Urinary bisphenol exposure and risk of type 1 diabetes and glycemic traits in Chinese children: a case–control study

Abstract

Background Bisphenol A (BPA) and its structural analogs, bisphenol F (BPF) and bisphenol S (BPS), are widely used in consumer products and increasingly detected in children. Although BPA has been linked to diabetes and impaired glucose metabolism in adults, evidence for BPF and BPS, particularly in the pediatric population, remains limited and inconsistent. This study examined the associations of individual and combined bisphenol exposures with type 1 diabetes mellitus (T1DM) risk and glucose homeostasis in children. Methods We conducted a case–control study including 122 children with T1DM and 287 controls from Shenyang, China. For biomarker analysis, a subset of 110 participants (55 cases and 55 controls) was selected. Urinary bisphenol concentrations were measured using high-performance liquid chromatography–tandem mass spectrometry. Associations with T1DM risk and glycemic outcomes were evaluated using multivariable logistic and linear regression models. Bayesian kernel machine regression (BKMR) and Restricted cubic spline (RCS) analyses were further used to explore potential nonlinear relationships and interaction effects. Results BPA was detected in all samples, with widespread exposure to BPF and BPS. Higher urinary BPA and BPF levels were significantly associated with increased odds of T1DM. BPS was not associated with T1DM status but was consistently linked to elevated fasting glucose (β = 0.987, 95% CI: 0.104–1.871) and HbA1c (β = 0.327, 95% CI: 0.012–0.642). BKMR characterized the joint associations of bisphenol mixtures with the study outcomes, whereas RCS analyses suggested near-linear exposure–response relationships between BPS and glycemic traits. Exploratory interaction analyses suggested heterogeneity in selected associations by sex and case–control status. Conclusion Higher urinary concentrations of BPA and BPF were associated with increased odds of T1DM in children, while BPS was linked to markers of impaired glucose regulation. These findings suggest that BPA substitutes may not be biologically inert and could be relevant to metabolic health during childhood. Further prospective and mechanistic studies are needed to better understand the biological pathways underlying these associations.