Exposure to bisphenol analogues and risk of anemia in young adults

BACKGROUND: Bisphenol A (BPA) and its analogues are widely used endocrine disruptors. Their potential role in anemia remains unclear. METHODS: We conducted a cross-sectional study of 940 adults aged 19-44 years from the Young Taiwanese Cohort (2017-2019) to assess associations of urinary bisphenol A and analogues (BPAF, BPS, BPF, BPB) with hematological indices and anemia risk. Urinary bisphenols were quantified, and hematological parameters including hemoglobin (Hb), hematocrit (Hct), mean corpuscular indices, ferritin, total iron-binding capacity (TIBC), serum iron, and transferrin saturation (TSAT) were analyzed using single- and multi-pollutant regression models to explore exposure effects and sex, age, and body mass index (BMI)-specific differences. RESULTS: Prevalence of anemia, iron deficiency, and iron deficiency anemia (IDA) was 8.9% (13.7% in women, 2.5% in men), 16.9% (28.0% in women, 1.8% in men), and 5.9% (9.2% in women, 1.3% in men), respectively. Higher urinary BPAF, BPS, and BPF were associated with lower hemoglobin, hematocrit, ferritin, and serum iron, and higher odds of anemia and iron-deficiency anemia. Associations were stronger in women. CONCLUSION: Exposure to BPA substitutes (BPAF, BPS, BPF) was associated with disrupted iron metabolism and increased anemia risk, particularly in women.