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Martin Laclaustra,^1,2 Ana Navas-Acien,^2,3 Saverio Stranges,⁴ Jose M. Ordovas,⁵ and Eliseo Guallar^1,2

¹Department of Cardiovascular Epidemiology and Population Genetics, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; ²Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, and ³Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; ⁴Clinical Sciences Research Institute, Warwick Medical School, University Hospital Coventry and Warwickshire, Coventry, United Kingdom; ⁵Nutrition and Genomics Laboratory, Jean Mayer–U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA

Abstract
Background: Increasing evidence suggests that high selenium levels are associated with diabetes and other cardiometabolic risk factors.

Objectives: We evaluated the association of serum selenium concentrations with fasting plasma glucose, glycosylated hemoglobin levels, and diabetes in the most recently available representative sample of the U.S. population.

Methods: We used a cross-sectional analysis of 917 adults ≥ 40 years of age who had a fasting morning blood sample in the National Health and Nutrition Examination Survey 2003–2004. We evaluated the association of serum selenium, measured by inductively coupled plasma-dynamic reaction cell-mass spectrometry, and diabetes, defined as a self-report of current use of hypoglycemic agents or insulin or as fasting plasma glucose ≥ 126 mg/dL.

Results: Mean serum selenium was 137.1 µg/L. The multivariable adjusted odds ratio [95% confidence interval (CI) ] for diabetes comparing the highest quartile of serum selenium (≥ 147 µg/L) with the lowest (< 124 µg/L) was 7.64 (3.34–17.46) . The corresponding average differences (95% CI) in fasting plasma glucose and glycosylated hemoglobin were 9.5 mg/dL (3.4–15.6 mg/dL) and 0.30% (0.14–0.46%) , respectively. In spline regression models, the prevalence of diabetes as well as glucose and glycosylated hemoglobin levels increased with increasing selenium concentrations up to 160 µg/L.

Conclusions: In U.S. adults, high serum selenium concentrations were associated with higher prevalence of diabetes and higher fasting plasma glucose and glycosylated hemoglobin levels. Given high selenium intake in the U.S. population, further research is needed to determine the role of excess selenium levels in the development or the progression of diabetes.

Key words: diabetes, glycosylated hemoglobin, National Health and Nutrition Examination Survey, NHANES, selenium. Environ Health Perspect 117:1409–1413 (2009) . doi:10.1289/ehp.0900704 available via http://dx.doi.org/ [Online 15 May 2009]

Address correspondence to E. Guallar, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, 2024 East Monument St., Room 2-639, Baltimore, MD 21205 USA. Telephone: (410) 614-0574. Fax: (410) 955-0476. E-mail: eguallar@jhsph.edu

This work was supported by grants ES012673 from the National Institute of Environmental Health Sciences, DK075030 from the National Institute of Diabetes, Digestive, and Kidney Disease, and 0230232N from the American Heart Association and by contract 58-1950-9-001 from the U.S. Department of Agriculture Research Service.

The authors declare they have no competing financial interests.

Received 19 February 2009 ; accepted 14 May 2009.