Alpha¹ by KaimenConfidential

Kaimen Rigor review

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

Harray AJ, Lucas AD, Herrmann SE, Vlaskovsky PS, Elagali A, Seewoo BJ, Chan DC, Chiarugi D, Kulkarni R, Trevenen M, Wang X, Mueller J, Thomas KV, Papendorf H, Miller C, Gaudieri S, Smith T, Salman S, Murray K, Symeonides C, Dunlop SA, Watts GF, PERTH Trial Consortium, Lucas M

DOI: 10.1038/s41591-026-04324-7
Record issued: 2026-08-15
Engine: 7.39.0
Exported: 2026-09-22

Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/9d345c0a-675b-491e-a3ca-c454c96e52c8 is authoritative.

Kaimen Rigor review

Kaimen Rigor reviewed

1 / 5

Critical — serious problems across many checks

Mixed Methods

Critical

High-priority

How this rating was calculated

Started at 5★ — deductions

IntegrityIntegrity concern ×3−1.5★
CitationsCitations & links (capped) ×10−1★
ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
ReportingStudy design partially met−0.25★
ReportingStatistical analysis partially met−0.25★

Citations & links are capped at −1★ combined, however many are flagged.

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Not verified in this report

Statistics were not checked: no recomputable values were found in this text — no test statistic reported with its degrees of freedom, no effect estimate printed with both a 95% CI and a p-value, and no percentage printed with both its count and its denominator.

Biggest issues

01Efficacy rests on an unvalidated surrogate endpoint
highOverreachreviewer-assessedFull detail
The primary outcome is reduction in urinary levels of plastic-associated chemicals (PACs), which are biomarkers of exposure, not clinical outcomes. The paper does not demonstrate target engagement at the tested dose (no PK/PD data) nor cite validated evidence linking these urinary PAC levels to clinical outcomes. The claim that reducing PACs is beneficial is based on epidemiological associations, not established surrogate validation.
“The primary trial outcome was a reduction in urinary plastics-associated chemicals levels.”
Find in source
02Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The reported reductions in urinary PAC levels (e.g., 37.5% for MnBP, 53.5% for MBzP, 59.7% for BPA) are statistically significant but are not anchored to any clinical or biological meaningfulness. The paper does not provide a minimal clinically important difference or link these reductions to improved health outcomes. The effect sizes are presented as percentage changes in biomarkers without context of clinical benefit.
“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.”
Find in source

Findings by category

101ArithmeticNumerical inconsistencies 202OverreachOverstated conclusions 103AuthenticityData authenticity concerns 204DisclosureReporting gaps 105AvailabilityBroken references and links 06Copyedit5 minor suggestions

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

The paper is a well-conducted mixed-methods study (cohort + pilot RCT) with strong scientific premise, clear ethics, and transparent reporting. The main weaknesses are the lack of a formal power analysis, incomplete reporting of randomization/blinding details, and imprecise p-value reporting with no multiple-comparison correction.

Both reviewers classified the study as mixed (observational + interventional), which was adopted. The statistics verification component could not recompute any tests (total=0) due to limited reporting of test statistics and CIs, so mathematical correctness is not confirmed. The citation check flagged 10 references not found in registries, which are integrity concerns.

Numerical inconsistencies

1 finding · worst low

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

lowinternal contradiction
The registration number in the Methods section has an extra digit compared to the Abstract.
“ACTRN126220012527070”
EthicsFind in source
lowinternal contradiction
The CI for Group 3 MnBP reduction is identical to Group 2's CI, which is suspicious.
“Group 3 (low-plastic PCPs only) decreased urinary MnBP by only 35.3% (95% CI: −55.6, −12.0; P = 0.013)”
ResultsFind in source

Overstated conclusions

2 findings · worst high

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Efficacy rests on an unvalidated surrogate endpointAssessed
Treatment effect not shown to be clinically meaningfulAssessed

7 major claims checked against the paper's own evidence: all adequately supported.

supportedReviewer 1
The RCT decreased urinary levels of MnBP, MBzP, and BPA.
The reported effect sizes and CIs for the intervention groups support this claim.
Evidence: Group 2 decreased MnBP by 37.5% (95% CI: −55.6, −12.0; P = 0.007), MBzP by 53.5% (95% CI: −72.7, −20.7; P = 0.005), and BPA by 59.7% (95% CI: −82.5, −6.88; P = 0.033).
decreased ... 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.
Abstractreviewer’s wording
supportedReviewers 1, 2
Highly processed, plastic-packaged and canned foods are important modifiable factors for urinary PAC levels.
The cohort analyses show associations between these dietary factors and urinary PACs.
Evidence: Each additional canned item was associated with 14.3% increase in urinary BPA (95% CI: 1.26, 29.1; P = 0.032).
“In the cohort study, highly processed, plastic-packaged and canned foods were important modifiable factors for urinary PAC metabolite levels.”
AbstractFind in source
supportedReviewer 1
Negative associations between cardiometabolic biomarkers and higher urinary DEHP metabolites were observed.
The reported associations support this claim, though the direction is unexpected.
Evidence: Higher MEHP was associated with 23.2% lower hsCRP (95% CI: −36.6, −7.08; P = 0.007).
“we observed negative associations between cardiometabolic biomarkers and higher urinary di(2-ethylhexyl) phthalate metabolites.”
AbstractFind in source
supportedReviewers 1, 2
Limiting food plastics touchpoints decreases select PACs in 7 days.
The RCT results support this claim for specific PACs (MnBP, MBzP, BPA), though not for DEHP metabolites.
Evidence: Groups 1, 2 and 4 combined decreased MnBP by 37.9% (95% CI: −53.0, −17.9; P < 0.001), MBzP by 44.5% (95% CI: −64.1, −14.3; P = 0.008), BPA by 51.6% (95% CI: −75.4, −4.62; P = 0.036).
“Despite constant plastic exposures, limiting food plastics touchpoints decreases select PACs in 7 days.”
AbstractFind in source
supportedReviewer 2
The RCT reduced urinary levels of MnBP, MBzP, and BPA.
The RCT results show significant decreases in these PACs in intervention groups compared to control, with effect sizes and CIs.
Evidence: Group 2 decreased MnBP by 37.5% (95% CI: −55.6, −12.0; P = 0.007), MBzP by 53.5% (95% CI: −72.7, −20.7; P = 0.005), and BPA by 59.7% (95% CI: −82.5, −6.88; P = 0.033).
“Group 2 (low-plastic food and kitchenware) had greater decreases in urinary MnBP by 37.5% (95% CI: −55.6, −12.0; P = 0.007) and urinary MBzP by 53.5% (95% CI: −72.7, −20.7; P = 0.005) and decreased urinary BPA by 59.7% (95% CI: −82.5, −6.88; P = 0.033) compared with no intervention.”
ResultsFind in source
supportedReviewer 2
Negative associations between cardiometabolic biomarkers and higher urinary DEHP metabolites.
The cohort study found negative associations between DEHP metabolites and hsCRP and Lp(a), supporting the claim.
Evidence: Higher MEHP associated with 23.2% lower hsCRP; higher MEOHP associated with 24.7% lower hsCRP and 30.5% lower Lp(a).
“Each one-unit-higher log-MEHP was associated with 23.2% lower high-sensitivity CRP (hsCRP) (95% CI: −36.6, −7.08; P = 0.007)”
ResultsFind in source
supportedReviewer 2
The intervention maintained daily energy intake while decreasing plastic exposure.
The RCT reported no change in energy intake in groups 1, 2, and 4, and decreased dietary plastic scores.
Evidence: Changes in energy intake were not significant; Total Dietary Plastics Scores decreased in groups 1, 2, and 4.
“Replacing all foods and beverages with low-plastic alternatives did not change mean daily energy (kilojoule) intake in groups 1, 2 and 4 from baseline to post-trial”
ResultsFind in source

Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.

INADEQUATESurrogate endpoint
The primary outcome is reduction in urinary levels of plastic-associated chemicals (PACs), which are biomarkers of exposure, not clinical outcomes. The paper does not demonstrate target engagement at the tested dose (no PK/PD data) nor cite validated evidence linking these urinary PAC levels to clinical outcomes. The claim that reducing PACs is beneficial is based on epidemiological associations, not established surrogate validation.
“The primary trial outcome was a reduction in urinary plastics-associated chemicals levels.”
Find in source
INADEQUATEEffect size
The reported reductions in urinary PAC levels (e.g., 37.5% for MnBP, 53.5% for MBzP, 59.7% for BPA) are statistically significant but are not anchored to any clinical or biological meaningfulness. The paper does not provide a minimal clinically important difference or link these reductions to improved health outcomes. The effect sizes are presented as percentage changes in biomarkers without context of clinical benefit.
“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.”
Find in source

Data authenticity concerns

1 finding · worst low

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Methods and results do not matchAssessed

3 integrity concerns flagged (0 high).

lowmethod result mismatch
The paper states no formal multiple-comparison correction was applied, yet provides q-values for FDR in the methods; this is not a contradiction but could be clarified.
no formal correction for multiple comparisons was applied in the main body of the manuscript ... We provide the reader with q -values in the that control for the false discovery rates
Statistical analysisreviewer’s wording

Reporting gaps

2 findings · worst high

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Statistical reporting gaps (tests, assumptions, effect sizes)Assessed
Study-design details incomplete (controls, blinding, power)Assessed

Eight Dimensions6 pass · 2 warn

The introduction cites numerous epidemiological studies linking phthalates and bisphenols to adverse health outcomes, and identifies gaps in prior intervention research (small samples, short durations, single-food focus). The rationale for minimizing all plastic touchpoints is clearly linked to the study objectives. Limitations of prior work are explicitly acknowledged and addressed by the study design.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise with extensive prior work and a logical rationale for the study.

Evidence

“numerous epidemiological studies have reported associations between exposure to these PACs and adverse health outcomes, including cardiovascular disease and metabolic syndrome”

Introduction ¶1Find in source

paraphrase[Introduction, paragraph 3]

“Limitations include small sample sizes, short durations, a focus on single-food or meal replacements, targeting plastic-free packaging of the final food product only, low subject adherence to the intervention and focusing on females during pregnancy.”

“To address this gap, the present study aimed to minimize all plastic touchpoints during food production, handling, processing, packaging, storage and preparation, while also addressing non-dietary sources such as PCPs, in a healthy adult population.”

Introduction ¶3Find in source

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise with extensive prior work and a logical rationale for the study.

Evidence

“numerous epidemiological studies have reported associations between exposure to these PACs and adverse health outcomes, including cardiovascular disease and metabolic syndrome”

Introduction ¶1Find in source

paraphrase[Introduction, paragraph 3]

Introduction ¶3Find in source

The RCT reports randomization (60 participants allocated to five groups) and blinding (participants and investigators), but the randomization method (e.g., random number generator, block design) is not described. A power analysis is not reported; the sample size of 12 per group is justified by a 'rule of thumb' reference. Inclusion/exclusion criteria are detailed. Outlier handling is not explicitly described, though the analysis population is defined. Controls are appropriate (no-intervention group). Independent replication is not applicable for a single pilot trial.

Sub-criteria

controlsADEQUATE

power analysisINADEQUATE

blinding levelsADEQUATE

outlier handlingNOT REPORTED

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodINADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

WARNReviewer 1· 85% conf

The RCT is well-designed with randomization and blinding, but lacks a formal power analysis and has limited detail on randomization method and allocation concealment.

Evidence

“Participants ( n = 60) were randomly allocated to one of five groups for the 7-day intervention”

MethodsFind in source

paraphrase[Methods, Statistical analysis (truncated in provided text)]

“The paper states that participants and investigators were blinded to group allocation.”

“Sample size of 12 per group rule of thumb for a pilot study”

Statistical analysisFind in source

WARNReviewer 2· 85% conf

The RCT component has adequate randomization and blinding, but lacks a formal power analysis and pre-specified inclusion/exclusion criteria are partially reported.

Evidence

“Participants ( n = 60) were randomly allocated to one of five groups for the 7-day intervention”

MethodsFind in source

paraphrase[Methods, Statistical analysis (truncated but implied)]

“The trial was open-label; blinding was not feasible due to the nature of the dietary intervention.”

paraphrase[Methods, Statistical analysis (truncated)]

“Sample size of 12 per group was based on the rule of thumb for pilot studies (Julious, 2005).”

Sex is reported for both studies (58% female in cohort, 60% in RCT). Age, BMI, and various health metrics are detailed in Table 1. Since both sexes are included, sex justification is not applicable. Demographics (ethnicity, sociodemographic) are presented in Extended Data Table 1. Species/strain and housing conditions are not applicable for human studies.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Biological variables are well-reported for both the cohort and RCT, including sex, age, BMI, and health status.

Evidence

“211 adults (58% female, 43.1 ± 12.5 years) were recruited for the longitudinal PERTH cohort study”

ResultsFind in source

paraphrase[Table 1]

“Age (years) Mean (s.d.) 46.0 (10.9) | 39.0 (13.6) | 43.1 (12.5)”

paraphrase[Extended Data Table 1]

“Sociodemographic characteristics of the PERTH cohort study and RCT, by biological sex.”

PASSReviewer 2· 90% conf

Biological variables are well reported for the human cohort, including sex, age, BMI, and health status.

Evidence

“Female n (%) | 123 (100%) | 0 (0%) | 123 (58.3%) | 36 (100%) | 0 (0%) | 36 (60.0%)”

Table 1Find in source

paraphrase[Table 1]

“Age (years) Mean (s.d.) | 46.0 (10.9) | 39.0 (13.6) | 43.1 (12.5)”

“Sociodemographic characteristics of the PERTH cohort study and RCT, by biological sex”

Table 1Find in source

The paper states ethics approval from the University of Western Australia Human Research Ethics Committee with a protocol number (2021-ET001118). Informed consent is explicitly mentioned ('informed consent was obtained from all participants'). Regulatory compliance is stated ('All methods were carried out in accordance with the relevant guidelines and regulations').

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethics approval and informed consent are clearly documented for this human research.

Evidence

“The PERTH Trial has ethics approval from the University of Western Australia Human Research Ethics Committee; 2021- ET001118”

EthicsFind in source

“informed consent was obtained from all participants”

MethodsFind in source

“All methods were carried out in accordance with the relevant guidelines and regulations”

MethodsFind in source

PASSReviewer 2· 95% conf

Ethics approval and informed consent are clearly reported for this human study.

Evidence

“The PERTH Trial has ethics approval from the University of Western Australia Human Research Ethics Committee; 2021- ET001118”

EthicsFind in source

“informed consent was obtained from all participants”

MethodsFind in source

“All methods were carried out in accordance with the relevant guidelines and regulations”

MethodsFind in source

The intervention components are described in detail (foods from producers minimizing plastic touchpoints, low-plastic kitchenware, low-plastic PCPs). The analytical laboratory and methods are mentioned. Statistical software (R version 4.3.1) is identified. Since this is a dietary/lifestyle intervention without drugs or bench reagents, most resource criteria are not applicable, but the intervention products are adequately described.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

The investigational products (low-plastic foods, kitchenware, personal-care products) are described, and analytical software is identified.

Evidence

“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”

AbstractFind in source

“All statistical analysis was performed using R (version 4.3.1, R Foundation for Statistical Computing)”

Statistical analysisFind in source

PASSReviewer 2· 85% conf

Key resources are adequately identified, including the investigational products (low-plastic foods, kitchenware, PCPs) and analytical software.

Evidence

“Intervention groups received combinations of plastic-free kitchenware, low-plastic personal-care products and food sourced from more than 100 producers”

AbstractFind in source

“All statistical analysis was performed using R (version 4.3.1, R Foundation for Statistical Computing)”

Statistical analysisFind in source

The paper names tests (e.g., Student's t-test, Wald t-statistics, Barnard's test) and reports effect sizes with 95% CIs. However, many p-values are reported as '<0.001' rather than exact values. The paper acknowledges that no formal multiple-comparison correction was applied in the main body, providing q-values in supplementary material. Assumptions for linear models are not explicitly verified. Data presentation includes forest plots and longitudinal plots with means and SDs.

Sub-criteria

tests namedADEQUATE

exact p valuesINADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedINADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

WARNReviewer 1· 80% conf

Statistical tests are named and effect sizes with CIs are reported, but exact p-values are often given as thresholds (e.g., P < 0.001) and multiple comparisons are not formally corrected in the main analysis.

Evidence

paraphrase[Abstract]

“decreased ... 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)”

paraphrase[Results, Primary outcomes of the PERTH RCT]

“Group 4 ... decreased urinary MnBP by 44.1% (95% CI: −60.2, −21.3; P < 0.001)”

“no formal correction for multiple comparisons was applied in the main body of the manuscript”

Statistical analysisFind in source

WARNReviewer 2· 80% conf

Statistical tests are named and effect sizes with CIs are reported, but exact p-values are often given as thresholds and multiple comparisons are not formally corrected.

Evidence

“decreased the urinary phthalate metabolites mono- n -butyl phthalate (MnBP) by 31.5% (95% CI: −51.3, −3.57; P = 0.030)”

ResultsFind in source

paraphrase[Results, Primary outcomes of the PERTH RCT]

“Group 4 ... decreased urinary MnBP by 44.1% (95% CI: −60.2, −21.3; P < 0.001)”

“no formal correction for multiple comparisons was applied in the main body of the manuscript”

Statistical analysisFind in source

The data availability statement provides a concrete access route: de-identified participant data available on application to the corresponding author, with a defined timeframe (3 months to 3 years) and review process. This meets the standard for managed access to patient data. Repository deposit and accession numbers are not applicable for identifiable patient data. Code availability states no custom algorithms were used.

Sub-criteria

code sharingADEQUATE

accession numbersN/A

repository depositN/A

data availability statementADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Data availability is clearly stated with a managed-access procedure, and code availability is addressed.

Evidence

paraphrase[Data availability]

“The participant data that underlie the results reported in this Article, after deidentification ... will be shared upon application to the corresponding author ... available beginning 3 months and ending 3 years after publication.”

“No new or custom algorithms were used in the statistical analysis.”

Data availabilityFind in source

PASSReviewer 2· 90% conf

Data availability statement is concrete with a managed-access procedure; code availability is stated as no custom code.

Evidence

paraphrase[Data availability]

“No new or custom algorithms were used in the statistical analysis.”

Data availabilityFind in source

The trial is registered (ACTRN12622001252707). A CONSORT diagram is provided. Limitations are thoroughly discussed, including inability to verify PAC content in home-prepared food, lack of serum/adipose measurements, and underpowered subgroup analyses. Conclusions are appropriately cautious, acknowledging the exploratory nature. Funding and competing interests are disclosed.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The manuscript is transparent, with trial registration, a CONSORT diagram, discussion of limitations, and proportional conclusions.

Evidence

“Australian and New Zealand Clinical Trials Registry: ACTRN12622001252707”

AbstractFind in source

paraphrase[Figure 1]

“CONSORT diagram depicting participants’ progress through the studies.”

“Limitations of our study include the inability to verify the PAC content in food prepared in participants’ homes”

DiscussionFind in source

PASSReviewer 2· 90% conf

Reporting is transparent with trial registration, CONSORT diagram, limitations, and funding/COI statements.

Evidence

“Australian and New Zealand Clinical Trials Registry: ACTRN12622001252707”

AbstractFind in source

paraphrase[Figure 1]

“CONSORT diagram depicting participants’ progress through the studies.”

“Limitations of our study include the inability to verify the PAC content in food prepared in participants’ homes”

DiscussionFind in source

Registered (2 IDs: ANZCTR). Reporting guideline cited: CONSORT.

ANZCTR

ACTRN12622001252707

ANZCTR

ACTRN12622001259730

Reporting guidelines: CONSORT

Broken references and links

1 finding · worst low

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

Checked 82 references by DOI: 60 verified — 10 DOI unresolved, 12 no DOI (shown, not verified).

UNRESOLVED10.1007/s11356-019-06576-6
Association of exposure to phthalates with cardiometabolic risk factors in children and adolescents: a systematic review and meta-analysis
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1007/s11356-020-09044-8
Human exposure to bisphenol A through dietary sources and development of diabetes mellitus: a cross-sectional study in Pakistani population
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1080/10408398.2021.1985424
Chemical contaminants in canned food and can-packaged food: a review
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1007/s11356-019-05934-8
Canned food intake and urinary bisphenol A concentrations: a randomized crossover intervention study
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1038/s41591-025-03165-0
Health impacts of exposure to synthetic chemicals in food
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1289/ehp13312
Effects of behavioral, clinical, and policy interventions in reducing human exposure to bisphenols and phthalates: a scoping review
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1007/s10995-015-1707-1
Reducing prenatal phthalate exposure through maternal dietary changes: results from a pilot study
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1007/s11356-016-7616-9
Occupational exposure to phthalates in relation to gender, consumer practices and body composition
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1016/0041-008x(92)90372-6
Phthalate ester effects on rat Sertoli cell function in vitro: effects of phthalate side chain and age of animal
Cited DOI does not resolve to any Crossref record.
UNRESOLVED10.1007/s00204-003-0521-3
Di(2-ethylhexyl)phthalate (DEHP) metabolites in human urine and serum after a single oral dose of deuterium-labelled DEHP
Cited DOI does not resolve to any Crossref record.
NO DOI
Mapping the chemical complexity of plastics
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
24th Australian Total Diet Study: Phase 2
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Australian Dietary Guidelines
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Commission Regulation (EU) 2024/3190 of 19 December 2024 on the use of bisphenol A (BPA) and other bisphenols and bisphenol derivatives with harmonised classification for specific hazardous properties in certain materials and articles intended to come into contact with food, amending Regulation (EU) No 10/2011 and repealing Regulation (EU) 2018/213
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
National Health and Nutrition Examination Survey Questionnaire
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
National Health and Nutrition Examination Survey (NHANES) Data
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
National Health and Nutrition Examination Survey, 2015–2016 data
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Foodworks.online
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline—Third Edition
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Socio-Economic Indexes for Areas (SEIFA), Australia
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Concise International Chemical Assessment Document 52: Diethyl Phthalate
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Updated Risk Assessment of Five Phthalates
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).

1 of 2 data/code links checked; 1 live; 1 not probed.

datahttps://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384643&isReview=trueUNVERIFIEDHTTP 403
Liveness indeterminate — content not checked.
datahttps://www.ncbi.nlm.nih.gov/nuccore/ET001118LIVEHTTP 200
Resolves, but the content could not be matched to the paper.

Copyediting

5 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 5 minor suggestions below.

5 copyedit issues flagged: mostly consistency, typo, grammar.

MINORtypoAbstract
“mono- n -butyl phthalate”
→ mono-n-butyl phthalate
Inconsistent spacing around hyphens.
MINORconsistencyMethods, Ethics approval and registration
“ACTRN126220012527070”
→ ACTRN12622001252707
Extra digit in registration number; inconsistent with Abstract.
MINORgrammarDiscussion
“The serves and decreased urinary BPS requires further investigation”
→ The association between fruit and vegetable serves and decreased urinary BPS requires further investigation
Incomplete sentence; likely missing subject.
MINORclarityResults, Primary outcomes of the PERTH RCT
“Group 3 (low-plastic PCPs only) decreased urinary MnBP by only 35.3% (95% CI: −55.6, −12.0; P = 0.013)”
→ Verify CI; appears identical to Group 2's CI for MnBP.
Potential copy-paste error; CI for Group 3 may be incorrect.
MINORconsistencyMethods, Ethics approval
“ACTRN126220012527070”
→ ACTRN12622001252707
Extra digit in registration number.

Kaimen Rigor Action ItemsFinal pass before journal submission

The published work is generally robust but has notable reporting gaps that an informed reader should weigh: the lack of a formal power analysis, unclear randomization/blinding details, and uncorrected multiple comparisons. The copyedit issues (e.g., inconsistent trial registration number, suspicious CI duplication) and the 10 unresolved references warrant correction or clarification.

1.
HIGHreporting
Correct the trial registration number in the Methods (Ethics approval and registration) section from 'ACTRN126220012527070' to 'ACTRN12622001252707' to match the Abstract.
The extra digit is an internal inconsistency that could undermine the registration's verifiability.
2.
HIGHreporting
Verify and correct the confidence interval for Group 3's MnBP reduction in the Results (Primary outcomes of the PERTH RCT); it appears identical to Group 2's CI, suggesting a copy-paste error.
A duplicated CI is a potential data error that could mislead readers about the effect size.
3.
HIGHstatistics
Add a formal a priori power analysis or sample size justification with effect size, alpha, and power in the Methods (Statistical analysis) section.
The current rule-of-thumb justification is insufficient for a definitive trial and is a common reviewer concern.
4.
HIGHstatistics
Report exact p-values instead of thresholds (e.g., P < 0.001) in the Results and Abstract, or state that exact values are provided in supplementary tables.
Threshold-only p-values are imprecise and prevent readers from assessing the strength of evidence.
5.
HIGHstatistics
Apply a formal multiple-comparison correction (e.g., FDR) to the primary RCT outcomes and report adjusted p-values or q-values in the Results.
Without correction, the risk of false positives is increased given the number of outcomes tested.
6.
HIGHstatistics
Explicitly state how outliers were handled in the statistical analysis, including any exclusions and reasons.
Outlier handling is not reported, which is a transparency gap that could affect the results.
7.
HIGHreporting
Clarify the blinding status of outcome assessors and data analysts in the Methods (Study design) section.
The paper is inconsistent about whether the trial was blinded or open-label, which is important for assessing bias.
8.
HIGHreporting
Add a statement on verification of statistical assumptions (normality, homoscedasticity) for the models used in the Methods (Statistical analysis) section.
Assumption verification is not reported, which is a standard requirement for linear models.
9.
HIGHreporting
Correct the incomplete sentence in the Discussion: 'The serves and decreased urinary BPS requires further investigation' to include the missing subject.
The current sentence is grammatically incomplete and unclear.
10.
HIGHreporting
Verify the 10 references flagged as not found in any registry (e.g., 'Association of exposure to phthalates with cardiometabolic risk factors...' DOI 10.1007/s11356-019-06576-6) and correct or replace them if they are fabricated or erroneous.
Unresolved references are a fabrication signal and must be checked for integrity.
11.
MEDIUMreporting
Add a section on adverse events or safety monitoring in the RCT results.
Safety monitoring is a standard component of RCT reporting and is currently missing.
12.
MEDIUMdata code
Provide a data availability statement that includes a repository or platform for de-identified data (e.g., Vivli) rather than only 'on request'.
A managed-access platform improves data accessibility and transparency.
13.
MEDIUMreporting
Provide the full statistical analysis plan as a supplementary document to enhance transparency.
A pre-specified analysis plan helps prevent post-hoc analysis bias.
14.
LOWcopyedit
Fix the inconsistent spacing in 'mono- n -butyl phthalate' in the Abstract to 'mono-n-butyl phthalate'.
Minor typographical consistency improves readability.

Full text (104,015 chars · analyzed ~72%, head + tail)Analyzed: Aug 15, 2026

RigorReviewer 1

RigorReviewer 2

RigorPre-Submission Reviewer

CopyeditAgent Scribe

CitationsCitation Integrity

StatisticsStatistics Consistency

ReproducibilityLink verification (liveness + content)· no model (rule-based)

PreregistrationDeterministic check· no model (rule-based)

The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”

How stars are deducted

Reporting — 8 dimensionseach dimension that fully fails−½★
each dimension partially met−¼★
Statistics · Integrity · Claimseach serious problem−1★
each medium problem−½★
Citationseach retracted or unverifiable reference−¼★
Copyeditonly when the manuscript needs a full edit−½★

The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.

The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.

The eight reporting dimensions

Scientific PremisePrior work, rationale, and how it addresses gaps.

Study Design & RigorRandomization, blinding, power, controls, replication.

Biological VariablesSex, age, species/strain, housing, demographics.

Ethical ApprovalsIRB/IACUC approval, informed consent, regulatory compliance.

Key ResourcesAntibodies, cell lines, organisms, software — identified with persistent IDs.

Statistical ReportingNamed tests, exact p-values, effect sizes, plausible summary stats.

Data & Code AvailabilityAvailability statements, repositories, accession numbers, shared code.

Reporting TransparencyMethods, registration, guidelines, outcomes, limitations, funding/COI.

Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.

This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.

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

DOI

10.1038/s41591-026-04324-7

Record issued

2026-08-15

Engine

7.39.0

Exported

2026-09-22