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

Arsenic exposure and prevalence of type 2 diabetes in US adults

Navas-Acien, A., Silbergeld, E. K., Pastor-Barriuso, R., & Guallar, E. (n.d.).

Publication year

2008

Journal title

JAMA

Volume

300

Issue

7

Page(s)

814-822

10.1001/jama.300.7.814

Abstract

Abstract

Context: High chronic exposure to inorganic arsenic in drinking water has been related to diabetes development, but the effect of exposure to low to moderate levels of inorganic arsenic on diabetes risk is unknown. In contrast, arsenobetaine, an organic arsenic compound derived from seafood intake, is considered nontoxic. Objective: To investigate the association of arsenic exposure, as measured in urine, with the prevalence of type 2 diabetes in a representative sample of US adults. Design, Setting, and Participants: Cross-sectional study in 788 adults aged 20 years or older who participated in the 2003-2004 National Health and Nutrition Examination Survey (NHANES) and had urine arsenic determinations. Main Outcome Measure: Prevalence of type 2 diabetes across intake of arsenic. Results: The median urine levels of total arsenic, dimethylarsinate, and arsenobetaine were 7.1, 3.0, and 0.9 μg/L, respectively. The prevalence of type 2 diabetes was 7.7%. After adjustment for diabetes risk factors and markers of seafood intake, participants with type 2 diabetes had a 26% higher level of total arsenic (95% confidence interval [CI], 2.0%-56.0%) and a nonsignificant 10% higher level of dimethylarsinate (95% CI, -8.0% to 33.0%) than participants without type 2 diabetes, and levels of arsenobetaine were similar to those of participants without type 2 diabetes. After similar adjustment, the odds ratios for type 2 diabetes comparing participants at the 80th vs the 20th percentiles were 3.58 for the level of total arsenic (95% CI, 1.18-10.83), 1.57 for dimethylarsinate (95% CI, 0.89-2.76), and 0.69 for arsenobetaine (95% CI, 0.33-1.48). Conclusions: After adjustment for biomarkers of seafood intake, total urine arsenic was associated with increased prevalence of type 2 diabetes. This finding supports the hypothesis that low levels of exposure to inorganic arsenic in drinking water, a widespread exposure worldwide, may play a role in diabetes prevalence. Prospective studies in populations exposed to a range of inorganic arsenic levels are needed to establish whether this association is causal.

Arsenic exposure and type 2 diabetes : A systematic review of the experimental and epidemiologic evidence

Navas-Acien, A., Silbergeld, E. K., Streeter, R. A., Clark, J. M., Burke, T. A., & Guallar, E. (n.d.).

Publication year

2006

Journal title

Environmental health perspectives

Volume

114

Issue

5

Page(s)

641-648

10.1289/ehp.8551

Abstract

Abstract

Chronic arsenic exposure has been suggested to contribute to diabetes development. We performed a systematic review of the experimental and epidemiologic evidence on the association of arsenic and type 2 diabetes. We identified 19 in vitro studies of arsenic and glucose metabolism. Five studies reported that arsenic interfered with transcription factors involved in insulin-related gene expression: upstream factor 1 in pancreatic β-cells and peroxisome proliferative-activated receptor γ in preadipocytes. Other in vitro studies assessed the effect of arsenic on glucose uptake, typically using very high concentrations of arsenite or arsenate. These studies provide limited insight on potential mechanisms. We identified 10 in vivo studies in animals. These studies showed inconsistent effects of arsenic on glucose metabolism. Finally, we identified 19 epidemiologic studies (6 in high-arsenic areas in Taiwan and Bangladesh, 9 in occupational populations, and 4 in other populations). In studies from Taiwan and Bangladesh, the pooled relative risk estimate for diabetes comparing extreme arsenic exposure categories was 2.52 (95% confidence interval, 1.69-3.75), although methodologic problems limit the interpretation of the association. The evidence from occupational studies and from general populations other than Taiwan or Bangladesh was inconsistent. In summary, the current available evidence is inadequate to establish a causal role of arsenic in diabetes. Because arsenic exposure is widespread and diabetes prevalence is reaching epidemic proportions, experimental studies using arsenic concentrations relevant to human exposure and prospective epidemiologic studies measuring arsenic biomarkers and appropriately assessing diabetes should be a research priority.

Arsenic exposure in relation to ischemic stroke the reasons for geographic and racial differences in stroke study

Tsinovoi, C. L., Xun, P., McClure, L. A., Carioni, V. M., Brockman, J. D., Cai, J., Guallar, E., Cushman, M., Unverzagt, F. W., Howard, V. J., & He, K. (n.d.).

Publication year

2018

Journal title

Stroke

Volume

49

Issue

1

Page(s)

19-26

10.1161/STROKEAHA.117.018891

Abstract

Abstract

Background and Purpose-The purpose of this case-cohort study was to examine urinary arsenic levels in relation to incident ischemic stroke in the United States. Methods-We performed a case-cohort study nested within the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort. A subcohort (n=2486) of controls was randomly sampled within region-race-sex strata while all incident ischemic stroke cases from the full REGARDS cohort (n=671) were included. Baseline urinary arsenic was measured by inductively coupled plasma-mass spectrometry. Arsenic species, including urinary inorganic arsenic and its metabolites monomethylarsonic acid and dimethylarsinic acid, were measured in a random subset (n=199). Weighted Cox's proportional hazards models were used to calculate hazard ratios and 95% confidence intervals of ischemic stroke by arsenic and its species. Results-The average follow-up was 6.7 years. Although incident ischemic stroke showed no association with total arsenic or total inorganic arsenic, for each unit higher level of urinary monomethylarsonic acid on a log-scale, after adjustment for potential confounders, ischemic stroke risk increased ∼2-fold (hazard ratio=1.98; 95% confidence interval: 1.12- 3.50). Effect modification by age, race, sex, or geographic region was not evident. Conclusions-A metabolite of arsenic was positively associated with incident ischemic stroke in this case-cohort study of the US general population, a low-to-moderate exposure area. Overall, these findings suggest a potential role for arsenic methylation in the pathogenesis of stroke, having important implications for future cerebrovascular research.

Arsenic exposure, arsenic metabolism, and incident diabetes in the strong heart study

Kuo, C. C., Howard, B. V., Umans, J. G., Gribble, M. O., Best, L. G., Francesconi, K. A., Goessler, W., Lee, E., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2015

Journal title

Diabetes Care

Volume

38

Issue

4

Page(s)

620-627

10.2337/dc14-1641

Abstract

Abstract

OBJECTIVE Little is known about arsenic metabolism in diabetes development. We investigated the prospective associations of low-moderate arsenic exposure and arsenic metabolism with diabetes incidence in the Strong Heart Study. RESEARCH DESIGN AND METHODS A total of 1,694 diabetes-free participants aged 45-75 years were recruited in 1989-1991 and followed through 1998-1999. We used the proportions of urine inorganic arsenic (iAs), monomethylarsonate (MMA), and dimethylarsinate (DMA) over their sum (expressed as iAs%, MMA%, and DMA%) as the biomarkers of arsenic metabolism. Diabetes was defined as fasting glucose ≥126 mg/dL, 2-h glucose ≥200 mg/dL, self-reported diabetes history, or self-reported use of antidiabetic medications. RESULTS Over 11,263.2 person-years of follow-up, 396 participants developed diabetes. Using the leave-one-out approach to model the dynamics of arsenic metabolism, we found that lower MMA% was associated with higher diabetes incidence. The hazard ratios (95% CI) of diabetes incidence for a 5% increase inMMA% were 0.77 (0.63-0.93) and 0.82 (0.73-0.92) when iAs% and DMA%, respectively,were left out of the model. DMA% was associated with higher diabetes incidence only when MMA% decreased (left out of the model) but not when iAs% decreased. iAs% was also associated with higher diabetes incidence when MMA% decreased. The association between MMA% and diabetes incidence was similar by age, sex, study site, obesity, and urine iAs concentrations. CONCLUSIONS Arsenicmetabolism, particularly lowerMMA%,was prospectively associated with increased incidence of diabetes. Research is needed to evaluate whether arsenic metabolism is related to diabetes incidence per se or through its close connections with one-carbon metabolism.

Arsenic exposure, diabetes prevalence, and diabetes control in the strong heart study

Gribble, M. O., Howard, B. V., Umans, J. G., Shara, N. M., Francesconi, K. A., Goessler, W., Crainiceanu, C. M., Silbergeld, E. K., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2012

Journal title

American Journal of Epidemiology

Volume

176

Issue

10

Page(s)

865-874

10.1093/aje/kws153

Abstract

Abstract

This study evaluated the association of arsenic exposure, as measured in urine, with diabetes prevalence, glycated hemoglobin, and insulin resistance in American Indian adults from Arizona, Oklahoma, and North and South Dakota (1989-1991). We studied 3,925 men and women 45-74 years of age with available urine arsenic measures. Diabetes was defined as a fasting glucose level of 126 mg/dL or higher, a 2-hour glucose level of 200 mg/dL or higher, a hemoglobin A1c (HbA1c) of 6.5 or higher, or diabetes treatment. Median urine arsenic concentration was 14.1 g/L (interquartile range, 7.9-24.2). Diabetes prevalence was 49.4. After adjustment for sociodemographic factors, diabetes risk factors, and urine creatinine, the prevalence ratio of diabetes comparing the 75th versus 25th percentiles of total arsenic concentrations was 1.14 (95 confidence interval: 1.08, 1.21). The association between arsenic and diabetes was restricted to participants with poor diabetes control (HbA1c

Arsenic exposure, hyperuricemia, and gout in US adults

Kuo, C. C., Weaver, V., Fadrowski, J. J., Lin, Y. S., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2015

Journal title

Environment international

Volume

76

Page(s)

32-40

10.1016/j.envint.2014.11.015

Abstract

Abstract

There is very limited information on the association between arsenic and serum uric acid levels or gout. The aim of this study was to investigate the association of arsenic with hyperuricemia and gout in US adults. Methods: A cross-sectional study was conducted in 5632 adults aged 20. years or older from the National Health and Nutrition Examination Survey (NHANES) 2003-2010 with determinations of serum uric acid and urine total arsenic and dimethylarsinate (DMA). Hyperuricemia was defined as serum uric acid higher than 7.0. mg/dL for men and 6.0. mg/dL for women. Gout was defined based on self-reported physician diagnosis and medication use. Results: After adjustment for sociodemographic factors, comorbidities and arsenobetaine levels, the increase in the geometric means of serum uric acid associated with one interquartile range increase in total arsenic and DMA levels was 3% (95% CI 2-5) and 3% (2-5), respectively, in men and 1% (0-3) and 2% (0-4), respectively, in women. In men, the adjusted odds ratio for hyperuricemia comparing the highest to lowest quartiles of total arsenic was 1.84 (95% CI, 1.26-2.68) and for DMA it was 1.41 (95% CI, 1.01-1.96). The corresponding odds ratios in women were 1.26 (0.77, 2.07) and 1.49 (0.96, 2.31), respectively. The odds ratio for gout comparing the highest to lowest tertiles was 5.46 (95% CI, 1.70-17.6) for total arsenic and 1.98 (0.64-6.15) for DMA among women older than 40. years old. Urine arsenic was not associated with gout in men. Conclusion: Low level arsenic exposures may be associated with the risk of hyperuricemia in men and with the prevalence of gout in women. Prospective research focusing on establishing the direction of the relationship among arsenic, hyperuricemia, and gout is needed.

Arsenic in drinking water and lung cancer : A systematic review

Celik, I., Gallicchio, L., Boyd, K., Lam, T. K., Matanoski, G., Tao, X., Shiels, M., Hammond, E., Chen, L., Robinson, K. A., Caulfield, L. E., Herman, J. G., Guallar, E., & Alberg, A. J. (n.d.).

Publication year

2008

Journal title

Environmental Research

Volume

108

Issue

1

Page(s)

48-55

10.1016/j.envres.2008.04.001

Abstract

Abstract

Exposure to inorganic arsenic via drinking water is a growing public health concern. We conducted a systematic review of the literature examining the association between arsenic in drinking water and the risk of lung cancer in humans. Towards this aim, we searched electronic databases for articles published through April 2006. Nine ecological studies, two case-control studies, and six cohort studies were identified. The majority of the studies were conducted in areas of high arsenic exposure (100 μg/L) such as southwestern Taiwan, the Niigata Prefecture, Japan, and Northern Chile. Most of the studies reported markedly higher risks of lung cancer mortality or incidence in high arsenic areas compared to the general population or a low arsenic exposed reference group. The quality assessment showed that, among the studies identified, only four assessed arsenic exposure at the individual level. Further, only one of the ecological studies presented results adjusted for potential confounders other than age; of the cohort and case-control studies, only one-half adjusted for cigarette smoking status in the analysis. Despite these methodologic limitations, the consistent observation of strong, statistically significant associations from different study designs carried out in different regions provide support for a causal association between ingesting drinking water with high concentrations of arsenic and lung cancer. The lung cancer risk at lower exposure concentrations remains uncertain.

Arsenic species and selected metals in human urine : Validation of HPLC/ICPMS and ICPMS procedures for a long-term population-based epidemiological study

Scheer, J., Findenig, S., Goessler, W., Francesconi, K. A., Howard, B., Umans, J. G., Pollak, J., Tellez-Plaza, M., Silbergeld, E. K., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2012

Journal title

Analytical Methods

Volume

4

Issue

2

Page(s)

406-413

10.1039/c2ay05638k

Abstract

Abstract

Exposure to high inorganic arsenic concentrations in drinking water has been related to detrimental health effects, including cancers and possibly cardiovascular disease, in many epidemiological studies. Recent studies suggest that arsenic might elicit some of its toxic effects also at lower concentrations. The Strong Heart Study, a large epidemiological study of cardiovascular disease in American Indian communities, collected urine samples and performed medical examinations on 4549 participants over a 10 year period beginning in 1989. We used anion-exchange HPLC/ICPMS to determine concentrations of arsenic species (methylarsonate, dimethylarsinate and arsenate) in 5095 urine samples from the Strong Heart Study. We repeated the chromatography on a portion of the urine sample that had been oxidised, by addition of H 2O 2, to provide additional information on the presence of As(iii) species and thio-arsenicals, and by difference, of arsenobetaine and other non-retained cations. Total concentrations for As, Cd, Mo, Pb, Sb, Se, U, W, and Zn were also determined in the urine samples by ICPMS. The dataset will be used to evaluate the relationships between the concentrations of urinary arsenic species and selected metals with various cardiometabolic health endpoints. We present and discuss the analytical protocol put in place to produce this large and valuable dataset.

Arsenic, obesity, and inflammation cytokines in Mexican adolescents

Guallar, E., Rubio-Andrade, M., García-Vargas, G. G., Silbergeld, E. K., Zamoiski, R., Resnick, C., Weaver, V., Navas-Acien, A., Guallar, E., Rothenberg, S. J., Steuerwald, A. J., & Parsons, P. (n.d.).

Publication year

2014

Page(s)

622-624

10.1201/b16767-230

Abstract

Abstract

The aim of this work was to determine the associations among arsenic (As) exposure, adiposity, and inflammatory cytokines in 384 adolescents aged 12-15 years in a cross-sectional study. As was measured by total As concentration in urine adjusted by creatinine, adiposity was assessed using Body Mass Index (BMI) and bioimpedance segmental body composition, cytokines were determined by standard procedures. Our results show prevalence of overweight and obesity of 39.5%. Median (interquartile range) of total As in urine was 36.2 (26.01, 46.8) μg/g creatinine. We found an inverse association between As exposure and the percentage of total body fat, which was no dependent from inflammatory cytokines.

Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery

Blasco-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

2009

Journal title

Archives of Internal Medicine

Volume

169

Issue

8

Page(s)

788-796

10.1001/archinternmed.2009.42

Abstract

Abstract

Background: 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.

Assessing the Accuracy of Estimated Lipoprotein(a) Cholesterol and Lipoprotein(a)-Free Low-Density Lipoprotein Cholesterol

Zheng, W., Chilazi, M., Park, J., Sathiyakumar, V., Donato, L. J., Meeusen, J. W., Lazo, M., Guallar, E., Kulkarni, K. R., Jaffe, A. S., Santos, R. D., Toth, P. P., Jones, S. R., & Martin, S. S. (n.d.).

Publication year

2022

Journal title

Journal of the American Heart Association

Volume

11

Issue

2

10.1161/JAHA.121.023136

Abstract

Abstract

BACKGROUND: Accurate measurement of the cholesterol within lipoprotein(a) (Lp[a]-C) and its contribution to low-density lipo-protein cholesterol (LDL-C) has important implications for risk assessment, diagnosis, and treatment of atherosclerotic cardiovascular disease, as well as in familial hypercholesterolemia. A method for estimating Lp(a)-C from particle number using fixed conversion factors has been proposed (Lp[a]-C from particle number divided by 2.4 for Lp(a) mass, multiplied by 30% for Lp[a]-C). The accuracy of this method, which theoretically can isolate “Lp(a)-free LDL-C,” has not been validated. METHODS AND RESULTS: In 177 875 patients from the VLDbL (Very Large Database of Lipids), we compared estimated Lp(a)-C and Lp(a)-free LDL-C with measured values and quantified absolute and percent error. We compared findings with an analo-gous data set from the Mayo Clinic Laboratory. Error in estimated Lp(a)-C and Lp(a)-free LDL-C increased with higher Lp(a)-C values. Median error for estimated Lp(a)-C

Association Between a Social-Business Eating Pattern and Early Asymptomatic Atherosclerosis

Peñalvo, J. L., Fernández-Friera, L., López-Melgar, B., Uzhova, I., Oliva, B., Fernández-Alvira, J. M., Laclaustra, M., Pocock, S., Mocoroa, A., Mendiguren, J. M., Sanz, G., Guallar, E., Bansilal, S., Vedanthan, R., Jiménez-Borreguero, L. J., Ibañez, B., Ordovás, J. M., Fernández-Ortiz, A., Bueno, H., & Fuster, V. (n.d.).

Publication year

2016

Journal title

Journal of the American College of Cardiology

Volume

68

Issue

8

Page(s)

805-814

10.1016/j.jacc.2016.05.080

Abstract

Abstract

Background The importance of a healthy diet in relation to cardiovascular health promotion is widely recognized. Identifying specific dietary patterns related to early atherosclerosis would contribute greatly to inform effective primary prevention strategies. Objectives This study sought to quantify the association between specific dietary patterns and presence and extent of subclinical atherosclerosis in a population of asymptomatic middle-aged adults. Methods The PESA (Progression of Early Subclinical Atherosclerosis) study enrolled 4,082 asymptomatic participants 40 to 54 years of age (mean age 45.8 years; 63% male) to evaluate the presence of subclinical atherosclerosis in multiple vascular territories. A fundamental objective of this cohort study was to evaluate the life-style–related determinants, including diet, on atherosclerosis onset and development. We conducted a cross-sectional analysis of baseline data, including detailed information on dietary habits obtained as part of the overall life-style and risk factor assessment, as well as a complete vascular imaging study that was performed blinded to the clinical information. Results Most PESA participants follow a Mediterranean (40% of participants) or a Western (41%) dietary pattern. A new pattern, identified among 19% of participants, was labeled as a social-business eating pattern, characterized by a high consumption of red meat, pre-made foods, snacks, alcohol, and sugar-sweetened beverages and frequent eating-out behavior. Participants following this pattern presented a significantly worse cardiovascular risk profile and, after adjustment for risk factors, increased odds of presenting subclinical atherosclerosis (odds ratio: 1.31; 95% confidence interval: 1.06 to 1.63) compared with participants following a Mediterranean diet. Conclusions A new social-business eating pattern, characterized by high consumption of red and processed meat, alcohol, and sugar-sweetened beverages, and by frequent snacking and eating out as part of an overall unhealthy life-style, is associated with an increased prevalence, burden, and multisite presence of subclinical atherosclerosis.

Association between aflatoxin-albumin adduct levels and tortilla consumption in Guatemalan adults

Kroker-Lobos, M. F., Alvarez, C. S., Rivera-Andrade, A., Smith, J. W., Egner, P., Torres, O., Lazo, M., Freedman, N. D., Guallar, E., Graubard, B. I., McGlynn, K. A., Ramírez-Zea, M., & Groopman, J. D. (n.d.).

Publication year

2019

Journal title

Toxicology Reports

Volume

6

Page(s)

465-471

10.1016/j.toxrep.2019.05.009

Abstract

Abstract

Aflatoxin B1 (AFB1) is a known human hepatocarcinogen and a recent study reported elevated AFB1 levels, measured by serum albumin biomarkers, among Guatemalan adults. While AFB1 can contaminate a variety of foodstuffs, including maize, Guatemala's main dietary staple, the relationship of maize intake to serum AFB1-albumin adducts levels in Guatemala has not been previously examined. As a result, a cross-sectional study was conducted among 461 Guatemalan adults living in five geographically distinct departments of the country. Participants provided a serum sample and completed a semi-quantitative food frequency questionnaire and a sociodemographic questionnaire. Multiple linear regression analysis was used to estimate the least square means (LSQ) and 95% confidence intervals (95% CI) of log-transformed AFB1-albumin adducts by quintiles of maize consumption in crude and adjusted models. Additionally, analyses of tortilla consumption and levels of maize processing were conducted. The median maize intake was 344.3 g per day [Interquartile Range (IQR): 252.2, 500.8], and the median serum AFB1-albumin adduct level was 8.4 pg/mg albumin (IQR: 3.8, 22.3). In adjusted analyses, there was no association between overall maize consumption and serum AFB1-albumin levels. However, there was a statistically significant association between tortilla consumption and AFB1-albumin levels (ptrend = 0.01). The LSM of AFB1-albumin was higher in the highest quintile of tortilla consumption compared to the lowest quintile [LSM:9.03 95%CI: 7.03,11.70 vs 6.23, 95%CI: 4.95,8.17, respectively]. These findings indicate that tortilla may be an important source of AFB1 exposure in the Guatemalan population. Therefore, efforts to control or mitigate AFB1 levels in contaminated maize used for tortillas may reduce overall exposure in this population.

Association between body mass index and cortical thickness : Among elderly cognitively normal men and women

Kim, H., Kim, C., Seo, S. W., Na, D. L., Kim, H. J., Kang, M., Shin, H. Y., Cho, S. K., Park, S. E., Lee, J., Hwang, J. W., Jeon, S., Lee, J. M., Kim, G. H., Cho, H., Ye, B. S., Noh, Y., Yoon, C. W., & Guallar, E. (n.d.).

Publication year

2015

Journal title

International Psychogeriatrics

Volume

27

Issue

1

Page(s)

121-130

10.1017/S1041610214001744

Abstract

Abstract

Background: There is increasing evidence of a relationship between underweight or obesity and dementia risk. Several studies have investigated the relationship between body weight and brain atrophy, a pathological change preceding dementia, but their results are inconsistent. Therefore, we aimed to evaluate the relationship between body mass index (BMI) and cortical atrophy among cognitively normal participants. Methods: We recruited cognitively normal participants (n = 1,111) who underwent medical checkups and detailed neurologic screening, including magnetic resonance imaging (MRI) in the health screening visits between September 2008 and December 2011. The main outcome was cortical thickness measured using MRI. The number of subjects with five BMI groups in men/women was 9/9, 148/258, 185/128, 149/111, and 64/50 in underweight, normal, overweight, mild obesity, and moderate to severe obesity, respectively. Linear and non-linear relationships between BMI and cortical thickness were examined using multiple linear regression analysis and generalized additive models after adjustment for potential confounders. Results: Among men, underweight participants showed significant cortical thinning in the frontal and temporal regions compared to normal weight participants, while overweight and mildly obese participants had greater cortical thicknesses in the frontal region and the frontal, temporal, and occipital regions, respectively. However, cortical thickness in each brain region was not significantly different in normal weight and moderate to severe obesity groups. Among women, the association between BMI and cortical thickness was not statistically significant. Conclusions: Our findings suggested that underweight might be an important risk factor for pathological changes in the brain, while overweight or mild obesity may be inversely associated with cortical atrophy in cognitively normal elderly males.

Association between cancer stigma and depression among cancer survivors : A nationwide survey in Korea

Cho, J., Choi, E. K., Kim, S. Y., Shin, D. W., Cho, B. L., Kim, C. H., Koh, D. H., Guallar, E., Bardwell, W. A., & Park, J. H. (n.d.).

Publication year

2013

Journal title

Psycho-Oncology

Volume

22

Issue

10

Page(s)

2372-2378

10.1002/pon.3302

Abstract

Abstract

Objective Cancer patients are more likely to experience depression than the general population. This study aims to evaluate the possible association between cancer stigma and depression among cancer patients. Methods As a part of the Korean government's program to develop comprehensive supportive care, we conducted a nationwide survey in 2010 at the National Cancer Center and in nine regional cancer centers across Korea. Cancer stigma was assessed by using a set of 12 questions grouped in three domains - impossibility of recovery, stereotypes of cancer patients, and experience of social discrimination. Depression was measured by using the Hospital Anxiety and Depression Scale. Results A total of 466 cancer patients were included in the study. Over 30% of the cancer survivors had negative attitudes toward cancer and held stereotypical views of themselves: about 10% of the participants experienced social discrimination due to cancer, and 24.5% reported clinically significant depressive symptoms. Patients who had or experienced cancer stigma were 2.5 times more likely to have depression than patients with positive attitudes. Conclusions Regardless of highly developed medical science and increased survivorship, cancer survivors had cancer stigmas, and it was significantly associated with depression. Impact Our findings emphasize the need for medical societies and health professionals to pay more attention to cancer stigma that patients are likely to experience during treatment.

Association between exposure to low to moderate arsenic levels and incident cardiovascular disease

Guallar, E., Moon, K. A., Guallar Dr., E., Umans Dr., J. G., Devereux Dr., R. B., Best Dr., L. G., Francesconi Dr., K. A., Goessler Dr., W., Pollak, J., Silbergeld Dr., E. K., Howard Dr., B. V., & Navas-Acien Dr., A. (n.d.).

Publication year

2013

Journal title

Annals of internal medicine

Volume

159

Issue

10

Page(s)

649-659

10.7326/0003-4819-159-10-201311190-00719

Abstract

Abstract

Background: Long-term exposure to high levels of arsenic is associated with increased risk for cardiovascular disease, whereas risk from long-term exposure to low to moderate arsenic levels (15.7 vs.

Association between markers of glucose metabolism and risk of colorectal adenoma

Rampal, S., Yang, M. H., Sung, J., Son, H. J., Choi, Y. H., Lee, J. H., Kim, Y. H., Chang, D. K., Rhee, P. L., Rhee, J. C., Guallar, E., & Cho, J. (n.d.).

Publication year

2014

Journal title

Gastroenterology

Volume

147

Issue

1

Page(s)

78-87.e3

10.1053/j.gastro.2014.03.006

Abstract

Abstract

Background & Aims Diabetes is a risk factor for colorectal cancer. We studied the association between markers of glucose metabolism and metabolic syndrome and the presence of colorectal adenomas in a large number of asymptomatic men and women attending a health screening program in South Korea. We also investigated whether these associations depend on adenoma location. Methods In a cross-sectional study, we measured fasting levels of glucose, insulin, hemoglobin A1c, and C-peptide and calculated homeostatic model assessment (HOMA) values (used to quantify insulin resistance) for 19,361 asymptomatic South Korean subjects who underwent colonoscopy examinations from January 2006 to June 2009. Participants completed a standardized self-administered health questionnaire and a validated semiquantitative food frequency questionnaire. Blood samples were collected on the day of the colonoscopy; fasting blood samples were also collected. Robust Poisson regression was used to model the associations of glucose markers with the prevalence of any adenoma. Results Using detailed multivariable-adjusted dose-response models, the prevalence ratios (aPR, 95% confidence interval [CI]) for any adenoma, comparing the 90th with the 10th percentile, were 1.08 (1.00-1.16; P =.04) for fasting glucose, 1.07 (0.99-1.15; P =.10) for insulin, 1.09 (1.02-1.18, P =.02) for HOMA, 1.09 (1.01-1.17; P =.02) for hemoglobin A1c, and 1.14 (1.05-1.24; P =.002) for C-peptide. The corresponding ratios for nonadvanced adenomas were 1.11 (0.99-1.25; P =.08), 1.10 (0.98-1.24; P =.12), 1.15 (1.02-1.29; P =.02), 1.14 (1.01-1.28; P =.03), and 1.20 (1.05-1.37; P =.007), respectively. The corresponding ratios for advanced adenomas were 1.32 (0.94-1.84; P =.11), 1.23 (0.87-1.75; P =.24), 1.30 (0.92-1.85; P =.14), 1.13 (0.79-1.61; P =.50), and 1.67 (1.15-2.42; P =.007), respectively. Metabolic syndrome was associated with the prevalence of any adenoma (aPR, 1.18; 95% CI, 1.13-1.24; P

Association between mitochondrial DNA copy number and sudden cardiac death : Findings from the Atherosclerosis Risk in Communities study (ARIC)

Zhang, Y., Guallar, E., Ashar, F. N., Longchamps, R. J., Castellani, C. A., Lane, J., Grove, M. L., Coresh, J., Sotoodehnia, N., Ilkhanoff, L., Boerwinkle, E., Pankratz, N., & Arking, D. E. (n.d.).

Publication year

2017

Journal title

European Heart Journal

Volume

38

Issue

46

Page(s)

3443-3448

10.1093/eurheartj/ehx354

Abstract

Abstract

Aims Sudden cardiac death (SCD) is a major public health burden. Mitochondrial dysfunction has been implicated in a wide range of cardiovascular diseases including cardiomyopathy, heart failure, and arrhythmias, but it is unknown if it also contributes to SCD risk. We sought to examine the prospective association between mtDNA copy number (mtDNA-CN), a surrogate marker of mitochondrial function, and SCD risk. Methods and results We measured baseline mtDNA-CN in 11 093 participants from the Atherosclerosis Risk in Communities (ARIC) study. mtDNA copy number was calculated from probe intensities of mitochondrial single nucleotide polymorphisms (SNP) on the Affymetrix Genome-Wide Human SNP Array 6.0. Sudden cardiac death was defined as a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual without evidence of a non-cardiac cause of cardiac arrest. Sudden cardiac death cases were reviewed and adjudicated by an expert committee. During a median follow-up of 20.4 years, we observed 361 SCD cases. After adjusting for age, race, sex, and centre, the hazard ratio for SCD comparing the 1st to the 5th quintiles of mtDNA-CN was 2.24 (95% confidence interval 1.58-3.19; P-trend

Association Between Retinopathy of Prematurity in Very-Low-Birth-Weight Infants and Neurodevelopmental Impairment

Han, G., Lim, D. H., Kang, D., Cho, J., Guallar, E., Chang, Y. S., Chung, T. Y., Kim, S. J., & Park, W. S. (n.d.).

Publication year

2022

Journal title

American Journal of Ophthalmology

Volume

244

Page(s)

205-215

10.1016/j.ajo.2022.08.010

Abstract

Abstract

Purpose: To evaluate the impact of retinopathy of prematurity (ROP) severity and the treatment of very-low-birth-weight infants (VLBWIs) on neurodevelopmental impairment in early childhood. Design: Prospective cohort study. Method: This was a prospective cohort study. The data were obtained from the Korean Neonatal Network (KNN), a nationwide registry for VLBWIs. Infants who were born from 2013 to 2015 and underwent ROP evaluation at birth and neurodevelopmental examinations at corrected ages of 18 to 24 months were included in the study. Infants with a history of meningitis or severe congenital anomalies were excluded. The VLBWI patients were grouped into no ROP, no treatment-requiring ROP (non−TR-ROP), and treatment-requiring ROP (TR-ROP) groups. Neurodevelopmental impairment was defined as participants who had at least 1 developmental problem according to the Bayley Scales of Infant and Toddler Development−2nd Edition (Bayley-II;

Association of arsenic and metals with concentrations of 25-hydroxyvitamin d and 1,25-dihydroxyvitamin D among adolescents in Torreón, Mexico

Zamoiski, R. D., Guallar, E., García-Vargas, G. G., Rothenberg, S. J., Resnick, C., Andrade, M. R., Steuerwald, A. J., Parsons, P. J., Weaver, V. M., Navas-Acien, A., & Silbergeld, E. K. (n.d.).

Publication year

2014

Journal title

Environmental health perspectives

Volume

122

Issue

11

Page(s)

1233-1238

10.1289/ehp.1307861

Abstract

Abstract

Background: Limited data suggest that lead (Pb), cadmium (Cd), and uranium (U) may disrupt vitamin D metabolism and inhibit production of 1,25-dihydroxyvitamin D [1,25(OH)2D], the active vitamin D metabolite, from 25-hydroxyvitamin D [25(OH)D] in the kidney.Objectives: We evaluated the association between blood lead (BPb) and urine arsenic (As), Cd, molybdenum (Mo), thallium (Tl), and U with markers of vitamin D metabolism [25(OH)D and 1,25(OH)2D].Methods: We conducted a cross-sectional study of 512 adolescents in Torreón, a town in Mexico with a Pb smelter near residential areas. BPb was measured using atomic absorption spectrometry. Urine As, Cd, Mo, Tl, and U were measured using inductively coupled plasma mass spectrometry. Serum 25(OH)D and 1,25(OH)2D were measured using a chemiluminescent immunoassay and a radioimmunoassay, respectively. Multivariable linear models with vitamin D markers as the outcome were used to estimate associations of BPb and creatinine-corrected urine As and metal concentrations with serum vitamin D concentrations, controlling for age, sex, adiposity, smoking, socioeconomic status, and time outdoors.Results: Serum 25(OH)D was positively associated with urine Mo and Tl [1.5 (95% CI: 0.4, 2.6) and 1.2 (95% CI: 0.3, 2.1) ng/mL higher with a doubling of exposure, respectively]. Serum 1,25(OH)2D was positively associated with urine As and U [3.4 (95% CI: 0.9, 5.9) and 2.2 (95% CI: 0.7, 3.7) pg/mL higher, respectively], with little change in associations after additional adjustment for serum 25(OH)D. Pb and Cd were not associated with 25(OH)D or 1,25(OH)2D concentrations.Conclusions: Overall, our findings did not support a negative effect of As or metal exposures on serum 1,25(OH)2D concentrations. Additional research is needed to confirm positive associations between serum 1,25(OH)2D and urine U and As concentrations and to clarify potential underlying mechanisms.

Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost : A nationwide cohort study

Lee, H., Cho, J., Shin, D. W., Lee, S. P., Hwang, S. S., Oh, J., Yang, H. K., Hwang, S. H., Son, K. Y., Chun, S. H., Cho, B. L., & Guallar, E. (n.d.).

Publication year

2015

Journal title

Preventive Medicine

Volume

70

Page(s)

19-25

10.1016/j.ypmed.2014.11.007

Abstract

Abstract

Objective: To determine whether a cardiovascular disease (CVD) health screening program is associated with CVD-related health conditions, incidence of cardiovascular events, mortality, healthcare utilization, and costs. Methods: Cohort study of a 3% random sample of all Korea National Health Insurance members 40. years of age or older and free of CVD or CVD-related health conditions was conducted. A total 443,337 study participants were followed-up from January 1, 2005 through December 31, 2010. Results: In primary analysis, the hazard ratios for CVD mortality, all-cause mortality, incident composite CVD events, myocardial infarction, cerebral infarction, and cerebral hemorrhage comparing participants who attended a screening exam during 2003-2004 compared to those who did not were 0.58 (95% CI: 0.53-0.63), 0.62 (95% CI: 0.60-0.64), 0.82 (95% CI: 0.78-0.85), 0.84 (95% CI: 0.75-0.93), 0.84 (95% CI: 0.79-0.89), and 0.73 (95% CI: 0.67-0.80), respectively. Screening attenders had higher rates of newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, lower inpatient days of stay and cost, and lower outpatient cost compared to non-attenders. Conclusions: Participation in CVD health screening was associated with lower rates of CVD, all-cause mortality, and CVD events, higher detection of CVD-related health conditions, and lower healthcare utilization and costs.

Association of cigarette smoking, alcohol consumption, and physical activity with sex steroid hormone levels in US men

Shiels, 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

2009

Journal title

Cancer Causes and Control

Volume

20

Issue

6

Page(s)

877-886

10.1007/s10552-009-9318-y

Abstract

Abstract

Background: 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.

Association of Eating and Sleeping Intervals With Weight Change Over Time : The Daily24 Cohort

Zhao, D., Guallar, E., Woolf, T. B., Martin, L., Lehmann, H., Coughlin, J., Holzhauer, K., Goheer, A. A., McTigue, K. M., Lent, M. R., Hawkins, M., Clark, J. M., & Bennett, W. L. (n.d.).

Publication year

2023

Journal title

Journal of the American Heart Association

Volume

12

Issue

3

10.1161/JAHA.122.026484

Abstract

Abstract

BACKGROUND: We aim to evaluate the association between meal intervals and weight trajectory among adults from a clinical cohort. METHODS AND RESULTS: This is a multisite prospective cohort study of adults recruited from 3 health systems. Over the 6-month study period, 547 participants downloaded and used a mobile application to record the timing of meals and sleep for at least 1 day. We obtained information on weight and comorbidities at each outpatient visit from electronic health records for up to 10 years before until 10 months after baseline. We used mixed linear regression to model weight trajectories. Mean age was 51.1 (SD 15.0) years, and body mass index was 30.8 (SD 7.8) kg/m2; 77.9% were women, and 77.5% reported White race. Mean interval from first to last meal was 11.5 (2.3) hours and was not associated with weight change. The number of meals per day was positively associated with weight change. The average difference in annual weight change (95% CI) associated with an increase of 1 daily meal was 0.28 kg (0.02–0.53). CONCLUSIONS: Number of daily meals was positively associated with weight change over 6 years. Our findings did not support the use of time-restricted eating as a strategy for long-term weight loss in a general medical population.

Association of electrocardiographic and imaging surrogates of left ventricular hypertrophy with incident atrial fibrillation : MESA (Multi-Ethnic Study of Atherosclerosis)

Chrispin, J., Jain, A., Soliman, E. Z., Guallar, E., Alonso, A., Heckbert, S. R., Bluemke, D. A., Lima, J. A., & Nazarian, S. (n.d.).

Publication year

2014

Journal title

Journal of the American College of Cardiology

Volume

63

Issue

19

Page(s)

2007-2013

10.1016/j.jacc.2014.01.066

Abstract

Abstract

Objectives This study sought to examine the association between left ventricular hypertrophy (LVH), dened by cardiac magnetic resonance (CMR) and electrocardiography (ECG), with incident atrial fibrillation (AF). Background Previous studies of the association between AF and LVH were based primarily on echocardiographic measures of LVH. Methods The MESA (Multi-Ethnic Study of Atherosclerosis) enrolled 4,942 participants free of clinically recognized cardiovascular disease. Incident AF was based on MESA-ascertained hospital-discharge International Classification of Diseases codes and Centers for Medicare and Medicaid Services inpatient hospital claims. CMR-LVH was defined as left ventricular mass ≥95th percentile of the MESA population distribution. Eleven ECG-LVH criteria were assessed. The association of LVH with incident AF was evaluated using multivariable Cox proportional hazards models adjusted for CVD risk factors. Results During a median follow-up of 6.9 years, 214 incident AF events were documented. Participants with AF were more likely to be older, hypertensive, and overweight. The risk of AF was greater in participants with CMR-derived LVH (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.15 to 3.62). AF was associated with ECG-derived LVH measure of Sokolow-Lyon voltage product after adjusting for CMR-LVH (HR: 1.83, 95% CI: 1.06 to 3.14, p = 0.02). The associations with AF for CMR-LVH and Sokolow-Lyon voltage product were attenuated when adjusted for CMR left atrial volumes. Conclusions In a multiethnic cohort of participants without clinically detected cardiovascular disease, both CMR and ECG-derived LVH were associated with incident AF. ECG-LVH showed prognostic significance independent of CMR-LVH. The association was attenuated when adjusted for CMR left atrial volumes.

Association of ferritin elevation and metabolic syndrome in males. Results from the Aragon Workers' Health Study (AWHS)

Ledesma, M., Hurtado-Roca, Y., Leon, M., Giraldo, P., Pocovi, M., Civeira, F., Guallar, E., Ordovas, J. M., Casasnovas, J. A., & Laclaustra, M. (n.d.).

Publication year

2015

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

100

Issue

5

Page(s)

2081-2089

10.1210/jc.2014-4409

Abstract

Abstract

Context: Ferritin concentration is associated with metabolic syndrome, but the possibility of a nonlinear association has never been explored. Objective: This study aimed to examine the relationship between serum ferritin levels and the metabolic syndrome in Spanish adult males. Design: This was a cross-sectional analysis of baseline data from the Aragon Workers' Health Study. Setting: Healthy workers from a factory were studied during their annual checkup. Participants: Spanish male adults (n = 3386) between the ages of 19 and 65 years participated. We excluded participants with ferritin > 500 μ/L, ferritin < 12 μg/L, or C-reactive protein > 10 mg/L. Main Outcome Measure: Metabolic syndrome was defined according to the 2009 consensus definition from the Joint Interim Statement of several international societies. Results: Metabolic syndrome prevalence was 27.1%. We found a positive association between elevated iron stores, measured as serum ferritin concentration, and metabolic syndrome and its criteria. Participants within the highest serum ferritin quintile had a higher risk than those in the lowest quintile for central obesity (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.46-2.42), hypertriglyceridemia (OR, 2.15; 95% CI, 1.69-2.74), and metabolic syndrome (OR, 1.92; 95% CI, 1.48-2.49). The association was nonlinear and occurred at serum ferritin concentrations > 100 μg/L (∼ 33th percentile). Ferritin was also associated with insulin resistance, measured by homeostatic model assessment-insulin resistance (HOMA-IR) (P trend < .001). Conclusions: Our findings suggest that serum ferritin is significantly associated with metabolic syndrome and its criteria (especially central obesity and hypertriglyceridemia), suggesting that ferritin could be an early marker of metabolic damage in the development of metabolic syndrome.