Parabens exposure, depression, and cardiovascular metabolic health in the elderly: Findings from a cross-sectional study in China

Parabens, ubiquitous preservatives with endocrine-disrupting potential, may adversely affect mental and cardiometabolic health, but evidence in elderly populations is limited. This study aimed to explore the relationships between urinary parabens and the risk of major depressive disorder (MDD) and cardiovascular and metabolic diseases (CMDs) among 921 community-dwelling elderly participants (aged ≥ 60 years) in Shandong, China. Urinary paraben concentrations were quantified using LC-MS. Multivariable logistic and linear regression were employed to assess the associations between individual parabens and health outcomes. The combined effects of the paraben mixture on MDD and CMDs were evaluated using Weighted Quantile Sum (WQS) and Bayesian Kernel Machine Regression (BKMR). Subgroup analyses were conducted by sex, age, BMI, and MDD status, with multiplicative interactions tested. Positive associations were observed between urinary methylparaben (MeP), ethylparaben (EtP), and the risk of MDD and CMDs (P-trend < 0.05). Compared with the reference, participants in the highest quartiles of MeP and EtP had significantly increased risks of MDD (MeP: OR = 2.88, 95% CI: 1.50-5.56; EtP: OR = 2.11, 95% CI: 1.01-3.89). For CMDs, MeP levels were associated with increased diabetes risk (OR = 1.65, 95% CI: 1.03-2.65). EtP levels were positively correlated with hypertension risk in males (OR = 1.85, 95% CI: 1.09-3.16), with significant sex differences (P-interaction = 0.034). WQS and BKMR regression analyses revealed significant positive joint effects of the paraben mixture on both MDD and CMDs, with MeP as the primary contributor. MeP also showed a significant positive association with composite burden scores for both MDD and CMDs. MDD and PHQ-9 scores were associated with increased Mets risk. Notably, the positive association of MeP and diabetes was confined to participants without MDD (OR = 1.82, 95% CI: 1.07-3.10). These findings implicate parabens as potentially modifiable environmental risk factors contributing to the dual burden of mental and cardiometabolic disorders in aging populations.