Eliseo Guallar

Chair and Professor of the Department of Epidemiology

Professional overview

Dr. Guallar is an epidemiologist whose research is focused on the study of cardiovascular disease epidemiology and prevention, with an emphasis on evaluating the role of environmental and nutritional exposures in the development of cardiovascular disease. This research has made critically important and novel contributions to our understanding of risk factors for chronic disease both in the US and globally. He has published seminal articles and is a leading figure in an emerging field highlighting the risks of exposure to levels of metals previously considered safe for cardiovascular health. In addition to his work in toxic metals, Dr. Guallar has made important contributions to understanding the effects of certain micronutrients and vitamin supplements on cardiovascular disease risk and outcomes. Publications in this area were influential in changing consumer habits and attitudes towards these products. Much of this research has been funded by the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Heart Association, the CDC, and other funders.

Dr. Guallar was the founding director of the Center for Clinical Epidemiology at the Samsung Medical Center and a lead investigator of the Kangbuk Samsung Cohort Study at the Kangbuk Samsung Hospital since its inception in 2010. Dr. Guallar has published over 500 research papers in peer-reviewed journals. He is also a Deputy Editor for Methods at the Annals of Internal Medicine and a past member and Chair of the Cancer, Heart, and Sleep Study Section at the National Institutes of Health.

Prior to teaching at NYU, Dr. Guallar was a Professor of Epidemiology and Medicine at the Johns Hopkins University Bloomberg School of Public Health and a core faculty member of the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins. In the Department of Epidemiology, Dr. Guallar was the Director of the Environmental and Occupational Area of Concentration and the Co-Director of the PhD Program. Dr. Guallar was also an adjunct Professor at the Department of Clinical Research Design and Evaluation of the Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, in Seoul, Korea.

Education

Diploma of English, Spanish Official School of Languages at Zaragoza (Escuela Oficial de Idiomas de Zaragoza), Zaragoza, Spain

MD, University of Zaragoza, Zaragoza, Spain

MPH, University of Minnesota, Minneapolis, MN

DrPH, Harvard University, Boston, MA

Honors and awards

Six Honor Calls in the MD Program, University of Zaragoza School of Medicine (1981)

Fellow of Spain’s Program of Training of Graduate Research of the Ministry of Education and Science, University of Zaragoza (1988)

Fulbright Scholar, sponsored by Spain’s Ministry of Health and Consumer Affairs (1989)

Faculty Innovation Award, Johns Hopkins University Bloomberg School of Public Health (2001)

Scientist Development Award, American Heart Association (2002)

Fellow of the American Heart Association, Council on Epidemiology and Prevention (2013)

Advising, Mentoring, and Teaching Recognition Award 2014 – 2015, Johns Hopkins University Bloomberg School of Public Health (2015)

High Impact Research Icon, University of Malaya (2015)

Publications

Publications

A behavioral weight-loss intervention in persons with serious mental illness

Daumit, G. L., Dickerson, F. B., Wang, N. Y., Dalcin, A., Jerome, G. J., Anderson, C. A., Young, D. R., Frick, K. D., Yu, A., Gennusa, J. V., Oefinger, M., Crum, R. M., Charleston, J., Casagrande, S. S., Guallar, E., Goldberg, R. W., Campbell, L. M., & Appel, L. J. (n.d.).

Publication year

2013

Journal title

New England Journal of Medicine

Volume

368

Issue

17

Page(s)

1594-1602

10.1056/NEJMoa1214530

Abstract

Abstract

BACKGROUND: Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of an 18-month tailored behavioral weight-loss intervention in adults with serious mental illness. METHODS: We recruited overweight or obese adults from 10 community psychiatric rehabilitation outpatient programs and randomly assigned them to an intervention or a control group. Participants in the intervention group received tailored group and individual weight-management sessions and group exercise sessions. Weight change was assessed at 6, 12, and 18 months. RESULTS: Of 291 participants who underwent randomization, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.3, and the mean weight was 102.7 kg (225.9 lb). Data on weight at 18 months were obtained from 279 participants. Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was -3.2 kg (-7.0 lb, P = 0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (P = 0.009). There were no significant between-group differences in adverse events. CONCLUSIONS: A behavioral weight-loss intervention significantly reduced weight over a period of 18 months in overweight and obese adults with serious mental illness. Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population. (Funded by the National Institute of Mental Health; ACHIEVE ClinicalTrials.gov number, NCT00902694).

A case-crossover study of fine particulate matter air pollution and onset of congestive heart failure symptom exacerbation leading to hospitalization

Guallar, E., Symons, J. M., Wang, L., Guallar, E., Howell, E., Dominici, F., Schwab, M., Ange, B. A., Samet, J., Ondov, J., Harrison, D., & Geyh, A. (n.d.).

Publication year

2006

Journal title

American Journal of Epidemiology

Volume

164

Issue

5

Page(s)

421-433

10.1093/aje/kwj206

Abstract

Abstract

Persons with congestive heart failure may be susceptible to ambient air pollution. The authors evaluated the association between exposure to particulate matter with an aerodynamic diameter of

A cohort study of hyperuricemia in middle-aged South Korean men

Ryu, S., Chang, Y., Zhang, Y., Kim, S. G., Cho, J., Son, H. J., Shin, H., & Guallar, E. (n.d.).

Publication year

2012

Journal title

American Journal of Epidemiology

Volume

175

Issue

2

Page(s)

133-143

10.1093/aje/kwr291

Abstract

Abstract

Few prospective studies have assessed the incidence and determinants of asymptomatic hyperuricemia in free-living populations. The authors' goals in this study were to estimate the incidence of hyperuricemia and quantify the dose-response relations of specific risk factors with hyperuricemia in middle-aged South Korean male workers. The authors followed a cohort of 10,802 hyperuricemia-free men aged 30-59 years, examining them annually or biennially at a university hospital in Seoul, South Korea, from 2002 to 2009. A parametric Cox model and a pooled logistic regression model were used to estimate adjusted hazard ratios for incident hyperuricemia (defined as serum uric acid level ≥7.0 mg/dL) according to prespecified risk factors. During 51,210.6 person-years of follow-up, 2,496 men developed hyperuricemia (incidence rate = 48.7 per 1,000 person-years, 95% confidence interval: 46.8, 50.7). The incidence of hyperuricema increased across baseline categories of age, body mass index, alcohol intake, blood pressure, metabolic syndrome, high-sensitivity C-reactive protein, triglycerides, gamma-glutamyltransferase, and fatty liver, whereas fasting glucose, estimated glomerular filtration rate, and high density lipoprotein cholesterol levels were inversely associated with incident hyperuricemia. Development of hyperuricemia, a very common outcome among apparently healthy South Korean men, was predicted by a variety of cardiovascular and metabolic risk factors, suggesting that lifestyle modification may help reduce the incidence of hyperuricemia.

A cohort study of serum bilirubin levels and incident non-alcoholic fatty liver disease in middle aged Korean workers.

Chang, Y., Ryu, S., Zhang, Y., Son, H. J., Kim, J. Y., Cho, J., & Guallar, E. (n.d.).

Publication year

2012

Journal title

PloS one

Volume

7

Issue

5

Page(s)

e37241

10.1371/journal.pone.0037241

Abstract

Abstract

Serum bilirubin may have potent antioxidant and cytoprotective effects. Serum bilirubin levels are inversely associated with several cardiovascular and metabolic endpoints, but their association with nonalcoholic fatty liver disease (NAFLD) has not been investigated except for a single cross-sectional study in a pediatric population. We assessed the prospective association between serum bilirubin concentrations (total, direct, and indirect) and the risk for NAFLD. We performed a cohort study in 5,900 Korean men, 30 to 59 years of age, with no evidence of liver disease and no major risk factors for liver disease at baseline. Study participants were followed in annual or biennial health examinations between 2002 and 2009. The presence of fatty liver was determined at each visit by ultrasonography. We observed 1,938 incident cases of NAFLD during 28,101.8 person-years of follow-up. Increasing levels of serum direct bilirubin were progressively associated with a decreasing incidence of NAFLD. In age-adjusted models, the hazard ratio for NAFLD comparing the highest to the lowest quartile of serum direct bilirubin levels was 0.61 (95% CI 0.54-0.68). The association persisted after adjusting for multiple metabolic parameters (hazard ratio comparing the highest to the lowest quartile 0.86, 95% CI 0.76-0.98; P trend = 0.039). Neither serum total nor indirect bilirubin levels were significantly associated with the incidence of NAFLD. In this large prospective study, higher serum direct bilirubin levels were significantly associated with a lower risk of developing NAFLD, even adjusting for a variety of metabolic parameters. Further research is needed to elucidate the mechanisms underlying this association and to establish the role of serum direct bilirubin as a marker for NAFLD risk.

A comparison of cancer screening practices in cancer survivors and in the general population : The Korean national health and nutrition examination survey (KNHANES) 2001-2007

Cho, J., Guallar, E., Hsu, Y. J., Shin, D. W., & Lee, W. C. (n.d.).

Publication year

2010

Journal title

Cancer Causes and Control

Volume

21

Issue

12

Page(s)

2203-2212

10.1007/s10552-010-9640-4

Abstract

Abstract

Objective: This study aimed to describe cancer screening rates for second primary cancer among cancer survivors in Korea, and to compare these rates with those of two control groups: individuals without a history of cancer but with other chronic diseases, and individuals without a history of cancer and without other chronic diseases. Methods: The study is a cross-sectional analysis of 15,556 adults ≥30 years old who participated in the 2001, 2005, and 2007 Korean National Health and Nutrition Examination Surveys (KNHANES). The prevalence of breast, cervical, gastric, and colorectal cancer screening examinations according to national guidelines was assessed and compared to two control groups. Results: Screening rates among cancer survivors were 48.5, 54.7, 34.7, and 28.6% for breast, cervical, gastric, and colorectal cancer screening, respectively. Cancer survivors showed higher screening rates for all four cancer sites compared with both control groups, but breast cancer screening was only statistically significant after adjusting gender, age, marital status, education, income, working status, health insurance, smoking and drinking status, and self-reported health status. Conclusions: Cancer survivors were more likely than individuals without a cancer history to obtain screening examinations according to recommended guidelines. Still, screening rates even among survivors were suboptimal, emphasizing the need for a more systematic approach to second primary cancer screening and prevention.

A gene-environment interaction analysis of plasma selenium with prevalent and incident diabetes : The Hortega study

Galan-Chilet, I., Grau-Perez, M., De Marco, G., Guallar, E., Martin-Escudero, J. C., Dominguez-Lucas, A., Gonzalez-Manzano, I., Lopez-Izquierdo, R., Briongos-Figuero, L. S., Redon, J., Chaves, F. J., & Tellez-Plaza, M. (n.d.).

Publication year

2017

Journal title

Redox Biology

Volume

12

Page(s)

798-805

10.1016/j.redox.2017.04.022

Abstract

Abstract

Background Selenium and single-nucleotide-polymorphisms in selenoprotein genes have been associated to diabetes. However, the interaction of selenium with genetic variation in diabetes and oxidative stress-related genes has not been evaluated as a potential determinant of diabetes risk. Methods We evaluated the cross-sectional and prospective associations of plasma selenium concentrations with type 2 diabetes, and the interaction of selenium concentrations with genetic variation in candidate polymorphisms, in a representative sample of 1452 men and women aged 18–85 years from Spain. Results The geometric mean of plasma selenium levels in the study sample was 84.2 µg/L. 120 participants had diabetes at baseline. Among diabetes-free participants who were not lost during the follow-up (N=1234), 75 developed diabetes over time. The multivariable adjusted odds ratios (95% confidence interval) for diabetes prevalence comparing the second and third to the first tertiles of plasma selenium levels were 1.80 (1.03, 3.14) and 1.97 (1.14, 3.41), respectively. The corresponding hazard ratios (95% CI) for diabetes incidence were 1.76 (0.96, 3.22) and 1.80 (0.98, 3.31), respectively. In addition, we observed significant interactions between selenium and polymorphisms in PPARGC1A, and in genes encoding mitochondrial proteins, such as BCS1L and SDHA, and suggestive interactions of selenium with other genes related to selenoproteins and redox metabolism. Conclusions Plasma selenium was positively associated with prevalent and incident diabetes. While the statistical interactions of selenium with polymorphisms involved in regulation of redox and insulin signaling pathways provide biological plausibility to the positive associations of selenium with diabetes, further research is needed to elucidate the causal pathways underlying these associations.

A graphical display useful for meta-analysis

Jiménez, F. J., Guallar, E., & Martín-Moreno, J. M. (n.d.).

Publication year

1997

Journal title

European Journal of Public Health

Volume

7

Issue

1

Page(s)

101-105

10.1093/eurpub/7.1.101

Abstract

Abstract

Graphical methods are frequently used in meta-analysis to summarize their results and to explore potential sources of heterogeneity across studies. In this paper, we illustrate a graphical method for meta-analysis of studies with dichotomous exposures and outcomes that complements other graphical and analytical approaches to meta-analysis. In prospective studies, the proportion of cases among the unexposed is plotted on the horizontal axis versus the proportion of cases among the exposed on the vertical axis. Contour lines for equal values of relative risk, odds ratio or risk difference and for the combined estimate of effect and its confidence interval are then superimposed on the graph. In case-control studies, the proportion of exposed controls is plotted on the horizontal axis versus the proportion of exposed cases on the vertical axis, although only the contour lines of equal odds ratios yield direct epidemiological interpretation. In these graphs, the distribution of the individual estimates of effect with respect to the contour lines offers a clue as to the adequacy of the scale of measurement used (additive or multiplicative). This graphical method also permits direct inspection of the range of disease frequency in follow-up studies and of the range of exposure in case-control studies. Its use is illustrated with the aid of 3 examples derived from the literature.

A guide to this supplement

Helfand, M., Morton, S., Guallar, E., & Mulrow, C. (n.d.).

Publication year

2005

Journal title

Annals of internal medicine

Volume

142

Issue

12 II

Page(s)

1033-1034

10.7326/0003-4819-142-12_part_2-200506211-00001

Abstract

Abstract

~

A Guideline for Reporting Mediation Analyses of Randomized Trials and Observational Studies : The AGReMA Statement

Lee, H., Cashin, A. G., Lamb, S. E., Hopewell, S., Vansteelandt, S., Vanderweele, T. J., MacKinnon, D. P., Mansell, G., Collins, G. S., Golub, R. M., McAuley, J. H., Localio, A. R., Van Amelsvoort, L., Guallar, E., Rijnhart, J., Goldsmith, K., Fairchild, A. J., Lewis, C. C., Kamper, S. J., … Henschke, N. (n.d.).

Publication year

2021

Journal title

JAMA - Journal of the American Medical Association

Volume

326

Issue

11

Page(s)

1045-1056

10.1001/jama.2021.14075

Abstract

Abstract

Importance: Mediation analyses of randomized trials and observational studies can generate evidence about the mechanisms by which interventions and exposures may influence health outcomes. Publications of mediation analyses are increasing, but the quality of their reporting is suboptimal. Objective: To develop international, consensus-based guidance for the reporting of mediation analyses of randomized trials and observational studies (A Guideline for Reporting Mediation Analyses; AGReMA). Design, Setting, and Participants: The AGReMA statement was developed using the Enhancing Quality and Transparency of Health Research (EQUATOR) methodological framework for developing reporting guidelines. The guideline development process included (1) an overview of systematic reviews to assess the need for a reporting guideline; (2) review of systematic reviews of relevant evidence on reporting mediation analyses; (3) conducting a Delphi survey with panel members that included methodologists, statisticians, clinical trialists, epidemiologists, psychologists, applied clinical researchers, clinicians, implementation scientists, evidence synthesis experts, representatives from the EQUATOR Network, and journal editors (n = 19; June-November 2019); (4) having a consensus meeting (n = 15; April 28-29, 2020); and (5) conducting a 4-week external review and pilot test that included methodologists and potential users of AGReMA (n = 21; November 2020). Results: A previously reported overview of 54 systematic reviews of mediation studies demonstrated the need for a reporting guideline. Thirty-three potential reporting items were identified from 3 systematic reviews of mediation studies. Over 3 rounds, the Delphi panelists ranked the importance of these items, provided 60 qualitative comments for item refinement and prioritization, and suggested new items for consideration. All items were reviewed during a 2-day consensus meeting and participants agreed on a 25-item AGReMA statement for studies in which mediation analyses are the primary focus and a 9-item short-form AGReMA statement for studies in which mediation analyses are a secondary focus. These checklists were externally reviewed and pilot tested by 21 expert methodologists and potential users, which led to minor adjustments and consolidation of the checklists. Conclusions and Relevance: The AGReMA statement provides recommendations for reporting primary and secondary mediation analyses of randomized trials and observational studies. Improved reporting of studies that use mediation analyses could facilitate peer review and help produce publications that are complete, accurate, transparent, and reproducible..

A longitudinal study of age-related changes in intraocular pressure : The kangbuk samsung health study

Zhao, D., Kim, M. H., Pastor-Barriuso, R., Chang, Y., Ryu, S., Zhang, Y., Rampal, S., Shin, H., Kim, J. M., Friedman, D. S., Guallar, E., & Cho, J. (n.d.).

Publication year

2014

Journal title

Investigative Ophthalmology and Visual Science

Volume

55

Issue

10

Page(s)

6244-6250

10.1167/iovs.14-14151

Abstract

Abstract

PURPOSE. To examine the longitudinal association between age and intraocular pressure (IOP) in a large sample of Korean men and women.METHODS. We conducted a prospective cohort study of 274,064 young and middle-aged Korean adults with normal fundoscopic findings, following them from January 1, 2002, to February 28, 2010. Health exams were scheduled annually or biennially. At each visit, IOP was measured in both eyes using automated noncontact tonometers. The longitudinal change in IOP with age was evaluated using three-level mixed models for longitudinal paired-eye data, accounting for correlations between paired eyes and repeated measurements over time.RESULTS. In fully adjusted models, the average longitudinal change in IOP per 1-year increase in age was -0.065 mm Hg (95% confidence interval [CI] -0.068 to -0.063), with marked sex differences (P < 0.001). In men, the average annual IOP change was -0.093 mm Hg (95% CI -0.096 to -0.091) throughout follow-up. In women, the average annual IOP change was -0.006 mm Hg (95% CI -0.010 to -0.003), with a relatively flat association in the age range of 30 to 59 years and more marked annual decreases at younger and older ages.CONCLUSIONS. Intraocular pressure was inversely associated with age in a large cohort of Korean adults attending health-screening visits. For men, this inverse association was observed throughout the entire age range, while for women it was evident only in younger (

A longitudinal study of association between adiposity markers and intraocular pressure : The kangbuk samsung health study

Zhao, D., Kim, M. H., Pastor-Barriuso, R., Chang, Y., Ryu, S., Zhang, Y., Rampal, S., Shin, H., Kim, J. M., Friedman, D. S., Guallar, E., & Cho, J. (n.d.).

Publication year

2016

Journal title

PloS one

Volume

11

Issue

1

10.1371/journal.pone.0146057

Abstract

Abstract

Importance Intraocular pressure (IOP) reduction or stabilization is the only proven method for glaucoma management. Identifying risk factors for IOP is crucial to understand the pathophysiology of glaucoma. Objective To examine the associations of change in body mass index (BMI), waist circumference, and percent fat mass with change in intraocular pressure (IOP) in a large sample of Korean adults. Design, setting and participants Cohort study of 274,064 young and middle age Korean adults with normal fundoscopic findings who attended annual or biennial health exams from January 1, 2002 to Feb 28, 2010 (577,981 screening visits). Exposures BMI, waist circumference, and percent fat mass. Main Outcome Measure(s) At each visit, IOP was measured in both eyes with automated noncontact tonometers. Results In multivariable-Adjusted models, the average increase in IOP (95% confidence intervals) over time per interquartile increase in BMI (1.26 kg/m2), waist circumference (6.20 cm), and percent fat mass (3.40%) were 0.18 mmHg (0.17 to 0.19), 0.27 mmHg (0.26 to 0.29), and 0.10 mmHg (0.09 to 0.11), respectively (all P < 0.001). The association was stronger in men compared to women (P < 0.001) and it was only slightly attenuated after including diabetes and hypertension as potential mediators in the model. Conclusions and Relevance Increases in adiposity were significantly associated with an increase in IOP in a large cohort of Korean adults attending health screening visits, an association that was stronger for central obesity. Further research is needed to understand better the underlying mechanisms of this association, and to establish the role of weight gain in increasing IOP and the risk of glaucoma and its complications.

A metabolomics approach identified toxins associated with uremic symptoms in advanced chronic kidney disease

Hu, J. R., Myint, L., Levey, A. S., Coresh, J., Inker, L. A., Grams, M. E., Guallar, E., Hansen, K. D., Rhee, E. P., & Shafi, T. (n.d.).

Publication year

2022

Journal title

Kidney International

Volume

101

Issue

2

Page(s)

369-378

10.1016/j.kint.2021.10.035

Abstract

Abstract

Uremic symptoms are common in patients with advanced chronic kidney disease, but the toxins that cause these symptoms are unknown. To evaluate this, we performed a cross-sectional study of the 12 month post-randomization follow-up visit of Modification of Diet in Renal Disease (MDRD) participants reporting uremic symptoms who also had available stored serum. We quantified 1,163 metabolites by liquid chromatography-tandem mass spectrometry. For each uremic symptom, we calculated a score as the severity multiplied by the number of days the symptom was experienced. We analyzed the associations of the individual symptom scores with metabolites using linear models with empirical Bayesian inference, adjusted for multiple comparisons. Among 695 participants, the mean measured glomerular filtration rate (mGFR) was 28 mL/min/1.73 m2. Uremic symptoms were more common in the subgroup of 214 patients with an mGFR under 20 mL/min/1.73 m2 (mGFR under 20 subgroup) than in the full group. For all metabolites with significant associations, the direction of the association was concordant in the full group and the subgroup. For gastrointestinal symptoms (bad taste, loss of appetite, nausea, and vomiting), eleven metabolites were associated with symptoms. For neurologic symptoms (decreased alertness, falling asleep during the day, forgetfulness, lack of pep and energy, and tiring easily/weakness), seven metabolites were associated with symptoms. Associations were consistent across sensitivity analyses. Thus, our proof-of-principle study demonstrates the potential for metabolomics to understand metabolic pathways associated with uremic symptoms. Larger, prospective studies with external validation are needed.

A Metabolomics Approach to Identify Metabolites Associated With Mortality in Patients Receiving Maintenance Hemodialysis

Al Awadhi, S., Myint, L., Guallar, E., Clish, C. B., Wulczyn, K. E., Kalim, S., Thadhani, R., Segev, D. L., McAdams DeMarco, M., Moe, S. M., Moorthi, R. N., Hostetter, T. H., Himmelfarb, J., Meyer, T. W., Powe, N. R., Tonelli, M., Rhee, E. P., & Shafi, T. (n.d.).

Publication year

2024

Journal title

Kidney International Reports

Volume

9

Issue

9

Page(s)

2718-2726

10.1016/j.ekir.2024.06.039

Abstract

Abstract

Introduction: Uremic toxins contributing to increased risk of death remain largely unknown. We used untargeted metabolomics to identify plasma metabolites associated with mortality in patients receiving maintenance hemodialysis. Methods: We measured metabolites in serum samples from 522 Longitudinal US/Canada Incident Dialysis (LUCID) study participants. We assessed the association between metabolites and 1-year mortality, adjusting for age, sex, race, cardiovascular disease, diabetes, body mass index, serum albumin, Kt/Vurea, dialysis duration, and country. We modeled these associations using limma, a metabolite-wise linear model with empirical Bayesian inference, and 2 machine learning (ML) models: Least absolute shrinkage and selection operator (LASSO) and random forest (RF). We accounted for multiple testing using a false discovery rate (pFDR) adjustment. We defined significant mortality-metabolite associations as pFDR < 0.1 in the limma model and metabolites of at least medium importance in both ML models. Results: The mean age of the participants was 64 years, the mean dialysis duration was 35 days, and there were 44 deaths (8.4%) during a 1-year follow-up period. Two metabolites were significantly associated with 1-year mortality. Quinolinate levels (a kynurenine pathway metabolite) were 1.72-fold higher in patients who died within year 1 compared with those who did not (pFDR, 0.009), wheras mesaconate levels (an emerging immunometabolite) were 1.57-fold higher (pFDR, 0.002). An additional 42 metabolites had high importance as per LASSO, 46 per RF, and 9 per both ML models but were not significant per limma. Conclusion: Quinolinate and mesaconate were significantly associated with a 1-year risk of death in incident patients receiving maintenance hemodialysis. External validation of our findings is needed.

A nationwide analysis of intensive care unit admissions, 2009–2014 – The Korean ICU National Data (KIND) study

Park, J., Jeon, K., Chung, C. R., Yang, J. H., Cho, Y. H., Cho, J., Park, C. M., Park, H., Cho, J., Guallar, E., & Suh, G. Y. (n.d.).

Publication year

2018

Journal title

Journal of Critical Care

Volume

44

Page(s)

24-30

10.1016/j.jcrc.2017.09.017

Abstract

Abstract

Purpose: To evaluate unbiased information on the characteristics, procedures, and outcomes of intensive care unit (ICU) admissions in a long-term nationwide study. Materials and methods: Cohort study of all ICU admissions in patients > 18 years of age in Korea between August 1, 2009 and September 30, 2014 (1,553,673 ICU admissions in 1,265,509 patients). Results: From August 2009 to September 2014, the age-standardized ICU admission rate was 744.6 per 100,000 person-years (869.5 per 100,000 person-years in men and 622.0 per 100,000 person-years in women). The overall in-hospital mortality was 13.8% (14.1% in men and 13.5% in women). Among all Koreans, the ICU mortality rate was 102.9 per 100,000 person-years (122.5 per 100,000 person years in men and 83.8 per 100,000 person years in women). The median ICU and hospital length of stay were 4 and 13 days, respectively. The median cost per ICU admission was $5051, which increased steadily over the study period. There were marked differences by gender in ICU admission rates, aggressive support, and outcomes. Conclusions: Our study identified increasing trends in ICU admissions and utilization of advance life support systems that add to the burden of care in a developed society.

A prospective study of dietary selenium intake and risk of type 2 diabetes

Stranges, S., Sieri, S., Vinceti, M., Grioni, S., Guallar, E., Laclaustra, M., Muti, P., Berrino, F., & Krogh, V. (n.d.).

Publication year

2010

Journal title

BMC public health

Volume

10

10.1186/1471-2458-10-564

Abstract

Abstract

Background: Growing evidence raises concern about possible associations of high selenium exposure with diabetes in selenium-replete populations such as the US. In countries with lower selenium status, such as Italy, there is little epidemiological evidence on the association between selenium and diabetes. This study examined the prospective association between dietary selenium intake and risk of type 2 diabetes. Methods: The ORDET cohort study comprised a large sample of women from Northern Italy (n = 7,182). Incident type 2 diabetes was defined as a self-report of a physician diagnosis, use of antidiabetic medication, or a hospitalization discharge. Dietary selenium intake was measured by a semi-quantitative food-frequency questionnaire at the baseline examination (1987-1992). Participants were divided in quintiles based on their baseline dietary selenium intake. Results: Average selenium intake at baseline was 55.7 μg/day. After a median follow-up of 16 years, 253 women developed diabetes. In multivariate logistic regression analyses, the odds ratio for diabetes comparing the highest to the lowest quintile of selenium intake was 2.39, (95% CI: 1.32, 4.32; P for linear trend = 0.005). The odds ratio for diabetes associated with a 10 μg/d increase in selenium intake was 1.29 (95% CI: 1.10, 1.52). Conclusions: In this population, increased dietary selenium intake was associated with an increased risk of type 2 diabetes. These findings raise additional concerns about the association of selenium intake above the Recommended Dietary Allowance (55 μg/day) with diabetes risk.

A prospective study of plasma ferritin level and incident diabetes : The Atherosclerosis Risk in Communities (ARIC) Study

Jehn, M. L., Guallar, E., Clark, J. M., Couper, D., Duncan, B. B., Ballantyne, C. M., Hoogeveen, R. C., Harris, Z. L., & Pankow, J. S. (n.d.).

Publication year

2007

Journal title

American Journal of Epidemiology

Volume

165

Issue

9

Page(s)

1047-1054

10.1093/aje/kwk093

Abstract

Abstract

The authors performed a case-cohort study nested within the Atherosclerosis Risk in Communities (ARIC) Study to determine the association between plasma ferritin level and risk of type 2 diabetes mellitus. Persons with incident cases of type 2 diabetes diagnosed over an average follow-up period of 7.9 years (n = 599) were compared with a random sample of the cohort (n = 690). After adjustment for age, gender, menopausal status, ethnicity, center, smoking, and alcohol intake, the hazard ratio for diabetes, comparing the fifth quintile of ferritin with the first quintile, was 1.74 (95% confidence interval: 1.14, 2.65; p-trend < 0.001). After further adjustment for body mass index and components of the metabolic syndrome, the hazard ratio was 0.81 (95% confidence interval: 0.49, 1.34; p-trend = 0.87). From a causal perspective, there are two alternative interpretations of these findings. Elevated iron stores, reflected in elevated plasma ferritin levels, may induce baseline metabolic abnormalities that ultimately result in diabetes. Alternatively, elevated ferritin may be just one of several metabolic abnormalities related to the underlying process that ultimately results in diabetes, rather than a causal factor for diabetes. Longitudinal studies with repeated measurements of glucose and iron metabolism parameters are needed to establish the role of iron stores and plasma ferritin in diabetes development.

A prospective study of plasma fish oil levels and incidence of myocardial infarction in U.S. male physicians

Guallar, E., Hennekens, C. H., Sacks, F. M., Willett, W. C., & Stampfer, M. J. (n.d.).

Publication year

1995

Journal title

Journal of the American College of Cardiology

Volume

25

Issue

2

Page(s)

387-394

10.1016/0735-1097(94)00370-6

Abstract

Abstract

Objectives. This study evaluated whether increased intake of fish oils (eicosapentaenoic and docosahexaenoic acids) might reduce the risk of coronary heart disease. Background. Observational and clinical studies have suggested that increased intake of fish oils, as reflected in plasma levels of fish oils, may reduce the risk of myocardial infarction. Methods. A nested case-control study was conducted among the 14,916 participants in the Physicians' Health Study with a sample of plasma before randomization. Each participant with myocardial infarction occurring during the first 5 years of follow-up was matched by smoking status and age with a randomly chosen control participant who had not developed coronary heart disease. Results. Mean levels of fish oils (with 95% confidence interval [CI] for paired differences and p values) in case and control participants, expressed as present of total fatty acids, were, for eicosapentaenoic acid, 0.26 versus 0.25 (95% CI - 0.03 to 0.05, p = 0.70) in cholesterol esters and 0.56 versus 0.54 (95% CI -0.04 to 0.09, p = 0.44) in phospholipids, and for docosahexaenoic acid, 0.23 versus 0.24 (95% CI -0.07 to 0.04, p = 0.64) in cholesterol esters and 2.22 versus 2.14 (95% CI -0.10 to 0.27, p = 0.36) in phospholipids. Results adjusted for major cardiovascular risk factors showed a very similar lack of association between fish oil levels and the incidence of myocardial infarction. Conclusions. These results indicate no beneficial effect of increased fish oil consumption on the incidence of a first myocardial infarction. However, the effect of very high levels of fish oils could not be evaluated.

A Randomized Trial of Selenium Supplementation and Risk of Type-2 Diabetes, as Assessed by Plasma Adiponectin

Rayman, M. P., Blundell-Pound, G., Pastor-Barriuso, R., Guallar, E., Steinbrenner, H., & Stranges, S. (n.d.).

Publication year

2012

Journal title

PloS one

Volume

7

Issue

9

10.1371/journal.pone.0045269

Abstract

Abstract

Background: Evidence that selenium affects the risk of type-2 diabetes is conflicting, with observational studies and a few randomized trials showing both lower and higher risk linked to the level of selenium intake and status. We investigated the effect of selenium supplementation on the risk of type-2 diabetes in a population of relatively low selenium status as part of the UK PRECISE (PREvention of Cancer by Intervention with SElenium) pilot study. Plasma adiponectin concentration, a recognised independent predictor of type-2 diabetes risk and known to be correlated with circulating selenoprotein P, was the biomarker chosen. Methods: In a randomized, double-blind, placebo-controlled trial, five hundred and one elderly volunteers were randomly assigned to a six-month intervention with 100, 200 or 300 μg selenium/d as high-selenium or placebo yeast. Adiponectin concentration was measured by ELISA at baseline and after six months of treatment in 473 participants with one or both plasma samples available. Results: Mean (SD) plasma selenium concentration was 88.5 ng/g (19.1) at baseline and increased significantly in the selenium-treatment groups. In baseline cross-sectional analyses, the fully adjusted geometric mean of plasma adiponectin was 14% lower (95% CI, 0-27%) in the highest than in the lowest quartile of plasma selenium (P for linear trend = 0.04). In analyses across randomized groups, however, selenium supplementation had no effect on adiponectin levels after six months of treatment (P = 0.96). Conclusions: These findings are reassuring as they did not show a diabetogenic effect of a six-month supplementation with selenium in this sample of elderly individuals of relatively low selenium status. Trial Registration: Controlled-Trials.com ISRCTN25193534.

Achievement of lipoprotein goals among patients with metabolic syndrome at high cardiovascular risk across Europe. the EURIKA study

Banegas, J. R., López-García, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., Massó-González, E. L., Sazova, O., Perk, J., Steg, P. G., De Backer, G., & Rodríguez-Artalejo, F. (n.d.).

Publication year

2013

Journal title

International Journal of Cardiology

Volume

166

Issue

1

Page(s)

210-214

10.1016/j.ijcard.2011.10.094

Abstract

Abstract

Objective: To examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe. Methods: Cross-sectional study conducted in 2009-2010 in 12 European countries among outpatients aged ≥ 50 years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥ 1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥ 2 additional major cardiovascular risk factors). Results: Among 1431 highest-risk patients, 64.6% (between-country range [BCR] 40-84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5-28.6%) had LDL-cholesterol < 70 mg/dl, non-HDL-cholesterol < 100 mg/dl, and apolipoprotein B < 80 mg/dl. Among 832 high-risk patients, 38.7% BCR: 27.5-55.3%) were on lipid-lowering medication. Of them, 20.5% (BCR: 5.5-57.6%) had LDL-cholesterol < 100 mg/dl, non-HDL-cholesterol < 130 mg/dl, and apolipoprotein B < 90 mg/dl. About 96% of highest-risk patients and 94% of high-risk patients were given at least one lifestyle advice (weight reduction, healthy diet, physical activity, no-smoking), but only 1.3% of the former and 4.9% of the latter reached all three lipid goals. Conclusion: There is a substantial gap between clinical guidelines and medical practice since only one in 5-7 patients met all treatment targets. Although most patients received lifestyle advice, the effectiveness of counseling was very low. Large between-country differences in outcomes suggest considerable room for improvement.

Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe : The EURIKA study

Banegas, J. R., López-García, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., Massó-González, E. L., Jiménez, F. J., Perk, J., Steg, P. G., De Backer, G., & Rodríguez-Artalejo, F. (n.d.).

Publication year

2011

Journal title

European Heart Journal

Volume

32

Issue

17

Page(s)

2143-2152

10.1093/eurheartj/ehr080

Abstract

Abstract

Aims Most studies on the primary prevention of cardiovascular disease (CVD) have been limited to patients at high CVD risk. We assessed the achievement of treatment goals for CVD risk factors among patients with a substantial variation in CVD risk. Methods and resultsThis study was conducted with 7641 outpatients aged

Adherence to Diet and Meal Timing in a Randomized Controlled Feeding Study of Time‐Restricted Feeding

Wu, B., White, K., Maw, M. T., Charleston, J., Zhao, D., Guallar, E., Appel, L. J., Clark, J. M., Maruthur, N. M., & Pilla, S. J. (n.d.).

Publication year

2022

Journal title

Nutrients

Volume

14

Issue

11

10.3390/nu14112283

Abstract

Abstract

Adherence is critical in feeding studies to determine the efficacy of dietary interventions. This time‐restricted intake of meals (TRIM) investigation was a controlled feeding study that randomized 41 participants to follow 12 weeks of time‐restricted feeding (TRF) or a usual feeding pattern (UFP). Adherence was optimized through careful screening and participant orientation, flexibility in beverages and seasonings, and frequent contact between participants and staff. Adherence was measured daily using a self‐administered diary form. We calculated the percentage of participant‐days with perfect adherence to meal timing (ate all meals within their designated time window) and to food consumption (ate all study food and no non‐study food). Adherence was compared between study arms, days of the week, and weeks of the study period using generalized estimating equations (GEE) regression. There was perfect adherence to meal timing on 87% of participant‐days and to food consumption on 94% of participant-days, with no significant difference by arm. In UFP, but not TRF, participants had lower adherence to meal timing over the weekend (p‐value = 0.002) and during the first two weeks of intervention (p‐value = 0.03). A controlled feeding study randomizing free‐living individuals to different meal timings achieved a high degree of adherence to meal timing and food consumption, utilizing multiple strategies.

Adiposity and Incident Heart Failure and its Subtypes : MESA (Multi-Ethnic Study of Atherosclerosis)

Rao, V. N., Zhao, D., Allison, M. A., Guallar, E., Sharma, K., Criqui, M. H., Cushman, M., Blumenthal, R. S., & Michos, E. D. (n.d.).

Publication year

2018

Journal title

JACC: Heart Failure

Volume

6

Issue

12

Page(s)

999-1007

10.1016/j.jchf.2018.07.009

Abstract

Abstract

Objectives: This study sought to compare various measures of adiposity with risk for incident hospitalized heart failure (HF) with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). Background: Obesity is a risk factor for HF, particularly HFpEF. It is unknown which measures of adiposity, including anthropometrics and computed tomography (CT)-measured fat area, are most predictive of HF subtypes. Methods: The authors studied 1,806 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) study without baseline cardiovascular disease who underwent anthropometrics (body mass index [BMI] and waist circumference) and an abdominal CT. Subcutaneous and visceral adipose tissue (VAT) were measured from a single CT slice at L2-L3. Cox hazard models were used to examine associations of adiposity with incident hospitalized HFpEF and HFrEF events. Fully adjusted models included demographics, HF risk factors, and N-terminal pro-B-type natriuretic peptide. Results: Over a mean follow-up of 11 years, there were 34 HFpEF and 36 HFrEF events. The fully adjusted hazard ratio (95% confidence interval [CI]) per 1-SD higher of each anthropometric and CT-measured adiposity measures for incident HFpEF were as follows: BMI HR: 1.66; 95% CI: 1.12 to 2.45; waist circumference HR: 1.59; 95% CI: 1.05 to 2.40; and VAT HR: 2.24; 95% CI: 1.44 to 3.49. None of these adiposity measures were associated with HFrEF. Even among overweight/obese adults (BMI ≥25 kg/m 2 ), assessment of VAT (per 1-SD) was strongly associated with HFpEF (HR: 2.78; 95% CI: 1.62 to 4.76). Subcutaneous adipose tissue was neither associated with HFpEF nor HFrEF. Conclusions: In a multiethnic cohort free of cardiovascular disease, CT-measured VAT was independently associated with incident hospitalized HFpEF but not HFrEF. Measuring visceral fat at the time of CT imaging for other indications may offer additional prognostication of HF risk.

Adulthood consumption of preserved and nonpreserved vegetables and the risk of nasopharyngeal carcinoma : A systematic review

Gallicchio, L., Matanoski, G., Tao, X., Chen, L., Lam, T. K., Boyd, K., Robinson, K. A., Balick, L., Mickelson, S., Caulfield, L. E., Herman, J. G., Guallar, E., & Alberg, A. J. (n.d.).

Publication year

2006

Journal title

International Journal of Cancer

Volume

119

Issue

5

Page(s)

1125-1135

10.1002/ijc.21946

Abstract

Abstract

The incidence rates of nasopharyngeal carcinoma (NPC) are dramatically higher in certain regions of Asia compared to the rest of the world. Few risk factors for NPC are known; however, in contrast to the hypothesized health benefits of nonpreserved vegetables, it is thought that preserved vegetable intake may play a role in contributing to the higher incidence of NPC in high-risk regions. Therefore, the purpose of this study was to systematically review the epidemiologic evidence on the associations between adulthood intake of preserved and nonpreserved vegetables and NPC risk. A search of the epidemiological literature from 1966 to 2004 was performed using several bibliographic databases, including PubMed and the Chinese Biomedical Literature Database System. There were no language restrictions. Meta-analysis was conducted to obtain pooled odds ratios (ORs) for the highest-versus-lowest categories of preserved and nonpreserved vegetable intake. A total of 16 case-control studies were identified in the search. Results showed that highest-versus-lowest preserved vegetable intake was associated with a 2-fold increase in the risk of NPC (Random Effects Odds Ratio (RE OR) 2.04; 95% Confidence Limits (CL) 1.43, 2.92). Conversely, high nonpreserved vegetable intake was associated with 36% decrease in the risk of NPC (RE OR 0.64; 95% CL 0.48, 0.85). Findings for both preserved and nonpreserved vegetables were consistent across vegetable type and by country of study. Further research in high-risk areas to gain insight into the risk associated with preserved vegetables and protection associated with nonpreserved vegetables may advance understanding of NPC and yield clues for prevention.

Adverse events during medical and surgical hospitalizations for persons with schizophrenia

Daumit, G. L., Pronovost, P. J., Anthony, C. B., Guallar, E., Steinwachs, D. M., & Ford, D. E. (n.d.).

Publication year

2006

Journal title

Archives of General Psychiatry

Volume

63

Issue

3

Page(s)

265-272

10.1001/archpsyc.63.3.267

Abstract

Abstract

Context: Persons with schizophrenia have a high risk of premature mortality. It is not clear if greater risk for adverse events during hospitalization is a contributing factor. Objectives: To estimate the prevalence of adverse events in medical and surgical hospitalizations for persons with schizophrenia compared with those for persons without schizophrenia and to examine the relation between adverse events and intensive care unit admission, in-hospital death, length of stay, and total charges for hospitalizations for persons with schizophrenia. Design: Cross-sectional study. Setting: We studied discharges from all Maryland acute care hospitals' medical and surgical services in 2001 and 2002. Patients: There were 1746 medical and surgical hospitalizations for adults with a secondary diagnosis of schizophrenia and 732 158 for adults without schizophrenia. Main Outcome Measures: For primary outcomes, we applied the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs), which were developed to detect adverse events in administrative data. We compared PSIs for hospitalizations for patients with a secondary diagnosis of schizophrenia with those for patients without and determined the association between schizophrenia and each PSI adjusting for patient and hospital characteristics. For hospitalizations for patients with schizophrenia, for secondary outcomes we examined the association between each PSI and intensive care unit admission, in-hospital death, length of stay, and total charges. Results: Hospitalizations for patients with schizophrenia had the following higher adjusted relative odds of having PSIs compared with those for patients without schizophrenia: infections due to medical care (odds ratio [OR], 2.49 [95% confidence interval (CI), 1.28 to 4.88]); postoperative respiratory failure (OR, 2.08 [95% CI, 1.41 to 3.06]); postoperative deep venous thrombosis (OR, 1.96 [95% CI, 1.18 to 3.26]); and postoperative sepsis (OR, 2.29 [95% CI, 1.49 to 3.51]). For hospitalizations for patients with schizophrenia, having respiratory failure or sepsis resulted in at least twice the adjusted odds for intensive care unit admission and death. The median adjusted increase in length of stay was at least 10 days, and median hospital charges were elevated by at least $20 000 for infections due to medical care, respiratory failure, deep venous thrombosis, and sepsis. Conclusions: Medical and surgical hospitalizations for persons with schizophrenia had at least twice the odds of several types of adverse events than those for persons without schizophrenia. These adverse events were associated with poor clinical and economic outcomes during the hospital admission. Efforts to reduce these adverse events should become a research priority.

Aflatoxin and viral hepatitis exposures in Guatemala : Molecular biomarkers reveal a unique profile of risk factors in a region of high liver cancer incidence

Smith, J. W., Kroker-Lobos, M. F., Lazo, M., Rivera-Andrade, A., Egner, P. A., Wedemeyer, H., Torres, O., Freedman, N. D., McGlynn, K. A., Guallar, E., Groopman, J. D., & Ramirez-Zea, M. (n.d.).

Publication year

2017

Journal title

PloS one

Volume

12

Issue

12

10.1371/journal.pone.0189255

Abstract

Abstract

Liver cancer is an emerging global health issue, with rising incidence in both the United States and the economically developing world. Although Guatemala experiences the highest rates of this disease in the Western hemisphere and a unique 1:1 distribution in men and women, few studies have focused on this population. Thus, we determined the prevalence and correlates of aflatoxin B1 (AFB1) exposure and hepatitis virus infection in Guatemalan adults. Healthy men and women aged 40 years (n = 461), residing in five departments of Guatemala, were enrolled in a cross-sectional study from May—October of 2016. Serum AFB1-albumin adducts were quantified using isotope dilution mass spectrometry. Multivariate linear regression was used to assess relationships between AFB1-albumin adduct levels and demographic factors. Biomarkers of hepatitis B virus and hepatitis C virus infection were assessed by immunoassay and analyzed by Fisher’s exact test. AFB1-albumin adducts were detected in 100% of participants, with a median of 8.4 pg/mg albumin (range, 0.2–814.8). Exposure was significantly higher (p