Association between urinary bisphenol levels and metabolic syndrome in Korean adults: a cross-sectional study using the fourth Korean National Environmental Health Survey.

BACKGROUND: Bisphenols are representative endocrine-disrupting chemicals and have shown an association with metabolic disorders. Although the use of alternative bisphenols such as bisphenol F (BPF) and bisphenol S (BPS) has been increasing while that of bisphenol A (BPA) has been declining, limited population-based studies exist in Korea examining the association between these substances and metabolic syndrome (MetS). Therefore, this study aimed to evaluate the association of urinary BPA, BPF, and BPS concentrations with MetS in South Korean adults using data from the fourth Korean National Environmental Health Survey (KoNEHS). METHODS: This study included 2,639 participants from the 2018-2019 KoNEHS. MetS was defined based on the modified National Cholesterol Education Program Adult Treatment Panel III criteria. The fasting blood glucose criterion was replaced with glycated hemoglobin (HbA1c) (≥5.7% or medication use). Urinary BPA, BPF, and BPS concentrations were categorized into tertiles per substance. Weighted binary logistic regression analysis accounting for the complex sampling design was performed to calculate odds ratio (OR) and 95% confidence interval (CI). RESULTS: In the final adjusted model, urinary BPF concentration demonstrated a significant positive association with MetS, with ORs of 1.320 (95% CI: 1.029-1.693) for T2 and 1.452 (95% CI: 1.122-1.878) for T3. Urinary BPS concentration demonstrated a significant association only in the highest tertile, with an OR of 1.476 (95% CI: 1.067-2.043) for T3. Conversely, urinary BPA concentration did not show a significant association with MetS. CONCLUSIONS: In this study, urinary BPF and BPS concentrations in the general Korean adult population showed a significant positive association with MetS. The study findings may provide a baseline for expanding our understanding of the effects of bisphenols on health. Future long-term, prospective studies involving the general population remain necessary.