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Table 2 Summary of results in studies used as primary data: diabetes, prediabetes and hyperglycemia (n = 12 publications)

From: Bisphenol A and the risk of cardiometabolic disorders: a systematic review with meta-analysis of the epidemiological evidence

Reference

Outcomes & definitions used

Urinary BPA categorisation

Main results

Adjustment in model(s) used for review

Prevalent diabetes (8 publications)

Ahmadkhaniha et al. 2014 [32]

Type 2 diabetes: self-reported and doctor-diagnosed T2D according to the ADA guideline (FPG >126 mg/dL, HbA1c >6.5 %) for more than one year

BPA in two groups based on the median (<0.85 and ≥0.85 μg/L)

OR = 57.6 (21.1–157.05)

Age, sex, BMI, hypertension, serum triglyceride level, serum cholesterol level, serum creatinine (smoking and consumption of sugared drinks in plastic bottles or canned food in two past weeks were exclusion criteria)

Casey & Neidell 2013 [37]

Diabetes: self-report of doctor diagnosis

BPA continuous (not log-transformed)

Per SD increase:

Age, sex, urinary creatinine concentration, race/ethnicity, income, smoking, body mass index, waist circumference, veteran/military status, citizenship status, marital status, household size, pregnancy status, language at subject interview, health insurance coverage, employment status in the prior week, consumption of bottled water in the past 24 h, consumption of alcohol, annual consumption of tuna fish, presence of emotional support in one’s life, being on a diet, using a water treatment device, access to a routine source of health care, vaccinated for Hepatitis A or B, consumption of dietary supplements (vitamins or minerals), inability to purchase balanced meals on a consistent basis + survey cycle for pooled analyses

2003/04: OR = 1.398 (1.183–1.653)

2005/06: OR = 1.008 (0.861–1.181)

2007/08: OR = 0.716 (0.500–1.025)

Pooled 2003/08: OR = 1.065 (0.973–1.166)

BPA continuous (log-transformed)

Per 10-fold increase:

2003/04: OR = 1.492 (1.267–1.757)

2005/06: OR = 1.230 (0.894–1.694)

2007/08: OR = 0.932 (0.759–1.146)

Pooled 2003/08: OR = 1.202 (1.049–1.377)

BPA in quartiles (ng/mL):

Q1: <1.2; Q2: 1.2–2.2; Q3: 2.3–4.2; Q4: >4.2

Pooled 2003/08:

Q2 vs. Q1: OR = 1.443 (0.982–2.119)

Q3 vs. Q1: OR = 1.512 (0.998–2.289)

Q4 vs. Q1: OR = 1.760 (1.137–2.724)

Kim & Park 2013 [56]

Type 2 diabetes: self-reported and doctor-diagnosed

BPA in quartiles (ng/mL):

Q1: <1.36; Q2: 1.36–2.14; Q3: 2.15–3.32; Q4: >3.32

Q2 vs. Q1: OR = 1.23 (0.62–2.43)

Urinary creatinine, age, sex, BMI, education, cigarette smoking, income, place of residence

Q3 vs. Q1: OR = 1.17 (0.60–2.28)

Q4 vs. Q1: OR = 1.71 (0.89–3.26)

p for trend = 0.374

Lang et al. 2008 [39]

Diabetes: self-report of doctor diagnosis

BPA continuous

Per SD increase:

Age, sex, race/ethnicity, education, income, BMI, WC, smoking status, urinary creatinine

OR = 1.39 (1.21–1.60)

Melzer et al. 2010 [40]

Diabetes: self-report of doctor diagnosis

BPA continuous

Per SD increase:

Age, gender, ethnicity, education, income, BMI, WC, smoking status, urinary creatinine

2003/04: OR = 1.40 (1.25–1.56)

2005/06: OR = 1.02 (0.76–1.38)

Pooled 2003/06: OR = 1.24 (1.10–1.40)

Ning et al. 2011 [51]

Type 2 diabetes: FPG ≥7.0 mmol/L or plasma glucose ≥11.1 mmol/L two hours after oral glucose tolerance test or use of diabetes medication

BPA in quartiles (ng/mL):

Q1: ≤0.47; Q2: 0.48 –0.81; Q3: 0.82–1.43; Q4: >1.43

Q2 vs. Q1: OR = 1.30 (1.03–1.64)

Age, sex, educational level, family history of diabetes, WC, systolic blood pressure, ln(TG level), ln(hsCRP level), ln(ALT level), estimated glomerular filtration rate, albumin level, total bilirubin level

Q3 vs. Q1: OR = 1.09 (0.86–1.39)

Q4 vs. Q1: OR = 1.37 (1.08–1.74)

p for trend not statistically significant

Shankar & Teppala 2011 [42]

Diabetes: fasting serum glucose >126 mg/dL or non-fasting serum glucose >200 mg/dL or HbA1c >6.5 % or self-reported current use of oral hypoglycemic medication or insulin

BPA in quartiles (ng/mL):

Q1: <1.10; Q2: 1.10–2.10; Q3: 2.11–4.20; Q4: >4.20

Q2 vs. Q1: OR = 1.42 (1.03–1.96)

Age, gender, race-ethnicity, education categories, smoking, alcohol intake, BMI, systolic and diastolic blood pressure, urinary creatinine, total cholesterol

Q3 vs. Q1: OR = 1.48 (1.05–2.08)

Q4 vs. Q1: OR = 1.68 (1.22–2.30)

p for trend = 0.002

 

Normal weight participants:

Q4 vs. Q1: OR = 3.17 (1.23–8.18)

Overweight/obese participants:

Q4 vs. Q1: OR = 1.56 (1.09–2.24)

Silver et al. 2011 [46]

Type 2 diabetes: HbA1c ≥6.5 % or self-reported use of diabetes medication (insulin or blood sugar-lowering pills)

BPA continuous (log-transformed)

For a doubling in uBPA concentration:

Age, age2, urinary creatinine as natural splines with 4° of freedom, gender, race-ethnicity, education, household income, BMI, WC, smoking status

2003/04: OR = 1.23 (1.07–1.41)

2005/06: OR = 1.06 (0.95–1.19)

2007/08: OR = 1.06 (0.91–1.23)

Pooled 2003/08: OR = 1.08 (1.02–1.16)

Incident diabetes (1 publication)

Sun et al. 2014 [61]

Type 2 diabetes: self-reported diagnosis confirmed with one of the ADA 1998 criteria: a) elevated glucose concentration and ≥1 symptom related to diabetes; b) no symptoms but elevated glucose concentrations on 2 separate occasions; or c) treatment with insulin or oral hypoglycemic medication

BPA in quartiles (ng/mL):

NHS cohort (older women):

Age at urine sample collection, ethnicity, fasting status, time of sample collection, menopausal status, use of hormone replacement therapy (NHSII only), urinary creatinine levels, smoking status, postmenopausal hormone use (NHS only), oral contraceptive use (NHSII only), physical activity, alcohol use, family history of diabetes, history of hypercholesterolemia or hypertension, Alternative Health Eating Index score, BMI

NHS cohort / NHSII cohort

Q2 vs. Q1: OR = 0.91 (0.56–1.48)

Q1: <1.0 / <1.3

Q3 vs. Q1: OR = 0.98 (0.60–1.61)

Q2: 1.0–1.5 / 1.3–2.0

Q4 vs. Q1: OR = 0.81 (0.48–1.38)

Q3: 1.5–2.7 / 2.0–3.5

p for trend = 0.45

Q4: >2.7 / >3.5

  

NHSII cohort (younger women):

Q2 vs. Q1: OR = 1.34 (0.70–2.27)

Q3 vs. Q1: OR = 1.91 (1.11–3.29)

Q4 vs. Q1: OR = 2.08 (1.17–3.69)

p for trend = 0.02

Prevalent prediabetes (1 publication)

Sabanayagam et al. 2013 [41]

Prediabetes: FPG = 100-125 mg/dL or 2-h glucose concentration = 140–199 mg/dL or HbA1c = 5.7–6.4 % (ADA guidelines)

BPA in tertiles (ng/mL):

T1: <1.3; T2: 1.3–3.2; T3: >3.2

T2 vs. T1: OR = 1.42 (1.14–1.76)

Age, gender, race-ethnicity, education, smoking, alcohol intake, BMI, physical inactivity, mean arterial blood pressure, C-reactive protein, total cholesterol/HDL ratio

T3 vs. T1: OR = 1.34 (1.03–1.73)

p for trend = 0.02

Stronger associations among women and obese participants.

Women:

T2 vs. T1: OR = 1.36 (0.96–1.91)

T3 vs. T1: OR = 1.49 (1.00–2.22)

p for trend = 0.04

Obese:

T2 vs. T1: OR = 1.71 (1.05–2.80)

T3 vs. T1: OR = 1.65 (1.04–2.80)

p for trend = 0.04

Prevalent hyperglycemia (2 publications)

Beydoun et al. 2014 [34]

Hyperglycemia: FPG ≥100 mg/dL

BPA continuous (log-transformed)

OR = 1.0 (0.9–1.2)

Age, sex, race, education, marital status, smoking status, physical activity, dietary energy intake, urinary creatinine, survey wave

 

BPA in quartiles (ng/mL):

Q1: 0.3 to <1.0; Q2: 1.0 to <2.0; Q3: 2.0 to <3.7; Q4: ≥3.7

Q2 vs. Q1: OR = 0.9 (0.52–1.42)

Q3 vs. Q1: OR = 1.2 (0.7–1.9)

Q4 vs. Q1: OR = 1.1 (0.6–1.9)

p for trend = 0.55

Ratio of BPA-to-creatinine continuous (log-transformed)

OR = 1.0 (0.9–1.2)

Ratio of BPA-to-creatinine in quartiles:

Q1: 0.001 to <0.01; Q2: 0.01 to <0.02; Q3: 0.02 to <0.03; Q4: ≥0.03

Q2 vs. Q1: OR = 1.1 (0.8–1.6)

Q3 vs. Q1: OR = 1.3 (0.8–1.9)

Q4 vs. Q1: OR = 1.2 (0.8–1.9)

p for trend = 0.30

Eng et al. 2013 [38]

Abnormal glucose: FPG ≥100 mg/dL

BPA in quartiles (ng/mL)

 

Age, gender, race/ethnicity, urine creatinine, poverty-to-income ratio, serum cotinine as a marker of smoking status, soda consumption, BMI percentile

Q1: <1.3

Q2 vs. Q1: OR = 0.77 (0.33–1.78)

Q2: 1.3–2.6

Q3 vs. Q1: OR = 1.32 (0.57–3.04)

Q3: 2.6–4.9

Q4 vs. Q1: OR = 0.63 (0.22–1.82)

Q4: >4.9

  1. ADA American Diabetes Association; ALT alanine aminotransferase; BMI body mass index; BPA bisphenol A; FPG fasting plasma glucose; HbA1c glycated hemoglobin; HDL high density lipoprotein; hsCRP high sensitivity C-reactive protein; NHS Nurses' Health Study; OR odds ratio, SD standard deviation; T2D type 2 diabetes; TG triglycerides; uBPA urinary bisphenol A; WC waist circumference