Article Text

Download PDFPDF
Original article
Urinary bisphenol A and incidence of metabolic syndrome among Chinese men: a prospective cohort study from 2013 to 2017
  1. Suyang Wu1,
  2. Feng Wang1,
  3. Shaoyou Lu2,
  4. Yi Chen3,
  5. Wenbo Li4,
  6. Zhimin Li5,
  7. Liuzhuo Zhang5,
  8. Hongying Huang5,
  9. Wenting Feng5,
  10. Victoria H Arrandale6,
  11. Greg J Evans6,
  12. Lap Ah Tse1
  1. 1 JC School of Public Health and Primary Care, the Chinese University of Hong Kong, New Territories, Hong Kong
  2. 2 School of Public Health (Shenzhen), Sun Yat-Sen University, Guangzhou, China
  3. 3 State Key Laboratory of Pollution Control and Resource Reuse, Nanjing University, Nanjing, China
  4. 4 Institute of Environmental Pollution and Health, Shanghai University, Shanghai, China
  5. 5 Institute of Occupational Medicine, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, China
  6. 6 Occupational and Environmental Health Division, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Professor Lap Ah Tse, JC School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong; shelly{at}


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.

  • epidemiology
  • smoking
  • endocrine disrupters

Statistics from


  • Contributors SW, FW and LAT drafted the manuscript. SL, YC, SW and WL performed laboratory tests. ZL, LZ, HH, WF, FW and SW carried out filed work and collected data. VHA and GJE critically reviewed the manuscript and provided important comments. LAT supervised the entire project and revised the manuscript critically. All authors discussed the results and approved the final manuscript.

  • Funding This work was supported by National Natural Science Foundation of China (project numbers 81273172 and 81372964).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No: CRE-2013.107).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.