Council on Environmental Health
Article Review

Prepared by: Megan T. Sandel, MD
December 2008

Association of Urinary Bisphenol A Concentration With Medical Disorders and Laboratory Abnormalities in Adults 

Iain A. Lang, PhD; Tamara S. Galloway, PhD; Alan Scarlett, PhD; William E. Henley, PhD; Michael Depledge, PhD, DSc; Robert B. Wallace, MD; David Melzer, MB, PhD

JAMA. 2008;300(11):1303-1310 

Cross sectional

Bisphenol A (BPA) is widely used plasticizer chemical added to epoxy resins lining food and beverage containers to make them harder. Evidence of effects in animals has generated concern over low-level chronic exposures in humans. 

This article looks at a cross-sectional analysis of BPA concentrations and health status in the general adult population of the United States, using data from the National Health and Nutrition Examination Survey 2003-2004, a large national survey done asking questions about health and nutrition by patient recall and some biomarker sampling of blood and urine. Participants were 1455 adults aged 18 through 74 years with measured urinary BPA and urine creatinine concentrations. Regression models were adjusted for age, sex, race/ethnicity, education, income, smoking, body mass index, waist circumference, and urinary creatinine concentration.

Higher urinary BPA concentrations were associated with cardiovascular diagnoses (angina, coronary heart disease, heart attack)  in age-, sex-, and fully adjusted models (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.18-1.63; P = .001 with full adjustment). Higher BPA concentrations were also associated with diabetes (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.21-1.60; P < .001) but not with other studied common diseases, such as arthritis, cancer, asthma, emphysema, liver disease, stroke or thyroid disease.) In addition, higher BPA concentrations were associated with clinically abnormal concentrations of the liver enzymes GGT (OR per 1-SD increase in BPA concentration, 1.29; 95% CI, 1.14-1.46; P < .001) and alkaline phosphatase (OR per 1-SD increase in BPA concentration, 1.48; 95% CI, 1.18-1.85; P = .002). 

Higher BPA exposure, reflected in higher urinary concentrations of BPA, may be associated with avoidable morbidity in the community-dwelling adult population. 

This is an interesting and well written article that represents the first large-scale and high-quality population-representative data set to become available to study the relationship between BPA and adult health outcomes.  Though these are adult findings, these findings add to the evidence suggesting adverse effects of low-dose BPA in animals and maybe relevant for children, but independent replication and follow-up studies are needed to confirm these findings and to provide evidence on whether the associations are causal.


Facts sheets from the Pediatric Environmental Health Specialty Units (PEHSUs), in English and Spanish:

Also from NIEHS and CDC:


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