In this issue of JAMA, Lang and colleagues1 report the results of the first major epidemiologic study to examine the health effects associated with the ubiquitous estrogenic chemical bisphenol A (BPA). This compound is the base chemical (monomer) used to make polycarbonate plastic food and beverage containers, the resin lining of cans, and dental sealants; it also is found in “carbonless” paper used for receipts as well as a wide range of other common household products. Based on their analysis of data from the National Health and Nutrition Examination Survey 2003-2004, Lang et al report a significant relationship between urine concentrations of BPA and cardiovascular disease, type 2 diabetes, and liver-enzyme abnormalities in a representative sample of the adult US population. This report, suggesting links between BPA and some of the most significant and economically burdensome human diseases, is based on a cross-sectional study and therefore cannot establish causality; follow-up longitudinal studies should thus be a high priority. Yet many peer-reviewed published studies report on related adverse effects of BPA in experimental animals,2 and cell culture studies identify the molecular mechanisms mediating these responses.3 These experimental findings add biological plausibility to the results reported by Lang et al.1
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