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Abstract Early life stunting may have long-term effects on body composition, resulting in obesity-related comorbidities. We tested the hypothesis that individuals stunted in early childhood may be at higher cardiometabolic risk later in adulthood. 1753 men and 1781 women participating in the 1982 Pelotas (Brazil) birth cohort study had measurements of anthropometry, body composition, lipids, glucose, blood pressure, and other cardiometabolic traits at age 30 years. Early stunting was defined as height-for-age Z-score at age 2 years below -2 against the World Health Organization growth standards. Linear regression models were performed controlling for sex, maternal race/ethnicity, family income at birth, and birthweight. Analyses were stratified by sex when p-interaction<0.05. Stunted individuals were shorter (β=-0.71 s.d.; 95% CI: -0.78 to -0.64), had lower BMI (β=-0.14 s.d.; 95%CI: -0.25 to -0.03), fat mass (β=-0.28 s.d.; 95%CI: -0.38 to -0.17), SAFT (β=-0.16 s.d.; 95%CI: -0.26 to -0.06), systolic (β=-0.12 s.d.; 95%CI: -0.21 to -0.02) and diastolic blood pressure (β=-0.11 s.d.; 95%CI: -0.22 to -0.01), and higher VFT/SAFT ratio (β=0.15 s.d.; 95%CI: 0.06 to 0.24), in comparison with non-stunted individuals. In addition, early stunting was associated with lower fat free mass in both men (β=-0.39 s.d.; 95%CI: -0.47 to -0.31) and women (β=-0.37 s.d.; 95%CI: -0.46 to -0.29) after adjustment for potential confounders. Our results suggest that early stunting has implications on attained height, body composition and blood pressure. The apparent tendency of stunted individuals to accumulate less fat-free mass and subcutaneous fat might predispose them towards increased metabolic risks in later life. ; The last phase of the 1982 Pelotas (Brazil) birth cohort study was supported by the Wellcome Trust and the Fundação de Aparo à Pesquisa do Estado do Rio Grande do Sul; Brazil (Edital 04/2012 – PQG; Processo 12/2185-9). Earlier phases were funded by the International Development Research Centre (Canada), the WHO (Department of Child and Adolescent Health and Development and Human Reproduction Programme) to BLH, the Overseas Development Administration (currently the Department for International Development, United Kingdom), the European Union, the United Nations Development Fund for Women, the National Program for Centres of Excellence, the Pastorate of the Child (Brazil), the National Council for Scientific and Technological Development (CNPq; Brazil), and the Ministry of Health (Brazil). GVAF was supported by the Brazilian Coordination of Improvement of Higher Education Personnel (scholarship process BEX 5077/13-3). EDLR and KKO are supported by the Medical Research Council [Unit Programme number MC_UU_12015/2]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Increases in the prevalence of noncommunicable diseases (NCDs), particularly cardiometabolic diseases such as cardiovascular disease, stroke and diabetes, and their major risk factors have not been uniform across settings: for example, cardiovascular disease mortality has declined over recent decades in high-income countries but increased in low- and middle-income countries (LMICs). The factors contributing to this rise are varied and are influenced by environmental, social, political and commercial determinants of health, among other factors. This Review focuses on understanding the rise of cardiometabolic diseases in LMICs, with particular emphasis on obesity and its drivers, together with broader environmental and macro determinants of health, as well as LMIC-based responses to counteract cardiometabolic diseases. © 2019, Springer Nature America, Inc.

This is the final version. Available from Nature Research via the DOI in this record. ; Summary GWAS statistics are publicly available at The Sleep Disorder Knowledge Portal webpage: http://sleepdisordergenetics.org/. ; Daytime napping is a common, heritable behavior, but its genetic basis and causal relationship with cardiometabolic health remain unclear. Here, we perform a genome-wide association study of self-reported daytime napping in the UK Biobank (n = 452,633) and identify 123 loci of which 61 replicate in the 23andMe research cohort (n = 541,333). Findings include missense variants in established drug targets for sleep disorders (HCRTR1, HCRTR2), genes with roles in arousal (TRPC6, PNOC), and genes suggesting an obesity-hypersomnolence pathway (PNOC, PATJ). Association signals are concordant with accelerometer-measured daytime inactivity duration and 33 loci colocalize with loci for other sleep phenotypes. Cluster analysis identifies three distinct clusters of nap-promoting mechanisms with heterogeneous associations with cardiometabolic outcomes. Mendelian randomization shows potential causal links between more frequent daytime napping and higher blood pressure and waist circumference. ; National Institute of Health ; National Institute of Health ; National Institute of Health ; National Institute of Health ; National Institute of Health ; MGH Research Scholar Fund, Academy of Finland ; Medical Research Council ; Spanish Government of Investigation, Development and Innovation ; Seneca Foundation ; NIDDK ; Instrumentarium Science Foundation ; Yrjö Jahnsson Foundation

Cardiometabolic diseases (CMD), including cardiovascular disease, diabetes mellitus and chronic renal failure are presently the leading cause of mortality worldwide. Since around 80% of cardiovascular diseases and over 90% of diabetes could be prevented or postponed by improving lifestyle alone, there is a large window of opportunity to prevent these diseases. Selective prevention targets at asymptomatic persons at high risk of CMD, including interventions to lower their risk and seems a promising strategy to prevent CMD. However, implementation in clinical practice is challenging and despite its importance, currently there is no European Union (EU) wide policy for selective prevention of CMD. More insight in current practices in different countries could help to find best practices, as well as barriers and facilitators for selective prevention of CMD. This provides the opportunity for countries to learn from each other's experiences and to provide recommendations on how to optimise CMD prevention across Europe. In this thesis we assessed the following research objectives: 1.Health care system level: To provide information on the current status of the implementation of health checks for CMD across Europe and on conditions to facilitate the implementation; 2.Health care provider level: To give more insight in the current activities and barriers and facilitators for general practitioners (GPs) to invite their patients for a CMD health check, as well as their attitude towards selective prevention of CMD; 3.Population level: To examine willingness of the target population to participate in a health check for CMD as well as barriers and facilitators for participation. The results in this thesis showed that in almost two-third of the countries in the EU a selective prevention programme for CMD is available. When studying five countries in more detail (the Czech Republic, Denmark, Greece, the Netherlands and Sweden), we conclude that although most GPs consider selective CMD prevention as useful, it is not universally implemented, with differences in GPs' activities between and within countries. We identified several facilitating and obstructing factors for GPs to undertake selective prevention of CMD. On population level, we conclude that most individuals are willing to participate in a CMD health check, and we identified facilitating and obstructing factors for individuals to participate in health checks. For successful implementation of selective prevention in general practice, changes on the level of the health care system, health care provider and population are essential. In short, GPs could play an important role in selective prevention of CMD, which asks for a formalisation of the role of GPs, adequate reimbursement and time to perform preventive activities. On the level of the population the optimal target population should be defined, as well as an optimal method to invite the target population for selective prevention programmes for CMD. A focus on prevention and the political willingness to invest and structurally fund prevention activities is thereby important. The EU could play an important role by making prevention programmes for CMD a political priority across Europe. Further research should focus on how to best implement selective prevention programmes for CMD in the different countries, in relation to their cost-effectiveness.

The haplogroup gap: The ticking time bomb of cardiometabolic disease in developing nations
Cardiometabolic disease (CMD) greatly increases an individual's risk for developing cardiovascular disease (CVD) and/or Type II diabetes (2), with the former being a leading cause of death worldwide. Decades of research efforts have significantly improved our understanding of cardiometabolic disease as a multifactorial 'whole-body' pathology caused not only by common 'modifiable' risk factors (such as exercise and dietary choices), but also increased inflammation within our muscles and fat, as well as inherited genetic risk. The genetic aspect of cardiometabolic disease has proven vexing to the medical and research communities – hundreds of genes have been associated with the hallmarks of CMD, yet none occur at a frequency that would explain the explosion in obesity and CMD rates documented worldwide over the past 25 years.

In both developed and developing countries, trans fatty acids (TFA) are largely consumed from partially hydrogenated vegetable oils. This article focuses on TFA as a modifiable dietary risk factor for cardiovascular disease, reviewing the evidence for lipid and non lipid effects; the relations of trans fat intake with clinical endpoints; and current policy and legislative issues. In both observational cohort studies and randomized clinical trials, TFA adversely affect lipid profiles (including raising LDL and triglyceride levels, and reducing HDL levels), systemic inflammation, and endothelial function. More limited but growing evidence suggests that TFA also exacerbate visceral adiposity and insulin resistance. These pluripotent effects of TFA on a plethora of cardiovascular risk factors are consistent with the strong associations seen in prospective cohort studies between TFA consumption and risk of myocardial infarction and coronary heart disease (CHD) death. The documented harmful effects of TFA along with the feasibility of substituting partially hydrogenated vegetable oils with healthy alternatives indicate little reason for continued presence of industrially-produced TFA in food preparation and manufacturing or in home cooking fats/oils. A comprehensive strategy to eliminate use of industrial TFA in both developed and developing countries, including education, food labeling, and policy and legislative initiatives, would likely prevent tens of thousands of CHD events worldwide each year.

The study was supported by the Spanish Ministry of Economy and Competitiveness via Retos de la Sociedad (DEP2016-79512-R to J.R.R.) and European Regional Development Funds (ERDF), the Spanish Ministry of Education (FPU 16/02828), the University of Granada Plan Propio de Investigacion 2016-Excellence actions: Unit of Excellence on Exercise and Health (UCEES), the Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades (ERDF: ref. SOMM17/6107/UGR), The Netherlands CardioVascular Research Initiative "the Dutch Heart Foundation, Dutch Federation of University Medical Centers, the Netherlands Organisation for Health Research and Development and the Royal Netherlands Academy of Sciences" (CVON2017-20 GENIUS-2) to P.C.N.R., and the Chinese Scholarship Council (CSC; No. 201707060012 to X.D., No. 201607060017 to W.Y.). B.M.T. is supported by an individual postdoctoral grant from the Fundacion Alfonso Martin Escudero. ; Context: Bile acids (BA) are known for their role in intestinal lipid absorption and can also play a role as signaling molecules to control energy metabolism. Prior evidence suggests that alterations in circulating BA levels and in the pool of circulating BA are linked to an increased risk of obesity and a higher incidence of type 2 diabetes in middleaged adults. Objective: We aimed to investigate the association between plasma levels of BA with cardiometabolic risk factors in a cohort of well-phenotyped, relatively healthy young adults. Methods: Body composition, brown adipose tissue, serum classical cardiometabolic risk factors, and a set of 8 plasma BA (including glyco-conjugated forms) in 136 young adults (age 22.1 ± 2.2 years, 67% women) were measured. Results: Plasma levels of chenodeoxycholic acid (CDCA) and glycoursodeoxycholic acid (GUDCA) were higher in men than in women, although these differences disappeared after adjusting for body fat percentage. Furthermore, cholic acid (CA), CDCA, deoxycholic acid (DCA), and glycodeoxycholic acid (GDCA) levels were positively, yet weakly associated, with lean body mass (LBM) levels, while GDCA and glycolithocholic acid (GLCA) levels were negatively associated with 18F-fluorodeoxyglucose uptake by brown adipose tissue. Interestingly, glycocholic acid (GCA), glycochenodeoxycholic acid (GCDCA), and GUDCA were positively associated with glucose and insulin serum levels, HOMA index, low-density lipoprotein cholesterol, tumor necrosis factor alpha, interleukin (IL)-2, and IL-8 levels, but negatively associated with high-density lipoprotein cholesterol, ApoA1, and adiponectin levels, yet these significant correlations partially disappeared after the inclusion of LBM as a confounder. Conclusion: Our findings indicate that plasma levels of BA might be sex dependent and are associated with cardiometabolic and inflammatory risk factors in young and relatively healthy adults. ; Spanish Ministry of Economy and Competitiveness via Retos de la Sociedad DEP2016-79512-R ; European Commission Spanish Government FPU 16/02828 ; University of Granada Plan Propio de Investigacion 2016-Excellence actions: Unit of Excellence on Exercise and Health (UCEES) ; Consejeria de Conocimiento, Investigacion y Universidades (ERDF) SOMM17/6107/UGR ; Netherlands CardioVascular Research Initiative "the Dutch Heart Foundation" CVON2017-20 GENIUS-2 Netherlands CardioVascular Research Initiative "Dutch Federation of University Medical Centers" CVON2017-20 GENIUS-2 ; Netherlands CardioVascular Research Initiative "Netherlands Organisation for Health Research and Development" CVON2017-20 GENIUS-2 Netherlands CardioVascular Research Initiative "Royal Netherlands Academy of Sciences" CVON2017-20 GENIUS-2 ; China Scholarship Council 201707060012 201607060017 ; Fundacion Alfonso Martin Escudero ; Junta de Andalucia

The health of Indigenous Australians is dramatically poorer than that of the non-Indigenous population. Amelioration of these differences has proven difficult. In part, this is attributable to a conceptualisation which approaches health disparities from the perspective of individual-level health behaviours, less so the environmental conditions that shape collective health behaviours. This ecological study investigated associations between the built environment and cardiometabolic mortality and morbidity in 123 remote Indigenous communities representing 104 Indigenous locations (ILOC) as defined by the Australian Bureau of Statistics. The presence of infrastructure and/or community buildings was used to create a cumulative exposure score (CES). Records of cardiometabolic-related deaths and health service interactions for the period 2010&ndash ; 2015 were sourced from government department records. A quasi-Poisson regression model was used to assess the associations between built environment &ldquo ; healthfulness&rdquo ; (CES, dichotomised) and cardiometabolic-related outcomes. Low relative to high CES was associated with greater rates of cardiometabolic-related morbidity for two of three morbidity measures (relative risk (RR) 2.41&ndash ; 2.54). Cardiometabolic-related mortality was markedly greater (RR 4.56, 95% confidence interval (CI), 1.74&ndash ; 11.93) for low-CES ILOCs. A lesser extent of &ldquo ; healthful&rdquo ; building types and infrastructure is associated with greater cardiometabolic-related morbidity and mortality in remote Indigenous locations. Attention to environments stands to improve remote Indigenous health.

Das Ziel dieser Dissertation ist es, einen Beitrag zu den Erkenntnissen über den Zugang zur Versorgung von Herz-Kreislauf-Erkrankungen (CVD) - der weltweit häufigsten Todesursache - zu leisten, indem a) der Stand der Hypercholesterinämie-Versorgung in einer Vielzahl von Ländern mit niedrigem und mittlerem Einkommen (LMICs) beschrieben und b) die Wirksamkeit von zwei Interventionen auf individueller Ebene getestet wird, die darauf abzielen, das Screening-Verhalten bei CVD in Indonesien und Südafrika zu verbessern. Diese Dissertation beschreibt, dass der Zugang zur CVD-Versorgung in vielen LM...

Das Ziel dieser Dissertation ist es, einen Beitrag zu den Erkenntnissen über den Zugang zur Versorgung von Herz-Kreislauf-Erkrankungen (CVD) - der weltweit häufigsten Todesursache - zu leisten, indem a) der Stand der Hypercholesterinämie-Versorgung in einer Vielzahl von Ländern mit niedrigem und mittlerem Einkommen (LMICs) beschrieben und b) die Wirksamkeit von zwei Interventionen auf individueller Ebene getestet wird, die darauf abzielen, das Screening-Verhalten bei CVD in Indonesien und Südafrika zu verbessern. Diese Dissertation beschreibt, dass der Zugang zur CVD-Versorgung in vielen LM...

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Purpose: In line with epidemiological and sociocultural changes in Korea over the past decades, reliable estimation of diseases as a result of dietary and metabolic risks is required. In this study, we aimed to evaluate the contributions of dietary and metabolic factors to cardiometabolic diseases (CMDs) in Korean adults (25–64 years old) during 2012–2013. Materials and Methods: Distribution of risk factors and cause-specific mortality by gender and age per year was obtained from the Korea National Health and Nutrition Examination Survey and Statistics Korea, respectively. The association between the two was obtained from published meta-analyses. The population-attributable fraction attributable to the risk factors was calculated across gender and age strata (male and female, age groups 25–34, 35–44, 45–54, and 55–64) in 2012 and 2013. Results: The results showed that during the period studied, high body mass index [5628 deaths; uncertainty intervals (UIs): 5473– 5781] and blood pressure (4202 deaths; UIs: 3992–4410) were major metabolic risks for CMD deaths, followed by dietary risks such as low intake of whole grain (4107 deaths; UIs: 3275–4870) and fruits (3886 deaths; UIs: 3227–4508), as well as high intake of sodium (2911 deaths, UIs: 2406–3425). Also, males and the younger population were seen more prone to be exposed to harmful dietary risk than their female and older counterparts. Conclusion: The findings provide the necessary information to develop targeted government interventions to improve cardiometabolic health at the population level.

Introduction: The aim of this study was to identify selected cardiometabolic risk markers and determine their correlation with lifestyles of adults with visual impairments. Methods: The study randomly selected 49 people with visual impairments (25 women and 24 men) aged 17–84 years (mean age 58.5 years). Body build, composition metrics, biochemical parameters, level of physical activity, and eating habits were evaluated. Results: Excessive body mass was found in 65% of respondents (72% women and 58% men). Above-typical blood total cholesterol levels were found in 52% of women and 42% of men, low-density lipoprotein (LDL) cholesterol levels in 33% of men and 20% of women, triglyceride levels in 16% of women and 17% of men and glucose in 56% of women and 42% of men. Reduced levels of high-density lipoprotein cholesterol were found in 25% of men and 20% of women. Results showed that 43% of respondents were not involved in physical activity at the recommended level. The use of nicotine was declared by 18% of respondents. No significant correlations were observed for the relationships between physical activity and somatic and biochemical parameters. Eating habits had a significant effect on the prevalence of above-typical LDL cholesterol levels, whereas smoking led to significant differences between study participants due to body mass index and fat percentage. Discussion: Lifestyles of individuals with visual impairments were not entirely healthy. Due to the characteristics of the disability, people with visual impairments are challenged with barriers to living healthy lifestyles. Implications for practitioners: The information obtained here can be used to implement adequate measures to provide equal opportunities for people who are blind or have low vision to lead healthy lifestyles and improve their quality of life.