Bisphenol A and the risk of cardiometabolic disorders: a systematic review with meta-analysis of the epidemiological evidence
Review
- ? Equal contributors
1 Inserm, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child¿s Health and Development (ORCHAD) Team, Villejuif, France
2 Univ Paris Descartes, UMR1153, Paris, France
3 Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne 3000, VIC, Australia
4 Faculty of Pharmacy, Univ Paris-Sud, Châtenay-Malabry, France
5 Department of Biosciences, University of Exeter, College of Life and Environmental Sciences, Exeter, UK
6 Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Environmental Health 2015, 14:46Â
doi:10.1186/s12940-015-0036-5
Fanny Rancière and Jasmine G. Lyons contributed equally to this work.
Published: 31 May 2015
Abstract (provisional)
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.