Liliana Aguayo, Ph.D. – Helping Families Make Heart-Healthy Choices

March 5, 2025

The culture, relationships, and behaviors that make up a person’s social circle are not always top of mind for environmental health researchers, who often focus on chemical exposures. But Liliana Aguayo, Ph.D., a research assistant professor in the Nell Hodgson Woodruff School of Nursing at Emory University, believes that social factors play a pivotal role in health outcomes, especially for children.

With this in mind, Aguayo, a scholar in the NIEHS-funded Pediatric and Reproductive Environmental Health Southeastern Environmental Exposures and Disparities (PREHS-SEED) program, uses qualitative and quantitative approaches to study the origins of cardiovascular health disparities in children.

“There is no one-size-fits-all answer when it comes to better health outcomes for children,” said Aguayo. “For each child, we need to determine the unique factors within their own social environments that are contributing to – or protecting them from – the development of disease.” 

Early Influences

Aguayo’s commitment to studying social factors formed at a young age. Her family frequently visited a small mountain village in Mexico. There, they knew a poor, older woman who had been kicked by her donkey while selling cheese.

Her parents helped the woman get to the hospital where she was treated. In the process, doctors were surprised by her exceptional health. As a woman in her 60s living alone in a rundown shed, they didn’t expect her exam to reveal the health of a 20-year-old.

“We know from the social determinants of health literature that people with a lower socioeconomic status have poorer health compared to those with a higher socioeconomic status,” said Aguayo. “And yet, this lady was so healthy.”

The woman may have benefitted from a healthy diet, strong social network, and daily walking routine, said Aguayo. Her lack of electricity – which could have resulted in an earlier bedtime and more sleep– may have also played a role.

“When I think about my research, I want to disentangle what this lady had been doing since childhood. What can we take from her lifelong experience to make sure that social or economic circumstances don't dictate our destiny in terms of health?” she said.

Getting to the Bottom of Health Differences

Aguayo took a roundabout path to her research position. After receiving a political science degree from Loyola University, she worked as a Spanish translator for a company that administers health-focused questionnaires to families.

There, she witnessed firsthand the role that language and culture play in health evaluation. For example, Spanish-speaking respondents who were asked to order objects by size for a cognition test would often perform poorly on the test. But Aguayo helped her colleagues realize that the word for one of the objects – “elk” – does not translate well into Spanish and is not a familiar concept for most Hispanic families.

Her passion for listening to respondents to understand their unique circumstances and improve health led her to pursue a joint master’s and doctoral degree in public health from the University of Illinois. Afterwards, as a postdoctoral researcher at the American Heart Association and Northwestern University’s Ann & Robert H. Lurie Children’s Hospital, she began to investigate why some children were more prone to poor cardiovascular health than others.

For example, she found that among Black and Hispanic children, those whose mothers had a higher pre-pregnancy body mass index score were at an increased risk of developing obesity in childhood. The finding suggests that interventions aimed at helping mothers achieve a healthy weight before pregnancy may help reduce childhood obesity in these populations.

Serving Communities

As a scholar in the PREHS-SEED program, Aguayo received funding to conduct a large-scale review of studies examining cardiovascular health predictors, outcomes, and mechanisms across the life course. This effort has informed her community-based research aimed at improving child health.

For one project called “Little Hearts,” she partnered with nursing faculty at Universidad Autonoma de San Luis Potosi in Mexico to provide free cardiovascular health assessments to mothers and children through a public kindergarten.

“Many of the mothers haven’t had health care evaluations since their children were born,” said Aguayo. “We identified and referred a few cases of diabetes and high blood pressure for further assessment, evaluated the children's health, and gave the information to the mothers so they can bring it to their pediatricians.”

The team is now using the data to develop an intervention aimed at curbing consumption of added sugars from ultra-processed foods.

For another project, Aguayo works with endocrinologists to develop a dietary intervention to prevent metabolic dysfunction-associated steatotic liver disease (MASLD) among Hispanic children aged 6-9 years in Atlanta. Studies have shown that Hispanic populations have the highest prevalence of MASLD in the U.S. As part of the program, participants and their siblings get access to free cardiovascular and liver health screenings.

Most recently, Aguayo joined an Emory University program that provides health services to farmworker families in Georgia.

“Farmworkers are one of the most vulnerable populations in the U.S., often experiencing dehydration, greater exposure to pesticides, and weather-related injuries,” said Aguayo. “Although they make it possible for us to have fresh foods and vegetables, in many cases they lack access to fresh produce. As a result, they are at greater risk for diabetes, MASLD, and other preventable chronic diseases.”

Aguayo’s long-term goal is to use data from these projects to devise ways to improve heart health. Her participation in the PREHS-SEED program has been paramount to helping her work towards this goal.

“Findings from these different projects and the statistical training and career development support I’ve received have helped me identify key knowledge gaps and how to address them as I move forward in my research career,” she said.