title: Bisphenol A and indicators of obesity, glucose metabolism/type 2 diabetes and cardiovascular disease: a systematic review of epidemiologic research.
abstract: BACKGROUND
  Bisphenol A (BPA), a high-volume chemical with weak estrogenic properties, has been linked to obesity, cardiovascular diseases (CVD) and diabetes mellitus (DM). This review evaluates both the consistency and the quality of epidemiological evidence from studies testing the hypothesis that BPA exposure is a risk factor for these health outcomes.
  
  
  METHODS
  We followed the current methodological guidelines for systematic reviews by using two independent researchers to identify, review and summarize the relevant epidemiological literature on the relation of BPA to obesity, CVD, DM, or related biomarkers. Each paper was summarized with respect to its methods and results with particular attention to study design and exposure assessment, which have been cited as the main areas of weakness in BPA epidemiologic research. As quantitative meta-analysis was not feasible, the study results were categorized qualitatively as positive, inverse, null, or mixed.
  
  
  RESULTS
  Nearly all studies on BPA and obesity-, DM- or CVD-related health outcomes used a cross-sectional design and relied on a single measure of BPA exposure, which may result in serious exposure misclassification. For all outcomes, results across studies were inconsistent. Although several studies used the same data and the same or similar statistical methods, when the methods varied slightly, even studies that used the same data produced different results.
  
  
  CONCLUSIONS
  Epidemiological study design issues severely limit our understanding of health effects associated with BPA exposure. Considering the methodological limitations of the existing body of epidemiology literature, assertions about a causal link between BPA and obesity, DM, or CVD are unsubstantiated.
authors.affiliation: LaKind Associates, LLC , Catonsville, MD , USA .
authors.forename: Judy S
authors.initials: JS
authors.lastname: Lakind
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.forename: Donald R
authors.initials: DR
authors.lastname: Mattison
mesh_terms: D001559:Benzhydryl Compounds / Q000633:toxicity*; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000453:epidemiology* / Q000378:metabolism; D004781:Environmental Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D004968:Estrogens, Non-Steroidal / Q000633:toxicity*; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D009765:Obesity / Q000139:chemically induced / Q000453:epidemiology* / Q000378:metabolism; D010636:Phenols / Q000633:toxicity*; D012307:Risk Factors; D000098826:Bisphenol A Compounds
chemical_list: D001559:Benzhydryl Compounds; D015415:Biomarkers; D004968:Estrogens, Non-Steroidal; D005947:Glucose; D010636:Phenols; C006780:bisphenol A; D000098826:Bisphenol A Compounds