Person: Joshipura, Kaumudi
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Joshipura
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Kaumudi
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Joshipura, Kaumudi
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Publication A Prospective Study of Periodontal Disease and Risk of Gastric and Duodenal Ulcer in Male Health Professionals(Nature Publishing Group, 2014) Boylan, Matthew R; Khalili, Hamed; Huang, Edward S; Michaud, Dominique S; Izard, Jacques; Joshipura, Kaumudi; Chan, AndrewOBJECTIVES: Periodontal disease has been associated with higher circulating levels of inflammatory markers and conditions associated with chronic inflammation, including vascular disease, diabetes mellitus, and cancer. Limited data exist on the relationship between periodontal disease and gastric and duodenal ulcer. METHODS: We conducted a prospective cohort study of 49,120 men in the Health Professionals Follow-up Study, aged 40–75 years at enrollment in 1986. Biennially, we assessed periodontal disease, tooth loss, and other risk factors for gastric and duodenal ulcer. We validated diagnoses of gastric and duodenal ulcer through medical record review. We used Cox proportional hazards modeling, adjusting for potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: We documented 138 cases of gastric ulcer and 124 cases of duodenal ulcer with available information on Helicobacter pylori status over 24 years of follow-up. After adjustment for risk factors, including smoking and regular use of aspirin and non-steroidal anti-inflammatory drugs, men with periodontal disease with bone loss had a multivariate HR of ulcer of 1.62 (95% CI, 1.24–2.12). Periodontal disease appeared to be associated with a similar risk of developing ulcers that were H. pylori negative (HR 1.75; 95% CI, 1.26–2.43) than H. pylori positive (HR 1.40; 95% CI, 0.87-2.24), as well as ulcers in the stomach (HR 1.75; 95% CI, 1.21–2.53) than ulcers in the duodenum (HR 1.47; 95% CI, 0.98–2.19). CONCLUSIONS: Periodontal disease is associated with an increased risk of incident gastric and duodenal ulcer. This relationship may be mediated by alterations in the oral and gastrointestinal microbiome and/or systemic inflammatory factors.Publication Neck Circumference May Be a Better Alternative to Standard Anthropometric Measures(Hindawi Publishing Corporation, 2016) Joshipura, Kaumudi; Muñoz-Torres, Francisco; Vergara, José; Palacios, Cristina; Pérez, Cynthia M.This paper evaluates neck circumference as a metabolic risk marker. Overweight/obese, nondiabetic Hispanics, 40–65 years old, who are free of major cardiovascular diseases, were recruited for the San Juan Overweight Adults Longitudinal Study (SOALS). Baseline exams were completed by 1,206 participants. Partial correlation coefficients (r) and logistic models adjusted for age, gender, smoking status, and physical activity were computed. Neck circumference was significantly correlated with waist circumference (r = 0.64), BMI (r = 0.66), and body fat % (r = 0.45). Neck circumference, highest (compared to lowest) tertile, had higher association with prediabetes: multivariable OR = 2.30 (95% CI: 1.71–3.06) compared to waist circumference OR = 1.97 (95% CI: 1.48–2.66) and other anthropometric measures. Neck circumference showed higher associations with HOMA, low HDL-C, and triglycerides, multivariable OR = 8.42 (95% CI: 5.43–13.06), 2.41 (95% CI: 1.80–3.21), and 1.52 (95% CI: 1.14–2.03), but weaker associations with hs-CRP and hypertension, OR = 3.61 (95% CI: 2.66–4.90) and OR = 2.58 (95% CI: 1.90–3.49), compared to waist circumference. AIC for model fit was generally similar for neck or waist circumference. Neck circumference showed similar or better associations with metabolic factors and is more practicable than waist circumference. Hence, neck circumference may be a better alternative to waist circumference.Publication ASSOCIATION BETWEEN WITHIN-VISIT SYSTOLIC BLOOD PRESSURE VARIABILITY AND DEVELOPMENT OF PRE-DIABETES AND DIABETES AMONG OVERWEIGHT/OBESE INDIVIDUALS(2017) Joshipura, Kaumudi; Muñoz-Torres, Francisco J.; Campos, Maribel; Rivera-Díaz, Alba D.; Zevallos, Juan C.Short-term blood pressure variability is associated with pre-diabetes/diabetes cross-sectionally, but there are no longitudinal studies evaluating this association. The objective of this study is to evaluate the association between within-visit systolic and diastolic blood pressure variability and development of pre-diabetes/diabetes longitudinally. The study was conducted among eligible participants from the San Juan Overweight Adults Longitudinal Study (SOALS), who completed the three-year follow-up exam. Participants were Hispanics, 40–65 years of age, and free of diabetes at baseline. Within-visit systolic and diastolic blood pressure variability was defined as the maximum difference between three measures, taken a few minutes apart, of systolic and diastolic blood pressure respectively. Diabetes progression was defined as development of pre-diabetes/diabetes over the follow-up period. We computed multivariate incidence rate ratios adjusting for baseline age, gender, smoking, physical activity, waist circumference and hypertension status. Participants with systolic blood pressure variability ≥10 mm Hg compared to those with <10 mm Hg, showed higher progression to pre-diabetes/diabetes (RR=1.77, 95% CI: 1.30–2.42). The association persisted among never smokers. Diastolic blood pressure variability ≥ 10 mm Hg (compared to < 10 mm Hg) did not show an association with diabetes status progression (RR=1.20, 95% CI: 0.71–2.01). Additional adjustment of baseline glycemia, C- reactive protein, and lipids (reported dyslipidemia or baseline HDL or triglycerides) did not change the estimates. Systolic blood pressure variability may be a novel independent risk factor and an early predictor for diabetes, which can be easily incorporated into a single routine outpatient visit at none to minimal additional cost.