Abstract Body: Introduction: Parabens are antimicrobial chemicals frequently used as preservatives in consumer products. Due to their chemical structure, exposure to parabens may impact cardiometabolic health by disrupting specific biological pathways.

Objective: To synthesize the literature on the associations between paraben exposure and cardiometabolic outcomes in pediatric populations.

Methods: Scopus, PubMed, Web of Science, and Embase databases were systematically searched for studies published before July 2024. Inclusion criteria were: at least one paraben exposure measure, at least one reported cardiometabolic outcome (excluding adiposity), and published in English or French. Data extraction included: demographic and methodological details and estimated associations between parabens and cardiometabolic outcomes. Quality was assessed using the Quality Assessment Tool for Quantitative Studies which was developed by the Effective Public Health Practice Project.

Results: Of the 9595 records identified: 935 were duplicates, 14 were retained in full-text, and five were included in the review. Excluded were: non-human studies, populations outside the age range of interest (3-19 years), or missing relevant exposure or outcome measures. All five studies were cross-sectional, including 4 of moderate and 1 of weak quality. Exposures studied included methyl (n=5), ethyl (n=5), propyl (n=5), butyl (n=4), and the sum of parabens (n=2), Outcomes studied included blood pressure (n=3), blood lipids (n=3), and measures of glucose and insulin indices (n=3). Confounders adjusted for in most studies included age, sex, socioeconomic status, physical activity, ethnicity, and smoking. Statistical methods included: linear regression models (n=3), Wilcoxon and Chi-squared tests (n=1) and Bayesian machine kernel regression (n=1). Study heterogeneity limited synthesis of study results. One study reported negative associations between ethyl paraben exposure and measures of blood pressure in children 4-6. One study reported a positive association between parabens (in a chemical mixture) and triglyceride/HDL ratios in adolescents. The remaining studies reported no meaningful associations.

Conclusion: Research on this topic is limited and heterogeneous making findings inconsistent and difficult to interpret. There is a need for longitudinal studies on parabens and cardiometabolic health, and for a greater understanding of the relationship between lifestyle and exposure patterns in youth.