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Table 3 Summary of results in studies used as primary data: indicators of anthropometry and adiposity (n = 16 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

Results

Adjustment in model(s) used for review

In children

Prevalent overweight (4 publications)

Eng et al. 2013 [38]

Overweight: BMI ≥85th percentile for age/gender

BPA in quartiles (ng/mL):

Q1: <1.3; Q2: 1.3–2.6; Q3: 2.6–4.9; Q4: >4.9

Q2 vs. Q1: OR = 1.00 (0.74–1.36)

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

Q3 vs. Q1: OR = 1.17 (0.89–1.54)

Q4 vs. Q1: OR = 1.07 (0.80–1.44)

Harley et al. 2013 [64]

Overweight: BMI ≥85th percentile at 5 and 9 years of age

Ratio of BPA-to-creatinine level as continuous (log2- transformed) at 5 years

OR = 1.07 (0.90–1.28)

Maternal prepregnancy BMI, household income, maternal education level, maternal years of residence in the United States, child’s environmental tobacco smoke exposure, soda intake, fast food intake, and sweet consumption

Ratio of BPA-to-creatinine level in 3 tertiles at 5 years (μg/g):

T2 vs. T1: OR = 0.80 (0.45–1.42)

T1: <LOD-2.4; T2: 2.4–4.5 μg/g; T3: 4.6–349.8 μg/g

T3 vs. T1: OR = 1.36 (0.75–2.47)

Ratio of BPA-to-creatinine level as continuous (log2- transformed) at 9 years

OR = 1.06 (0.85–1.33)

Ratio of BPA-to-creatinine level in 3 groups at 9 years (μg/g):

G2 vs. G1: OR = 3.08 (1.18–8.02)

G1: <LOD (<0.4); G2: detectable < median (0.4–1.8); G3: detectable > median (1.8–22.5)

G3 vs. G1: OR = 4.20 (1.60–11.02)

Li et al. 2013 [49]

Overweight: age- and gender-specific weight >90th percentile of the underlying population

BPA in 2 classes (ng/mL):

Low BPA level: <2 (reference); high BPA level: ≥2

(2 mg/L is about the median urine BPA level in the U.S. population)

Girls

Age, gender, school, residence, paternal and maternal education and overweight, playing video games, unbalanced diet, eating junk food, vegetables or fruit, depression scores, sports/activities

All: OR=1.29 (0.83–2.01)

Age 9-12: OR= 2.32 (1.15-4.65)

Age>12: OR= 0.90 (0.48-1.72)

 

Boys

All: OR=0.82 (0.55–1.23)

Age 9-12: OR= 0.71 (0.34-1.45)

Age>12: OR= 0.87 (0.52-1.45)

Trasande et al. 2012 [47]

Overweight: BMI z-score ≥1.036 (85th percentile for age/sex)

BPA continuous (log-transformed)

OR = 1.04 (0.92–1.18)

Sex, caloric intake, television watching, poverty to income ratio, parental education, serum cotinine level, urinary creatinine level, age, race/ethnicity categories

BPA in quartiles (ng/mL):

Q1: ≤1.5; Q2: 1.5–2.7; Q3: 2.8–5.5; Q4: >5.6

Q2 vs. Q1: OR = 1.26 (0.96–1.64)

Q3 vs. Q1: OR = 1.28 (0.98–1.66)

Q4 vs. Q1: OR = 1.26 (0.86–1.82)

Prevalent obesity (3 publications)

Bhandari et al. 2013 [35]

Obesity: BMI ≥ 95th percentile for age/gender

BPA continuous (log-transformed)

OR = 1.25 (1.09–1.43)

Age, sex, race/ethnicity, education, moderate activity, urinary creatinine, serum cotinine

BPA in quartiles (ng/mL):

Q1: <1.5; Q2: 1.5–2.7; Q3: 2.8–5.4; Q4: >5.4

Q2 vs. Q1: OR = 2.35 (1.56–3.53)

 

Q3 vs. Q1: OR = 1.78 (1.13–2.79)

Q4 vs. Q1: OR = 2.55 (1.65–3.95)

p for trend = 0.002

Stratified analyses by sex (p for interaction = 0.07): association of strong magnitude and statistically significant among boys

Eng et al. 2013 [38]

Obesity: BMI ≥95th percentile for age/gender

BPA in quartiles (ng/mL):

Q1: <1.3; Q2: 1.3–2.6; Q3: 2.6–4.9; Q4: >4.9

Q2 vs. Q1: OR = 1.73 (1.16–2.58)

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

Q3 vs. Q1: OR = 1.63 (1.08–2.46)

Q4 vs. Q1: OR = 2.05 (1.38–3.04)

Trasande et al. 2012 [47]

Obesity: BMI z-score ≥1.64 (95th percentile for age/sex)

BPA continuous (log-transformed)

Continuous: OR = 1.24 (1.08–1.44)

Sex, caloric intake, television watching, poverty-to-income ratio, parental education, serum cotinine level, urinary creatinine level, age, race/ethnicity categories

BPA in quartiles (ng/mL):

Q1: ≤1.5; Q2: 1.5–2.7; Q3: 2.8–5.5; Q4: >5.6

Q2 vs. Q1: OR = 2.24 (1.54–3.24)

Q3 vs. Q1: OR = 2.08 (1.46–2.96)

Q4 vs. Q1: OR = 2.57 (1.72–3.83)

Prevalent elevated waist circumference

Eng et al. 2013 [38]

Abnormal WC: WC ≥90th percentile for age/gender

Abnormal WC-to-height ratio: WC-to-height ratio ≥0.5

BPA in quartiles (ng/mL):

Q1: <1.3; Q2: 1.3–2.6; Q3: 2.6–4.9; Q4: >4.9

Abnormal WC

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

Q2 vs. Q1: OR = 1.33 (0.90–1.97)

Q3 vs. Q1: OR = 1.16 (0.75–1.81)

Q4 vs. Q1: OR = 1.40 (0.91–2.15)

Abnormal WC-to-height ratio

Q2 vs. Q1: OR = 1.37 (0.97–1.92)

Q3 vs. Q1: OR = 1.41 (1.07–1.87)

Q4 vs. Q1: OR = 1.56 (1.11–2.17)

Other

Braun et al. 2014 [63]

Change in BMI z-score between 2 and 5 years of age, as continuous

Ratio of BPA-to-creatinine continuous (log10-transformed)

Per 10-fold increase:

β = −0.2 (−0.6, 0.1)

Maternal race, marital status, parity, age at delivery, household income, education, employment, insurance, BMI at 16 weeks of pregnancy, depressive symptoms at baseline, prenatal serum cotinine

Ratio of BPA-to-creatinine in tertiles (μg/g creatinine):

T2 vs. T1: β = 0.0 (−0.3, 0.3)

T1: 2.1–11; T2: 11–20; T3: 20–314

T3 vs. T1: β = −0.2 (−0.5, 0.1)

Eng et al. 2013 [38]

Prevalent abnormal body fat: body fat ≥85th percentile for age/gender

BPA in quartiles (ng/mL):

Q1: <1.3; Q2: 1.3–2.6; Q3: 2.6–4.9; Q4: >4.9

Q2 vs. Q1: OR = 4.85 (0.80–21.4)

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

Q3 vs. Q1: OR = 5.36 (0.71–43.3)

Q4 vs. Q1: OR = 2.10 (0.24–17.8)

Harley et al. 2013 [64]

Incident overweight: BMI ≥85th percentile at 9 years of age

Ratio of BPA-to-creatinine level at 5 years as continuous (log2- transformed)

OR = 1.02 (0.84–1.23)

Maternal prepregnancy BMI, household income, maternal education level, maternal years of residence in the United States, child’s environmental tobacco smoke exposure, soda intake, fast food intake, and sweet consumption at age 5 years

Ratio of BPA-to-creatinine level at 5 years in tertiles (μg/g):

T2 vs. T1: 0.91 (0.48–1.73)

T1: <LOD-2.4; T2: 2.4–4.5; T3: 4.6–349.8

T3 vs. T1: 1.28 (0.65–2.51)

Wang et al. 2012b [50]

Prevalent BMI as continuous (kg/m2)

BPA continuous (log-transformed and corrected for specific gravity)

β = 0.017 (0.002–0.032)

Age, sex

Wells et al. 2013 [48]

Prevalent waist-to-height ratio as continuous

BPA in quartiles (ng/mL):

Q1: <1.2; Q2: 1.2–2.6; Q3: 2.6–5.1; Q4: >5.1

Change in waist-to-height ratio:

Urinary creatinine, age, sex, race/ethnicity, education, smoking status based on serum cotinine, caloric intake

Q2 vs. Q1: β = 0.011 (0.001–0.020)

Q3 vs. Q1: β = 0.010 (0.001–0.019)

Q4 vs. Q1: β = 0.016 (0.007–0.026)

Significant associations among boys but not girls.

In adults

Prevalent overweight (3 publications)

Carwile & Michels 2011 [36]

Overweight: 25 ≤ BMI < 30 kg/m2 (reference: BMI <25 kg/m2)

BPA in quartiles (ng/mL):

Q1: ≤1.1; Q2: 1.2–2.3; Q3: 2.4–4.6; Q4: ≥4.7

Q2 vs. Q1: OR = 1.66 (1.21–2.27)

Age, gender, race/ethnicity, education, smoking status, urinary creatinine

Q3 vs. Q1: OR = 1.26 (0.85–1.87)

Q4 vs. Q1: OR = 1.31 (0.80–2.14)

Kim et al. 2011 [55]

Overweight: BMI = 23-24.9 kg/m2, according to the WHO definitions for the Asian populations (reference: BMI <18.5 kg/m2)

BPA continuous (log-transformed)

Adjusted proportional change (95 % CI) = 1.01 (0.78–1.31)

Age, gender, education, income, cigarette smoking status, place of residence, urinary creatinine

Wang et al. 2012a [52]

Generalized overweight: 24 ≤ BMI < 28 kg/m2, according to Chinese criteria (reference = BMI <24 kg/m2)

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 = 1.23 (0.97–1.57)

Age, sex, urinary creatinine, smoking, alcohol drinking, education levels, systolic blood pressure, HDL cholesterol, LDL cholesterol, total cholesterol, TG, hsCRP, fasting plasma glucose, fasting serum insulin, serum ALT and GGT

Q3 vs. Q1: OR = 1.28 (1.01–1.63)

Q4 vs. Q1: OR = 1.24 (0.97–1.59)

Prevalent obesity (4 publications)

Carwile & Michels 2011 [36]

Obesity: BMI ≥30 kg/m2 (reference: BMI <25 kg/m2)

BPA in quartiles (ng/mL):

Q1: ≤1.1; Q2: 1.2–2.3; Q3: 2.4–4.6; Q4: ≥4.7

Q2 vs. Q1: OR = 1.85 (1.22–2.79)

Age, gender, race/ethnicity, education, smoking status, urinary creatinine

Q3 vs. Q1: OR = 1.60 (1.05–2.44)

Q4 vs. Q1: OR = 1.76 (1.06–2.94)

Kim et al. 2011 [55]

Obesity: BMI ≥25 kg/m2, according to the WHO definitions for the Asian populations (reference = BMI <18.5 kg/m2)

BPA continuous (log-transformed)

Adjusted proportional change (95 % CI) = 0.96 (0.75–1.23)

Age, gender, education, income, cigarette smoking status, place of residence, urinary creatinine

Shankar et al. 2012 [44]

Obesity: BMI ≥30 kg/m2 (reference = BMI <30 kg/m2)

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 = 1.40 (1.10–1.76)

Age, gender, race/ethnicity, education categories, smoking, alcohol consumption, physical inactivity, diabetes, hypertension, total cholesterol

Q3 vs. Q1: OR = 1.59 (1.25–2.02)

Q4 vs. Q1: OR = 1.69 (1.30–2.20)

p for trend < 0.0001

Associations still significant in analyses stratified by sex.

Wang et al. 2012a [52]

Generalized obesity: BMI ≥28 kg/m2, according to Chinese criteria (reference: BMI <28 kg/m2)

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 = 1.14 (0.87–1.50)

Age, sex, urinary creatinine, smoking, alcohol drinking, education levels, systolic blood pressure, HDL cholesterol, LDL cholesterol, total cholesterol, TG, hsCRP, fasting plasma glucose, fasting serum insulin, serum ALT and GGT

Q3 vs. Q1: OR = 1.19 (0.90–1.57)

Q4 vs. Q1: OR = 1.50 (1.15–1.97)

Prevalent elevated waist circumference (4 publications)

Carwile & Michels 2011 [36]

Elevated WC: WC ≥102 cm in men and WC ≥88 cm in women

BPA in quartiles (ng/mL):

Q1: ≤1.1; Q2: 1.2–2.3; Q3: 2.4–4.6; Q4: ≥4.7

Q2 vs. Q1: OR = 1.62 (1.11–2.36)

Age, gender, race/ethnicity, education, smoking status, urinary creatinine

Q3 vs. Q1: OR = 1.39 (1.02–1.90)

Q4 vs. Q4: OR = 1.58 (1.03–2.42)

Ko et al. 2014 [57]

Abdominal obesity: WC ≥90 cm in men and WC ≥85 cm in women

BPA in quartiles (μg/mL)

Q1: <0.853; Q2: 0.853–1.407; Q3: 1.407–2.594; Q4: >2.594

Q2 vs. Q1: 1.117 (0.757–1.649)

Age, sex, urinary creatinine, education, income, alcohol consumption, smoking status

Q3 vs. Q1: 1.337 (0.908–1.967)

Q4 vs. Q1: 1.938 (1.314–2.857)

p for trend = 0.01

Shankar et al. 2012 [44]

Abdominal obesity: WC ≥102 cm in men and WC ≥88 cm in women

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 = 1.63 (1.20–2.22)

Age, gender, race/ethnicity, education categories, smoking, alcohol consumption, physical inactivity, diabetes, hypertension, total cholesterol

Q3 vs. Q1: OR = 1.66 (1.28–2.14)

Q4 vs. Q1: OR = 1.59 (1.21–2.09)

p for trend = 0.0009

Associations still significant in analyses stratified by sex

Wang et al. 2012a [52]

Abdominal obesity: WC ≥90 cm in men and WC ≥85 cm in women

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 = 1.26 (1.02–1.57)

Age, sex, urinary creatinine, smoking, alcohol drinking, education levels, systolic blood pressure, HDL cholesterol, LDL cholesterol, total cholesterol, TG, hsCRP, fasting plasma glucose, fasting serum insulin, serum ALT and GGT

Q3 vs. Q1: OR = 1.28 (1.03–1.59)

Q4 vs. Q1: OR = 1.28 (1.03–1.60)

Other

Galloway et al. 2010 [58]

Prevalent WC as continuous

Prevalent weight as continuous

Daily BPA excretion (μg/day) as a continuous variable

WC: β = 0.0062 (0.0016–0.0108)

Age, sex, study site

Weight: β = 0.0064 (0.0023–0.0104)

Kim et al. 2011 [55]

Prevalent normal weight: BMI = 18.5–22.9 kg/m2, according to the WHO definitions for the Asian populations (reference: BMI < 18.5 kg/m2)

BPA continuous (log-transformed)

Adjusted proportional change (95 % CI) = 0.92 (0.72–1.17)

Age, gender, education, income, cigarette smoking status, place of residence, urinary creatinine

Song et al. 2014 [62]

Weight change rate (WCR) during follow-up (kg/year)

BPA in quartiles (nmol/L):

 

Age at baseline, urinary creatinine concentration, cohort origin, menopausal status, smoking, alcohol consumption, physical activity, alternative healthy eating index, total energy intake

Q1: median (IQR) = 3.6 (2.6–4.5)

Q2 vs. Q1: WCR = 0.15 (0.00–0.31)

Q2: median (IQR) = 6.4 (5.8–7.3)

Q3 vs. Q1: WCR = 0.18 (0.03–0.34)

Q3: median (IQR) = 10.5 (9.0–12.1)

Q4 vs. Q1: WCR = 0.23 (0.07–0.38)

Q4: median (IQR) = 21.9 (16.8–35.7)

p for trend = 0.02

Zhao et al. 2012 [53]

Fat mass, fat-free mass, body weight, BMI, WC, hip circumference, waist-hip ratio (all variables as continuous)

BPA continuous

Fat mass: r = 0.35 (p < 0.001)

Age

Fat-free mass: r = 0.186 (p = 0.009)

Body weight: r = 0.24 (p = 0.001)

BMI: r = 0.298 (p < 0.001)

WC: r = 0.296 (p < 0.001)

Hip circumference: r = 0.27 (p < 0.001)

Waist-hip ratio: r = 0.149 (p = 0.035)

With additional adjustment for age and BMI, BPA was still significantly associated with fat mass (r = 0.193, p = 0.006) but not with fat-free mass.

  1. ALT alanine aminotransferase; BMI body mass index; BPA bisphenol A; GGT gamma glutamyltransferase; HDL high density lipoprotein; hsCRP high sensitivity C-reactive protein; IQR interquartile range; LDL low density lipoprotein; LOD limit of detection; OR odds ratio; TG triglycerides; WC waist circumference; WCR weight change rate