Urinary bisphenol A and incidence of metabolic syndrome among Chinese men: a prospective cohort study from 2013 to 2017

Occup Environ Med. 2019 Oct;76(10):758-764. doi: 10.1136/oemed-2019-105893. Epub 2019 Aug 22.


Objectives: Experimental studies suggested that bisphenol A (BPA) exposure increased the risk of metabolic syndrome (MetS) through the mechanism of insulin resistance. All previous epidemiological studies of BPA and MetS were cross-sectional studies, and their findings were mixed. This study aims to provide further evidence on the association between urinary BPA and risk of MetS using a prospective cohort study in China.

Methods: The study population was from the Shenzhen Night shift workers' cohort. A total of 1227 male workers were recruited from the baseline survey in 2013 and then followed until 2017. Modified Adult Treatment Panel III criteria were used to identify the cases of MetS. Urinary BPA concentration was assessed using high-performance liquid chromatography-tandem mass spectrometry, and it was categorised into three subgroups by tertiles to obtain the adjusted HR (aHR) and 95% CI using Cox proportional hazard model.

Results: During 4 years of follow-up, 200 subjects developed MetS. Compared with the lowest urinary BPA subgroup, a weakly increased risk of MetS was suggested among those with the middle (aHR=1.19, 95% CI 0.87 to 1.63) and high level of urinary BPA (aHR=1.16, 95% CI 0.84 to 1.59); however, the significant association with MetS was restricted primarily to the smokers, showing a positive gradient with urinary BPA (middle level: aHR=2.40, 95% CI 1.13 to 5.08; high level: aHR=2.87, 95% CI 1.38 to 5.98; p trend= 0.010).

Conclusion: This prospective cohort study provided further evidence that exposure to BPA may increase the risk of MetS, and this association was further positively modified by cigarette smoking.

Keywords: endocrine disrupters; epidemiology; smoking.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Benzhydryl Compounds / urine*
  • China / epidemiology
  • Cigarette Smoking
  • Cohort Studies
  • Humans
  • Incidence
  • Male
  • Metabolic Syndrome / epidemiology*
  • Middle Aged
  • Phenols / urine*
  • Prospective Studies


  • Benzhydryl Compounds
  • Phenols
  • bisphenol A