title: Bisphenol A and the risk of cardiometabolic disorders: a systematic review with meta-analysis of the epidemiological evidence.
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.
authors.affiliation: Inserm, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child's Health and Development (ORCHAD) Team, Villejuif, France. fanny.ranciere@inserm.fr.|Univ Paris Descartes, UMR1153, Paris, France. fanny.ranciere@inserm.fr.|Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3000, Australia. fanny.ranciere@inserm.fr.
authors.forename: Fanny
authors.initials: F
authors.lastname: Rancière
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3000, Australia. jasmine.lyons@bakeridi.edu.au.
authors.forename: Jasmine G
authors.initials: JG
authors.lastname: Lyons
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3000, Australia. venurs.loh@bakeridi.edu.au.
authors.forename: Venurs H Y
authors.initials: VH
authors.lastname: Loh
authors.affiliation: Inserm, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child's Health and Development (ORCHAD) Team, Villejuif, France. jeremie.botton@inserm.fr.|Univ Paris Descartes, UMR1153, Paris, France. jeremie.botton@inserm.fr.|Faculty of Pharmacy, Univ Paris-Sud, Châtenay-Malabry, France. jeremie.botton@inserm.fr.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Botton
authors.affiliation: Department of Biosciences, University of Exeter, College of Life and Environmental Sciences, Exeter, UK. t.s.galloway@exeter.ac.uk.
authors.forename: Tamara
authors.initials: T
authors.lastname: Galloway
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. wtg@live.cn.
authors.forename: Tiange
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3000, Australia. jonathan.shaw@bakeridi.edu.au.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Shaw
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3000, Australia. dianna.magliano@bakeridi.edu.au.
authors.forename: Dianna J
authors.initials: DJ
authors.lastname: Magliano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001559:Benzhydryl Compounds / Q000009:adverse effects* / Q000652:urine*; D015415:Biomarkers / Q000652:urine*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D044882:Glucose Metabolism Disorders / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010636:Phenols / Q000009:adverse effects* / Q000652:urine*; D011446:Prospective Studies; D012307:Risk Factors; D044465:White People; D055815:Young Adult; D000098826:Bisphenol A Compounds
chemical_list: D001559:Benzhydryl Compounds; D015415:Biomarkers; D010636:Phenols; C006780:bisphenol A; D000098826:Bisphenol A Compounds