Exposure to Bisphenol A, S, and F and its Association with Obesity and Diabetes Mellitus in General Adults of Korea: Korean National Environmental Health Survey (KoNEHS) 2015–2017

Health concerns on bisphenol A (BPA) have led to the increasing use of its substitutes, such as bisphenol S (BPS) and F (BPF), worldwide. While association of BPA with obesity and diabetes mellitus (DM) is frequently reported, those of BPS and BPF are not well understood. We employed an adult population (n = 3780) participating in the Korean National Environmental Health Survey 2015–2017 (Cycle 3), and assessed the associations of urinary BPA, BPS, and BPF concentrations with obesity, DM, and metabolic parameters. The detection frequencies of BPA, BPS, and BPF in the urine of the adult population were 99.8%, 55.2%, and 44.1%, respectively. Survey-weighted geometric means (geometric standard errors) were 1.180 (1.058), 0.032 (1.045), and 0.111 (1.043) μg/L, respectively. After adjusting for relevant covariates, a unit increase of the covariates-standardized urinary BPA level (1 μg/L) was associated with the increase of BMI by 1.28 kg/m² (95% CI 1.15–1.45) in the current population. Among the participants with detectable levels of urinary BPS, the odds of a BMI ≥ 30 kg/m² increased as the BPS tertile increased (p = 0.048). For DM, urinary BPA level showed a borderline significance (p for trend = 0.049). Among the participants with concentrations above LOD, BPS in the highest tertile also showed significantly elevated DM odds (OR 2.13, 95% CI 1.29–3.50, p = 0.003) compared to the lowest tertile. For BPF, however, association with DM was not observed. In addition, BPA levels were positively associated with serum triglyceride levels (β = 0.02, p = 0.049), and BPS levels with high-density lipoprotein cholesterol levels (β = 0.80, p = 0.015). Our observation on a representative adult population of Korea supports significant association of BPA with obesity, and to lesser extent with DM. Moreover, urinary BPS levels are associated with obesity and DM among the participants with the concentrations above LOD. As the use of alternative bisphenols is expected to rise, further studies are warranted to confirm these observations.