By 2008, questions about the safety of BPA in humans had begun to capture the public’s attention.6,7 The Canadian government declared BPA toxic and banned its use in manufacturing, and environmental-health advocates in the United States called for state legislatures to restrict BPA in children’s products.

Retailers and consumer groups started demanding non-BPA-containing plastics. Pediatricians were particularly concerned about limiting BPA exposure in pregnant women, infants, and young children.4,8


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Emerging research 


BPA in food or water has the potential for widespread biologic effects in humans. Many studies link high BPA exposure with obesity and cardiovascular disease risk factors. Trasande, Attina, and Blustein found a positive correlation between BPA and obesity in children and adolescents. In their cross-sectional analysis of urinary BPA levels in 2,838 participants aged 6 through 19 years randomly selected from the 2003-2008 National Health and Nutrition Examination Survey (NHANES), higher BMI was shown to be associated with greater urinary BPA levels.1

Looking at levels of urinary BPA and the BMI and waist circumference of 2,747 adults from the 2003-2004 NHANES, Carwile and Michels found a positive correlation of higher BPA exposure with general and central obesity in the adult population.9

Wang et al found similar results in a study of 3,390 Chinese adults older than age 40 years. In addition to a positive correlation of BPA with generalized obesity and abdominal obesity, the investigators also found an association between BPA and insulin resistance in the middle-aged adult population.10

A study of 1,380 subjects from the 2003-2004 NHANES showed a positive correlation of increasing levels of urinary BPA with hypertension independent of such confounding risk factors as age, gender, ethnicity/race, smoking, BMI, diabetes mellitus, and total serum cholesterol levels. A positive correlation was also found between high urinary BPA levels and diabetes mellitus.11 Subsequent studies have reached similar conclusions.12

Lind and Lind proposed that circulating levels of BPA are related to carotid atherosclerosis in the elderly. Circulating levels of BPA in 1,016 subjects older than age 70 years were correlated with echogenicity of carotid artery plaque, suggesting that BPA may play a role in atherosclerosis.13

According to Shankar, Teppala, and Sabanayagam, BPA may have a role in the development of peripheral arterial disease as well as cardiovascular disease risk factors, including weight gain, insulin resistance, and endothelial dysfunction.14

Perinatal exposure to endocrine-disrupting compounds (including BPA) appear to be associated with the occurrence of autism as well as ADHD in children.15

What is being done?


In general, regulatory authorities have concluded that current studies are insufficient and preclude a complete understanding of the effects of BPA in humans. Since BPA is such a widely used chemical, there are substantial commercial interests dedicated to keeping BPA in products, on the market, and unregulated.16 There simply are not enough hard data to persuade national legislators to work against corporate interests.17

In an effort to address this problem, two NIH organizations, the National Institute of Environmental Health Sciences (NIEHS) and the National Toxicology Program, have developed an integrated and multipronged consortium-based approach to optimize BPA research.17 This effort aims to provide more credible information and resolve controversies over the potential human health effects of BPA exposure.18

Due to ongoing questions and concerns many manufacturers of infant and baby items voluntarily chose to start using BPA-free plastics in their products, and 10 states have passed legislation limiting BPA use in products intended for use by infants and children.5

In July 2012, the FDA officially banned BPA in baby bottles and children’s drinking cups, but the prohibition does not apply more broadly to the use of BPA in other containers, such as cans and water bottles. The agency has stated that the decision is not a reversal of it’s position on BPA, but a move to boost consumer confidence.19

The FDA previously turned down a petition from the Natural Resources Defense Council (NRDC) that called for a complete ban of BPA in all food and beverage containers.20

What to tell your patients about BPA


  • Reduce use of canned foods and beverages unless the label specifically states that the container is BPA-free. 

  • When possible, opt for glass, porcelain, or stainless steel containers, particularly for hot food or liquids.

  • Avoid using plastic containers for hot food or liquid.

  • Do not pour hot liquids into a plastic baby bottle unless it is BPA-free.

  • Discard worn or scratched baby bottles and cups. 

  • Before mixing water with powdered infant formula, boil in a BPA-free container and allow to cool to lukewarm.

  • Do not heat canned ready-to-feed liquid formula on the stove or in boiling water.

  • Do not heat baby bottles of any kind in the microwave. 

  • Only use containers marked “dishwasher-safe” in the dishwasher and “microwave-safe” in the microwave.

  • Direct patients to the following resources for more information on BPA and what is being done to improve consumer safety: the EPA’s BPA Action Plan Summary, the U.S. Department of Health and Human Services BPA Information for Parents, and the NIEHS Questions and Answers about BPA.


Conclusion


Past research concentrated on the carcinogenicity of low doses of BPA, with no convincing evidence of its cancer-causing potential. New research on low doses of BPA suggests an association with a variety of adverse health effects.

Current studies link BPA to multiple pathophysiologic effects, including obesity, hypertension, insulin resistance, and neurobehavioral problems in children. These new findings challenge the long-standing scientific presumption of BPA’s safety.

More investigation is needed to determine the potential adverse health effects of BPA in humans and to understand the multiple pathways through which it acts.

Theresa Capriotti, DO, MSN, CRNP, is Clinical Associate Professor, Villanova University College of Nursing, Villanova, Pa., where Ms. Aurora Vandewark is a junior level honors student.


References


  1. Trasande L, Attina TM, Blustein J. Association between urinary bisphenol A concentration and obesity prevalence in children and adolescents. JAMA. 2012;308:1113-1121. 

  2. Vogel SA. The politics of plastics: the making and unmaking of bisphenol a “safety”. Am J Public Health. 2009;99:S559-S566. 

  3. Geens T, Aerts D, Berthot C, et al. A review of dietary and non-dietary exposure to bisphenol-A. Food Chem Toxicol. 2012;50:3725-3740.

  4. Groff T. Bisphenol A: invisible pollution. Curr Opin Pediatr. 2010;22:
524-529.

  5. Roberts R. BPA exposure and health effects: educating physicians and patients. Am Fam Physician. 2012;85:1040-1044.

  6. Lang IA, Galloway TS, Scarlett A, et al. Association of urinary bisphenol A concentration with medical disorders and laboratory abnormalities in adults. JAMA. 2008;300:1303-1310. 

  7. Walsh B. The chemical within. BPA is everywhere. Is it dangerous? We don’t really know. Time. 2011;178:22. 

  8. Vom Saal FS, Nagel SC, Coe BL, et al. The estrogenic endocrine disrupting chemical bisphenol A (BPA) and obesity. Mol Cell Endocrinol. 2012;354:74-84. 

  9. Carwile JL, Michels KB. Urinary bisphenol A and obesity: NHANES 2003-2006. Environ Res. 2011;111:825-830. 

  10. Wang T, Li M, Chen B, et al. Urinary bisphenol A (BPA) concentration associates with obesity and insulin resistance. J Clin Endocrinol Metab. 2012;97:E223-E227. 

  11. Shankar A, Teppala S. Urinary bisphenol A and hypertension in a multiethnic sample of US adults. J Environ Public Health. 2012;2012:481641.

  12. Shankar A, Teppala S. Relationship between urinary bisphenol A levels and diabetes mellitus. J Clin Endocrinol Metab. 2011;96:3822-3826. 

  13. Lind PM, Lind L. Circulating levels of bisphenol A and phthalates are related to carotid atherosclerosis in the elderly. Atherosclerosis. 2011;218:207-213.

  14. Shankar A, Teppala S, Sabanayagam C. Bisphenol A and Peripheral Arterial Disease: Results from the NHANES. Environ Health Perspect. 2012;120:1297-1300. 

  15. de Cock M, Maas YG, van de Bor M. Does perinatal exposure to endocrine disruptors induce autism spectrum and attention deficit hyperactivity disorders? Acta Paediatr. 2012;101:811-818.

  16. Betancourt AM, Eltoum IA, Desmond RA, Russo J, Lamartiniere CA. In utero exposure to bisphenol A shifts the window of susceptibility for mammary carcinogenesis in the rat. Environ Health Perspect. 2010;118:1614-1619. 

  17. Borrell B. Toxicology: The big test for bisphenol A. Nature. 2010;464:1122-1124. 

  18. Birnbaum LS, Bucher JR, Collman GW, et al. Consortium-based science: the NIEHS’s multipronged, collaborative approach to assessing the health effects of bisphenol A. Environ Health Perspect. 2012;120:1640-1644.
  19. Tavernese S.”FDA Makes it Official: BPA Can’t Be Used in Baby Bottles and Cups.” New York Times. July 17, 2012.
  20. U.S. Department of Health and Human Services. FDA Letter to Natural Resources Defense Council – Petition Denial. March 30, 2012.