Urinary Bisphenol A and Obesity in US Children
Urinary Bisphenol A and Obesity in US Children
Childhood obesity, a major public health problem, can lead to cardiovascular disease in adulthood. Studies have implicated exposure to bisphenol A (BPA), a commonly used chemical, in the development of obesity in adults. However, literature is limited on this association in children. We examined the association between urinary BPA and obesity in children aged 6–18 years from the National Health and Nutrition Examination Survey (2003–2008). The primary exposure was urinary BPA and the outcome was obesity, defined as the ≥95th percentile of body mass index specific for age and sex. We found a positive association between increasing levels of urinary BPA and obesity, independent of age, sex, race/ethnicity, education, physical activity, serum cotinine, and urinary creatinine. Compared with children in the lowest quartile of BPA (<1.5 ng/mL), children in the highest quartile (>5.4 ng/mL) had a multivariable odds ratio for obesity of 2.55 (95% confidence interval (CI): 1.65, 3.95) (Ptrend < 0.01). The observed positive association was predominantly present in boys (odds ratio = 3.80, 95% CI: 2.25, 6.43) (Ptrend < 0.001) and in non-Hispanic whites (odds ratio = 5.87, 95% CI: 2.15, 16.05) (Ptrend < 0.01). In a representative sample of children, urinary BPA was associated with obesity, predominantly in non-Hispanic white boys, independent of major risk factors.
Obesity is a risk factor for several health conditions including cardiovascular diseases, certain cancers, and respiratory ailments, and it adversely affects the health-related quality of life (1). In addition, obese children are at a much a higher risk of being obese in adulthood. In 2009–2010, 16.9% of the US children and adolescents (2–19 years of age) were obese, suggesting that obesity is a severe public health problem in American children. Obesity is caused by a combination of genetic, behavioral, and environmental factors. Several animal studies conducted to date show an association between exposure to endocrine-disrupting chemicals, such as bisphenol A (BPA), and obesity. BPA is a chemical manufactured in large quantities all over the world and used primarily as an intermediate in the production of polycarbonate plastic and epoxy resin that are used in plastic bottles, as lining for food cans, and for dental sealants.
In humans, epidemiologic studies examining this association in adults have generally found a positive association between BPA exposure and obesity. Recent studies have shown that infants and children have higher exposure to BPA than adults. BPA intake is estimated to be highest in infants and children because they eat, drink, and breathe more per pound of their body weight, and they may ingest more BPA because they explore objects orally. Therefore, in addition to studies examining the association between BPA exposure and obesity in adults, we believe it is important to study this hypothesis separately in children also.
There is also a need to study if the association between BPA and obesity varies by gender and race/ethnicity. In animal studies, the effect of exposure to BPA, an environmental estrogen, on later body fat has been shown to be stronger in males. Similarly, because of the reported differences in endogenous estrogen levels by race/ethnicity, it is possible that the contribution of BPA on obesity may vary by race/ethnicity also, in addition to gender.
In this context, we examined the association of urinary BPA and obesity among children aged 6–18 years by combining the National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2008. We also analyzed this association between urinary BPA and obesity separately by race/ethnicity and gender.
Abstract and Introduction
Abstract
Childhood obesity, a major public health problem, can lead to cardiovascular disease in adulthood. Studies have implicated exposure to bisphenol A (BPA), a commonly used chemical, in the development of obesity in adults. However, literature is limited on this association in children. We examined the association between urinary BPA and obesity in children aged 6–18 years from the National Health and Nutrition Examination Survey (2003–2008). The primary exposure was urinary BPA and the outcome was obesity, defined as the ≥95th percentile of body mass index specific for age and sex. We found a positive association between increasing levels of urinary BPA and obesity, independent of age, sex, race/ethnicity, education, physical activity, serum cotinine, and urinary creatinine. Compared with children in the lowest quartile of BPA (<1.5 ng/mL), children in the highest quartile (>5.4 ng/mL) had a multivariable odds ratio for obesity of 2.55 (95% confidence interval (CI): 1.65, 3.95) (Ptrend < 0.01). The observed positive association was predominantly present in boys (odds ratio = 3.80, 95% CI: 2.25, 6.43) (Ptrend < 0.001) and in non-Hispanic whites (odds ratio = 5.87, 95% CI: 2.15, 16.05) (Ptrend < 0.01). In a representative sample of children, urinary BPA was associated with obesity, predominantly in non-Hispanic white boys, independent of major risk factors.
Introduction
Obesity is a risk factor for several health conditions including cardiovascular diseases, certain cancers, and respiratory ailments, and it adversely affects the health-related quality of life (1). In addition, obese children are at a much a higher risk of being obese in adulthood. In 2009–2010, 16.9% of the US children and adolescents (2–19 years of age) were obese, suggesting that obesity is a severe public health problem in American children. Obesity is caused by a combination of genetic, behavioral, and environmental factors. Several animal studies conducted to date show an association between exposure to endocrine-disrupting chemicals, such as bisphenol A (BPA), and obesity. BPA is a chemical manufactured in large quantities all over the world and used primarily as an intermediate in the production of polycarbonate plastic and epoxy resin that are used in plastic bottles, as lining for food cans, and for dental sealants.
In humans, epidemiologic studies examining this association in adults have generally found a positive association between BPA exposure and obesity. Recent studies have shown that infants and children have higher exposure to BPA than adults. BPA intake is estimated to be highest in infants and children because they eat, drink, and breathe more per pound of their body weight, and they may ingest more BPA because they explore objects orally. Therefore, in addition to studies examining the association between BPA exposure and obesity in adults, we believe it is important to study this hypothesis separately in children also.
There is also a need to study if the association between BPA and obesity varies by gender and race/ethnicity. In animal studies, the effect of exposure to BPA, an environmental estrogen, on later body fat has been shown to be stronger in males. Similarly, because of the reported differences in endogenous estrogen levels by race/ethnicity, it is possible that the contribution of BPA on obesity may vary by race/ethnicity also, in addition to gender.
In this context, we examined the association of urinary BPA and obesity among children aged 6–18 years by combining the National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2008. We also analyzed this association between urinary BPA and obesity separately by race/ethnicity and gender.
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