Abstract
Bisphenol A (BPA) is suspected to be associated with several chronic metabolic diseases. The aim of the present study was to review the epidemiological literature on the relation between BPA exposure and the risk of cardiometabolic disorders. PubMed and Embase databases were searched up to August 2014 by two independent investigators using standardized subject terms. We included observational studies (cohort, case–control and cross-sectional studies) carried out in children or adults, measuring urinary BPA (uBPA), including at least 100 participants and published in English. The health outcomes of interest were diabetes, hyperglycemia, measures of anthropometry, cardiovascular disease (CVD) and hypertension. Data were extracted and meta-analyzed when feasible, using a random-effects model. Thirty-three studies with sample size ranging from 239 to 4811 met the inclusion criteria, including five with a prospective design. Twelve studies reported on diabetes or hyperglycemia, 16 on anthropometry, 6 on CVD and 3 on hypertension. Evidence for a positive association between uBPA concentrations and diabetes, overweight, obesity, elevated waist circumference (WC), CVD and hypertension was found in 7/8, 2/7, 6/7, 5/5, 4/5 and 2/3 of the cross-sectional studies, respectively. We were able to conduct outcome-specific meta-analyses including 12 studies. When comparing the highest vs. the lowest uBPA concentrations, the pooled ORs were 1.47 (95 % CI: 1.21–1.80) for diabetes, 1.21 (95 % CI: 0.98–1.50) for overweight, 1.67 (95 % CI: 1.41–1.98) for obesity, 1.48 (95 % CI: 1.25–1.76) for elevated WC, and 1.41 (95 % CI: 1.12–1.79) for hypertension. Moreover, among the five prospective studies, 3 reported significant findings, relating BPA exposure to incident diabetes, incident coronary artery disease, and weight gain. To conclude, there is evidence from the large body of cross-sectional studies that individuals with higher uBPA concentrations are more likely to suffer from diabetes, general/abdominal obesity and hypertension than those with lower uBPA concentrations. Given the potential importance for public health, prospective cohort studies with proper adjustment for dietary characteristics and identification of critical windows of exposure are urgently needed to further improve knowledge about potential causal links between BPA exposure and the development of chronic disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-015-0036-5) contains supplementary material, which is available to authorized users.
Highlights
In recent decades, large and rapid increases in diabetes and obesity prevalence have been observed worldwide
895 studies were excluded after screening of the titles/abstracts
Twelve independent cross-sectional studies were selected for quantitative synthesis, making meta-analysis possible for 5 health outcomes: diabetes, overweight, obesity, elevated waist circumference (WC) and hypertension
Summary
Large and rapid increases in diabetes and obesity prevalence have been observed worldwide. BPA is a synthetic monomer used in the manufacture of polycarbonate plastics and epoxy resins, with a world production estimated at 3.8 million tons in 2006 [6]. This production of BPA is expected to increase further in the coming years, given the robust demand for polycarbonate plastics and epoxy resins from China [7] and other emerging markets. BPA is ubiquitous in our environment, as evidenced by the fact that over 90 % of individuals have detectable levels of BPA present in their urine [13], which is the primary route of excretion in humans [14]. BPA has been found in neonates, children and adults [13], and can be measured in a range of bodily fluids and tissues, including urine, blood, saliva, placental tissue, adipose tissue and breast milk [13, 15]
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