Use of NHANES data to link chemical exposures to chronic diseases: a cautionary tale

Association between levels of serum bisphenol A, a potentially harmful chemical in plastic containers, and carotid artery intima-media thickness in adolescents and young adults

OBJECTIVE

Bisphenol A (BPA) is a chemical produced at high volumes and used widely in food and drink packaging. In adults, elevated BPA concentrations are associated with cardiovascular disease. BPA exposure is plausibly linked to atherosclerosis in adolescents and young adults, but evidence is lacking to date.

METHODS

We recruited 886 subjects (12-30 years of age) from a population-based sample of adolescents and young adults based on a mass urine screening to determine the relationship between serum levels of BPA and carotid intima-media thickness (CIMT).

RESULTS

The geometric mean (standard deviation) of concentrations of BPA were 1.72 (5.5) ng/mL After controlling for confounding factors, linear regression analyzes showed a 1-unit increase in natural log BPA was significantly associated with an increase in mean CIMT (mm) (β = 0.005, 95% C.I. = 0.003-0.007, p < 0.001) and other measurement of CIMT (including right and left side of common carotid artery, carotid bulb and internal carotid artery).

CONCLUSION

Higher serum concentrations of BPA were associated with increased CIMT in this cross-sectional study of adolescents and young adults. Studies to clarify the mechanisms of these associations are needed.

Rapid responses and mechanism of action for low-dose bisphenol S on ex vivo rat hearts and isolated myocytes: evidence of female-specific proarrhythmic effects

BACKGROUND

Bisphenol S (BPS) has increasingly been used as a substitute for bisphenol A (BPA) in some "BPA-free" consumer goods and in thermal papers. Wide human exposure to BPS has been reported; however, the biological and potential toxic effects of BPS are poorly understood.

OBJECTIVE

In this study, we sought to elucidate the sex-specific rapid effect of BPS in rat hearts and its underlying mechanism.

METHODS

We examined the rapid effects of BPS in rat hearts using electrophysiology, confocal and conventional fluorescence imaging, and immunoblotting. Treatment was administered via acute perfusion of excised hearts or isolated cardiac myocytes.

RESULTS

In female rat hearts acutely exposed to 10-9 M BPS, the heart rate was increased; in the presence of catecholamine-induced stress, the frequency of ventricular arrhythmia events was markedly increased. BPS-exposed hearts showed increased incidence of arrhythmogenic-triggered activities in female ventricular myocytes and altered myocyte Ca2+ handling, particularly spontaneous Ca2+ release from the sarcoplasmic reticulum. The dose responses of BPS actions were inverted U-shaped. The impact of BPS on myocyte Ca2+ handling was mediated by estrogen receptor β signaling and by rapid increases in the phosphorylation of key Ca2+ handling proteins, including ryanodine receptor and phospholamban. The proarrhythmic effects of BPS were female specific; male rat hearts were not affected by BPS at the organ, myocyte, or protein levels.

CONCLUSION

Rapid exposure to low-dose BPS showed proarrhythmic impact on female rat hearts; these effects at the organ, cellular, and molecular levels are remarkably similar to those reported for BPA. Evaluation of the bioactivity and safety of BPS and other BPA analogs is necessary before they are used as BPA alternatives in consumer products.

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

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.

Bisphenol-A plasma levels are related to inflammatory markers, visceral obesity and insulin-resistance: a cross-sectional study on adult male population

BACKGROUND

The current increase of obesity and metabolic syndrome (MS) focuses attention on bisphenol-A (BPA), "obesogen" endocrine disruptor, main plastic component. Aim was to verify the role of BPA in metabolic alterations, insulin resistance, low grade inflammation and visceral obesity.

METHODS

A cross-sectional study was performed in 76 out of 139 environmentally exposed adult males, unselected Caucasian subjects, enrolled by routine health survey at the "Federico II" University of Naples outpatient facilities. BPA plasma levels (ELISA), metabolic risk factors, homeostasis model assessment of insulin resistance index, plasma monocyte chemoattractant protein 1, interleukin-6 (IL-6) and tumor necrosis factor-alpha were performed. Clinical and biochemical parameters have been compared with BPA and pro-inflammatory cytokines levels.

RESULTS

In total 24 subjects out of 76 (32%) presented with waist circumference (WC) >102 cm, 36 (47%) had impaired fasting glucose and 24 (32%) subjects had insulin resistance [11 out 52 (21%) with WC ≤102 cm and 13 out of 24 with WC >102 cm (54%), χ(2) 6.825, p = 0.009]. BPA and pro-inflammatory cytokine levels were significantly higher in subjects with visceral adiposity (WC > 102 cm). BPA correlated with WC, triglycerides, glucose homeostasis and inflammatory markers. At the multivariate analysis WC and IL-6 remained the main predictors of BPA.

CONCLUSIONS

Detectable BPA plasma levels have been found also in our population. The strictly association between BPA and WC, components of MS, and inflammatory markers, further supports the BPA role in visceral obesity-related low grade chronic inflammation.

Variation in urinary flow rates according to demographic characteristics and body mass index in NHANES: potential confounding of associations between health outcomes and urinary biomarker concentrations

BACKGROUND

Urinary analyte concentrations are affected both by exposure level and by urinary flow rate (UFR). Systematic variations in UFR with demographic characteristics or body mass index (BMI) could confound assessment of associations between health outcomes and biomarker concentrations.

OBJECTIVES

We assessed patterns of UFR (milliliters per hour) and body weight-adjusted UFR (UFRBW; milliliters per kilogram per hour) across age, sex, race/ethnicity, and BMI category in the NHANES (National Health and Nutrition Examination Survey) 2009-2012 data sets.

METHODS

Geometric mean (GM) UFR and UFRBW were compared across age-stratified (6-11, 12-19, 20-39, 40-59, and ≥ 60 years) subgroups (sex, race/ethnicity, and BMI category). Patterns of analyte urinary concentration or mass excretion rates (nanograms per hour and nanograms per kilogram per hour BW) were assessed in sample age groups for case study chemicals bisphenol A and 2,5-dichlorophenol.

RESULTS

UFR increased from ages 6 to 60 years and then declined with increasing age. UFRBW varied inversely with age. UFR, but not UFRBW, differed significantly by sex (males > females after age 12 years). Differences in both metrics were observed among categories of race/ethnicity. UFRBW, but not UFR, varied inversely with BMI category and waist circumference in all age groups. Urinary osmolality increased with increasing BMI. Case studies demonstrated different exposure-outcome relationships depending on exposure metric. Conventional hydration status adjustments did not fully address the effect of flow rate variations.

CONCLUSIONS

UFR and UFRBW exhibit systematic variations with age, sex, race/ethnicity, and BMI category. These variations can confound assessments of potential exposure-health outcome associations based on urinary concentration. Analyte excretion rates are valuable exposure metrics in such assessments.

A proposal for assessing study quality: Biomonitoring, Environmental Epidemiology, and Short-lived Chemicals (BEES-C) instrument

The quality of exposure assessment is a major determinant of the overall quality of any environmental epidemiology study. The use of biomonitoring as a tool for assessing exposure to ubiquitous chemicals with short physiologic half-lives began relatively recently. These chemicals present several challenges, including their presence in analytical laboratories and sampling equipment, difficulty in establishing temporal order in cross-sectional studies, short- and long-term variability in exposures and biomarker concentrations, and a paucity of information on the number of measurements required for proper exposure classification. To date, the scientific community has not developed a set of systematic guidelines for designing, implementing and interpreting studies of short-lived chemicals that use biomonitoring as the exposure metric or for evaluating the quality of this type of research for WOE assessments or for peer review of grants or publications. We describe key issues that affect epidemiology studies using biomonitoring data on short-lived chemicals and propose a systematic instrument--the Biomonitoring, Environmental Epidemiology, and Short-lived Chemicals (BEES-C) instrument--for evaluating the quality of research proposals and studies that incorporate biomonitoring data on short-lived chemicals. Quality criteria for three areas considered fundamental to the evaluation of epidemiology studies that include biological measurements of short-lived chemicals are described: 1) biomarker selection and measurement, 2) study design and execution, and 3) general epidemiological study design considerations. We recognize that the development of an evaluative tool such as BEES-C is neither simple nor non-controversial. We hope and anticipate that the instrument will initiate further discussion/debate on this topic.

Impact of bisphenol a on the cardiovascular system - epidemiological and experimental evidence and molecular mechanisms

Bisphenol A (BPA) is a ubiquitous plasticizing agent used in the manufacturing of polycarbonate plastics and epoxy resins. There is well-documented and broad human exposure to BPA. The potential risk that BPA poses to the human health has attracted much attention from regulatory agencies and the general public, and has been extensively studied. An emerging and rapidly growing area in the study of BPA's toxicity is its impact on the cardiovascular (CV) system. Recent epidemiological studies have shown that higher urinary BPA concentration in humans is associated with various types of CV diseases, including angina, hypertension, heart attack and coronary and peripheral arterial disease. Experimental studies have demonstrated that acute BPA exposure promotes the development of arrhythmias in female rodent hearts. Chronic exposure to BPA has been shown to result in cardiac remodeling, atherosclerosis, and altered blood pressure in rodents. The underlying mechanisms may involve alteration of cardiac Ca2+ handling, ion channel inhibition/activation, oxidative stress, and genome/transcriptome modifications. In this review, we discuss these recent findings that point to the potential CV toxicity of BPA, and highlight the knowledge gaps in this growing research area.

Metabolic response to chronic bisphenol A exposure in C57bl/6n mice

Fetal/neonatal exposure to the endocrine disruptor bisphenol A (BPA) has induced obesity and increased glucose intolerance. We hypothesized that chronic BPA exposure would worsen the obesity and glucose intolerance induced by a high fat diet (HFD). The drinking water of C57bl/6n dams was treated with vehicle (VEH) or BPA (25 ng/ml) from gestation day 11.5 to postnatal day 21. Another group was treated with oral diethylstilbestrol (DES, 1 μg/kg/day) during gestation. Progeny were treated with VEH (VEH and DES groups) or BPA (2.5 ng/ml) in the drinking water and fed either a control diet (CD) or HFD from weaning until euthanasia at 4 months of age. CD-fed mice were similar in size; however HFD-BPA males and HFD-DES mice were smaller than HFD-VEH mice. No CD-fed mice were glucose intolerant. All HFD-fed mice were glucose intolerant. Cholesterol and triglyceride were increased in HFD-VEH mice and HFD-BPA males. Total fat weight and adipocyte area were similar in HFD-VEH and HFD-BPA mice and reduced in HFD-DES mice. HFD-BPA females increased perirenal and reduced gonadal fat weights. Reduced leptin and increased IL-6 in CD-BPA and CD-DES mice were not found in their HFD-cohorts. Adiponectin levels were similar. Thus, although chronic BPA exposure did not increase body size or increase glucose intolerance, it induced an adipokine imbalance in CD-fed mice and sex-specifically altered the lipid response and adipose deposition when fed the HFD.

Higher urinary heavy metal, phthalate and arsenic concentrations accounted for 3-19% of the population attributable risk for high blood pressure: US NHANES, 2009-2012

The link between environmental chemicals and human health has emerged, but has not been completely examined in terms of its risk factors. Therefore, we aimed to study the relationships of different sets of urinary environmental chemical concentrations and high blood pressure (BP) in a national, population-based study. Data were retrieved from the United States National Health and Nutrition Examination Surveys, 2009-2012, including demographics, BP readings and urinary environmental chemical concentrations. Analyses included χ(2)-test, t-test, survey-weighted logistic regression models and population attributable risk estimation. Urinary cesium (odds ratio (OR) 1.52, 95% confidence interval (CI) 1.06-2.18, P=0.026), molybdenum (OR 1.45, 95% CI 1.04-2.02, P=0.029), lead (OR 1.49, 95% CI 1.12-1.98, P=0.009), platinum (OR 1.66, 95% CI 1.14-2.21, P=0.002), antimony (OR 1.44, 95% CI 1.12-1.86, P=0.008) and tungsten (OR 1.48, 95% CI 1.22-1.79, P<0.001) concentrations were observed to be associated with high BP. Similar results were observed for mono-2-ethyl-5-carboxypentyl (OR 1.29, 95% CI 1.04-1.59, P=0.024), mono-n-butyl (OR 1.36, 95% CI 1.11-1.67, P=0.005), mono-2-ethyl-5-hydroxyhexyl (OR 1.21, 95% CI 1.01-1.46, P=0.041), mono-n-methyl (OR 1.24, 95% CI 1.01-1.46, P=0.014), mono-2-ethyl-5-oxohexyl (OR 1.21, 95% CI 1.01-1.45, P=0.036), mono-benzyl (OR 1.41, 95% CI 1.15-1.74, P=0.002), dimethylarsonic acid (OR 1.38, 95% CI 1.08-1.76, P=0.012) and trimethylarsine oxide (OR 2.56, 95% CI 1.29-5.07, P=0.010) concentrations. Each chemical could account for 3-19% of the population attributable risk for high BP. A small sex difference was found. However, there are no associations between environmental parabens and pesticides and high BP. Urinary heavy metal, phthalate and arsenic concentrations were associated with high BP, although a causal effect cannot be established. Elimination of environmental chemical exposure in humans still needs to be pursued.

Bisphenol A, obesity, and type 2 diabetes mellitus: genuine concern or unnecessary preoccupation?

Bisphenol A (BPA) is a ubiquitous industrial chemical found in a variety of plastic containers intended for food storage and in the epoxy resin linings of metal food and beverage cans, where it is used to prevent corrosion, food contamination, and spoilage. BPA has been linked recently to a wide variety of medical disorders and is known to have estrogenic activity with genomic as well as nongenomic estrogen receptor-mediated effects. Given the rapidly increasing prevalence rates of metabolic disorders such as obesity and type 2 diabetes, BPA has come under recent intense scrutiny in scientific and lay communities as a potential endocrine-disrupting compound with diabetogenic effects. The purpose of this review is to examine critically the available literature investigating the link between BPA and alterations in metabolic health. Typical levels of exposure to BPA in daily life are discussed, and both epidemiologic human data and mechanistic preclinical studies that have tested associations between BPA and obesity and diabetes are analyzed. Last, current policies and views of national and international regulatory agencies regarding the safety of BPA use are summarized.

Higher urinary heavy metal, arsenic, and phthalate concentrations in people with high blood pressure: US NHANES, 2009-2010

BACKGROUND

A link between environmental chemicals and human health has emerged but not complete in risk factors. This work aimed to study the relationships of different sets of urinary environmental chemical concentrations and risk of high blood pressure (BP) in a national, population-based study.

METHODS

Data was retrieved from United States National Health and Nutrition Examination Surveys, 2009-2010, including demographics, BP readings and urinary environmental chemical concentrations. Analyses included t-test and survey-weighted logistic regression models.

RESULTS

Urinary mercury concentrations were not associated with high BP (OR = 1.19, 95% CI 0.97-1.48, p = 0.095). Urinary cobalt (OR = 1.35, 95% CI 1.01-1.81, p = 0.044), lead (OR = 1.77, 95% CI 1.31-2.38, p = 0.001), antimony (OR = 1.37, 95% CI 1.09-1.72, p = 0.010) and tungsten (OR = 1.52, 95% CI 1.27-1.81, p < 0.001) concentrations were observed to increase the risk of high BP. There are no clear associations between environmental parabens and high BP. The effect of environmental bisphenol A (OR = 1.14, 95% CI 1.00-1.30, p = 0.051) disappeared after additionally adjusting for subsample weighting (OR = 1.12, 95% CI 0.93-1.35, p = 0.225). People with higher urinary mono-2-ethyl-5-carboxypentyl phthalate (OR = 1.26, 95% CI 1.00-1.58, p = 0.051), mono-n-butyl phthalate (OR = 1.19, 95% CI 1.01-1.41, p = 0.042) and mono-n-methyl phthalate metabolites (OR = 1.16, 95% CI 1.03-1.32, p = 0.021) tended to have high BP. Moreover, urinary o-phenyl phenol concentrations (OR = 1.49, 95% CI 1.25-1.77, p < 0.001) and dimethylarsonic acid concentrations (OR = 1.35, 95% CI 1.06-1.73, p = 0.019) were also seen to be associated with high BP.

CONCLUSIONS

Urinary environmental chemical concentrations were associated with risk of high BP, although the causal effect cannot be established. Elimination of environmental chemicals in humans would need to be continued.

Association of urinary concentrations of bisphenol A and phthalate metabolites with risk of type 2 diabetes: a prospective investigation in the Nurses' Health Study (NHS) and NHSII cohorts

BACKGROUND

Prospective evidence regarding associations for exposures to bisphenol A (BPA) and phthalates with type 2 diabetes (T2D) is lacking.

OBJECTIVE

We prospectively examined urinary concentrations of BPA and phthalate metabolites with T2D risk.

METHODS

We measured BPA and eight major phthalate metabolites among 971 incident T2D case-control pairs from the Nurses' Health Study (NHS) (mean age, 65.6 years) and NHSII (mean age, 45.6 years).

RESULTS

In the NHSII, BPA levels were not associated with incident T2D in multivariate-adjusted analysis until body mass index was adjusted: odds ratio (OR) comparing extreme BPA quartiles increased from 1.40 (95% CI: 0.91, 2.15) to 2.08 (95% CI: 1.17, 3.69; p(trend) = 0.02) with such an adjustment. In contrast, BPA concentrations were not associated with T2D in the NHS (OR = 0.81; 95% CI: 0.48, 1.38; p(trend) = 0.45). Likewise, urinary concentrations of total phthalate metabolites were associated with T2D in the NHSII (OR comparing extreme quartiles = 2.14; 95% CI: 1.19, 3.85; p(trend) = 0.02), but not in the NHS (OR = 0.87; 95% CI: 0.49, 1.53; p(trend) = 0.29). Summed metabolites of butyl phthalates or di-(2-ethylhexyl) phthalates were significantly associated with T2D only in the NHSII; ORs comparing extreme quartiles were 3.16 (95% CI: 1.68, 5.95; p(trend) = 0.0002) and 1.91 (95% CI: 1.04, 3.49; p(trend) = 0.20), respectively.

CONCLUSIONS

These results suggest that BPA and phthalate exposures may be associated with the risk of T2D among middle-aged, but not older, women. The divergent findings between the two cohorts might be explained by menopausal status or simply by chance. Clearly, these results need to be interpreted with caution and should be replicated in future studies, ideally with multiple urine samples collected prospectively to improve the measurement of these exposures with short half-lives.

Programming of metabolic effects in C57BL/6JxFVB mice by exposure to bisphenol A during gestation and lactation

The global rise in prevalence of obesity is not fully explained by genetics or life style factors. The developmental origins of health and disease paradigm suggests that environmental factors during early life could play a role. In this perspective, perinatal exposure to bisphenol A (BPA) has been indicated as a programming factor for obesity and related metabolic disorders later in life. Here we study early life programming by BPA using an experimental design that is relevant for human exposure. C57BL/6JxFVB hybrid mice were exposed during gestation and lactation via maternal feed to 8 non-toxic doses (0-3000 μg/kg body weight/day (μg/kg bw/d)) of BPA. After weaning, offspring were followed for 20 weeks without further exposure. Adult male offspring showed dose-dependent increases of body and liver weights, no effects on fat pad weights and a dose-dependent decrease in circulating glucagon. Female offspring showed a dose-dependent decrease in body weight, liver, muscle and fat pad weights, adipocyte size, serum lipids, serum leptin and adiponectin. Physical activity was decreased in exposed males and suggested to be increased in exposed females. Brown adipose tissue showed slightly increased lipid accumulation in males and lipid depletion in females, and ucp1 expression was dose-dependently increased in females. The effects in females were more reliable and robust than in males due to wide confidence intervals and potential confounding by litter size for male data. The lowest derived BMDL (lower bound of the (two-sided) 90%-confidence interval for the benchmark dose) of 233 μg/kg bw/d (for interscapular weight in females) was below the proposed BMDL of 3633 μg/kg bw/d as a basis for tolerable daily intake. Although these results suggest that BPA can program for an altered metabolic phenotype, the sexual dimorphism of effects and diversity of outcomes among studies similar in design as the present study do not mark BPA as a specific obesogen. The consistency within the complex of observed metabolic effects suggests that upstream key element(s) in energy homeostasis are modified. Sex-dependent factors contribute to the final phenotypic outcome.

Toxicity evaluation of bisphenol A administered by gavage to Sprague Dawley rats from gestation day 6 through postnatal day 90

Bisphenol A (BPA) is a high production volume industrial chemical to which there is widespread human oral exposure. Guideline studies used to set regulatory limits detected adverse effects only at doses well above human exposures and established a no-observed-adverse-effect level (NOAEL) of 5 mg/kg body weight (bw)/day. However, many reported animal studies link BPA to potentially adverse effects on multiple organ systems at doses below the NOAEL. The primary goals of the subchronic study reported here were to identify adverse effects induced by orally (gavage) administered BPA below the NOAEL, to characterize the dose response for such effects and to determine doses for a subsequent chronic study. Sprague Dawley rat dams were dosed daily from gestation day 6 until the start of labor, and their pups were directly dosed from day 1 after birth to termination. The primary focus was on seven equally spaced BPA doses (2.5-2700 μg/kg bw/day). Also included were a naïve control, two doses of ethinyl estradiol (EE2) to demonstrate the estrogen responsiveness of the animal model, and two high BPA doses (100,000 and 300,000 μg/kg bw/day) expected from guideline studies to produce adverse effects. Clear adverse effects of BPA, including depressed gestational and postnatal body weight gain, effects on the ovary (increased cystic follicles, depleted corpora lutea, and antral follicles), and serum hormones (increased serum estradiol and prolactin and decreased progesterone), were observed only at the two high doses of BPA. BPA-induced effects partially overlapped those induced by EE2, consistent with the known weak estrogenic activity of BPA.

Bisphenol A and indicators of obesity, glucose metabolism/type 2 diabetes and cardiovascular disease: a systematic review of epidemiologic research

INTRODUCTION

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.

CONCLUSION

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.

Disconcordance in statistical models of bisphenol A and chronic disease outcomes in NHANES 2003-08

Background

Bisphenol A (BPA), a high production chemical commonly found in plastics, has drawn great attention from researchers due to the substance’s potential toxicity. Using data from three National Health and Nutrition Examination Survey (NHANES) cycles, we explored the consistency and robustness of BPA’s reported effects on coronary heart disease and diabetes.

Methods And Findings

We report the use of three different statistical models in the analysis of BPA: (1) logistic regression, (2) log-linear regression, and (3) dose-response logistic regression. In each variation, confounders were added in six blocks to account for demographics, urinary creatinine, source of BPA exposure, healthy behaviours, and phthalate exposure. Results were sensitive to the variations in functional form of our statistical models, but no single model yielded consistent results across NHANES cycles. Reported ORs were also found to be sensitive to inclusion/exclusion criteria. Further, observed effects, which were most pronounced in NHANES 2003-04, could not be explained away by confounding.

Conclusions

Limitations in the NHANES data and a poor understanding of the mode of action of BPA have made it difficult to develop informative statistical models. Given the sensitivity of effect estimates to functional form, researchers should report results using multiple specifications with different assumptions about BPA measurement, thus allowing for the identification of potential discrepancies in the data.

Bisphenol A and chronic disease risk factors in US children

OBJECTIVE

To evaluate the relationship between urinary bisphenol A (BPA) levels and measures of adiposity and chronic disease risk factors for a nationally representative US pediatric sample.

METHODS

We used the NHANES 2003-2010 to evaluate cross-sectional associations between urinary BPA and multiple measures of adiposity, cholesterol, insulin, and glucose for children aged 6 to 18 years, adjusting for relevant covariates (eg, demographics, urine creatinine, tobacco exposure, and soda consumption).

RESULTS

We found a higher odds of obesity (BMI ≥95th percentile) with increasing quartiles of BPA for quartiles 2 vs 1 (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.17-2.60, P = .008), 3 vs 1 (OR 1.64, 95% CI 1.09-2.47, P = .02), and 4 vs 1 (OR 2.01, 95% CI 1.36-2.98, P = .001). We also found a higher odds of having an abnormal waist circumference-to-height ratio (quartiles 2 vs 1 [OR 1.37, 95% CI 0.98-1.93, P = .07], 3 vs 1 [OR 1.41, 95% CI 1.07-1.87, P = .02], and 4 vs 1 [OR 1.55, 95% CI 1.12-2.15, P = .01]). We did not find significant associations of BPA with any other chronic disease risk factors.

CONCLUSIONS

Higher levels of urinary BPA were associated with a higher odds of obesity (BMI >95%) and abnormal waist circumference-to-height ratio. Longitudinal analyses are needed to elucidate temporal relationships between BPA exposure and the development of obesity and chronic disease risk factors in children.

Bisphenol A and human health: a review of the literature

There is growing evidence that bisphenol A (BPA) may adversely affect humans. BPA is an endocrine disruptor that has been shown to be harmful in laboratory animal studies. Until recently, there were relatively few epidemiological studies examining the relationship between BPA and health effects in humans. However, in the last year, the number of these studies has more than doubled. A comprehensive literature search found 91 studies linking BPA to human health; 53 published within the last year. This review outlines this body of literature, showing associations between BPA exposure and adverse perinatal, childhood, and adult health outcomes, including reproductive and developmental effects, metabolic disease, and other health effects. These studies encompass both prenatal and postnatal exposures, and include several study designs and population types. While it is difficult to make causal links with epidemiological studies, the growing human literature correlating environmental BPA exposure to adverse effects in humans, along with laboratory studies in many species including primates, provides increasing support that environmental BPA exposure can be harmful to humans, especially in regards to behavioral and other effects in children.

Advancing human health risk assessment: integrating recent advisory committee recommendations

Over the last dozen years, many national and international expert groups have considered specific improvements to risk assessment. Many of their stated recommendations are mutually supportive, but others appear conflicting, at least in an initial assessment. This review identifies areas of consensus and difference and recommends a practical, biology-centric course forward, which includes: (1) incorporating a clear problem formulation at the outset of the assessment with a level of complexity that is appropriate for informing the relevant risk management decision; (2) using toxicokinetics and toxicodynamic information to develop Chemical Specific Adjustment Factors (CSAF); (3) using mode of action (MOA) information and an understanding of the relevant biology as the key, central organizing principle for the risk assessment; (4) integrating MOA information into dose-response assessments using existing guidelines for non-cancer and cancer assessments; (5) using a tiered, iterative approach developed by the World Health Organization/International Programme on Chemical Safety (WHO/IPCS) as a scientifically robust, fit-for-purpose approach for risk assessment of combined exposures (chemical mixtures); and (6) applying all of this knowledge to enable interpretation of human biomonitoring data in a risk context. While scientifically based defaults will remain important and useful when data on CSAF or MOA to refine an assessment are absent or insufficient, assessments should always strive to use these data. The use of available 21st century knowledge of biological processes, clinical findings, chemical interactions, and dose-response at the molecular, cellular, organ and organism levels will minimize the need for extrapolation and reliance on default approaches.

Obesogens and obesity--an alternative view?

It is accepted that diet is a major contributor to the obesity epidemic, but environmental 'obesogenic' chemicals have also been suggested recently as playing a role, based on in vitro, animal and epidemiological studies. Using two such 'obesogen' examples (bisphenol A, certain phthalate esters), we argue that their association with obesity and obesity-related disorders in humans could be circumstantial, and thus non-causal, because a Western style diet increases exposure to these compounds. This possibility needs to be addressed before further (confounded) epidemiological studies on 'obesogens' are undertaken.

Lifelong exposure to bisphenol a alters cardiac structure/function, protein expression, and DNA methylation in adult mice

Bisphenol A (BPA) is an estrogenizing endocrine disruptor compound of concern. Our objective was to test whether lifelong BPA would impact cardiac structure/function, calcium homeostasis protein expression, and the DNA methylation of cardiac genes. We delivered 0.5 and 5.0 µg/kg/day BPA lifelong from gestation day 11 or 200 µg/kg/day from gestation day 11 to postnatal day 21 via the drinking water to C57bl/6n mice. BPA 5.0 males and females had increased body weight, body mass index, body surface area, and adiposity. Echocardiography identified concentric remodeling in all BPA-treated males. Systolic and diastolic cardiac functions were essentially similar, but lifelong BPA enhanced male and reduced female sex-specific differences in velocity of circumferential shortening and ascending aorta velocity time integral. Diastolic blood pressure was increased in all BPA females. The calcium homeostasis proteins sarcoendoplasmic reticulum ATPase 2a (SERCA2a), sodium calcium exchanger-1, phospholamban (PLB), phospho-PLB, and calsequestrin 2 are important for contraction and relaxation. Changes in their expression suggest increased calcium mobility in males and reduced calcium mobility in females supporting the cardiac function changes. DNA methyltransferase 3a expression was increased in all BPA males and BPA 0.5 females and reduced in BPA 200 females. Global DNA methylation was increased in BPA 0.5 males and reduced in BPA 0.5 females. BPA induced sex-specific altered DNA methylation in specific CpG pairs in the calsequestrin 2 CpG island. These results suggest that continual exposure to BPA impacts cardiac structure/function, protein expression, and epigenetic DNA methylation marks in males and females.