Association of urinary bisphenol A concentration with medical disorders and laboratory abnormalities in adults.

JAMA

Sep 2008

DOI: 10.1001/jama.300.11.1303

Citations:1239

Influential Citations:54

Observational Studies (Human)

Enhanced Details

Methods

Cross-sectional NHANES 2003–2004 analysis of associations between urinary BPA concentrations and health status in the U.S. adult population. Participants: 1,455 adults aged 18–74 years with measured urinary BPA and urinary creatinine. Complex-sample design with weighting; regression models adjusted for age, sex, race/ethnicity, education, income, smoking, BMI, waist circumference, and urinary creatinine. Outcomes included eight blood-based analytes (CRP; GGT; alkaline phosphatase; lactate dehydrogenase; LDL-C; triglycerides; fasting glucose; fasting insulin) and major chronic diseases (cardiovascular disease, angina, coronary heart disease, heart attack, diabetes, liver disease, stroke, thyroid disease). Analyses used logistic regression for diagnoses and linear regression for biomarkers; 80% power to detect ORs of 1.4 per 1-SD change in BPA for prevalences around 5%.

Results

Higher urinary BPA concentrations were associated with higher odds of cardiovascular disease (OR per 1-SD increase in BPA, 1.39; 95% CI 1.18–1.63; P=0.001) and diabetes (OR per 1-SD increase, 1.39; 95% CI 1.21–1.60; P<0.001) after full adjustment. Higher BPA concentrations were also linked to clinically abnormal liver enzymes: GGT (OR per 1-SD increase, 1.29; 95% CI 1.14–1.46; P<0.001) and alkaline phosphatase (OR per 1-SD increase, 1.48; 95% CI 1.18–1.85; P=0.002). Associations persisted across alternative exposure metrics; in some analyses, highest BPA concentration quartile showed stronger associations with cardiovascular disease. No robust associations were found for several other conditions. Interpretation: higher BPA exposure, reflected by urinary BPA, may be linked to avoidable morbidity in community-dwelling adults; however, the cross-sectional design precludes causal inference, and replication with longitudinal data is needed.

Limitations

Cross-sectional design prevents causal inference; single-spot urinary BPA measurement may not reflect long-term exposure due to temporal variability. Potential residual confounding and measurement error; small numbers in some subgroups limit precision; results may not generalize beyond the U.S. adult population. Independent replication and longitudinal studies are needed to confirm causal relationships.

Abstract

CONTEXT Bisphenol A (BPA) is widely used in epoxy resins lining food and beverage containers. Evidence of effects in animals has generated concern over low-level chronic exposures in humans. OBJECTIVE To examine associations between urinary BPA concentrations and adult health status. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of BPA concentrations and health status in the general adult population of the United States, using data from the National Health and Nutrition Examination Survey 2003-2004. Participants were 1455 adults aged 18 through 74 years with measured urinary BPA and urine creatinine concentrations. Regression models were adjusted for age, sex, race/ethnicity, education, income, smoking, body mass index, waist circumference, and urinary creatinine concentration. The sample provided 80% power to detect unadjusted odds ratios (ORs) of 1.4 for diagnoses of 5% prevalence per 1-SD change in BPA concentration, or standardized regression coefficients of 0.075 for liver enzyme concentrations, at a significance level of P < .05. MAIN OUTCOME MEASURES Chronic disease diagnoses plus blood markers of liver function, glucose homeostasis, inflammation, and lipid changes. RESULTS Higher urinary BPA concentrations were associated with cardiovascular diagnoses in age-, sex-, and fully adjusted models (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.18-1.63; P = .001 with full adjustment). Higher BPA concentrations were also associated with diabetes (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.21-1.60; P < .001) but not with other studied common diseases. In addition, higher BPA concentrations were associated with clinically abnormal concentrations of the liver enzymes gamma-glutamyltransferase (OR per 1-SD increase in BPA concentration, 1.29; 95% CI, 1.14-1.46; P < .001) and alkaline phosphatase (OR per 1-SD increase in BPA concentration, 1.48; 95% CI, 1.18-1.85; P = .002). CONCLUSION Higher BPA exposure, reflected in higher urinary concentrations of BPA, may be associated with avoidable morbidity in the community-dwelling adult population. show less