To the Editor: Dr Lang and colleagues1 reported that higher levels of urinary bisphenol A (BPA) were associated with type 2 diabetes and cardiovascular diseases in a cross-sectional analysis of US National Health and Nutrition Examination Survey (NHANES) data. While these findings have public health importance, I am concerned about the classification of diabetes in this study, in which the authors combined self-reported diagnosed diabetes and borderline diabetes as a single group of diabetes.
To my knowledge, a majority of patients who were classified as borderline diabetes by interviewers in NHANES data did not have evidence of taking diabetes medications or meeting plasma glucose criteria for diabetes by the American Diabetes Association. Selective recall of diabetes due to increased exposure to suspected diabetic agents such as fat and some chemicals is possible in participants with borderline diabetes. For this reason, it would be better to eliminate those participants with borderline diabetes from the analysis to clarify the association between BPA and diabetes.
In addition, because it is likely that only some of the participants with borderline diabetes actually represent diabetes, the concentrations of BPA should show an increasing trend from the nondiabetic group to the borderline diabetes group to the diabetes group if BPA is indeed a causative agent of type 2 diabetes. The authors should present the means of concentrations for those 3 groups. The absence of such a trend would not support a causative association of BPA with diabetes.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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