Serum Selenium Concentrations and Diabetes in U.S. Adults: National Health and Nutrition Examination Survey (NHANES) 2003-2004

By Laclaustra, Martin; Navas-Acien, Ana et al. | Environmental Health Perspectives, September 2009 | Go to article overview

Serum Selenium Concentrations and Diabetes in U.S. Adults: National Health and Nutrition Examination Survey (NHANES) 2003-2004


Laclaustra, Martin, Navas-Acien, Ana, Stranges, Saverio, Ordovas, Jose M., Guallar, Eliseo, Environmental Health Perspectives


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 [greater than or equal to] 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 [greater than or equal to] 126 mg/dL.

RESULTS: Mean serum selenium was 137.1 [micro]g/L. The multivariable adjusted odds ratio [95% confidence interval (CI)] for diabetes comparing the highest quartile of serum selenium ([greater than or equal to] 147 [micro]g/L) with the lowest (< 124 [micro]g/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 [micro]g/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]

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Most Americans have selenium intake ranging from 60 to 220 [micro]g/day (Combs 2001), well above the recommended dietary allowance of 55 [micro]g/day (Institute of Medicine and Panel on Dietary Antioxidants and Related Compounds 2000; Rayman 2008). This high level of intake, particularly compared with other countries, is attributable to the high soil content of selenium in several areas of the United States, which is eventually incorporated in the food chain (Rayman 2008). Although selenium is required for adequate function of glutathione peroxidase and other selenoproteins, the risk of selenium deficiency in the U.S. general population is negligible. Additional selenium intake at high intake levels does not increase glutathione peroxidase synthesis or activity, but rather increases plasma selenium concentration by the nonspecific incorporation of selenomethionine into plasma proteins (Institute of Medicine and Panel on Dietary Antioxidants and Related Compounds 2000), with unknown health effects.

Bleys et al. (2007) reported a positive association between serum selenium concentrations and the prevalence of diabetes among participants in the Third National Health and Nutrition Examination Survey (NHANES III). Stranges et al. (2007) reported an increased risk of diabetes among participants randomized to long-term selenium supplementation (200 [micro]g/day) in the Nutritional Prevention of Cancer (NPC) trial. Recently, the Selenium and Vitamin E Cancer Prevention Trial (SELECT), a mega-trial aimed to evaluate the efficacy of selenium in preventing prostate cancer, was prematurely stopped by the data and safety monitoring committee because of lack of benefit on the primary end point and the possibility of an increased risk of diabetes in the selenium-only arm (Lippman et al. 2009). Additionally, high selenium status has been linked with hypercholesterolemia (Bleys et al. …

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