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Environ Health Perspect. 2019 Oct;127(10):107013. doi: 10.1289/EHP5159. Epub 2019 Oct 30.

Exposure to Bisphenol A and Bisphenol S and Incident Type 2 Diabetes: A Case-Cohort Study in the French Cohort D.E.S.I.R.

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Centre of Research in Epidemiology and Statistics (CRESS), Unité mixte de recherche (UMR) 1153, Institut national de la santé et de la recherche médicale (Inserm), Université de Paris, Paris, France.
Faculté de Pharmacie de Paris, Université de Paris, Paris, France.
Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, France.
Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, U1209, Institute for Advanced Biosciences (IAB), Inserm-Centre national de la recherche scientifique (CNRS) and Université Grenoble-Alpes joint research center, Grenoble, France.
IAB, Université Grenoble-Alpes, Grenoble, France.
Toxalim, Université de Toulouse, Institut national de la recherche agronomique (INRA), National Veterinary College of Toulouse (ENVT), Institut National Polytechnique de Toulouse (INPT-EI Purpan), Université Toulouse III - Paul Sabatier (UPS), Toulouse, France.
National Infrastructure of Metabolomics and Fluxomics, Axiom platform, MetaToul-MetaboHUB, Toulouse, France.
Centre de Recherche des Cordeliers, UMRS 1138, Inserm, Paris, France.
Département Hospitalo-Universitaire (DHU) FIRE (Fibrose Inflammation Remodelage), Diabetology, Endocrinology and Nutrition, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
Unité de formation et de recherche (UFR) de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Inserm, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, Villejuif, France.
Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Institut inter-Régional pour la Santé (IRSA), La Riche, France.



The question of whether exposure to bisphenol A (BPA) contributes to the development of type 2 diabetes is still unresolved. Most epidemiological evidence on the association between BPA and diabetes is from cross-sectional studies or longitudinal studies with single urinary measurements. No prospective study has examined exposure to BPA analogs such as bisphenol S (BPS) in relation to incident type 2 diabetes.


We aimed to investigate whether exposure to BPA and BPS, assessed at up to two time points, was associated with the incidence of type 2 diabetes.


We performed a case-cohort study on 755 participants without diabetes at baseline and followed-up over 9 y as part of the French prospective cohort Data from an Epidemiological Study on the Insulin Resistance Syndrome (D.E.S.I.R.). BPA-glucuronide (BPA-G) and BPS-glucuronide (BPS-G) were assessed in fasting spot urine samples collected during the health examinations at baseline and 3 y later. Associations with incident diabetes were examined using Prentice-weighted Cox regression models adjusted for potential confounders.


A total of 201 incident cases of type 2 diabetes were diagnosed over the follow-up, including 30 in the subcohort. Compared with participants with the lowest average BPA exposure (below the first quartile), participants in the second, third, and fourth quartile groups of exposure had a near doubling of the risk of type 2 diabetes, with a hazard ratio (HR)= 2.56 (95% CI: 1.16, 5.65), 2.35 (95% CI: 1.07, 5.15), and 1.56 (95% CI: 0.68, 3.55), respectively. The detection of BPS-G in urine at one or both time points was associated with incident diabetes, with an HR= 2.81 (95% CI: 1.74, 4.53).


This study shows positive associations between exposure to BPA and BPS and the incidence of type 2 diabetes, independent of traditional diabetes risk factors. Our results should be confirmed by recent, population-based observational studies in different populations and settings. Overall, these findings raise concerns about using BPS as a BPA substitute. Further research on BPA analogs is warranted.

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