Eliseo Guallar
Eliseo Guallar
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Chair and Professor of the Department of Epidemiology
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Professional overview
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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.
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Education
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Diploma of English, Spanish Official School of Languages at Zaragoza (Escuela Oficial de Idiomas de Zaragoza), Zaragoza, SpainMD, University of Zaragoza, Zaragoza, SpainMPH, University of Minnesota, Minneapolis, MNDrPH, Harvard University, Boston, MA
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Honors and awards
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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)
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Publications
Publications
Urine arsenic and hypertension in US adults: The 2003-2008 national health and nutrition examination survey
AbstractJones, M. R., Tellez-Plaza, M., Sharrett, A. R., Guallar, E., & Navas-Acien, A. (n.d.).Publication year
2011Journal title
EpidemiologyVolume
22Issue
2Page(s)
153-161AbstractBackground: High chronic exposure to inorganic arsenic may contribute to the development of hypertension. Limited information is available, however, on the association of low to moderate exposure to inorganic arsenic with blood pressure levels and hypertension. We investigated the association of exposure to inorganic arsenic (as measured in urine) with systolic and diastolic blood pressure levels and the prevalence of hypertension in US adults. Methods: We studied 4167 adults 20 years of age or older who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 through 2008 and for whom total arsenic, dimethylarsinate (DMA), and arsenobetaine had been assessed in urine. Results: The median (interquartile range) urine concentrations were 8.3 μg/L (4.2-17.1) for total arsenic, 3.6 μg/L (2.0-6.0) for DMA, and 1.4 μg/L (0.3-6.3) for arsenobetaine. The weighted prevalence of hypertension in the study population was 36%. After multivariable adjustment, a 2-fold increase in total arsenic was associated with a hypertension odds ratio of 0.98 (95% confidence interval = 0.86-1.11). A doubling of total arsenic minus arsenobetaine was associated with a hypertension OR of 1.03 (0.94-1.14) and a doubling of DMA concentrations was associated with a hypertension OR of 1.11 (0.99-1.24). Total arsenic, total arsenic minus arsenobetaine, or DMA levels were not associated with systolic or diastolic blood pressure. Conclusions: At the low to moderate levels, typical of the US population, total arsenic, total arsenic minus arsenobetaine, and DMA concentrations in urine were not associated with the prevalence of hypertension or with systolic or diastolic blood pressure levels. A weak association of DMA with hypertension could not be ruled out.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
AbstractCho, J., Guallar, E., Hsu, Y. J., Shin, D. W., & Lee, W. C. (n.d.).Publication year
2010Journal title
Cancer Causes and ControlVolume
21Issue
12Page(s)
2203-2212AbstractObjective: 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 prospective study of dietary selenium intake and risk of type 2 diabetes
AbstractStranges, S., Sieri, S., Vinceti, M., Grioni, S., Guallar, E., Laclaustra, M., Muti, P., Berrino, F., & Krogh, V. (n.d.).Publication year
2010Journal title
BMC public healthVolume
10AbstractBackground: 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.Blood lead level and kidney function in US adolescents: The third national health and nutrition examination survey
AbstractFadrowski, J. J., Navas-Acien, A., Tellez-Plaza, M., Guallar, E., Weaver, V. M., & Furth, S. L. (n.d.).Publication year
2010Journal title
Archives of Internal MedicineVolume
170Issue
1Page(s)
75-82AbstractBackground: Chronic, high-level lead exposure is a known risk factor for kidney disease. The effect of current low-level environmental lead exposure is less well known, particularly among children, a population generally free from kidney disease risk factors such as hypertension and diabetes mellitus. Therefore, in this study, we investigated the association between lead exposure and kidney function in a representative sample of US adolescents. Methods: Participants included 769 adolescents aged 12 to 20 years for whom whole blood lead and serum cystatin C were measured in the Third National Health and Nutrition Examination Survey, conducted from 1988-1994. The association between blood lead level and level of kidney function (glomerular filtration rate [GFR]), determined by cystatin C-based and creatinine-based estimating equations, was examined. Results: Median whole blood lead level was 1.5 μg/dL (to convert to micromoles per liter, multiply by 0.0483), and median cystatin C-estimated GFR was 112.9 mL/min/ 1.73 m2. Participants with lead levels in the highest quartile (≥3.0 μg/dL) had 6.6 mL/min/1.73 m2-lower estimated GFR (95% confidence interval, -0.7 to -12.6 mL/min/1.73m2) compared with those in the first quartile (<1 μg/dL). A doubling of blood lead level was associated with a 2.9 mL/min/1.73 m2-lower estimated GFR (95% confidence interval, -0.7 to -5.0 mL/min/1.73 m2). Lead levels were also associated with lower creatinine-based estimated GFR levels, but the association was weaker than with cystatin C-based GFR and not statistically significant. Conclusions: Higher blood lead levels in a range below the current Centers for Disease Control and Prevention-designated level of concern (10 μg/dL) were associated with lower estimated GFRs in a representative sample of US adolescents. This finding contributes to the increasing epidemiologic evidence indicating an adverse effect of low-level environmental lead exposure.Cadmium and peripheral arterial disease: Gender differences in the 1999-2004 US national health and nutrition examination survey
AbstractTellez-Plaza, M., Navas-Acien, A., Crainiceanu, C. M., Sharrett, A. R., & Guallar, E. (n.d.).Publication year
2010Journal title
American Journal of EpidemiologyVolume
172Issue
6Page(s)
671-681AbstractGender differences in the association of blood and urine cadmium concentrations with peripheral arterial disease (PAD) were evaluated by using data from 6,456 US adults aged ≥40 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial blood pressure index of <0.9 in at least one leg. For men, the adjusted odds ratios for PAD comparing the highest with the lowest quintiles of blood and urine cadmium concentrations were 1.82 (95% confidence interval (CI): 0.82, 4.05) and 4.90 (95% CI: 1.55, 15.54), respectively, with a progressive dose-response relation and no difference by smoking status. For women, the corresponding odds ratios were 1.19 (95% CI: 0.66, 2.16) and 0.56 (95% CI: 0.18, 1.71), but there was evidence of effect modification by smoking: among women ever smokers, there was a positive, progressive dose-response relation; among women never smokers, there was a U-shaped dose-response relation. Higher blood and urine cadmium levels were associated with increased prevalence of PAD, but women never smokers showed a U-shaped relation with increased prevalence of PAD at very low cadmium levels. These findings add to the concern of increased cadmium exposure as a cardiovascular risk factor in the general population.Higher selenium status is associated with adverse blood lipid profile in British adults
AbstractStranges, S., Laclaustra, M., Ji, C., Cappuccio, F. P., Navas-Acien, A., Ordovas, J. M., Rayman, M., & Guallar, E. (n.d.).Publication year
2010Journal title
Journal of NutritionVolume
140Issue
1Page(s)
81-87AbstractRecent findings have raised concern about possible associations of high selenium exposure with diabetes and hyperlipidemia in the US, a population with high selenium status. In the UK, a population with lower selenium status, there is little data on the association of selenium status with cardio-metabolic risk factors in the general population. Weexamined the association of plasma selenium concentration with blood lipids in a nationally representative sample of British adults. A cross-sectional study was conducted among 1042 white participants (aged 19-64 y) in the 2000-2001 UK National Diet and Nutrition Survey. Plasma selenium was measured by inductively coupled-plasma mass spectrometry. Total and HDL cholesterol were measured in nonfasting plasma samples. Mean plasma selenium concentration was 1.10 ± 0.19 μmol/L. The multivariate adjusted differences between the highest (≥1.20 μmol/L) and lowest (<0.98 μmol/L) quartiles of plasma selenium were 0.39 (95% CI 0.18, 0.60) mmol/L for total cholesterol, 0.38 (0.17, 0.59) for non-HDL cholesterol, and 0.01 (-0.05, 0.07) for HDL cholesterol. Higher plasma selenium (i.e., ≥1.20 μmol/L) was associated with increased total and non-HDL cholesterol levels but not with HDL in the UK adult population. These findings raise additional concern about potential adverse cardio-metabolic effects of high selenium status. Randomized and mechanistic evidence is necessary to assess causality and to evaluate the impact of this association on cardiovascular risk.In response
Guallar, E., Miller, E. R., Ordovas, J. M., & Stranges, S. (n.d.). In Annals of internal medicine (1–).Publication year
2010Volume
153Issue
3Page(s)
209-210Is there an association between low-to-moderate alcohol consumption and risk of cognitive decline?
AbstractLobo, E., Dufouil, C., Marcos, G., Quetglas, B., Saz, P., Guallar, E., & Lobo, A. (n.d.).Publication year
2010Journal title
American Journal of EpidemiologyVolume
172Issue
6Page(s)
708-716AbstractThe authors evaluated the association of low-to-moderate alcohol consumption with risk of cognitive decline in a census-based cohort study of men and women aged ≥55 years conducted in Zaragoza, Spain (1994-1999). Participants free of dementia at baseline (N = 3,888) were examined after 2.5 and 4.5 years of follow-up. Information on alcohol intake was collected with the EURODEM Risk Factors Questionnaire and the History and Aetiology Schedule. The study endpoint was severe cognitive decline, defined as loss of ≥1 point/year on the Mini-Mental State Examination or a diagnosis of incident dementia (Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, Text Revision criteria). Compared with those for abstainers, the multivariate-adjusted odds ratios for severe cognitive decline for male drinkers of <12 g alcohol/day, drinkers of 12-24 g alcohol/day, and former drinkers were 0.61 (95% confidence interval (CI): 0.31, 1.20), 1.19 (95% CI: 0.61, 2.32), and 1.03 (95% CI: 0.59, 1.82), respectively. The corresponding odds ratios for women were 0.88 (95% CI: 0.45, 1.72), 2.38 (95% CI: 0.98, 5.77), and 1.03 (95% CI: 0.48, 2.23). This study did not support the hypothesis that low-to-moderate alcohol consumption prevents cognitive decline. The inverse association between low-to-moderate alcohol intake and cognitive decline observed in other studies may have been due to inclusion of former drinkers in the abstainers reference category.Meta-analysis of folic acid supplementation trials on risk of cardiovascular disease and risk interaction with baseline homocysteine levels
AbstractMiller, E. R., Juraschek, S., Pastor-Barriuso, R., Bazzano, L. A., Appel, L. J., & Guallar, E. (n.d.).Publication year
2010Journal title
American Journal of CardiologyVolume
106Issue
4Page(s)
517-527AbstractExperimental models and observational studies suggest that homocysteine-lowering therapy with folic acid (FA) may prevent cardiovascular disease (CVD). However, FA also stimulates cell proliferation and might promote progression of atherosclerosis. Our objectives were to perform a meta-analysis of FA supplementation trials on CVD events and to explore a potential interaction between FA supplementation and baseline homocysteine levels on CVD events. We searched MEDLINE for randomized controlled trials of FA supplementation to prevent CVD events (January 1966 to July 2009) and performed meta-analyses using random effects models. For trials that reported responses to FA supplementation stratified by baseline levels of homocysteine, we pooled within-trial estimates of differences in log-relative risks by baseline homocysteine levels using a random effects model. Overall, FA supplementation did not affect primary cardiovascular clinical end points (relative risk 1.02, 95% confidence interval [CI] 0.93 to 1.13, p = 0.66) or stroke (relative risk 0.95, 95% CI 0.84 to 1.08, p = 0.43). However, in trials that reported analyses stratified by baseline homocysteine, effect of FA supplementation differed by strata of baseline homocysteine (p for interaction = 0.030). Specifically, risks of primary clinical CVD events comparing FA supplementation to control were 1.06 (95% CI 1.00 to 1.13) in strata with mean baseline homocysteine levels >12 μmol/L and 0.94 (95% CI 0.86 to 1.03) in strata with baseline homocysteine levels <12 μmol/L. In conclusion, FA had no effect on CVD or stroke. However, analysis of within-trial results stratified by baseline homocysteine suggests potential harm in those with high homocysteine at baseline. This interaction may have important implications for recommendations of FA supplement use. In the meantime, FA supplementation should not be recommended as a means to prevent or treat CVD or stroke.Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness
AbstractBlecker, S., Zhang, Y., Ford, D. E., Guallar, E., DosReis, S., Steinwachs, D. M., Dixon, L. B., & Daumit, G. L. (n.d.).Publication year
2010Journal title
General Hospital PsychiatryVolume
32Issue
3Page(s)
255-261AbstractObjective: To examine the association between severe mental illness (SMI) and quality of care in heart failure. Methods: We conducted a cohort study between 2001 and 2004 of disabled Maryland Medicaid participants with heart failure. Quality measures and clinical outcomes were compared for individuals with and without SMI. Results: Of 1801 individuals identified with heart failure, 341 had comorbid SMI. SMI was not associated with differences in quality measures, including left ventricular assessment [adjusted relative risk (aRR) 0.99; 95% CI 0.91-1.07], utilization of angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) (aRR 1.04; 95% CI 0.92-1.17), or beta-blocker use (aRR 1.13; 95% CI 0.99-1.29). During the study period, 52.2% of individuals in the cohort filled a prescription for an ACE inhibitor or ARB and 45.5% filled a beta-blocker prescription. Individuals with and without SMI had similar rates of clinical outcomes, including hospitalizations, readmissions, and mortality. Both medication interventions were associated with improved mortality. Conclusions: In this sample of disabled Medicaid recipients with heart failure, persons with SMI received similar quality of care as those without SMI. Both groups had low rates of beneficial medical treatments. Quality improvement programs should consider how best to target these vulnerable populations.Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: The ACHIEVE trial
AbstractCasagrande, S. S., Jerome, G. J., Dalcin, A. T., Dickerson, F. B., Anderson, C. A., Appel, L. J., Charleston, J., Crum, R. M., Young, D. R., Guallar, E., Frick, K. D., Goldberg, R. W., Oefinger, M., Finkelstein, J., Gennusa, J. V., Fred-Omojole, O., Campbell, L. M., Wang, N. Y., & Daumit, G. L. (n.d.).Publication year
2010Journal title
BMC psychiatryVolume
10AbstractBackground: Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group.Methods/Design: A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m2) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months.Discussion: Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness.Rationale and methods of the european study on cardiovascular risk prevention and management in daily practice (EURIKA)
AbstractRodríguez-Artalejo, F., Guallar, E., Borghi, C., Dallongeville, J., De Backer, G., Halcox, J. P., Hernndez-Vecino, R., Jiménez, F. J., Massá-Gonzlez, E. L., Perk, J., Steg, P. G., & Banegas, J. R. (n.d.).Publication year
2010Journal title
BMC public healthVolume
10AbstractBackground. The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD) across Europe. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice. Methods/Design. Cross-sectional study conducted simultaneously in 12 countries across Europe. The study has two components: firstly at the physician level, assessing eight hundred and nine primary care and specialist physicians with a daily practice in CVD prevention. A physician specific questionnaire captures information regarding physician demographics, practice settings, cardiovascular prevention beliefs and management. Secondly at the patient level, including 7641 patients aged 50 years or older, free of clinical CVD and with at least one classical risk factor, enrolled by the participating physicians. A patient-specific questionnaire captures information from clinical records and patient interview regarding sociodemographic data, CVD risk factors, and current medications. Finally, each patient provides a fasting blood sample, which is sent to a central laboratory for measuring serum lipids, apolipoproteins, hemoglobin-A1c, and inflammatory biomarkers. Discussion. Primary prevention of CVD is an extremely important clinical issue, with preventable circulatory diseases remaining the leading cause of major disease burden. The EURIKA study will provide key information to assess effectiveness of and attitudes toward primary prevention of CVD in Europe. A transnational study creates opportunities for benchmarking good clinical practice across countries and improving outcomes.Selenium status and cardiometabolic health: State of the evidence
AbstractStranges, S., Navas-Acien, A., Rayman, M. P., & Guallar, E. (n.d.).Publication year
2010Journal title
Nutrition, Metabolism and Cardiovascular DiseasesVolume
20Issue
10Page(s)
754-760AbstractUse of selenium enriched foods, supplements and fertilizers has increased markedly in recent years in the US and other Western countries because of the perception that the anti-oxidant properties of selenium could potentially reduce the risk of cancer and other chronic diseases. However, concern has been raised recently about possible adverse cardiometabolic effects of high selenium exposure, including an increased risk of diabetes and hyperlipidemia with high selenium intake. Hence, from a public health perspective, the relationship between selenium status and cardiometabolic health should be clarified in order to help guide consumers in their choices of nutritional supplements and enriched food products. Additional experimental evidence is needed to provide new insights into the role of selenium and of specific selenoproteins in human biology, especially to clarify the underlying mechanisms linking selenium to chronic disease endpoints. Further epidemiological studies and randomized clinical trials across populations with different selenium status should be conducted to determine the causal effect of selenium on cardiovascular disease and risk factors. Nevertheless, at the present time the widespread use of selenium supplements or other strategies that artificially increase selenium status above the level required for optimal selenoprotein activity is not justified and should not be encouraged.Serum selenium and serum lipids in US adults: National Health and Nutrition Examination Survey (NHANES) 2003-2004
AbstractLaclaustra, M., Stranges, S., Navas-Acien, A., Ordovas, J. M., & Guallar, E. (n.d.).Publication year
2010Journal title
AtherosclerosisVolume
210Issue
2Page(s)
643-648AbstractObjective: High selenium has been recently associated with several cardiovascular and metabolic risk factors including diabetes, blood pressure and lipid levels. We evaluated the association of serum selenium with fasting serum lipid levels in the National Health and Nutrition Examination Survey (NHANES) 2003-2004, the most recently available representative sample of the US population that measured selenium levels. Methods: Cross-sectional analysis of 1159 adults ≥40 years old from NHANES 2003-2004. Serum selenium was measured by inductively coupled plasma-dynamic reaction cell-mass spectrometry. Fasting serum total cholesterol, triglycerides, and HDL cholesterol were measured enzymatically and LDL cholesterol was calculated. Results: Mean serum selenium was 136.7 μg/L. The multivariable adjusted average differences (95% confidence interval) comparing the highest (≥147 μg/L) to the lowest (<124 μg/L) selenium quartiles were 18.9 (9.9, 28.0). mg/dL for total cholesterol, 12.7 (3.3, 22.2). mg/dL for LDL cholesterol, 3.9 (0.4, 7.5). mg/dL for HDL cholesterol, and 11.5 (-7.6, 30.7). mg/dL for triglycerides. In spline regression models, total and LDL cholesterol levels increased progressively with increasing selenium concentrations. HDL cholesterol increased with selenium but reached a plateau above 120 μg/L of serum selenium (20th percentile). The triglyceride-selenium relationship was U-shaped. Conclusion: In US adults, high serum selenium concentrations were associated with increased serum concentrations of total and LDL cholesterol. Selenium was associated with increasing HDL cholesterol only at low selenium levels. Given increasing trends in dietary selenium intake and supplementation, the causal mechanisms underlying these associations need to be fully characterized.Sex steroid hormone concentrations and risk of death in US men
AbstractMenke, A., Guallar, E., Rohrmann, S., Nelson, W. G., Rifai, N., Kanarek, N., Feinleib, M., Michos, E. D., Dobs, A., & Platz, E. A. (n.d.).Publication year
2010Journal title
American Journal of EpidemiologyVolume
171Issue
5Page(s)
583-592AbstractThe association of sex hormone levels with mortality over a median of 16 years of follow-up was evaluated in a prospective cohort study. The study included 1,114 US men who participated in phase 1 (1988-1991) of the Third National Health and Nutrition Examination Survey Mortality Study and had no history of cardiovascular disease or cancer at baseline. Multivariable adjusted hazard ratios for all-cause mortality associated with a decrease in hormone concentration equal to the difference between the 90th and 10th percentiles of the sex hormone distributions were estimated by using proportional hazards regression. The hazard ratios associated with low free testosterone and low bioavailable testosterone levels were 1.43 (95% confidence interval (CI): 1.09, 1.87) and 1.52 (95% CI: 1.15, 2.02), respectively, for follow-up between baseline and year 9; they were 0.94 (95% CI: 0.51, 1.72) and 0.98 (95% CI: 0.56, 1.72), respectively, for follow-up between year 9 and year 18. Men with low free and bioavailable testosterone levels may have a higher risk of mortality within 9 years of hormone measurement. Future studies should be conducted to fully characterize the association of low free and bioavailable testosterone concentrations and mortality in men and to describe the mechanism underlying the association.Something fishy? News media presentation of complex health issues related to fish consumption guidelines
AbstractGreiner, A., Clegg Smith, K., & Guallar, E. (n.d.).Publication year
2010Journal title
Public Health NutritionVolume
13Issue
11Page(s)
1786-1794AbstractObjective The news media are an important source of dietary information. Understanding news content, particularly the portrayal of risks and benefits of certain foods, is relevant for effective public health communication. Fish consumption may reduce risk for CVD and aid neonatal development, but recent work shows public confusion about the benefits of fish, challenged by the evidence of mercury and other contaminants in fish. We present an analysis of the messages about fish in US news media over 15 years, identifying trends in coverage and highlighting implications of current messaging.Design We conducted a descriptive text analysis and coded for manifest content: locality of focus, story frame, reference to studies, inclusion of government guidelines and portrayal of uncertainty. We identified chronological patterns and analysed the data for statistically significant relationships between media source and content.Setting News stories were selected from five daily newspapers and five television networks (1993-2007).Subjects We analysed 310 health-related news stories on fish.Results Risk messages outweighed benefit messages four to one, and health benefits only became prominent after 2002. No difference existed in coverage topic by news source. Fish consumption has increasingly become a national issue.Conclusions With the bulk of messages about fish consumption focused on risk, the benefits may be lost to consumers. This gap creates a need for public health to work with news media to more effectively communicate benefits and risks around fish consumption and health and to consider options for communicating tailored information where it can be more readily utilised.Vitamin D supplementation in the age of lost innocence
Guallar, E., Miller, E. R., Ordovas, J. M., & Stranges, S. (n.d.).Publication year
2010Journal title
Annals of internal medicineVolume
152Issue
5Page(s)
327-329Alcohol consumption and the risk of nasopharyngeal carcinoma: A systematic review
AbstractChen, L., Gallicchio, L., Boyd-Lindsley, K., Tao, X., Robinson, K. A., Lam, T. K., Herman, J. G., Caulfield, L. E., Guallar, E., & Alberg, A. J. (n.d.).Publication year
2009Journal title
Nutrition and CancerVolume
61Issue
1Page(s)
1-15AbstractThe evidence concerning the influence of alcohol drinking on the risk of nasopharyngeal carcinoma (NPC) has yielded intriguing findings but has lacked a clear-cut interpretation due to inconsistencies. To unify this body of evidence, we performed a systematic review. With funding and using a protocol developed by the World Cancer Research Fund (WCRF), 15 bibliographic databases were searched for epidemiological studies that reported a measure of association between alcoholic beverage consumption and NPC. Pooled odds ratios (ORs) for highest-vs.-lowest categories of total alcohol intake was obtained by using an inverse-variance weighted random-effects model. A dose-response trend was examined in models using generalized least square estimation. The search identified 14 case-control studies from 5 countries. For total alcohol intake, the pooled ORs in a comparison of the highest to the lowest category was 1.33 (95% CI: = 1.09-1.62) in 11 studies. Data from 6 studies indicated a J-shape dose-response trend, with NPC risk decreasing with up to 15 drinks/wk and increasing with higher intake. Fewer data were available to assess the associations between NPC and intake of beer, wine, and spirits. The potential J-shaped dose-response trend suggests a reduced risk of NPC related to the light alcohol drinking, an observation that warrants further study. Considered in total, the quantitative summaries of the case-control evidence suggest that heavy alcohol consumption is associated with an increased risk of NPC.Antioxidant enzyme activity and coronary heart disease: Meta-analyses of observational studies
AbstractCovas, M. I., Flores-Mateo, G., Carrillo-Santisteve, P., Elosua, R., Guallar, E., Marrugat, J., & Bleys, J. (n.d.).Publication year
2009Journal title
American Journal of EpidemiologyVolume
170Issue
2Page(s)
135-147AbstractControversial data exist concerning the relation between the activities of scavenger antioxidant enzymes and coronary heart disease (CHD) risk. The authors report updated meta-analyses of studies assessing the activities of 3 antioxidant enzymes - glutathione peroxidase, superoxide dismutase, and catalase - and CHD risk. Computer-based and manual searches of the relevant literature from January 1966 to January 2008 were performed. Studies assessing glutathione peroxidase, superoxide dismutase, and catalase activities in cells or biologic fluids and clinical CHD outcomes were selected. Pooled odds ratios for CHD were calculated by using an inverse-variance-weighted random-effects model. Forty-two case-control studies and 3 prospective studies were included. The pooled odds ratios for CHD associated with a 1-standard-deviation increase in glutathione peroxidase, superoxide dismutase, and catalase activity levels were 0.51 (95% confidence interval: 0.35, 0.75), 0.48 (95% confidence interval: 0.32, 0.72), and 0.32 (95% confidence interval: 0.16, 0.61), respectively, with substantial between-study heterogeneity (I 2>90% for the 3 enzymes). These findings were remarkably robust in the sensitivity analysis. The authors' meta-analyses support an inverse association between circulating levels of superoxide dismutase, glutathione peroxidase, and catalase activities with CHD and emphasize the need for additional high-quality prospective studies.Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery
AbstractBlasco-Colmenares, E., Perl, T. M., Guallar, E., Baumgartner, W. A., Conte, J. V., Alejo, D., Pastor-Barriuso, R., Sharrett, A. R., & Faraday, N. (n.d.).Publication year
2009Journal title
Archives of Internal MedicineVolume
169Issue
8Page(s)
788-796AbstractBackground: The risks associated with the use of the combination of aspirin and clopidogrel before surgery are incompletely understood. Pharmacologic suppression of platelet function may increase the risk of postoperative infection by inhibiting hemostasis, immunity, or both. Methods: We performed a retrospective cohort study of 1677 patients undergoing coronary artery bypass surgery to determine the relationship of the preoperative use of aspirin plus clopidogrel vs aspirin alone to the 30-day incidence of postoperative surgical site infection and bacteremia. Results: The cumulative incidence of infection at 30 days was 23.1% and 16.1% in patients who were receiving dual antiplatelet therapy and aspirin monotherapy, respectively (unadjusted hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.09-2.08). The risk of infection remained higher among patients who were receiving dual antiplatelet therapy after adjustment for demographic, socioeconomic, preoperative, and intraoperative risk factors (HR, 1.42; 95% CI, 1.01-2.00) and propensity score (HR, 1.43; 95% CI, 1.01-2.01]). Transfusion rates were also higher among patients who were receiving dual antiplatelet therapy than among patients who were receiving aspirin monotherapy (68.4% vs 60.4%, P=.04), but transfusion played a modest role in mediating the risk of infection (adjusted HR, 1.37; 95% CI, 0.96-1.93]). Mortality rates at 30 days were 5.2% and 3.1% in patients who were receiving dual antiplatelet and aspirin monotherapy, respectively (adjusted HR, 1.44; 95% CI, 0.70-2.99]). Conclusions: Preoperative use of aspirin plus clopidogrel is associated with an increased risk of infection after coronary artery bypass surgery. These findings merit additional work to clarify the risks and benefits of uninterrupted dual antiplatelet therapy in surgical patients and the impact of platelet inhibition on infectious outcomes in populations that are at heightened infectious risk.Association of cigarette smoking, alcohol consumption, and physical activity with sex steroid hormone levels in US men
AbstractShiels, M. S., Rohrmann, S., Menke, A., Selvin, E., Crespo, C. J., Rifai, N., Dobs, A., Feinleib, M., Guallar, E., & Platz, E. A. (n.d.).Publication year
2009Journal title
Cancer Causes and ControlVolume
20Issue
6Page(s)
877-886AbstractBackground: We evaluated the associations of smoking, alcohol consumption, and physical activity with sex steroid hormone concentrations among 1,275 men =20 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Methods: Serum concentrations of testosterone, estradiol, and sex hormone-binding globulin (SHBG) were measured. We compared geometric mean concentrations across levels of smoking, alcohol, and physical activity using multiple linear regression. Results: Current smokers had higher total testosterone (5.42, 5.10, and 5.26 ng/ml in current, former, and never smokers), free testosterone (0.110, 0.102, and 0.104 ng/ml), total estradiol (40.0, 34.5, and 33.5 pg/ml), and free estradiol (1.05, 0.88, and 0.84 pg/ml) compared with former and never smokers (all p = 0.05). Men who consumed =1 drink/day had lower SHBG than men who drank less frequently (31.5 vs. 34.8 nmol/l, p = 0.01); total (p-trend = 0.08) and free testosterone (p-trend = 0.06) increased with number of drinks per day. Physical activity was positively associated with total (p-trend = 0.01) and free testosterone (p-trend = 0.05). Conclusions: In this nationally representative sample of men, smoking, alcohol, and physical activity were associated with hormones and SHBG, thus these factors should be considered as possible confounders or upstream variables in studies of hormones and men's health, including prostate cancer.Blood cadmium and lead and chronic kidney disease in US sdults: A joint analysis
AbstractWeaver, V., Navas-Acien, A., Tellez-Plaza, M., Guallar, E., Muntner, P., Silbergeld, E., & Jaar, B. (n.d.).Publication year
2009Journal title
American Journal of EpidemiologyVolume
170Issue
9Page(s)
1156-1164AbstractEnvironmental cadmium and lead exposures are widespread, and both metals are nephrotoxic at high exposure levels. Few studies have evaluated the associations between low-level cadmium and clinical renal outcomes, particularly with respect to joint cadmium and lead exposure. The geometric mean levels of blood cadmium and lead were 0.41 μg/L (3.65 nmol/L) and 1.58 μg/dL (0.076 μmol/L), respectively, in 14,778 adults aged ≥20 years who participated in the National Health and Nutrition Examination Survey (1999-2006). After adjustment for survey year, sociodemographic factors, chronic kidney disease risk factors, and blood lead, the odds ratios for albuminuria (≥30 mg/g creatinine), reduced estimated glomerular filtration rate (eGFR) (<60 mL/minute/1.73 m2), and both albuminuria and reduced eGFR were 1.92 (95% confidence interval (CI): 1.53, 2.43), 1.32 (95% CI: 1.04, 1.68), and 2.91 (95% CI: 1.76, 4.81), respectively, comparing the highest with the lowest blood cadmium quartiles. The odds ratios comparing participants in the highest with the lowest quartiles of both cadmium and lead were 2.34 (95% CI: 1.72, 3.18) for albuminuria, 1.98 (95% CI: 1.27, 3.10) for reduced eGFR, and 4.10 (95% CI: 1.58, 10.65) for both outcomes. These findings support consideration of cadmium and lead as chronic kidney disease risk factors in the general population and provide novel evidence of risk with environmental exposure to both metals.Body mass index and serum aminotransferase levels in Korean men and women
AbstractSull, J. W., Yun, J. E., Lee, S. Y., Ohrr, H., Jee, S. H., Guallar, E., & Samet, J. M. (n.d.).Publication year
2009Journal title
Journal of Clinical GastroenterologyVolume
43Issue
9Page(s)
869-875AbstractBACKGROUND AND AIMS: Obesity has been postulated as contributing to the risk of nonalcoholic steatohepatitis. With the surging obesity epidemic, an ensuing epidemic of nonalcoholic steatohepatitis and its sequelae is of concern. The objectives of this clinical research study were to examine the association between body mass index (BMI) and serum aminotransferase levels. METHOD: A study was carried out on 1,166,847 Koreans (731,560 men and 435,287 women), 30 to 95 years of age, who received health insurance from the National Health Insurance Corp and had a biennial medical evaluation from 1992 to 1995. RESULTS: Across the range of BMI values (<18.5 to 32 kg/m) in men, alanine aminotransferase (ALT) was estimated to increase by 18.8 U/L and aspartate aminotransferase (AST) increased by 7.1 U/L. In women, ALT increased by 9.9 U/L, whereas AST increased by 4.5 U/L. In men, interactions between BMI and alcohol consumption were significant (P<0.001) for ALT and AST, but the degree of effect modification was quantitatively minor. However, ALT and AST levels were somewhat higher in heavy alcohol drinkers than in nondrinkers. For women, the relationship of aminotransferase levels with BMI did not vary by alcohol consumption. The relationship of BMI with aminotransferase weakened with increasing age. CONCLUSIONS: In Korea, ALT and AST are strongly associated with BMI and increased progressively from the lowest to the highest strata of BMI. The association of BMI with aminotransferase levels was modified by age and sex.Cadmium levels in urine and mortality among U.S. adults
AbstractMenke, A., Muntner, P., Silbergeld, E. K., Platz, E. A., & Guallar, E. (n.d.).Publication year
2009Journal title
Environmental health perspectivesVolume
117Issue
2Page(s)
190-196AbstractBackground: Cadmium exposure has been associated with increased all-cause, cancer, and cardiovascular disease mortality. However, studies investigating this association have included participants with considerably higher levels of cadmium than those found in the general population. Objective: We aimed to evaluate the association of creatinine-corrected urinary cadmium levels with all-cause and cause-specific mortality in the U.S. general population. Methods: We analyzed the relationship between cadmium measured in 13,958 adults who participated in the Third National Health and Nutrition Examination Survey in 1988-1994 and were followed through 31 December 2000, and all-cause, cancer, cardiovascular disease, and coronary heart disease mortality. Results: The geometric mean levels of urinary cadmium per gram of urinary creatinine in study participants were 0.28 and 0.40 μg/g for men and women, respectively (p < 0.001). After multivariable adjustment, including smoking, a major source of cadmium exposure in nonoccupationally exposed populations, the hazard ratios [95% confidence interval (CI)] for all-cause, cancer, cardiovascular disease, and coronary heart disease mortality associated with a 2-fold higher creatinine-corrected urinary cadmium were, respectively, 1.28 (95% CI, 1.15-1.43), 1.55 (95% CI, 1.21-1.98), 1.21 (95% CI, 1.07-1.36), and 1.36 (95% CI, 1.11-1.66) for men and 1.06 (95% CI, 0.96-1.16), 1.07 (95% CI, 0.85-1.35), 0.93 (95% CI, 0.84-1.04), and 0.82 (95% CI, 0.76-0.89) for women. Conclusions: Environmental cadmium exposure was associated with an increased risk of all-cause, cancer, and cardiovascular disease mortality among men, but not among women. Additional efforts are warranted to fully explain gender differences on the impact of environmental cadmium exposure.Cruciferous vegetable consumption and lung cancer risk: A systematic review
AbstractTram, K. L., Gallicchio, L., Lindsley, K., Shiels, M., Hammond, E., Tao, X., Chen, L., Robinson, K. A., Caulfield, L. E., Herman, J. G., Guallar, E., & Alberg, A. J. (n.d.).Publication year
2009Journal title
Cancer Epidemiology Biomarkers and PreventionVolume
18Issue
1Page(s)
184-195AbstractBackground: Cruciferous vegetables, rich in isothiocyanates, may protect against lung cancer. Glutathione S-transferases are important in metabolizing isothiocyanates; hence, variants in GST genes may modify the association between cruciferous vegetable intake and lung cancer. We carried out a systematic review to characterize the association between cruciferous vegetable intake and lung cancer risk, with an emphasis on the potential interaction between cruciferous vegetables and GSTM1 and GSTT1 gene variants. Methods: A search of the epidemiologic literature through December 2007 was conducted using 15 bibliographic databases without language restrictions. Thirty studies on the association between lung cancer and either total cruciferous vegetable consumption (6 cohort and 12 case-control studies) or specific cruciferous vegetables (1 cohort and 11 case-control studies) were included. Results: The risk for lung cancer among those in the highest category of total cruciferous vegetable intake was 22% lower in case-control studies [random-effects pooled odds ratio, 0.78; 95% confidence interval (95% CI), 0.70-0.88] and 17% lower in cohort studies (pooled relative risk, 0.83; 95% CI, 0.62-1.08) compared with those in the lowest category of intake. The strongest inverse association of total cruciferous vegetable intake with lung cancer risk was seen among individuals with GSTM1 and GSTT1 double null genotypes (odds ratio, 0.41; 95% CI, 0.26-0.65; P for interaction = 0.01). Conclusions: Epidemiologic evidence suggests that cruciferous vegetable intake may be weakly and inversely associated with lung cancer risk. Because of a gene-diet interaction, the strongest inverse association was among those with homozygous deletion for GSTM1 and GSTT1.