Jarvie, Jochen Mueller, Philip S. Vlaskovsky, Amy Prosser, Xianyu Wang, Lydia Rock, Susan E. Herrmann
article en
1 citations

Abstract

The everyday use of plastic products exposes us to plastic-associated chemicals (PACs), which have been associated with risks to human health. We present the results of the Plastic Exposure Reduction Transforms Health Trial, with an observational cohort of 211 Australian participants and a 7-day pilot randomized controlled trial in 60 participants. Intervention groups received combinations of plastic-free kitchenware, low-plastic personal-care products and food sourced from more than 100 producers that minimized all plastic touchpoints from paddock to plate, while the control group received no intervention. The primary trial outcome was a reduction in urinary plastics-associated chemicals levels. In the cohort study, highly processed, plastic-packaged and canned foods were important modifiable factors for urinary PAC metabolite levels. Additionally, we observed negative associations between cardiometabolic biomarkers and higher urinary di(2-ethylhexyl) phthalate metabolites. Our randomized controlled dietary intervention maintained participants' daily energy intake while decreasing plastic exposure (P < 0.001) and urinary levels of mono-n-butyl phthalate, monobenzyl phthalate and bisphenol A by 37.5% (95% confidence interval (CI): -55.6, -12.0; P = 0.007), 53.5% (95% CI: -72.7, -20.6; P = 0.005) and 59.7% (95% CI: -82.5, -6.87; P = 0.033), respectively. Intervention groups provided with foods that had minimal to no contact with plastic had the broadest effect on PAC excretion, and replacing low-plastic personal-care products alone led to an independent decrease in urinary mono-n-butyl phthalate, compared to no intervention. Despite constant plastic exposures, limiting food plastics touchpoints decreases select PACs in 7 days. Australian and New Zealand Clinical Trials Registry: ACTRN12622001252707 .

Nature Medicine
SIB Swiss Institute of Bioinformatics (CH), Royal Children's Hospital (AU), The University of Queensland (AU), The Kids Research Institute Australia (AU), The University of Western Australia (AU), Florey Institute of Neuroscience and Mental Health (AU), Royal Perth Hospital (AU), Princess Margaret Hospital for Children (AU), Government of Western Australia Department of Health (AU), Sir Charles Gairdner Hospital (AU), ChemCentre (AU), Pathwest Laboratory Medicine (AU)
Openalex Percentile: Top 1%
Effects and risks of endocrine disrupting chemicals
18.28
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.