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Original Research |

Relationship of Urinary Bisphenol A Concentration to Risk for Prevalent Type 2 Diabetes in Chinese Adults: A Cross-sectional Analysis

Guang Ning, MD, PhD; Yufang Bi, MD; Tiange Wang, MD; Min Xu, MD; Yu Xu, MD; Yun Huang, MD; Mian Li, MD; Xiaoying Li, MD, PhD; Weiqing Wang, MD; Yuhong Chen, MD; Yaohua Wu, MM; Jianing Hou, MD; Aiyun Song, MD; Yu Liu, MD; and Shenghan Lai, MD, MPH
[+] Article and Author Information

From Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; and Johns Hopkins University School of Medicine, Baltimore, Maryland.


Acknowledgment: The authors thank the field workers for their contribution and the participants for their cooperation.

Grant Support: By Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health (1994DP131044), National Key New Drug Creation and Manufacturing Program of Ministry of Science and Technology (2008ZX09312-019), Sector Funds of Ministry of Health (201002002), Creative Research Group of Ministry of Education (IRT0932), Major Project of Shanghai Committee of Science and Technology (09DZ1950200), National Key Technologies Research and Development Program of Ministry of Science and Technology (2008BAI52B03), and the National Natural Science Foundation of China (30725037).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1419.

Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Ning (e-mail, gning@sibs.ac.cn).

Corresponding Author: Guang Ning, MD, PhD, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai 200025, China; e-mail, gning@sibs.ac.cn.

Current Author Addresses: Drs. Ning, Bi, T. Wang, M. Xu, Y. Xu, Huang, M. Li, X. Li, W. Wang, Chen, Wu, Hou, Song, and Liu: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai 200025, China.

Dr. Lai: Johns Hopkins School of Medicine, 600 North Wolfe Street, Pathology 301, Baltimore, MD 21287.

Author Contributions: Conception and design: G. Ning, S. Lai.

Analysis and interpretation of the data: G. Ning, Y. Bi, T. Wang, M. Xu, Y. Xu, Y. Huang, S. Lai.

Drafting of the article: G. Ning, Y. Bi, T. Wang, M. Xu, Y. Xu, Y. Huang, S. Lai.

Critical revision of the article for important intellectual content: G. Ning, Y. Bi, T. Wang, M. Xu, Y. Xu, Y. Huang.

Final approval of the article: G. Ning, Y. Bi, T. Wang, M. Xu, Y. Xu, Y. Huang, M. Li, X. Li, W. Wang, Y. Chen, Y. Wu, J. Hou, A. Song, Y. Liu, S. Lai.

Provision of study materials or patients: G. Ning.

Statistical expertise: G. Ning, Y. Bi, T. Wang, M. Xu, Y. Xu, Y. Huang, S. Lai.

Obtaining of funding: G. Ning.

Administrative, technical, or logistic support: G. Ning.

Collection and assembly of data: Y. Bi, T. Wang, M. Xu, Y. Xu, Y. Huang, M. Li, X. Li, W. Wang, Y. Chen, Y. Wu, J. Hou, A. Song, Y. Liu.


Ann Intern Med. 2011;155(6):368-374. doi:10.7326/0003-4819-155-6-201109200-00005
Text Size: A A A

Background: Greater bisphenol A exposure has been shown to be associated with a higher risk for self-reported adverse health outcomes, including diabetes.

Objective: To examine the association between bisphenol A exposure and type 2 diabetes in adults.

Design: Cross-sectional study.

Setting: Songnan, Baoshan District, Shanghai, China.

Participants: 3423 local residents aged 40 years or older who were enrolled from 27 June 2008 to 10 August 2009.

Measurements: Urinary concentrations of bisphenol A from morning spot urine samples (exposure) and fasting plasma glucose concentration, plasma glucose concentration 2 hours after an oral glucose tolerance test, and serum insulin concentration (outcomes).

Results: Median age of the participants was 59.0 years (interquartile range, 53.0 to 68.7 years), 40% were men, and 1087 had type 2 diabetes. The median urinary bisphenol A level was 0.81 ng/mL (interquartile range, 0.47 to 1.43 ng/mL). Clinical characteristics differed between participants with normal glucose regulation and those with impaired glucose regulation and by bisphenol A quartile, but in multivariable analyses, there was no clear association between bisphenol A levels and type 2 diabetes. The adjusted odds ratio (OR) of type 2 diabetes was slightly increased for participants in the second bisphenol A quartile (0.48 to 0.81 ng/mL) (adjusted OR, 1.30 [95% CI, 1.03 to 1.64]) and the fourth quartile (>1.43 ng/mL) (adjusted OR, 1.37 [CI, 1.08 to 1.74]) but not the third quartile (0.82 to 1.43 ng/mL) (adjusted OR, 1.09 [CI, 0.86 to 1.39]), and a test of the trend of the association was not statistically significant.

Limitations: The cross-sectional study design and nonrandom sample of participants limit the conclusions that can be drawn. Many patients in the study already had diabetes, successful treatment of which could have obscured apparent associations. Dietary variables were not measured; however, this is necessary in observational studies of bisphenol A and diabetes because the presence of the chemical in the body may reflect consumption of sugared drinks in plastic bottles.

Conclusion: These findings do not confirm a previously reported association between urinary bisphenol A levels and self-reported type 2 diabetes.

Primary Funding Source: Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Key New Drug Creation and Manufacturing Program of Ministry of Science and Technology, Sector Funds of Ministry of Health, Creative Research Group of Ministry of Education, Major Project of Shanghai Committee of Science and Technology, National Key Technologies Research and Development Program of Ministry of Science and Technology, and the National Natural Science Foundation of China.

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Summary for Patients

Does the Plastic Chemical Bisphenol A Contribute to Type 2 Diabetes?

The full report is titled “Relationship of Urinary Bisphenol A Concentration to Risk for Prevalent Type 2 Diabetes in Chinese Adults. A Cross-sectional Analysis.” It is in the 20 September 2011 issue of Annals of Internal Medicine (volume 155, pages 368-374). The authors are G. Ning, Y. Bi, T. Wang, M. Xu, Y. Xu, Y. Huang, M. Li, X. Li, W. Wang, Y. Chen, Y. Wu, J. Hou, A. Song, Y. Liu, and S. Lai.

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