Table 1.
Human studies addressing exposure to BPA and obesity (n=31)
| Authors, year | Country | Study design, quality | Study objective | Source population | Sex and age | Sample size | Sample, compounds (DR) and method | Outcomes | Adjustment for confounding factors | Main findings |
| Carwile et al, 201138 | USA | Cross-sectional, 7 | To investigate the association between [urinary BPA] and general and central obesity | General adult population, NHANES 2003–2006 | Female and male, 18–74 years | 2747 | Urine BPA (92%) HPLC-MS |
BMI, WC | Age, sex, race, education, smoking, urinary creatinine | Higher [urinary BPA] associated with higher BMI and WC |
| Shankar et al, 201217 | USA | Cross-sectional, 7 | To investigate the association between [urinary BPA] and obesity by gender and race/ethnicity | General adult population, NHANES 2003–2008 | Female and male, >20 years (mean 44.9±0.4 years) | 3967 | Urine BPA (NS) HPLC-GC-MS |
BMI, WC | Age, gender, race/ethnicity, education, smoking, alcohol intake, physical inactivity, diabetes, hypertension, TC | Positive association between [urinary BPA] and higher BMI and WC, independent of gender and race/ethnicity |
| Trasande et al, 201218 | USA | Cross-sectional, 7 | To investigate the association between [urinary BPA] and body mass outcomes | Children, NHANES 2003–2008 | Female and male, 6–19 years | 2338 | Urine BPA (96.5%) HPLC-MS |
BMI (sex-standardised and age-standardised z-score) | Age, sex, race/ethnicity, caregiver education, poverty to income ratio, serum cotinine levels, caloric intake, television watching, urinary creatinine | Significant association between [urinary BPA] and obesity |
| Wang et al, 201264 | China | Cross-sectional, 7 | To investigate the association between [urinary BPA] and obesity and insulin resistance | General adult population | >40 years | 3390 | Urine BPA (NS) HPLC-MS |
BMI, WC | Age, sex, education, smoking, urinary creatinine, alcohol drinking, systolic blood pressure, HDL-C, LDL-C, TC, TG, hs-CRP, fasting blood glucose and insulin, ALT, GGT | Higher [urinary BPA] associated with higher BMI and WC |
| Wang et al, 201265 | China | Cross-sectional, 6 | To investigate the association between [urinary BPA] and obesity | Primary and middle school children | Female and male, 8–15 years | 259 | Urine BPA (84.9%) HPLC-MS |
BMI (categories identified according to the Working Group on Obesity in China) | Age, sex, urine specific gravity | Higher [urinary BPA] associated with higher BMI, significant only for girls aged 8–11 years after stratification for age and sex |
| Bhandari et al, 201319 | USA | Cross-sectional, 7 | To investigate the association between [urinary BPA] and obesity | General paediatric population, NHANES 2003–2008 | Female and male, 6–18 years | 2664 | Urine BPA (NS) HPLC-MS/MS |
BMI, OB (BMI > p95) | Age, sex, race/ethnicity, parent/guardian education, urinary creatinine, serum cotinine, moderate physical activity | Higher [urinary BPA] associated with obesity |
| Eng et al, 201320 | USA | Cross-sectional, 7 | To investigate the association between [urinary BPA] and measures of adiposity and chronic disease risk factors | General paediatric population, NHANES 2003–2010 | Female and male, 6–18 years | 3370 (BMI), 2231 (WC), 3321 (WC-to-height), 775 (%BF) | Urine BPA (95.5%) HPLC-MS |
BMI categories (OW > p85, OB > p95), WC (> p75 or > p90), WC-to-height (> 0.5), %BF, DXA (> p85, age-adjusted and gender-adjusted) | Age, gender, race/ethnicity, urine creatinine, poverty-to-income ratio, serum cotinine, soda consumption | Higher [urinary BPA] associated with higher odds of obesity (BMI > p95) and abnormal WC-to-height ratio |
| Li et al, 201366 | China | Cross-sectional, 6 | To investigate the association between [urinary BPA] and overweight/obesity in school-age children | General population of children and adolescents (from a larger national study of pubertal development and health of adolescents) | Female and male, >9 years | 1326 | Urine BPA (NS) HPLC-fluorescence detection |
Weight (OW > p90), BMI, HC, WC, WC-to-height ratio, skinfold thickness | Age, gender, school grade, residence, paternal and maternal education and OW, playing video games, unbalanced diet, junk food consumption, vegetables or fruit consumption, depression scores, sports/activities | Higher [urinary BPA] associated with higher risk of overweight among girls aged 9–12 years, in a dose-dependent fashion |
| Harley et al, 201346 | USA | Cross-sectional, 7, and prospective, 8 | To investigate the association between [urinary BPA] anthropometric parameters and prevalent OW/OB in children | Subjects from the CHAMACOS cohort | Male and female, 9 years | 311 | Urine BPA (NS) HPLC-MS/MS |
BMI z-score, BMI categories (OW > p85, OB > p95), WC, BF% (bioimpedance) | Urine-specific gravity, maternal prepregnancy BMI, household income, maternal education level, maternal years of residence in the USA, child’s environmental tobacco smoke exposure, soda intake, fast food intake, and sweet consumption at ages 5 and 9 years | [Urinary BPA] at 9 years associated with increased BMI z-score, WC, BF% and prevalent OB/OW at 9 years; [urinary BPA] at 5 years not associated with anthropometric parameters or prevalent OB/OW at 5 or 9 years |
| Choi et al, 201467 | South Korea | Cross-sectional, 4 | To investigate the association between obesity and POPs | Subjects from a medical college in Seoul | Female, 6–14 years | 127 (58 controls, 69 obese) | Urine and serum BPA (NS) GC-MS |
BMI (OB > p85) | None | [Serum and urinary BPA] not associated with obesity |
| Ko et al, 201468 | South Korea | Cross-sectional, 7 | To investigate the association between [urine BPA] and WC | General adult population, from a previous study on integrated exposure to hazardous materials for safety control | Female and male, 44.3±14.6 years | 1030 | Urine BPA (NS) HPLC-MS |
BMI, WC (abdominal OB: > 90 cm for men and > 85 cm for women), %BF* | Age, sex, urinary creatinine (for all outcomes) Age, sex, urinary creatinine, education, income, alcohol consumption, smoking status (for abdominal obesity) | Higher [urinary BPA] associated with higher BMI, WC and BF |
| Ronn et al, 201447 | Sweden | Cross-sectional, 6 | To investigate the association between [serum BPA] and different indices of obesity | General elderly population | Female and male, 70 years | 890 (DXA) and 287 (MRI) | Serum total BPA (98%) Isotope liquid chromatography-MS |
Fat mass by DXA and MRI | Sex, height, lean mass, smoking, exercise habits, educational level, total daily energy intake, alcohol consumption | [Serum BPA] not associated with fat mass or fat distribution |
| Song et al, 201421 | USA | Cross-sectional, 6, and prospective, 8 | To investigate the association between [urinary BPA] and prospective weight change during 10-year follow-up | Adult female non-diabetic (control) population from NHS and NHSII | Female, 53–79 years | 977 | Urine BPA (NS) HPLC-MS |
BMI, weight change (kg) | Age, urinary creatinine, cohort origin, menopausal status, smoking, physical activity, alcohol consumption, AHEI and total energy intake | [Urinary BPA] not associated with baseline BMI Higher [urinary BPA] associated with modestly greater weight gain in a dose-dependent fashion |
| D’Aniello et al, 201548 | Italy | Cross-sectional, 4 | To investigate the association between sleep deprivation/fragmentation, fructose-rich diets and [urinary BPA] and obesity | Children from the teaching hospital and at the local health service outpatient obesity clinics and well-child visits in Salerno | Female and male, 5–16 years | 54 | Urine total (94.4%) and free BPA (90.7%) GC-MS |
BMI (normal p5-p85, OW p85-p95, OB > p95), WC, WC-to-height ratio, WC-to-hip ratio | Urinary creatinine | Higher total and free [urinary BPA] associated with increase in BMI, WC and WC-to-height ratio |
| Geens et al, 201549 | Belgium | Cross-sectional, 6 | To investigate the association between [urinary BPA] and anthropometric data | OW and obese adults from the Endorup trial (Antwerp University Hospital), lean controls from hospital staff and volunteers | Female and male, >18 years | 194 | Urine BPA (>99%) GC-MS |
BMI, WC | Age, gender, weight loss, urinary creatinine | Higher [ urinary BPA] in obese subjects |
| Lee et al, 201569 | South Korea | Cross-sectional, 7 | To investigate the association between [urinary BPA] and obesity | Participants of the Korean Elderly Environmental Panel study | Female and male, >60 years | 558 | Urine BPA (NS), average concentration from five samples collected at intervals from 6 to 12 months HPLC-MS |
BMI, OW (BMI > 25 kg/m2) | Age, sex, LDL-C, alcohol consumption, regular exercise, total calorie intake, fatty acid intake, urinary cotinine, diabetes | Higher [urinary BPA] significantly associated with OW in elderly women |
| Milic et al, 201550 | Serbia | Cross-sectional, 3 | To investigate the occurrence of BPA in morning spot urine and the association between [urinary BPA] and obesity | Residents in Novi Sad, Serbia | Female, 19–59 years | 145 | Urine BPA (29.3%–54.5%) GC-MS |
BMI | Urinary creatinine | [Urinary BPA] not associated with OW and OB |
| Sopon et al, 201570 | Thailand | Cross-sectional, 5 | To investigate exposure of children and adolescents to BPA and the association between [urinary BPA] and obesity | Children and adolescents from two schools in the Patumwan District of Bangkok | Female and male, 3.58–17.17 years | 376 | Urine BPA (75.3%) HPLC-MS |
BMI (OW: z-score > 1.036 or > p85 for age and sex; OB: z-score > 1.64 or > p95 for age and sex) | Urinary creatinine | BPA detection rate significantly higher in obese children, but there was no difference in BPA levels according to BMI category |
| Savastano et al, 201551 | Italy | Cross-sectional, 5 | To investigate the association between [plasma BPA] and visceral obesity | Adult non-diabetic and Caucasian male, enrolled by routine health survey at the ‘Frederico II’ University of Naples outpatient facility | Male, 53.5±5.7 years | 76 | Plasma BPA (NS) ELISA |
BMI and WC | Not stated | Increased [plasma BPA] correlated with increased WC |
| Xue et al, 201571 | India | Cross-sectional, 6 | To investigate the association between [urinary POPs] and obesity | Patients from the Endocrinology Outpatient Department of the Amrita Institute of Medical Sciences, Kochi, India | Male and female, 2–14 years | 103 (49 OW or obese and 27 normal-weight healthy controls) | Urine BADGE, BADGE.2H2O, TBAFs, BPA, BPS, total BPS (70%–99%) LC-MS |
BMI (OW: BMI > p85; OB: BMI > p95) | Age, sex, family income, parent education, physical activity, urinary creatinine | [Urinary bisphenol group compounds] not associated with obesity |
| Hoepner et al, 201640 | USA | Cross-sectional, 7, and prospective, 7 | To investigate the association between [urinary BPA] at 3 and 5 years, and BMI z-score, FMI, %BF, and WC at 5 and 7 years | Participants from the Columbia Center for Children’s Environmental Health New York City birth cohort | Male and female, 3 and 5 years | 408 | Urine BPA (98%) HPLC-MS/MS |
BMI z-score, %BF, FMI, WC | Maternal variables: prepregnancy maternal BMI, race/ethnicity, child variables: sex, birth weight, gestational age at birth, urinary SG, height, (urinary PHT levels) | [Urinary BPA] were not associated with BMI and WC cross-sectionally or prospectively |
| Vafeiadi et al, 201663 | Greece | Cross-sectional, 7, and prospective, 7 | To investigate the association between [urinary BPA] at 2.5 and 4.0 years and BMI, WC, skinfold thickness and prevalent obesity at 2.5 and 4.0 years | Subjects from the Rhea Mother-Child Study | Male and female, at 2.5 and 4.0 years | 500 | Urine BPA (98.8-99.6%) HPLC-EI-MS/MS |
BMI, WC, BMI z-score, WC; abdominal obesity (WC > p90), skinfold thickness | Maternal educational level, maternal age, prepregnancy BMI, working status during pregnancy, child sex, z score of birth weight for gestational age and breastfeeding status | [Urinary BPA] at 4 years positively associated with BMI z-score, WC, skinfold thickness and prevalence of obesity [Urinary BPA] at 2.5 years not associated with anthropometric measures at 2.5 years or prevalence of obesity at 4 years |
| Hong et al, 201772 | South Korea | Cross-sectional, 6 | To investigate the association between [urinary EDCs] and insulin resistance and obesity in healthy, reproductive-aged women | Subjects recruited using local advertisement at a community health and service centre and Ewha Womans University Mokdong Hospital outpatient clinic | Female, 30–49 years | 296 | Urine BPA (NS) HPLC-MS |
BMI, WC | Age, smoking, alcohol consumption, TG, TC, HDL-C, urinary creatinine | [Urinary BPA] positively associated with BMI and WC |
| Li et al, 201722 | USA | Cross-sectional, 6 | To investigate the association between [urinary BPA] and body composition | General adult population, NHANES 2003–2006 | Male and female, 8–19 years | 1860 | Urine BPA (NS) HPLC-MS |
BF% (DXA) | Age, ethnicity/race, height, caregiver's education, family income to poverty ratio, serum cotinine level, daily calorie intake, television/video watching, computer use, survey year, urinary creatinine | [Urinary BPA] positively associated with lean BMI in boys, and positively associated with elevated FMI in girls. Lower [urinary BPA] associated with lower percentage of trunk fat in girls |
| Milosevic et al, 201752 | Serbia | Cross-sectional, 3 | To investigate the association between [urinary BPA] and obesity and abdominal obesity among non-occupationally BPA-exposed women | Residents in the Autonomous Region of Vojvodina, Serbia | Female, 19–50 years | 103 | Urine BPA (35.9%) GC-MS |
BMI, WC, OW/obesity (BMI > 25), WHR, visceral adiposity index | Urinary creatinine | Detectable [urinary BPA] significantly associated with higher WC and WHR. Linear correlation between [urinary BPA] and BMI, WC and WHR among obese women |
| Hao et al, 201773 | China | Cohort, 8 | To investigate the association between [urinary BPA] and incident abdominal obesity | Residents in the Songnan Community, Baoshan District, Shangai, China, free from abdominal obesity at baseline | Male and female, >40 years | 888 | Urine BPA (NS) HPLC-MS |
WC (> 90 cm for men and > 80 cm for women, IDF criteria for Chinese adults) after 4 years | Age, sex, urinary creatinine, BMI, diabetes, smoking, alcohol consumption, education | [Urinary BPA] associated with increased risk of incident abdominal obesity after 4 years |
| Deierlein et al, 201736 | USA | Cohort, 9 | To investigate the association between [urinary EDCs] and changes in adiposity measurements after 8 years, in elementary school-aged girls | Subjects from the puberty cohort studies of the Breast Cancer and Environment Research Program | Female, 6–8 years | 1017 | Urine BPA (>80%) HPLC-MS | BMI, WC, BF% (bioelectrical impedance analysis) | Age, urinary creatinine, race/ethnicity, site of study, caregiver education, early puberty, baseline weight | [Urinary BPA] not associated with changes in adiposity measurements after 8 years |
| Kataria et al, 201737 | USA | Cross-sectional, 5 | To investigate the association between [urinary bisphenols and PHT] and body mass in children | Children from the General Pediatric Clinic at Bellevue Medical Center | Female and male, 10–13 years | 41 | Urine BPA, BPS, BPF (NS) HPLC-MS/MS |
BMI | Urinary creatinine, gender, age, caloric intake, physical activity | [Urinary bisphenols] not associated with BMI |
| Yang et al, 201786 | Mexico | Cross-sectional, 8 | To investigate the association between exposure to BPA and PHTs and obesity | Participants from the 22-year Early Life Exposure in Mexico to Environmental Toxicants cohort | Female and male, 8–14 years | 249 | Urine BPA (85%) LC-MS/MS |
WC, BF (skinfold thickness), BMI z-score | Urine-specific gravity, mother’s age, BMI, years of schooling and smoking status, child’s age and gender | [Urinary BPA] positively associated with skinfold thickness among girls but not boys |
| Liu et al, 201739 | USA | Cross-sectional, 7 | To investigate the association between [urinary BPA, BPF and BPS] and obesity | General adult population, NHANES 2013–2014 | Male and female, >20 years | 1521 | Urine BPA (94.94%), BPF (65.42%), BPS (90.6%) HPLC-MS/MS |
OB and OW defined by BMI, abdominal obesity defined by WC | Age, sex, urinary creatinine, race/ethnicity, education, family income, cigarette smoking, physical activity, total energy intake, BPA, BPF and BPS | [Urinary BPA] associated with general and abdominal obesity |
| Mouneimne et al, 201782 | Lebanon | Cross-sectional, 5 | To investigate the association between [urinary BPA] and metabolic disorders | Residents from the District of the Greater Beirut area, random selection | Male and female, >18 years | 501 | Urine BPA (89%) HPLC-MS | OB defined by BMI | Gender, education, age, smoking status, physical activity | [Urinary BPA] not associated with obesity |
*No description of %BF assessment.
AHEI, Alternative Healthy Eating Index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BADGE, bisphenol A diglycidyl ether; BF, body fat; BMI, body mass index; BPA, bisphenol A; BPF, bisphenol F; BPS, bisphenol S; CHAMACOS, Center for the Health Assessment of Mothers and Children of Salinas; DR, detection rate; DXA, dual-energy X-ray absorptiometry; EDC, endocrine-disrupting chemical; ELISA, enzyme-linked immunosorbent assay; FMI, fat mass index; GC-MS, gas chromatography–mass spectrometry; GGT, gamma-glutamyl transferase; HA, hypothalamic amenorrhea; HC, hip circumference; HDL-C, high-density lipoprotein cholesterol; HPLC-EI-MS/MS, high performance liquid chromatography combined with electrospray ionisation and tandem mass spectrometry; HPLC-GC-MS, high-performance liquid chromatography–gas chromatography/mass spectrometry; HPLC-MS, high performance liquid chromatography-mass spectrometry; HPLC-MS/MS, high performance liquid chromatography-tandem mass spectrometry; hs-CRP, high-sensitivity C reactive protein; IDF, International Diabetes Federation; LC-MS, liquid chromatography-mass spectrometry; LC-MS/MS, isotope dilution-liquid chromatography-tandem mass spectrometry; LDL-C, low-density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Survey; NHS, Nurses’ Health Study; NHSII, Nurses' Health Study II; NS, not stated; OB, obesity; OW, overweight; PCOS, polycystic ovary syndrome; PHT, phthalate; POP, persistent organic pollutant; SG, specific gravity; TBAFs, tetrabutylamonium fluorides; TC, total cholesterol; TG, triglyceride; WC, waist circumference; WHR, waist-to-hip ratio.