BACKGROUND: Exposure to benzophenone-1 (BP-1) and benzophenone-3 (BP-3), widely used as UV filters in personal care products, has been associated with adverse health effects. However, epidemiological evidence is limited and inconclusive, particularly in vulnerable populations such as teenagers. OBJECTIVE: To examine the relation between BP-1 and BP-3 concentrations and obesity, cardiometabolic biomarkers, and asthma/allergy outcomes in European teenagers, including possible sex-specific associations. METHODS: A multi-country cross-sectional study was conducted using pooled data from six aligned studies from the Human Biomonitoring for Europe Initiative (HBM4EU). Sociodemographic data, cardiometabolic biomarkers, and asthma/allergy outcomes were collected through questionnaires. Anthropometric data and BMI z-scores were calculated (n = 1339). Plasma/serum cardiometabolic biomarkers and asthma/allergy outcomes were available for a subsample (n = 173-594). Urinary BP-1 and BP-3 concentrations were adjusted for creatinine dilution using the traditional standardization (trad.) and the covariate-adjusted creatinine standardization (CAS) method. Generalized additive models, linear, logistic, and multinomial mixed models were applied, and sex-interaction terms were tested. RESULTS: Each natural log-unit increase in urinary BP-3 (CAS) concentrations was associated with higher odds of obesity in the whole population (OR: 1.20; 95%CI: 1.04-1.38). Sex-specific associations were also found with BP-1 (CAS) and BP-3 (CAS) concentrations, which were associated with higher odds of obesity in male teenagers (OR: 1.25; 95% CI: 1.01-1.55; OR: 1.34; 95%CI: 1.09-1.65, respectively). Linear mixed models showed consistent findings toward higher BMI z-scores. A negative association was found between BP-1 (CAS) concentration and serum adiponectin levels in females (% change per loge-unit increase: -3.73, 95%CI: -7.32, -0.10). BP-3 (CAS) concentrations were also associated with higher odds of non-food allergies in males (OR: 1.27; 95%CI: 1.00-1.63). Traditional creatinine adjustment showed similar or slightly attenuated estimates compared to the CAS method. CONCLUSIONS: BP-1 and BP-3 exposure was cross-sectionally associated with higher odds of obesity in European male teenagers, highlighting the need to update regulations and keep exposure levels as low as practically achievable. Longitudinal studies are needed to confirm these findings.

Department of Biomedical Sciences University of Antwerp Belgium

Department of Environmental and Occupational Health Santé Publique France French Public Health Agency France

Department of Food Safety and Centre for Sustainable Diets Norwegian Institute of Public Health Oslo Norway

Department of Risk Benefit Assessment Swedish Food Agency Uppsala Sweden

German Environment Agency Berlin Germany

Instituto de Investigación Biosanitaria 2400 Mol Belgium

Instituto de Investigación Biosanitaria Spain

Instituto de Investigación Biosanitaria Spain; Servicio de Radiodiagnóstico Hospital Universitario Clínico San Cecilio Granada Spain

National Centre for Environmental Health Instituto de Salud Carlos 3 Majadahonda Madrid Spain

Nofer Institute of Occupational Medicine Department of Environmental and Biological Monitoring Poland

RECETOX Faculty of Science Masaryk University Brno Czech Republic

Toxicology Unit Research Institute of Biomedical and Health Sciences Spain

Unidad de Gestión Clínica de Laboratorios Hospital Universitario Clínico San Cecilio Granada Spain

University of Granada Biomedical Research Center Granada Spain

University of Granada Biomedical Research Center Spain

VITO Health Flemish Institute for Technological Research 2400 Mol Belgium

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