Journal of Pediatrics Review

Published by: Kowsar

Association of Endocrine Disrupting Chemicals, Bisphenol A and Phthalates, with Childhood Obesity: A Systematic Review

Maryam Zarean 1 , Parinaz Poursafa 1 , * , Mohammad Mehdi Amin 1 and Roya Kelishadi 2
Authors Information
1 Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, IR Iran
2 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, IR Iran
Article information
  • Journal of Pediatrics Review: January 2018, 6 (1); e11894
  • Published Online: October 8, 2017
  • Article Type: Review Article
  • Received: April 19, 2017
  • Revised: June 25, 2017
  • Accepted: July 6, 2017
  • DOI: 10.5812/jpr.11894

To Cite: Zarean M, Poursafa P, Amin M M, Kelishadi R. Association of Endocrine Disrupting Chemicals, Bisphenol A and Phthalates, with Childhood Obesity: A Systematic Review, J Pediatr Rev. 2018 ;6(1):e11894. doi: 10.5812/jpr.11894.

Copyright © 2017, Journal of Pediatrics Review. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Context
2. Objectives
3. Data Sources
4. Study Selection
5. Data Extraction
6. Results
7. Discussion
8. Conclusions
  • 1. Bhandari RK, Deem SL, Holliday DK, Jandegian CM, Kassotis CD, Nagel SC, et al. Effects of the environmental estrogenic contaminants bisphenol A and 17alpha-ethinyl estradiol on sexual development and adult behaviors in aquatic wildlife species. Gen Comp Endocrinol. 2015;214:195-219. doi: 10.1016/j.ygcen.2014.09.014. [PubMed: 25277515].
  • 2. Guida M, Troisi J, Ciccone C, Granozio G, Cosimato C, Di Spiezio Sardo A, et al. Bisphenol A and congenital developmental defects in humans. Mutat Res. 2015;774:33-9. doi: 10.1016/j.mrfmmm.2015.02.007. [PubMed: 25796969].
  • 3. Iughetti L, Lucaccioni L, Predieri B. Childhood obesity and environmental pollutants: a dual relationship. Acta Biomed. 2015;86(1):5-16. [PubMed: 25948022].
  • 4. Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev. 2007;29:62-76. doi: 10.1093/epirev/mxm003. [PubMed: 17478440].
  • 5. Liu Y, Peterson KE. Maternal Exposure to Synthetic Chemicals and Obesity in the Offspring: Recent Findings. Curr Environ Health Rep. 2015;2(4):339-47. doi: 10.1007/s40572-015-0068-6. [PubMed: 26403844].
  • 6. Biro FM, Greenspan LC, Galvez MP. Puberty in girls of the 21st century. J Pediatr Adolesc Gynecol. 2012;25(5):289-94. doi: 10.1016/j.jpag.2012.05.009. [PubMed: 22841372].
  • 7. Xu X, Tan L, Himi T, Sadamatsu M, Tsutsumi S, Akaike M, et al. Changed preference for sweet taste in adulthood induced by perinatal exposure to bisphenol A-A probable link to overweight and obesity. Neurotoxicol Teratol. 2011;33(4):458-63. doi: 10.1016/ [PubMed: 21704699].
  • 8. Singh S, Li SS. Bisphenol A and phthalates exhibit similar toxicogenomics and health effects. Gene. 2012;494(1):85-91. doi: 10.1016/j.gene.2011.11.035. [PubMed: 22173104].
  • 9. Kasper-Sonnenberg M, Koch HM, Wittsiepe J, Bruning T, Wilhelm M. Phthalate metabolites and bisphenol A in urines from German school-aged children: results of the Duisburg birth cohort and Bochum cohort studies. Int J Hyg Environ Health. 2014;217(8):830-8. doi: 10.1016/j.ijheh.2014.06.001. [PubMed: 24986699].
  • 10. Marmugi A, Lasserre F, Beuzelin D, Ducheix S, Huc L, Polizzi A, et al. Adverse effects of long-term exposure to bisphenol A during adulthood leading to hyperglycaemia and hypercholesterolemia in mice. Toxicology. 2014;325:133-43. doi: 10.1016/j.tox.2014.08.006. [PubMed: 25168180].
  • 11. Troisi J, Mikelson C, Richards S, Symes S, Adair D, Zullo F, et al. Placental concentrations of bisphenol A and birth weight from births in the Southeastern U.S. Placenta. 2014;35(11):947-52. doi: 10.1016/j.placenta.2014.08.091. [PubMed: 25227326].
  • 12. Hong SB, Hong YC, Kim JW, Park EJ, Shin MS, Kim BN, et al. Bisphenol A in relation to behavior and learning of school-age children. J Child Psychol Psychiatry. 2013;54(8):890-9. doi: 10.1111/jcpp.12050. [PubMed: 23445117].
  • 13. Perera F, Vishnevetsky J, Herbstman JB, Calafat AM, Xiong W, Rauh V, et al. Prenatal bisphenol a exposure and child behavior in an inner-city cohort. Environ Health Perspect. 2012;120(8):1190-4. doi: 10.1289/ehp.1104492. [PubMed: 22543054].
  • 14. Angle BM, Do RP, Ponzi D, Stahlhut RW, Drury BE, Nagel SC, et al. Metabolic disruption in male mice due to fetal exposure to low but not high doses of bisphenol A (BPA): evidence for effects on body weight, food intake, adipocytes, leptin, adiponectin, insulin and glucose regulation. Reprod Toxicol. 2013;42:256-68. doi: 10.1016/j.reprotox.2013.07.017. [PubMed: 23892310].
  • 15. Mirmira P, Evans-Molina C. Bisphenol A, obesity, and type 2 diabetes mellitus: genuine concern or unnecessary preoccupation?. Transl Res. 2014;164(1):13-21. doi: 10.1016/j.trsl.2014.03.003. [PubMed: 24686036].
  • 16. Ferguson KK, Peterson KE, Lee JM, Mercado-Garcia A, Blank-Goldenberg C, Tellez-Rojo MM, et al. Prenatal and peripubertal phthalates and bisphenol A in relation to sex hormones and puberty in boys. Reprod Toxicol. 2014;47:70-6. doi: 10.1016/j.reprotox.2014.06.002. [PubMed: 24945889].
  • 17. Moosazadeh M, Nekoei-Moghadam M, Emrani Z, Amiresmaili M. Prevalence of unwanted pregnancy in Iran: a systematic review and meta-analysis. Int J Health Plann Manage. 2014;29(3):e277-90. doi: 10.1002/hpm.2184. [PubMed: 23630092].
  • 18. Bhandari R, Xiao J, Shankar A. Urinary bisphenol A and obesity in U.S. children. Am J Epidemiol. 2013;177(11):1263-70. doi: 10.1093/aje/kws391. [PubMed: 23558351].
  • 19. D'Aniello R, Troisi J, D'Amico O, Sangermano M, Massa G, Moccaldo A, et al. Emerging pathomechanisms involved in obesity. J Pediatr Gastroenterol Nutr. 2015;60(1):113-9. doi: 10.1097/MPG.0000000000000559. [PubMed: 25199037].
  • 20. Eng DS, Lee JM, Gebremariam A, Meeker JD, Peterson K, Padmanabhan V. Bisphenol A and chronic disease risk factors in US children. Pediatrics. 2013;132(3):e637-45. doi: 10.1542/peds.2013-0106. [PubMed: 23958765].
  • 21. Lee BE, Park H, Hong YC, Ha M, Kim Y, Chang N, et al. Prenatal bisphenol A and birth outcomes: MOCEH (Mothers and Children's Environmental Health) study. Int J Hyg Environ Health. 2014;217(2-3):328-34. doi: 10.1016/j.ijheh.2013.07.005. [PubMed: 23911140].
  • 22. Li DK, Miao M, Zhou Z, Wu C, Shi H, Liu X, et al. Urine bisphenol-A level in relation to obesity and overweight in school-age children. PLoS One. 2013;8(6). e65399. doi: 10.1371/journal.pone.0065399. [PubMed: 23776476].
  • 23. Maserejian NN, Hauser R, Tavares M, Trachtenberg FL, Shrader P, McKinlay S. Dental composites and amalgam and physical development in children. J Dent Res. 2012;91(11):1019-25. doi: 10.1177/0022034512458691. [PubMed: 22972857].
  • 24. Pornkunwilai S, Nosoongnoen W, Jantarat C, Wachrasindhu S, Supornsilchai V. Urinary bisphenol A detection is significantly associated with young and obese Thai children. Asian Biomed. 2015;9(3):363-72.
  • 25. Trasande L, Attina TM, Blustein J. Association between urinary bisphenol A concentration and obesity prevalence in children and adolescents. JAMA. 2012;308(11):1113-21. doi: 10.1001/2012.jama.11461. [PubMed: 22990270].
  • 26. Valvi D, Casas M, Mendez MA, Ballesteros-Gomez A, Luque N, Rubio S, et al. Prenatal bisphenol a urine concentrations and early rapid growth and overweight risk in the offspring. Epidemiology. 2013;24(6):791-9. doi: 10.1097/EDE.0b013e3182a67822. [PubMed: 24036610].
  • 27. Wang HX, Zhou Y, Tang CX, Wu JG, Chen Y, Jiang QW. Association between bisphenol A exposure and body mass index in Chinese school children: a cross-sectional study. Environ Health. 2012;11:79. doi: 10.1186/1476-069X-11-79. [PubMed: 23083070].
  • 28. Wells EM, Jackson LW, Koontz MB. Association between bisphenol A and waist-to-height ratio among children: National Health and Nutrition Examination Survey, 2003-2010. Ann Epidemiol. 2014;24(2):165-7. doi: 10.1016/j.annepidem.2013.06.002. [PubMed: 23830935].
  • 29. Durmaz E, Asci A, Erkekoglu P, Akcurin S, Gumusel BK, Bircan I. Urinary bisphenol a levels in girls with idiopathic central precocious puberty. J Clin Res Pediatr Endocrinol. 2014;6(1):16-21. doi: 10.4274/Jcrpe.1220. [PubMed: 24637305].
  • 30. Padmanabhan V, Siefert K, Ransom S, Johnson T, Pinkerton J, Anderson L, et al. Maternal bisphenol-A levels at delivery: a looming problem?. J Perinatol. 2008;28(4):258-63. doi: 10.1038/ [PubMed: 18273031].
  • 31. Wang B, Wang H, Zhou W, He Y, Zhou Y, Chen Y, et al. Exposure to bisphenol A among school children in eastern China: a multicenter cross-sectional study. J Expo Sci Environ Epidemiol. 2014;24(6):657-64. doi: 10.1038/jes.2014.36. [PubMed: 24866264].
  • 32. Xue J, Wu Q, Sakthivel S, Pavithran PV, Vasukutty JR, Kannan K. Urinary levels of endocrine-disrupting chemicals, including bisphenols, bisphenol A diglycidyl ethers, benzophenones, parabens, and triclosan in obese and non-obese Indian children. Environ Res. 2015;137:120-8. doi: 10.1016/j.envres.2014.12.007. [PubMed: 25531816].
  • 33. Agay-Shay K, Martinez D, Valvi D, Garcia-Esteban R, Basagaña X, Robinson O, et al. Exposure to Endocrine-Disrupting Chemicals during Pregnancy and Weight at 7 Years of Age: A Multi-pollutant Approach. Environ Health Perspect. 2015;123(10). doi: 10.1289/ehp.1409049.
  • 34. Casas M, Valvi D, Ballesteros-Gomez A, Gascon M, Fernandez MF, Garcia-Esteban R, et al. Exposure to Bisphenol A and Phthalates during Pregnancy and Ultrasound Measures of Fetal Growth in the INMA-Sabadell Cohort. Environ Health Perspect. 2016;124(4):521-8. doi: 10.1289/ehp.1409190. [PubMed: 26196298].
  • 35. Buckley JP, Engel SM, Braun JM, Whyatt RM, Daniels JL, Mendez MA, et al. Prenatal Phthalate Exposures and Body Mass Index Among 4- to 7-Year-old Children: A Pooled Analysis. Epidemiology. 2016;27(3):449-58. doi: 10.1097/EDE.0000000000000436. [PubMed: 26745610].
  • 36. Li J, Lai H, Chen S, Zhu H, Lai S. Gender differences in the associations between urinary bisphenol A and body composition among American children: The National Health and Nutrition Examination Survey, 2003-2006. J Epidemiol. 2017;27(5):228-34. doi: 10.1016/ [PubMed: 28142049].
  • 37. Vafeiadi M, Roumeliotaki T, Myridakis A, Chalkiadaki G, Fthenou E, Dermitzaki E, et al. Association of early life exposure to bisphenol A with obesity and cardiometabolic traits in childhood. Environ Res. 2016;146:379-87. doi: 10.1016/j.envres.2016.01.017. [PubMed: 26821262].
  • 38. Harley KG, Schall RA, Chevrier J, Tyler K, Aguirre H, Bradman A, et al. Prenatal and postnatal bisphenol A exposure and body mass index in childhood in the CHAMACOS cohort. Environ Health Perspect. 2013;121(4):514.
  • 39. Braun JM, Lanphear BP, Calafat AM, Deria S, Khoury J, Howe CJ, et al. Early-life bisphenol A exposure and child body mass index: a prospective cohort study. Environ Health Perspect. 2014;122(11):1239.
  • 40. Buser MC, Murray HE, Scinicariello F. Age and sex differences in childhood and adulthood obesity association with phthalates: analyses of NHANES 2007-2010. Int J Hyg Environ Health. 2014;217(6):687-94. doi: 10.1016/j.ijheh.2014.02.005. [PubMed: 24657244].
  • 41. Choi J, Eom J, Kim J, Lee S, Kim Y. Association between some endocrine-disrupting chemicals and childhood obesity in biological samples of young girls: a cross-sectional study. Environ Toxicol Pharmacol. 2014;38(1):51-7. doi: 10.1016/j.etap.2014.04.004. [PubMed: 24908636].
  • 42. Hatch EE, Nelson JW, Qureshi MM, Weinberg J, Moore LL, Singer M, et al. Association of urinary phthalate metabolite concentrations with body mass index and waist circumference: a cross-sectional study of NHANES data, 1999-2002. Environ Health. 2008;7:27. doi: 10.1186/1476-069X-7-27. [PubMed: 18522739].
  • 43. Hou JW, Lin CL, Tsai YA, Chang CH, Liao KW, Yu CJ, et al. The effects of phthalate and nonylphenol exposure on body size and secondary sexual characteristics during puberty. Int J Hyg Environ Health. 2015;218(7):603-15. doi: 10.1016/j.ijheh.2015.06.004. [PubMed: 26163779].
  • 44. Saravanabhavan G, Walker M, Guay M, Aylward L. Urinary excretion and daily intake rates of diethyl phthalate in the general Canadian population. Sci Total Environ. 2014;500-501:191-8. doi: 10.1016/j.scitotenv.2014.08.089. [PubMed: 25217994].
  • 45. Teitelbaum SL, Mervish N, Moshier EL, Vangeepuram N, Galvez MP, Calafat AM, et al. Associations between phthalate metabolite urinary concentrations and body size measures in New York City children. Environ Res. 2012;112:186-93. doi: 10.1016/j.envres.2011.12.006. [PubMed: 22222007].
  • 46. Trasande L, Attina TM, Sathyanarayana S, Spanier AJ, Blustein J. Race/Ethnicity-Specific Associations of Urinary Phthalates with Childhood Body Mass in a Nationally Representative Sample. Environ Health Perspect. 2013. doi: 10.1289/ehp.1205526.
  • 47. Wang H, Zhou Y, Tang C, He Y, Wu J, Chen Y, et al. Urinary phthalate metabolites are associated with body mass index and waist circumference in Chinese school children. PLoS One. 2013;8(2). e56800. doi: 10.1371/journal.pone.0056800. [PubMed: 23437242].
  • 48. Boas M, Frederiksen H, Feldt-Rasmussen U, Skakkebaek NE, Hegedus L, Hilsted L, et al. Childhood exposure to phthalates: associations with thyroid function, insulin-like growth factor I, and growth. Environ Health Perspect. 2010;118(10):1458-64. doi: 10.1289/ehp.0901331. [PubMed: 20621847].
  • 49. Valvi D, Casas M, Romaguera D, Monfort N, Ventura R, Martinez D, et al. Prenatal Phthalate Exposure and Childhood Growth and Blood Pressure: Evidence from the Spanish INMA-Sabadell Birth Cohort Study. Environ Health Perspect. 2015;123(10):1022-9. doi: 10.1289/ehp.1408887. [PubMed: 25850106].
  • 50. Kelishadi R, Poursafa P. A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease. Curr Probl Pediatr Adolesc Health Care. 2014;44(3):54-72. doi: 10.1016/j.cppeds.2013.12.005. [PubMed: 24607261].
  • 51. Trasande L, Cronk C, Durkin M, Weiss M, Schoeller DA, Gall EA, et al. Environment and obesity in the National Children's Study. Environ Health Perspect. 2009;117(2):159-66. doi: 10.1289/ehp.11839. [PubMed: 19270782].
  • 52. LaKind JS, Naiman DQ. Temporal trends in bisphenol A exposure in the United States from 2003-2012 and factors associated with BPA exposure: Spot samples and urine dilution complicate data interpretation. Environ Res. 2015;142:84-95. doi: 10.1016/j.envres.2015.06.013. [PubMed: 26121292].
  • 53. Ranciere F, Lyons JG, Loh VH, Botton J, Galloway T, Wang T, et al. Bisphenol A and the risk of cardiometabolic disorders: a systematic review with meta-analysis of the epidemiological evidence. Environ Health. 2015;14:46. doi: 10.1186/s12940-015-0036-5. [PubMed: 26026606].
  • 54. Braun JM, Hauser R. Bisphenol A and children's health. Curr Opin Pediatr. 2011;23(2):233-9. doi: 10.1097/MOP.0b013e3283445675. [PubMed: 21293273].
  • 55. Khalil N, Ebert JR, Wang L, Belcher S, Lee M, Czerwinski SA, et al. Bisphenol A and cardiometabolic risk factors in obese children. Sci Total Environ. 2014;470-471:726-32. doi: 10.1016/j.scitotenv.2013.09.088. [PubMed: 24184549].
  • 56. Johns LE, Cooper GS, Galizia A, Meeker JD. Exposure assessment issues in epidemiology studies of phthalates. Environ Int. 2015;85:27-39. doi: 10.1016/j.envint.2015.08.005. [PubMed: 26313703].
  • 57. Kelishadi R, Poursafa P, Jamshidi F. Role of environmental chemicals in obesity: a systematic review on the current evidence. J Environ Public Health. 2013;2013.
  • 58. Howe CJ, Cole SR, Chmiel JS, Munoz A. Limitation of inverse probability-of-censoring weights in estimating survival in the presence of strong selection bias. Am J Epidemiol. 2011;173(5):569-77. doi: 10.1093/aje/kwq385. [PubMed: 21289029].
  • 59. Zarean M, Keikha M, Poursafa P, Khalighinejad P, Amin M, Kelishadi R. A systematic review on the adverse health effects of di-2-ethylhexyl phthalate. Environ Sci Pollut Res Int. 2016;23(24):24642-93. doi: 10.1007/s11356-016-7648-3. [PubMed: 27714658].
  • 60. Pinney SE, Mesaros CA, Snyder NW, Busch CM, Xiao R, Aijaz S, et al. Second trimester amniotic fluid bisphenol A concentration is associated with decreased birth weight in term infants. Reprod Toxicol. 2017;67:1-9. doi: 10.1016/j.reprotox.2016.11.007. [PubMed: 27829162].
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments