Exposure to BPA, BPA Alternatives Could Increase Risk of Hyperuricemia, Gout in Women

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A recent study points to a link between bisphenol exposure and elevated uric acid levels, with implications for gout risk, especially in women.

Exposure to bisphenol A (BPA) and its alternatives were linked to the development of elevated uric acid levels in the general population as well as gout in women specifically, according to a new study.

An analysis of data from the National Health and Examination Survey (NHANES), results of the study suggest elevated urinary bisphenol concentrations were linked to increased risk of elevated serum uric acid in both men and women, with total bisphenol concentrations associated with an increased risk of having gout in females.1

“Given the widespread use and adverse effects, our findings underline the need for the government to reassess the presence of bisphenols in daily life,” wrote investigators.1 “Additional prospective studies and mechanical research are required to verify our findings and shed light on the precise mechanisms involved.”

An industrial chemical found in specific plastics and resin products, use of BPA, as well as its alternatives BPS and BPF, began in the 1950s. A growing body of research suggests elevated exposure to BPA was associated with potential deleterious health effects—from impacting children’s behavior to a possible link with type 2 diabetes.2

In the current study, a team of investigators led by Bo Li, PhD, of Ninjing Medical university, sought to develop a greater understanding of associations between bisphenols exposure and hyperuricemia risk after previous research was inconclusive. With this in mind, investigators conducted a retrospective analysis of data from individuals aged 20 years or older from the NHANES 2013-2014 and 2015-2016 cycles with available information on serum uric acid concentration (n = 3367), gout (n = 3495), urinary bisphenols and creatinine levels (n = 3495) were included. Of note, these cycles were chosen because BPS and BPF were detected from 2013 onward.

Investigators used multivariable linear and logistic regression models to estimate associations between urinary bisphenol concentrations with serum uric acid levels, hyperuricemia, and gout prevalence among the overall population as well as stratified by sex. Investigators pointed out a restricted cubic spline model was used to assess dose-response relationships.

Investigators highlighted a trend toward greater median concentrations of median concentration of BPA, BPS, and total bisphenol concentration was observed among the gout group, but this failed to achieve statistical significance. In contrast, concentration of BPA, BPF, and total bisphenol concentration were significantly greater among the hyperuricemia group relative to the non-hyperuricemia group (P < .05).

Upon analysis, results suggested a doubling in urinary BPS or total bisphenol concentration was associated with increases of 2.64 μmol/L (95% CI, 0.54-4.74) and 3.29 μmol/L (95% CI, 0.59-5.99) in serum uric acid levels, respectively. Investigators highlighted the RCS model indicated a significantly J-shaped dose-response relationship existed between BPS exposure and serum uric acid levels.

Further analysis revealed males in the greatest quartile of urinary BPS displayed a 13.06 μmol/L (95% CI, 0.75-25.37) rise in serum uric acid levels compared to the study’s reference group. Among women, a doubling of urinary BPS concentrations was associated with a 3.30 μmol/L (95% CI, 0.53-6.07) increase in serum uric acid levels, with a significant linear dose-response relationship.

In the total population, a doubling or urinary BPA concentrations Wass associated with an increased risk of developing hyperuricemia, with an inverted U curve. Additionally, a doubling of total urinary bisphenol concentrations was associated with an increased adjusted risk of hyperuricemia in total population (Odds ratio [OR], 1.05; 95% CI, 0.96-1.14), with a significant monotonic dose-response relationship.

Among the total population, no significant associations and dose-response relationships were observed between bisphenol exposure and gout prevalence. In females, a doubling of urinary BPS was associated with a 1.45-fold greater risk of having gout (OR, 1.45; 95% CI, 1.01-2.08), with a J shaped NMDR relationship (P non-linear = .26).

Investigators called attention to their study’s limitations before conducting. Specific limitations highlighted by investigators included the cross-sectional design of the study and only assessing bisphenol exposure in urine samples.


  1. Jiang S, Wang Y, Wang Z, et al. Bisphenol A and its alternatives bisphenol S and F exposure with serum uric acid levels, hyperuricemia, and gout prevalence among US adults: a nationally representative cross-sectional study. BMC Public Health. 2024;24(1):370. Published 2024 Feb 5. doi:10.1186/s12889-024-17883-6
  2. Bauer BA. Tips to reduce BPA exposure. Mayo Clinic. March 24, 2023. Accessed February 22, 2024.