Lipid and Creatinine Adjustment to Evaluate Health Effects of Environmental Exposures

Katie M. O’Brien, Kristen Upson, Jessie P. Buckley

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations


Purpose of Review: Urine- and serum-based biomarkers are useful for assessing individuals’ exposure to environmental factors. However, variations in urinary creatinine (a measure of dilution) or serum lipid levels, if not adequately corrected for, can directly impact biomarker concentrations and bias exposure-disease association measures. Recent Findings: Recent methodological literature has considered the complex relationships between creatinine or serum lipid levels, exposure biomarkers, outcomes, and other potentially relevant factors using directed acyclic graphs and simulation studies. The optimal measures of urinary dilution and serum lipids have also been investigated. Summary: Existing evidence supports the use of covariate-adjusted standardization plus creatinine adjustment for urinary biomarkers and standardization plus serum lipid adjustment for lipophilic, serum-based biomarkers. It is unclear which urinary dilution measure is best, but all serum lipid measures performed similarly. Future research should assess methods for pooled biomarkers and for studying diseases and exposures that affect creatinine or serum lipids directly.

Original languageEnglish (US)
Pages (from-to)44-50
Number of pages7
JournalCurrent environmental health reports
Issue number1
StatePublished - Mar 1 2017


  • Biomarkers
  • Creatinine adjustment
  • Environmental exposures
  • Lipid adjustment

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nature and Landscape Conservation
  • Management, Monitoring, Policy and Law
  • Health, Toxicology and Mutagenesis


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