Table 2.
Summary of results in studies used as primary data: diabetes, prediabetes and hyperglycemia (n = 12 publications)
| Reference | Outcomes & definitions used | Urinary BPA categorisation | Main results | Adjustment in model(s) used for review |
|---|---|---|---|---|
| Prevalent diabetes (8 publications) | ||||
| Ahmadkhaniha et al. 2014 [32] | Type 2 diabetes: self-reported and doctor-diagnosed T2D according to the ADA guideline (FPG >126 mg/dL, HbA1c >6.5 %) for more than one year | BPA in two groups based on the median (<0.85 and ≥0.85 μg/L) | OR = 57.6 (21.1–157.05) | Age, sex, BMI, hypertension, serum triglyceride level, serum cholesterol level, serum creatinine (smoking and consumption of sugared drinks in plastic bottles or canned food in two past weeks were exclusion criteria) |
| Casey & Neidell 2013 [37] | Diabetes: self-report of doctor diagnosis | BPA continuous (not log-transformed) | Per SD increase: | Age, sex, urinary creatinine concentration, race/ethnicity, income, smoking, body mass index, waist circumference, veteran/military status, citizenship status, marital status, household size, pregnancy status, language at subject interview, health insurance coverage, employment status in the prior week, consumption of bottled water in the past 24 h, consumption of alcohol, annual consumption of tuna fish, presence of emotional support in one’s life, being on a diet, using a water treatment device, access to a routine source of health care, vaccinated for Hepatitis A or B, consumption of dietary supplements (vitamins or minerals), inability to purchase balanced meals on a consistent basis + survey cycle for pooled analyses |
| 2003/04: OR = 1.398 (1.183–1.653) | ||||
| 2005/06: OR = 1.008 (0.861–1.181) | ||||
| 2007/08: OR = 0.716 (0.500–1.025) | ||||
| Pooled 2003/08: OR = 1.065 (0.973–1.166) | ||||
| BPA continuous (log-transformed) | Per 10-fold increase: | |||
| 2003/04: OR = 1.492 (1.267–1.757) | ||||
| 2005/06: OR = 1.230 (0.894–1.694) | ||||
| 2007/08: OR = 0.932 (0.759–1.146) | ||||
| Pooled 2003/08: OR = 1.202 (1.049–1.377) | ||||
| BPA in quartiles (ng/mL): Q1: <1.2; Q2: 1.2–2.2; Q3: 2.3–4.2; Q4: >4.2 |
Pooled 2003/08: | |||
| Q2 vs. Q1: OR = 1.443 (0.982–2.119) | ||||
| Q3 vs. Q1: OR = 1.512 (0.998–2.289) | ||||
| Q4 vs. Q1: OR = 1.760 (1.137–2.724) | ||||
| Kim & Park 2013 [56] | Type 2 diabetes: self-reported and doctor-diagnosed | BPA in quartiles (ng/mL): Q1: <1.36; Q2: 1.36–2.14; Q3: 2.15–3.32; Q4: >3.32 |
Q2 vs. Q1: OR = 1.23 (0.62–2.43) | Urinary creatinine, age, sex, BMI, education, cigarette smoking, income, place of residence |
| Q3 vs. Q1: OR = 1.17 (0.60–2.28) | ||||
| Q4 vs. Q1: OR = 1.71 (0.89–3.26) | ||||
| p for trend = 0.374 | ||||
| Lang et al. 2008 [39] | Diabetes: self-report of doctor diagnosis | BPA continuous | Per SD increase: | Age, sex, race/ethnicity, education, income, BMI, WC, smoking status, urinary creatinine |
| OR = 1.39 (1.21–1.60) | ||||
| Melzer et al. 2010 [40] | Diabetes: self-report of doctor diagnosis | BPA continuous | Per SD increase: | Age, gender, ethnicity, education, income, BMI, WC, smoking status, urinary creatinine |
| 2003/04: OR = 1.40 (1.25–1.56) | ||||
| 2005/06: OR = 1.02 (0.76–1.38) | ||||
| Pooled 2003/06: OR = 1.24 (1.10–1.40) | ||||
| Ning et al. 2011 [51] | Type 2 diabetes: FPG ≥7.0 mmol/L or plasma glucose ≥11.1 mmol/L two hours after oral glucose tolerance test or use of diabetes medication | 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 = 1.30 (1.03–1.64) | Age, sex, educational level, family history of diabetes, WC, systolic blood pressure, ln(TG level), ln(hsCRP level), ln(ALT level), estimated glomerular filtration rate, albumin level, total bilirubin level |
| Q3 vs. Q1: OR = 1.09 (0.86–1.39) | ||||
| Q4 vs. Q1: OR = 1.37 (1.08–1.74) | ||||
| p for trend not statistically significant | ||||
| Shankar & Teppala 2011 [42] | Diabetes: fasting serum glucose >126 mg/dL or non-fasting serum glucose >200 mg/dL or HbA1c >6.5 % or self-reported current use of oral hypoglycemic medication or insulin | 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 = 1.42 (1.03–1.96) | Age, gender, race-ethnicity, education categories, smoking, alcohol intake, BMI, systolic and diastolic blood pressure, urinary creatinine, total cholesterol |
| Q3 vs. Q1: OR = 1.48 (1.05–2.08) | ||||
| Q4 vs. Q1: OR = 1.68 (1.22–2.30) | ||||
| p for trend = 0.002 | ||||
| Normal weight participants: | ||||
| Q4 vs. Q1: OR = 3.17 (1.23–8.18) | ||||
| Overweight/obese participants: | ||||
| Q4 vs. Q1: OR = 1.56 (1.09–2.24) | ||||
| Silver et al. 2011 [46] | Type 2 diabetes: HbA1c ≥6.5 % or self-reported use of diabetes medication (insulin or blood sugar-lowering pills) | BPA continuous (log-transformed) | For a doubling in uBPA concentration: | Age, age2, urinary creatinine as natural splines with 4° of freedom, gender, race-ethnicity, education, household income, BMI, WC, smoking status |
| 2003/04: OR = 1.23 (1.07–1.41) | ||||
| 2005/06: OR = 1.06 (0.95–1.19) | ||||
| 2007/08: OR = 1.06 (0.91–1.23) | ||||
| Pooled 2003/08: OR = 1.08 (1.02–1.16) | ||||
| Incident diabetes (1 publication) | ||||
| Sun et al. 2014 [61] | Type 2 diabetes: self-reported diagnosis confirmed with one of the ADA 1998 criteria: a) elevated glucose concentration and ≥1 symptom related to diabetes; b) no symptoms but elevated glucose concentrations on 2 separate occasions; or c) treatment with insulin or oral hypoglycemic medication | BPA in quartiles (ng/mL): | NHS cohort (older women): | Age at urine sample collection, ethnicity, fasting status, time of sample collection, menopausal status, use of hormone replacement therapy (NHSII only), urinary creatinine levels, smoking status, postmenopausal hormone use (NHS only), oral contraceptive use (NHSII only), physical activity, alcohol use, family history of diabetes, history of hypercholesterolemia or hypertension, Alternative Health Eating Index score, BMI |
| NHS cohort / NHSII cohort | Q2 vs. Q1: OR = 0.91 (0.56–1.48) | |||
| Q1: <1.0 / <1.3 | Q3 vs. Q1: OR = 0.98 (0.60–1.61) | |||
| Q2: 1.0–1.5 / 1.3–2.0 | Q4 vs. Q1: OR = 0.81 (0.48–1.38) | |||
| Q3: 1.5–2.7 / 2.0–3.5 | p for trend = 0.45 | |||
| Q4: >2.7 / >3.5 | ||||
| NHSII cohort (younger women): | ||||
| Q2 vs. Q1: OR = 1.34 (0.70–2.27) | ||||
| Q3 vs. Q1: OR = 1.91 (1.11–3.29) | ||||
| Q4 vs. Q1: OR = 2.08 (1.17–3.69) | ||||
| p for trend = 0.02 | ||||
| Prevalent prediabetes (1 publication) | ||||
| Sabanayagam et al. 2013 [41] | Prediabetes: FPG = 100-125 mg/dL or 2-h glucose concentration = 140–199 mg/dL or HbA1c = 5.7–6.4 % (ADA guidelines) | BPA in tertiles (ng/mL): T1: <1.3; T2: 1.3–3.2; T3: >3.2 |
T2 vs. T1: OR = 1.42 (1.14–1.76) | Age, gender, race-ethnicity, education, smoking, alcohol intake, BMI, physical inactivity, mean arterial blood pressure, C-reactive protein, total cholesterol/HDL ratio |
| T3 vs. T1: OR = 1.34 (1.03–1.73) | ||||
| p for trend = 0.02 | ||||
| Stronger associations among women and obese participants. | ||||
| Women: | ||||
| T2 vs. T1: OR = 1.36 (0.96–1.91) | ||||
| T3 vs. T1: OR = 1.49 (1.00–2.22) | ||||
| p for trend = 0.04 | ||||
| Obese: | ||||
| T2 vs. T1: OR = 1.71 (1.05–2.80) | ||||
| T3 vs. T1: OR = 1.65 (1.04–2.80) | ||||
| p for trend = 0.04 | ||||
| Prevalent hyperglycemia (2 publications) | ||||
| Beydoun et al. 2014 [34] | Hyperglycemia: FPG ≥100 mg/dL | BPA continuous (log-transformed) | OR = 1.0 (0.9–1.2) | Age, sex, race, education, marital status, smoking status, physical activity, dietary energy intake, urinary creatinine, survey wave |
| BPA in quartiles (ng/mL): Q1: 0.3 to <1.0; Q2: 1.0 to <2.0; Q3: 2.0 to <3.7; Q4: ≥3.7 |
Q2 vs. Q1: OR = 0.9 (0.52–1.42) | |||
| Q3 vs. Q1: OR = 1.2 (0.7–1.9) | ||||
| Q4 vs. Q1: OR = 1.1 (0.6–1.9) | ||||
| p for trend = 0.55 | ||||
| Ratio of BPA-to-creatinine continuous (log-transformed) | OR = 1.0 (0.9–1.2) | |||
| Ratio of BPA-to-creatinine in quartiles: Q1: 0.001 to <0.01; Q2: 0.01 to <0.02; Q3: 0.02 to <0.03; Q4: ≥0.03 |
Q2 vs. Q1: OR = 1.1 (0.8–1.6) | |||
| Q3 vs. Q1: OR = 1.3 (0.8–1.9) | ||||
| Q4 vs. Q1: OR = 1.2 (0.8–1.9) | ||||
| p for trend = 0.30 | ||||
| Eng et al. 2013 [38] | Abnormal glucose: FPG ≥100 mg/dL | BPA in quartiles (ng/mL) | Age, gender, race/ethnicity, urine creatinine, poverty-to-income ratio, serum cotinine as a marker of smoking status, soda consumption, BMI percentile | |
| Q1: <1.3 | Q2 vs. Q1: OR = 0.77 (0.33–1.78) | |||
| Q2: 1.3–2.6 | Q3 vs. Q1: OR = 1.32 (0.57–3.04) | |||
| Q3: 2.6–4.9 | Q4 vs. Q1: OR = 0.63 (0.22–1.82) | |||
| Q4: >4.9 | ||||
ADA American Diabetes Association; ALT alanine aminotransferase; BMI body mass index; BPA bisphenol A; FPG fasting plasma glucose; HbA1c glycated hemoglobin; HDL high density lipoprotein; hsCRP high sensitivity C-reactive protein; NHS Nurses' Health Study; OR odds ratio, SD standard deviation; T2D type 2 diabetes; TG triglycerides; uBPA urinary bisphenol A; WC waist circumference