Table 5.
Epidemiologic studies on the relationship between BPA and NAFLD related biomarkers.
| Substance | Reference | Country | Population | Sample size | Biological materials | Measurement | Exposure assessment | Outcomes | Results | Adjustment factors |
|---|---|---|---|---|---|---|---|---|---|---|
| BPA | Fu et al. (90) | China 2017–2018 | Children (5–14 years) | 1,006 | Serum | HPLC | Median BPA: 26.31 ng/mL | ALT, AST, TBIL | Exposure to BPA would have negative effects on hepatic function, and these effects showed differences in gender and geographical location. | Age, address, gender |
| BPA | An et al. (83) | Korea 2015–2017 | KoNEHS (≥18 years) | 3,476 | Urine | UPLC | Geometric mean (SE) ug/L BPA: 2.24(0.08) non-NAFLD 2.56(0.15) NAFLD | NAFLD prevalence ALT, AST, GGT | The prevalence of NAFLD and abnormal ALT were increased in accordance with the increase of urinary BPA concentrations. There were no relationships between AST, GGT and BPA levels. | Age, sex, drinking and smoking status, physical activity, household income, education level, marriage, medication taking |
| BPA | Federico et al. (91) | Italy 2017 | Male patients with NAFLD | 32 | Urine, plasma | HPLC LCMS/MS | mean ± SD ng/mL Plasm BPA: 6.45 ± 4.51 Urine free BPA: 2.73 ± 2.06 Urine total BPA: 5.84 ± 3.07 | ALT, AST, GGT | NAFLD patients showed higher levels of ALT, plasmatic, free urine and total urine BPA. | NR |
| BPA | Kim et al. (92) | USA 2005–2014 | NHANES adults | 7,605 (HSI) 3,631 (USFLI) | Urine | SPE-HPLC | NAFLD and ALT according to BPA levels. | NAFLD defined by HIS or USFLI | The prevalence of NAFLD and abnormal ALT levels was correlated with urinary BPA levels. | Race/ethnicity, education, hypertension, diabetes, smoking status, alcohol consumption |
| BPA | Verstraete et al. (93) | Spain 2003–2010 | NHANES adolescents (12–19 years) | 944 | Urine | HPLC-MS | NAFLD and ALT according to BPA levels. Median(IQR) BPA: 2.6(1.3–5.3) ng/mL NAFLD | NAFLD risk | Risk of suspected NAFLD was increased in the second quartile of BPA levels. | Age, gender, race/ethnicity, country of birth, poverty to income ratio, tobacco exposure, daily caloric intake |
| BPA | Lee et al. (94) | Korea 2005–2016 | Children of Ewaha Birth and Growth Cohort Study | 164 | Urine | HPLC | Median(IQR) ug/L BPA: 0.61(0.35–1.09) 3–5 years old 0.60(0.34–1.15) 7–9 years old | AST, ALT, GGT | The urinary BPA concentrations at 7–9 years was associated with the serum levels of liver enzymes at 10–13 years of age, but 3–5 years not. | sex, age, BMI, monthly household income, maternal educational level, pubertal status, the frequencies of canned fish and soft drink consumption, exposure to secondhand smoke |
| BPA | Dallio et al. (84) | Italy | NAFLD patients with or without T2DM | 60 | Urine plasma | LC-MS/MS | Urine BPA: 6.17 ± 0.85 ng/ml NAFLD 0.80 ± 0.17 ng/mL control plasma BPA: 5.30 ± 0.78 ng/ml NAFLD 0.36 ± 0.06 ng/ml control | ALT, AST, GGT grade of NAFLD | BPA resulted to be significantly higher in NAFLD subjects compared to controls both in urine and plasma. BPA plasma levels in NASH patients was higher in NAFL patients. | NR |
| BPA | Albeldawi et al. (95) | USA 2005–2006 | NHANES (18–74 years) | 175 | Urine | SPE-HPLC-MS/MS | OR (95%CI) Urinary BPA (1 ng/mL, increase): 0.92(0.83, 1.02) | ALT | BPA exposure was not associated with abnormal ALT levels and risk of liver disease. | Age, sex, race/ethnicity, education, smoking, BMI, waist circumference, urinary creatinine concentration |
UPLC, ultra-high-performance liquid chromatography; HPLC, high-performance liquid chromatography; SPE, solid-phase extraction; HPLC-MS, high-performance liquid chromatography–tandem mass spectrometry; LC-MS, liquid chromatography-mass spectrometry; LC-MS/MS, liquid chromatography coupled to tandem-mass spectrometry.