Epidemic of cardiometabolic diseases: a Latin American point of view

Electrodiagnostic assessment of autonomic nervous system in diabetic autonomic neuropathy: Case series in 72 diabetes patients

Diabetic autonomic neuropathy is one of the most common complications of diabetes which is asymptomatic in early stage. Hence HRV and AFT are performed to detect and prevent its progression to advanced stages. To discuss the HRV and AFT findings in diabetic patients. An observational study was conducted in Physiology department of AIIMS, Bhopal in collaboration with the Medicine department of the institute. Seventy-two diagnosed Type-2 Diabetes mellitus patients were examined using POWER LAB AND LAB CHART 8 BY AD INSTRUMENT: For recording heart rate variability (HRV) and Ewing's battery of tests: For Autonomic function testing. Microsoft Excel was utilized for data compilation and for result analysis. In the present study, based on HRV parameters sympathetic involvement was seen in 39% while parasympathetic involvement was seen in 15% of patients. Balanced state was observed in 46% of the patients. Based on AFT battery, normal early involvement was observed in 62% of the patients while definite and severe involvement was observed in 14 and 24%, respectively. Diabetic autonomic neuropathy was observed in 72% of the patients based on HRV and AFT testing. In severe involvement, orthostatic hypotension was seen. Severe involvement was observed in 24% of the patients in present study. Involvement of the vagal parasympathetic component of ANS was obvious evidenced by increase in resting heart rate, decrease in Valsalva ratio, E/I index, and standing ratio. Diabetic autonomic neuropathy was observed in majority of patients with normal early involvement seen predominantly and though majority of them were in balanced state, sympathetic involvement was also seen at large. HRV studies depicted a decrease of total power, decreased low frequency (LF) and high frequency (HF) with LF/HF and SD1/SD2 ratios depicting sympathetic involvement.

Association between the triglyceride-glucose index and all-cause and CVD mortality in the young population with diabetes

BACKGROUND

Although studies have demonstrated the value of the triglyceride-glucose (TyG) index for cardiovascular disease (CVD) and cardiovascular mortality, however, few studies have shown that the TyG index is associated with all-cause or CVD mortality in young patients with diabetes. This study aimed to investigate the association between the TyG index and all-cause and CVD mortality in young patients with diabetes in the United States.

METHODS

Our study recruited 2440 young patients with diabetes from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Mortality outcomes were determined by linking to National Death Index (NDI) records up to December 31, 2019. Cox regression modeling was used to investigate the association between TyG index and mortality in young patients with diabetes. The nonlinear association between TyG index and mortality was analyzed using restricted cubic splines (RCS), and a two-segment Cox proportional risk model was constructed for both sides of the inflection point.

RESULTS

During a median follow-up period of 8.2 years, 332 deaths from all causes and 82 deaths from cardiovascular disease were observed. Based on the RCS, the TyG index was found to have a U-shaped association with all-cause and CVD mortality in young patients with diabetes, with threshold values of 9.18 and 9.16, respectively. When the TyG index was below the threshold value (TyG index < 9.18 in all-cause mortality and < 9.16 in CVD mortality), its association with all-cause and CVD mortality was not significant. When the TyG index was above the threshold (TyG index ≥ 9.18 in all-cause mortality and ≥ 9.16 in CVD mortality), it showed a significant positive association with all-cause mortality and CVD mortality (HR 1.77, 95% CI 1.05-2.96 for all-cause mortality and HR 2.38, 95% CI 1.05-5.38 for CVD mortality).

CONCLUSION

Our results suggest a U-shaped association between TyG index and all-cause and CVD mortality among young patients with diabetes in the United States, with threshold values of 9.18 and 9.16 for CVD and all-cause mortality, respectively.

Association of the triglyceride glucose index with all-cause and cardiovascular mortality in a general population of Iranian adults

BACKGROUND

The triglyceride glucose (TyG) index is a new and low-cost marker to determine insulin resistant which may be a predictor of cardiovascular disease (CVD). Although available evidence showed that its association with CVD mortality (CVM) and all-cause mortality (ACM) may differ in different populations, scarce data are available in this regard specially in low and middle-income countries.

PURPOSE

To examine the association between TyG index and risk of CVM and ACM in Iranians.

METHODS

This prospective cohort study included 5432 adults (age ≥ 35 years) with no history of CVD events. Fasting glucose and triglyceride were measured at baseline in all participants and TyG index was calculated. Cox frailty model was used to calculate hazard ratios (HRs) for CVM and ACM across the tertiles of TyG index.

RESULTS

After a median follow-up of 11.25 years, a total number of 191 cardiovascular deaths, and 487 all-cause mortality was recorded. The risk of both CVM and ACM increased across the tertiles of TyG index. In the adjusted model for lifestyle and metabolic variables, the risks of ACM and CVM increased by 41% (95% CI 1.11, 1.81; P for trend = 0.005) and 64% (95% CI 1.07, 2.50; P for trend = 0.024), respectively. However, adjustment for diabetes mellitus disappeared the significance for both ACM and CVM. These associations may vary by sex. TyG was not related to the risk of non-CVD mortality.

CONCLUSION

The predicting value of TyG index for ACM and CVM might be mediated by diabetes status. Further studies are required to confirm these findings.

Precocious evaluation of cardiovascular risk and its correlation with perinatal condition

The cardiovascular disease is the main cause of worldwide death. This profile is potentialized by the increased severity of infections in people with obesity, type 2 diabetes and hypertension. Children and adolescents are target groups for the prevention of non-communicable diseases. The Developmental Origins of Health and Disease concept points that perinatal conditions are an important risk factor to development of non-communicable disease in adulthood. In this context, the present review identifies perinatal factor that induces precocious cardiovascular risk factors, related with cardiometabolic syndrome. The low or high birth weight and caesarean delivery are risk factors that induce increased occurrence of cardiovascular risk biomarkers in children and adolescents, while the breast feeding or feeding with breast milk from the birth until two years-old is a protector strategy. Evaluation of perinatal conditions associated with precocious identification of cardiovascular risk factors in children and adolescents is an efficient strategy to prevent and control cardiovascular mortality; through interventions, as lifestyle changes during vulnerable windows of development, able to set up the risk to cardiometabolic disease.

Exploring long COVID condition in Latin America: Its impact on patients' activities and associated healthcare use

Background

Studies exploring long COVID condition (LCC) in low- and middle-income countries are scarce. Further characterization of LCC patients experiencing activity limitations and their associated healthcare use is needed. This study aimed to describe LCC patients' characteristics, its impact on activities, and associated healthcare use in Latin America (LATAM).

Participants

Individuals who (cared for someone or) had COVID-19 and could read, write, and comprehend Spanish and lived in a LATAM country were invited to complete a virtual survey. Sociodemographic characteristics, COVID-19 and LCC symptoms, activity limitations, and healthcare use.

Results

Data from 2,466 people from 16 countries in LATAM were analyzed (females = 65.9%; mean age of 39.5 ± 53.3 years). 1,178 (48%) of the respondents had LCC symptoms (≥3 months). These were more likely to have COVID-19 earlier in the pandemic, were older, had no COVID vaccines, had more comorbidities, needed supplementary oxygen, and reported significantly more COVID-19 symptoms during the infectious period. 33% of the respondents visited a primary care provider, 13% went to the emergency department, 5% were hospitalized, 21% visited a specialist, and 32% consulted ≥1 therapist for LCC symptoms mainly extreme fatigue, sleep difficulties, headaches, muscle or joint pain, and shortness of breath with activity. The most consulted therapists were respiratory therapists (15%) and psychologists (14%), followed by physical therapists (13%), occupational therapists (3%), and speech pathologists (1%). One-third of LCC respondents decreased their regular activities (e.g., work, school) and 8% needed help with activities of daily living (ADLs). LCC respondents who reduced their activities reported more difficulty sleeping, chest pain with activity, depression, and problems with concentration, thinking, and memory, while those who needed help with ADLs were more likely to have difficulty walking, and shortness of breath at rest. Approximately 60% of respondents who experienced activity limitations sought a specialist and 50% consulted therapists.

Conclusions and relevance

Results supported previous findings in terms of the LCC demographics, and provided insight into LCC impact on patients' activities and healthcare services used in LATAM. This information is valuable to inform service planning and resource allocation in alignment with the needs of this population.

Association of the triglyceride glucose index as a measure of insulin resistance with mortality and cardiovascular disease in populations from five continents (PURE study): a prospective cohort study

BACKGROUND

The triglyceride glucose (TyG) index is an easily accessible surrogate marker of insulin resistance, an important pathway in the development of type 2 diabetes and cardiovascular diseases. However, the association of the TyG index with cardiovascular diseases and mortality has mainly been investigated in Asia, with few data available from other regions of the world. We assessed the association of insulin resistance (as determined by the TyG index) with mortality and cardiovascular diseases in individuals from five continents at different levels of economic development, living in urban or rural areas. We also examined whether the associations differed according to the country's economical development.

METHODS

We used the TyG index as a surrogate measure for insulin resistance. Fasting triglycerides and fasting plasma glucose were measured at the baseline visit in 141 243 individuals aged 35-70 years from 22 countries in the Prospective Urban Rural Epidemiology (PURE) study. The TyG index was calculated as Ln (fasting triglycerides [mg/dL] x fasting plasma glucose [mg/dL]/2). We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random effects to test the associations between the TyG index and risk of cardiovascular diseases and mortality. The primary outcome of this analysis was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, and non-fatal myocardial infarction, or stroke). Secondary outcomes were non-cardiovascular mortality, cardiovascular mortality, all myocardial infarctions, stroke, and incident diabetes. We also did subgroup analyses to examine the magnitude of associations between insulin resistance (ie, the TyG index) and outcome events according to the income level of the countries.

FINDINGS

During a median follow-up of 13·2 years (IQR 11·9-14·6), we recorded 6345 composite cardiovascular diseases events, 2030 cardiovascular deaths, 3038 cases of myocardial infarction, 3291 cases of stroke, and 5191 incident cases of type 2 diabetes. After adjusting for all other variables, the risk of developing cardiovascular diseases increased across tertiles of the baseline TyG index. Compared with the lowest tertile of the TyG index, the highest tertile (tertile 3) was associated with a greater incidence of the composite outcome (HR 1·21; 95% CI 1·13-1·30), myocardial infarction (1·24; 1·12-1·38), stroke (1·16; 1·05-1·28), and incident type 2 diabetes (1·99; 1·82-2·16). No significant association of the TyG index was seen with non-cardiovascular mortality. In low-income countries (LICs) and middle-income countries (MICs), the highest tertile of the TyG index was associated with increased hazards for the composite outcome (LICs: HR 1·31; 95% CI 1·12-1·54; MICs: 1·20; 1·11-1·31; p_interaction=0·01), cardiovascular mortality (LICs: 1·44; 1·15-1·80; p_interaction=0·01), myocardial infarction (LICs: 1·29; 1·06-1·56; MICs: 1·26; 1·10-1·45; p_interaction=0·08), stroke (LICs: 1·35; 1·02-1·78; MICs: 1·17; 1·05-1·30; p_interaction=0·19), and incident diabetes (LICs: 1·64; 1·38-1·94; MICs: 2·68; 2·40-2·99; p_interaction <0·0001). In contrast, in high-income countries, higher TyG index tertiles were only associated with an increased hazard of incident diabetes (2·95; 2·25-3·87; p_interaction <0·0001), but not of cardiovascular diseases or mortality.

INTERPRETATION

The TyG index is significantly associated with future cardiovascular mortality, myocardial infarction, stroke, and type 2 diabetes, suggesting that insulin resistance plays a promoting role in the pathogenesis of cardiovascular and metabolic diseases. Potentially, the association between the TyG index and the higher risk of cardiovascular diseases and type 2 diabetes in LICs and MICs might be explained by an increased vulnerability of these populations to the presence of insulin resistance.

FUNDING

Full funding sources are listed at the end of the paper (see Acknowledgments).

Acute Myocardial Infarction in Young Patients and its Correlation with Obesity Status at Pre-adolescent Stage: A Narrative Review

Background:

Cardiovascular diseases (CVD), especially acute myocardial infarction (AMI), remain a worldwide major cause of premature morbidity and mortality, with considerable health care costs. Metabolic, behavioural, environmental, and social risk factors are significant drivers of AMI, with obesity being a key determinant among them. Childhood obesity constitutes a major health threat that is considered a global epidemic of the 21st century.

Objective:

To assess whether excess weight from the first years of life acts as a predisposing factor in increasing the risk of AMI in young adults.

Methods:

This is a narrative review of the evidence concerning the epidemiology of early AMI and obesity, using PubMed and Google Scholar.

Results:

There is substantial evidence showing that excess weight during childhood multiplies the risk of AMI at an early age.

Conclusion:

Premature AMI seems to have significant drivers related to lifestyle factors, such as childhood obesity. In the era of a childhood obesity epidemic, the aforementioned relationship underlines the need for early prevention and management.

Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications

Cardiovascular autonomic neuropathy (CAN) is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier, even before diabetes is diagnosed. CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers, which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control. The entire mechanism is still not elucidated, but several aspects of the pathophysiology of CAN have already been described, such as the production of advanced glycation end products, reactive oxygen species, nuclear factor kappa B, and pro-inflammatory cytokines. This microvascular complication is an important risk factor for silent myocardial ischemia, chronic kidney disease, myocardial dysfunction, major cardiovascular events, cardiac arrhythmias, and sudden death. It has also been suggested that, compared to other traditional cardiovascular risk factors, CAN progression may have a greater impact on cardiovascular disease development. However, CAN might be subclinical for several years, and a late diagnosis increases the mortality risk. The duration of the transition period from the subclinical to clinical stage remains unknown, but the progression of CAN is associated with a poor prognosis. Several tests can be used for CAN diagnosis, such as heart rate variability (HRV), cardiovascular autonomic reflex tests, and myocardial scintigraphy. Currently, it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV, which is a non-invasive test with a lower operating cost. Therefore, considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes, the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.

Effect of Moderate- Versus High-Intensity Interval Exercise Training on Heart Rate Variability Parameters in Inactive Latin-American Adults: A Randomized Clinical Trial

Ramírez-Vélez, R, Tordecilla-Sanders, A, Téllez-T, LA, Camelo-Prieto, D, Hernández-Quiñonez, PA, Correa-Bautista, JE, Garcia-Hermoso, A, Ramírez-Campillo, R, and Izquierdo, M. Effect of moderate- versus high-intensity interval exercise training on heart rate variability parameters in inactive Latin-American adults: a randomized clinical trial. J Strength Cond Res 34(12): 3403-3415, 2020-We investigated the effect of moderate versus high-intensity interval exercise training on the heart rate variability (HRV) indices in physically inactive adults. Twenty inactive adults were randomly allocated to receive either moderate-intensity training (MCT group) or high-intensity interval training (HIT group). The MCT group performed aerobic training at an intensity of 55-75%, which consisted of walking on a treadmill at 60-80% of the maximum heart rate (HRmax) until the expenditure of 300 kcal. The HIT group ran on a treadmill for 4 minutes at 85-95% peak HRmax and had a recovery of 4 minutes at 65% peak HRmax until the expenditure of 300 kcal. Supine resting HRV indices (time domain: SDNN = SD of normal-to-normal intervals; rMSSD = root mean square successive difference of R-R intervals and frequency domain: HFLn = high-frequency spectral power; LF = low-frequency spectral power and HF/LF ratio) were measured at baseline and 12 weeks thereafter. The SDNN changes were 3.4 (8.9) milliseconds in the MCT group and 29.1 (7.6) milliseconds in the HIT group {difference between groups 32.6 (95% confidence interval, 24.9 to 40.4 [p = 0.01])}. The LF/HFLn ratio changes were 0.19 (0.03) milliseconds in the MCT group and 0.13 (0.01) milliseconds in the HIT group (p between groups = 0.016). No significant group differences were observed for the rMSSD, HF, and LF parameters. In inactive adults, this study showed that a 12-week HIT training program could increase short-term HRV, mostly in vagally mediated indices such as SDNN and HF/LFLn ratio power. Trial registration. ClinicalTrials.gov NCT02738385 https://clinicaltrials.gov/ct2/show/NCT01796275, registered on March 23, 2016.

Optimal waist circumference cutoff values to predict cardiometabolic alterations in a Venezuela national representative sample. The EVESCAM study

BACKGROUND

Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela.

AIMS

The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela.

METHODS

The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated.

RESULTS

Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions.

CONCLUSION

The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

PURPOSE OF REVIEW

Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes.

RECENT FINDINGS

The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.

Latin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome

: The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.

Manejo interprofesoral de las enfermedades cardiovasculares

Se conocen como enfermedades cardiovasculares (ECV) al infarto agudo de miocardio (IAM), el accidente cerebrovascular (ACV) isquémico o hemorrágico y la enfermedad vascular periférica, también conocidas como enfermedades vasculares ateroscleróticas, pues tienen en común que el proceso fisiopatológico básico es el desarrollo de aterosclerosis en la vasculatura que irriga a los órganos afectados. El IAM y ACV son eventos agudos que se deben principalmente a obstrucciones en los vasos, las cuales se presentan cuando se produce ruptura de una placa aterosclerótica ocasionando un cuadro de atero-trombosis, fenómeno que explica la sintomatología de los eventos agudos. Actualmente las ECV se constituyen en la primera causa de morbi-mortalidad en todo el mundo, ocasionando que cada año mueran más personas por estas enfermedades que por cualquier otra causa. Según la Organización Mundial de la Salud (OMS), anualmente 17,5 millones de personas en el mundo, es decir el 31% de las defunciones totales mueren a causa de alguna ECV, siendo que 7,4 millones se debe a IAM y 6,7 millones AVC.  Las ECV son consideradas al momento como una epidemia global que afecta a individuos de todos los países, independientemente de sus ingresos económicos, pero que han tenido un gran incremento en los países de ingresos medianos y bajos, afectando casi por igual a ambos sexos. Actualmente las ECV en su conjunto son la principal causa de muerte en Colombia, con el IAM ocasionando el 17% de la mortalidad general, tanto en hombres como en mujeres, seguida por el ACV y las enfermedades hipertensivas.Como citar este artículo: Lopez-Jaramillo P, Rueda-García D. Manejo interprofesoral de las enfermedades cardiovasculares. Rev Cuid. 2019; 10(2): e756. http://dx.doi.org/10.15649/cuidarte.v10i2.756

Reevaluating nutrition as a risk factor for cardio-metabolic diseases

Introduction:

The consumption of saturated fats is considered a risk factor for cardiovascular diseases.

Objective:

Review published papers on the role of macro-nutrient intake in cardiovascular risk.

Results:

Recent reports from the PURE study and several previous meta-analyses, show that the consumption of total saturated and unsaturated fat is not associated with risk of acute myocardial infarction or mortality due to cardiovascular disease. High carbohydrate intake was associated with the highest risk of total and cardiovascular mortality, while total fat consumption or of its different types was associated with a lower risk of mortality. A high consumption of fruits, vegetables and legumes was associated with lower risk of total mortality and non-cardiovascular mortality. The consumption of 100 g of legumes, two or three times a week, ameliorated deficiencies of the nutrients contained in these foods and was associated with a reduction in the risk of developing chronic non-communicable diseases.

Conclusion:

A healthy diet should be balanced and varied, be composed of a proportion of complex carbohydrates rich in fibber between 50-55% of the daily energy consumed, of saturated and unsaturated fat (25-30%), animal and vegetable protein (including legumes) between 15-25%, vitamins, minerals and water. These nutrients are abundantly present in fruits, vegetables, cereals, legumes, milk and its derivatives, eggs and meats, so public policies should promote the availability and access to these nutrients within primary prevention programs to reduce the growing prevalence of cardio-metabolic diseases.

The Role of Body Adiposity Index in Determining Body Fat Percentage in Colombian Adults with Overweight or Obesity

The aim of this study is to investigate the accuracy of body adiposity index (BAI) as a convenient tool for assessing body fat percentage (BF%) in a sample of adults with overweight/obesity using bioelectrical impedance analysis (BIA). The study population was composed of 96 volunteers (60% female, mean age 40.6 ± 7.5 years old). Anthropometric characteristics (body mass index, height, waist-to-height ratio, hip and waist circumference), socioeconomic status, and diet were assessed, and BF% was measured by BIA-BF% and by BAI-BF%. Pearson’s correlation coefficient was used to evaluate the correlation between BAI-BF% and BF% assessed by BIA-BF%, while controlling for potential confounders. The concordance between the BF% measured by both methods was obtained with a paired sample t-test, Lin’s concordance correlation coefficient, and Bland-Altman plot analysis. Overall, the correlation between BF% obtained by BIA-BF% and estimated by BAI-BF% was r = 0.885, p < 0.001, after adjusting for potential confounders (age, socioeconomic status, and diet). Lin’s concordance correlation coefficient was moderate in both sexes. In the men, the paired t-test showed a significant mean difference in BF% between the methods (−5.6 (95% CI −6.4 to −4.8); p < 0.001). In the women, these differences were (−3.6 (95% CI −4.7 to −2.5); p < 0.001). Overall, the bias of the BAI-BF% was −4.8 ± 3.2 BF%; p < 0.001), indicating that the BAI-BF% method significantly underestimated the BF% in comparison with the reference method. In adults with overweight/obesity, the BAI presents low agreement with BF% measured by BIA-BF%; therefore, we conclude that BIA-BF% is not accurate in either sex when body fat percentage levels are low or high. Further studies are necessary to confirm our findings in different ethnic groups.

Similar cardiometabolic effects of high- and moderate-intensity training among apparently healthy inactive adults: a randomized clinical trial

BACKGROUND

Metabolic syndrome (MetS) increases the risk of morbidity and mortality from cardiovascular disease, and exercise training is an important factor in the treatment and prevention of the clinical components of MetS.

OBJECTIVE

The aim was to compare the effects of high-intensity interval training and steady-state moderate-intensity training on clinical components of MetS in healthy physically inactive adults.

METHODS

Twenty adults were randomly allocated to receive either moderate-intensity continuous training [MCT group; 60-80% heart rate reserve (HRR)] or high-intensity interval training (HIT group; 4 × 4 min at 85-95% peak HRR interspersed with 4 min of active rest at 65% peak HRR). We used the revised International Diabetes Federation criteria for MetS. A MetS Z-score was calculated for each individual and each component of the MetS.

RESULTS

In intent-to-treat analyses, the changes in MetS Z-score were 1.546 (1.575) in the MCT group and -1.249 (1.629) in the HIT group (between-groups difference, P =  0.001). The average number of cardiometabolic risk factors changed in the MCT group (-0.133, P = 0.040) but not in the HIT group (0.018, P = 0.294), with no difference between groups (P = 0.277).

CONCLUSION

Among apparently healthy physically inactive adults, HIT and MCT offer similar cardiometabolic protection against single MetS risk factors but differ in their effect on average risk factors per subject. Trial registration ClinicalTrials.gov NCT02738385 registered on March 23, 2016.

Atherogenic Dyslipidemia in Latin America: Prevalence, causes and treatment: Expert's position paper made by The Latin American Academy for the Study of Lipids (ALALIP) Endorsed by the Inter-American Society of Cardiology (IASC), the South American Society of Cardiology (SSC), the Pan-American College of Endothelium (PACE), and the International Atherosclerosis Society (IAS)

This is an executive summary made by a group of experts named Latin American Academy for the study of Lipids (ALALIP). In the current clinical guidelines, atherogenic dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named (ALALIP) to generate a document in order to analyze their prevalence and to offer practical recommendations.

METHODOLOGY

using the Delphi methodology, we conducted a comprehensive literature review with emphasis on those publications related to LA. Subsequently, we developed key questions for discussion. As a convention, those recommendations that had a 100% of acceptance were considered unanimous, those with >80% were consensual, and those with <80% were in disagreement.

RESULTS

a systematic analysis of national health surveys and regional cohort studies showed a consistently high prevalence of the lipid abnormalities that define AD: low levels of high-density lipoprotein cholesterol (HDL-C) range from 34.1% to 53.3% and elevated triglycerides (TG) range from 25.5% to 31.2%. These abnormalities could be related to high consumption of food with a high caloric density, cholesterol and trans fats, a sedentary lifestyle and perhaps epigenetic changes CONCLUSIONS: lipid abnormalities that define AD have a high prevalence in LA. The interaction between an unfavorable lifestyle, inheritance and epigenetic changes is probably their cause. It is important to design a global study of risk factors in LA to know its true prevalence in the region, its consequences and to derive from its treatment strategies.

A Cross-Sectional Study of the Prevalence of Metabolic Syndrome and Associated Factors in Colombian Collegiate Students: The FUPRECOL-Adults Study

Metabolic syndrome (MetS) is one of the major public health problems worldwide. The objective of the present study is to investigate the prevalence and the associated variables of MetS in Colombian collegiate students. This cross-sectional study included a total of 890 (52% women) healthy collegiate students (21.3 ± 3.2 years old). The prevalence of MetS was determined by the definition provided by the International Diabetes Federation (IDF). We further examined associations between the prevalence of MetS and related factors, such as age, gender, anthropometric and body composition, weight status, and nutrition profile. The overall prevalence of MetS was 6.0% (95% CI = 4.5% to 7.6%), and it was higher in men than women. The most prevalent components were low high-density lipoprotein cholesterol, high triglyceride levels, waist circumference, and blood pressure levels. The predisposing factors for having a MetS included: being male, over 23 years old, overweight or obese, and having an unhealthy waist-to-height ratio. In conclusion, the occurrence of MetS in young adults is substantial. These findings may be relevant to health promotion efforts for collegiate students in order to develop prospective studies and screening for young adults, which will aid in targeted intervention development to decrease cardiometabolic risk factors.

Body Adiposity Index Performance in Estimating Body Fat Percentage in Colombian College Students: Findings from the FUPRECOL-Adults Study

Recently, a body adiposity index (BAI = (hip circumference)/((height)(1.5))-18) was developed and validated in adult populations. The aim of this study was to evaluate the performance of BAI in estimating percentage body fat (BF%) in a sample of Colombian collegiate young adults. The participants were comprised of 903 volunteers (52% females, mean age = 21.4 years ± 3.3). We used the Lin's concordance correlation coefficient, linear regression, Bland-Altman's agreement analysis, concordance correlation coefficient (ρc) and the coefficient of determination (R²) between BAI, and BF%; by bioelectrical impedance analysis (BIA)). The correlation between the two methods of estimating BF% was R² = 0.384, p < 0.001. A paired-sample t-test showed a difference between the methods (BIA BF% = 16.2 ± 3.1, BAI BF% = 30.0 ± 5.4%; p < 0.001). For BIA, bias value was 6.0 ± 6.2 BF% (95% confidence interval (CI) = -6.0 to 18.2), indicating that the BAI method overestimated BF% relative to the reference method. Lin's concordance correlation coefficient was poor (ρc = 0.014, 95% CI = -0.124 to 0.135; p = 0.414). In Colombian college students, there was poor agreement between BAI- and BIA-based estimates of BF%, and so BAI is not accurate in people with low or high body fat percentage levels.

International Variation in Outcomes Among People with Cardiovascular Disease or Cardiovascular Risk Factors and Impaired Glucose Tolerance: Insights from the NAVIGATOR Trial

Background

Regional differences in risk of diabetes mellitus and cardiovascular outcomes in people with impaired glucose tolerance are poorly characterized. Our objective was to evaluate regional variation in risk of new‐onset diabetes mellitus, cardiovascular outcomes, and treatment effects in participants from the NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research) trial.

Methods and Results

NAVIGATOR randomized people with impaired glucose tolerance and cardiovascular risk factors or with established cardiovascular disease to valsartan (or placebo) and to nateglinide (or placebo) with a median 5‐year follow‐up. Data from the 9306 participants were categorized by 5 regions: Asia (n=552); Europe (n=4909); Latin America (n=1406); North America (n=2146); and Australia, New Zealand, and South Africa (n=293). Analyzed outcomes included new‐onset diabetes mellitus; cardiovascular death; a composite cardiovascular outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke; and treatment effects of valsartan and nateglinide. Respective unadjusted 5‐year risks for new‐onset diabetes mellitus, cardiovascular death, and the composite cardiovascular outcome were 33%, 0.4%, and 4% for Asia; 34%, 2%, and 6% for Europe; 37%, 4%, and 8% for Latin America; 38%, 2%, and 6% for North America; and 32%, 4%, and 8% for Australia, New Zealand, and South Africa. After adjustment, compared with North America, European participants had a lower risk of new‐onset diabetes mellitus (hazard ratio 0.86, 95% CI 0.78–0.94; P=0.001), whereas Latin American participants had a higher risk of cardiovascular death (hazard ratio 2.68, 95% CI 1.82–3.96; P<0.0001) and the composite cardiovascular outcome (hazard ratio 1.48, 95% CI 1.15–1.92; P=0.003). No differential interactions between treatment and geographic location were identified.

Conclusions

Major regional differences regarding the risk of new‐onset diabetes mellitus and cardiovascular outcomes in NAVIGATOR participants were identified. These differences should be taken into account when planning global trials.

Clinical Trial Registration

URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00097786.

Risk factors for developing cardiovascular disease in women

OBJECTIVES

To evaluate the factors that predispose to the development of cardiovascular diseases in women who were attended at a Basic Health Unit in Londrina, Paraná, Brazil.

METHODS

The research was characterized as observational and quantitative. The population sample consisted of 60 women aged over 18 years, being chosen at random. For data collection, mHealth Data Collector (mHDC), a mobile device, was used with a questionnaire on daily habits, health status, and disease. Measurements were made of glucose and blood cholesterol, blood pressure and anthropometric measurements. Data collection took place in February 2014 to November 2014.

RESULTS

Risk factors were overweight / obesity (63.8%) and sedentary lifestyle (65%), followed by family history of cardiovascular disease (43.3%), hypercholesterolemia (38.3%), and hypertension (13.3%).

CONCLUSIONS

This population of women presented risk factors for the development of cardiovascular disease in all ages, being necessary the implementation of measures that stimulate changes in the daily habits and improve health conditions among women by the health team.

Hypertension in Latin America: Current perspectives on trends and characteristics

The region of Latin America, which includes Central America, the Caribbean and South America, is one that is rapidly developing. Signified by socio-economic growth, transition and development over the last few decades, living standards in countries like Brazil and Mexico have improved dramatically, including improvements in education and health care. An important marker of socio-economic change has been the epidemiological shift in disease burden. Cardiovascular disease is now the leading cause of death in Latin America, and the drop in prevalence of infectious diseases has been accompanied by a rise in non-communicable diseases. Hypertension is the major risk factor driving the cardiovascular disease continuum. In this article we aim to discuss the epidemiological and management trends and patterns in hypertension that may be specific or more common to Latin-American populations - what we term 'Latin American characteristics' of hypertension - via a review of the recent literature. Recognizing that there may be a specific profile of hypertension for Latin-American patients may help to improve their treatment, with the ultimate goal to reduce their cardiovascular risk. We focus somewhat on the countries of Brazil, Mexico and Venezuela, the experience of which may reflect other Latin American countries that currently have less published data regarding epidemiology and management practices.

Predictive Validity of the Body Adiposity Index in Overweight and Obese Adults Using Dual-Energy X-ray Absorptiometry

The body adiposity index (BAI) is a recent anthropometric measure proven to be valid in predicting body fat percentage (BF%) in some populations. However, the results have been inconsistent across populations. This study was designed to verify the validity of BAI in predicting BF% in a sample of overweight/obese adults, using dual-energy X-ray absorptiometry (DEXA) as the reference method. A cross-sectional study was conducted in 48 participants (54% women, mean age 41.0 ± 7.3 years old). DEXA was used as the “gold standard” to determine BF%. Pearson’s correlation coefficient was used to evaluate the association between BAI and BF%, as assessed by DEXA. A paired sample t-test was used to test differences in mean BF% obtained with BAI and DEXA methods. To evaluate the concordance between BF% as measured by DEXA and as estimated by BAI, we used Lin’s concordance correlation coefficient and Bland–Altman agreement analysis. The correlation between BF% obtained by DEXA and that estimated by BAI was r = 0.844, p < 0.001. Paired t-test showed a significant mean difference in BF% between methods (BAI = 33.3 ± 6.2 vs. DEXA 39.0 ± 6.1; p < 0.001). The bias of the BAI was −6.0 ± 3.0 BF% (95% CI = −12.0 to 1.0), indicating that the BAI method significantly underestimated the BF% compared to the reference method. Lin’s concordance correlation coefficient was considered stronger (ρc = 0.923, 95% CI = 0.862 to 0.957). In obese adults, BAI presented low agreement with BF% measured by DEXA; therefore, BAI is not recommended for BF% prediction in this overweight/obese sample studied.

Is myopia another clinical manifestation of insulin resistance?

Myopia is a multifactorial visual refraction disease, in which the light rays from distant objects are focused in front of retina, causing blurry vision. Myopic eyes are characterized by an increased corneal curvature and/or ocular axial length. The prevalence of myopia has increased in recent decades, a trend that cannot be attributed exclusively to genetic factors. Low and middle income countries have a higher burden of refractive error, which we propose could be a consequence of a shorter exposure time to a westernized lifestyle, a phenomenon that may also explain the rapid increase in cardiometabolic diseases, such as diabetes, among those populations. We suggest that interactions between genetic, epigenetic and a rapidly changing environment are also involved in myopia onset and progression. Furthermore, we discuss several possible mechanisms by which insulin resistance may promote abnormal ocular growth and myopia to support the hypothesis that insulin resistance and hyperinsulinemia are involved in its pathogenesis, providing a link between trends in myopia and those of cardiometabolic diseases. There is evidence that insulin have direct ocular growth promoting effects as well an indirect effect via the induction of insulin-like growth factors leading to decreases insulin-like growth factor-binding protein, also implicated in ocular growth.

The Role of Adiponectin in Cardiometabolic Diseases: Effects of Nutritional Interventions

Adiponectin is an adipocyte-derived hormone abundantly present in plasma that exerts its effects through the activation of 3 receptors. Its concentrations are negatively regulated by the accumulation of visceral fat, and clinical studies implicate hypoadiponectinemia in the pathogenesis of diabetes mellitus type 2, coronary artery disease, hypertension, and left ventricular hypertrophy. In contrast, high concentrations of adiponectin are associated with a decreased risk of coronary artery disease, with an improvement in the differentiation of preadipocytes into adipocytes, and with increased endothelial nitric oxide production. Therefore, adiponectin appears to be an important molecule involved in limiting the pathogenesis of obesity-linked disorders, and it may have potential benefits in the treatment and prevention of cardiovascular disease. Caloric restriction, moderate alcohol consumption, and consuming a Mediterranean diet increase adiponectin concentrations, and current evidence suggests a positive, dose-dependent relation between ω-3 (n-3) fatty acid intake and circulating concentrations of adiponectin. Recently, it was reported that the administration of aged garlic extract and a single food intervention with pistachios can increase adiponectin concentrations in individuals with metabolic syndrome. Moreover, the Mediterranean diet is associated with higher adiponectin concentrations. Additional studies are needed to evaluate the potential benefits of increasing adiponectin by nutritional interventions in the treatment and prevention of cardiometabolic diseases.

[Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome]

The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.

Maternal undernutrition and cardiometabolic disease: a Latin American perspective

The current epidemic of obesity and cardiometabolic diseases in developing countries is described as being driven by socioeconomic inequalities. These populations have a greater vulnerability to cardiometabolic diseases due to the discrepancy between the maternal undernutrition and its consequence, low-birth weight progeny, and the subsequent modern lifestyles which are associated with socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Maternal undernutrition can generate epigenetic modifications, with potential long-term consequences. Throughout life, people are faced with the challenge of adapting to changes in their environment, such as excessive intake of high energy density foods and sedentary behavior. However, a mismatch between conditions experienced during fetal programming and current environmental conditions will make adaptation difficult for them, and will increase their susceptibility to obesity and cardiovascular diseases. It is important to conduct research in the Latin American context, in order to define the best strategies to prevent the epidemic of cardiometabolic diseases in the region.

Is the present cut-point to define type 2 diabetes appropriate in Latin-Americans?

The diagnosis of diabetes mellitus type 2 (DM2) is based either on increased plasma glucose or Glycated hemoglobin levels. Since these measures are the only means for diagnosis of DM2, they must be well adapted to each population according to their metabolic characteristics, given that these may vary in each population. The World Health Organization (WHO) determined the cut-points of plasma glucose levels for the diagnosis of DM2 by associating hyperglycemia with the risk of a specific microvascular complication-retinopathy. Cardiovascular diseases are however the principal causes of mortality in patients with DM2 and we reported that in the Colombo-Ecuadorian population impaired fasting glucose and impaired glucose tolerance are both risk markers for myocardial infarction. We propose that the current cut-points accepted by the WHO need to be revaluated in populations such as Latin America and that there should be lower cut points for glycaemia in this population, to reduce the prevalence of cardiovascular complications associated with DM2.

The goal of blood pressure in the hypertensive patient with diabetes is defined: now the challenge is go from recommendations to practice

The recent Latin American and European guidelines published this year has proposed as a goal for blood pressure control in patients with diabetes type 2 a value similar or inferior to 140/90 mmHg. High blood pressure is the leading cause of cardiovascular diseases and deaths globally. Although once hypertension is detected, 80% of individuals are on a pharmacologic therapy only a minority is controlled. Diabetes also is a risk factor for other serious chronic diseases, including cardiovascular disease. Whether specifically targeting lower fasting glucose levels can reduce cardiovascular outcomes remains unknown. Hypertension is present in 20% to 60% of patients with type 2 diabetes, depending on age, ethnicity, obesity, and the presence of micro or macro albuminuria. High blood pressure substantially increases the risk of both macro and micro vascular complications, doubling the risk of all-cause mortality and stroke, tripling the risk of coronary heart disease and significantly hastening the progression of diabetic nephropathy, retinopathy, and neuropathy. Thus, blood pressure lowering is a major priority in preventing cardiovascular and renal events in patients with diabetes and hypertension. During many years the BP goals recommended in patients with diabetes were more aggressive than in patients without diabetes. As reviewed in this article many clinical trials have demonstrated not only the lack of benefits of lowering the BP below 130/80 mmHg, but also the J-shaped relationship in DM patients. Overall we discuss the importance of define the group of patients in whom significant BP reduction could be particularly dangerous and, on the other hand, those with a high risk of stroke who could benefit most from an intensive hypotensive therapy. In any case, the big challenge now is avoid the therapeutic inertia (leaving diabetic patients with BP values of 140/90 mmHg or higher) at all costs, as this would lead to an unacceptable toll in terms of human lives, suffering, and socioeconomic costs.

Higher household income and the availability of electronic devices and transport at home are associated with higher waist circumference in Colombian children: the ACFIES study

Background: The current “epidemic” of childhood obesity is described as being driven by modern lifestyles with associated socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Objective: To evaluate the association between household income and the availability of electronic devices and transport at home, and the values of waist circumference (WC), as an indicator of abdominal obesity, in children and adolescents from Bucaramanga, Colombia. Methods: Cross-sectional study of public elementary and high school population, of low-middle socioeconomic status. Results: A total of 668 schoolchildren were recruited. After adjusting for potential confounders, significant positive associations between waist circumference and higher household income (p = 0.011), and waist circumference and the availability of electronic devices and transport at home (p = 0.026) were found. Conclusions: In low-middle socioeconomic status schoolchildren in a developing country, those from relatively more affluent families had greater waist circumference, an association that is opposite to that observed in developed countries. This finding could be related to higher income family’s ability to purchase electronic devices and motorized transport which discourage physical activity and for their children to buy desirable and more costly western fast food.

Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome

The present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of 'metabolic syndrome' is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that 'metabolic syndrome' is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.

Inflammation and hypertension: are there regional differences?

Hypertension is a chronic disease with global prevalence and incidence rapidly increasing in low and medium income countries. The surveillance of cardiovascular risk factors, such as hypertension, is a global health priority in order to estimate the burden and trends, to appropriately direct resources, and to measure the effect of interventions. We propose here that the adoption of Western lifestyles in low and middle incomes countries has dramatically increased the prevalence of abdominal obesity, which is the main source of proinflammatory cytokines, and that the vascular systemic inflammation produced by adipose tissue contributes to the development of hypertension. The concentration of proinflammatory cytokines is higher in the Latin American population than that reported in developed countries, suggesting a higher susceptibility to develop systemic low-degree inflammation at a given level of abdominal obesity. These particularities are important to be considered when planning resources for health care programs. Moreover, studying these singularities may provide a better understanding of the causes of the burden of cardiovascular risk factors and the remarkable variability in the prevalence of these medical conditions within and between countries.

Maternal obesity, lipotoxicity and cardiovascular diseases in offspring

Maternal obesity has risen dramatically over the past 20 years, by nearly 42% in African-Americans and 29% in Caucasians. Maternal obesity is afflicted with many maternal obstetric complications in the offspring including high blood pressure, obesity, gestational diabetes and increased perinatal morbidity. Maternal nutritional environment plays a rather important role in the programming of the health set-points in the offspring such as glucose and insulin metabolism, energy balance and predisposition to metabolic disorders. In particular, maternal obesity is associated with elevated prevalence of cardiovascular diseases in the offspring. Evidence from human and experimental studies including rodents and nonhuman primates has indicated that maternal obesity or overnutrition programs offspring for an increased risk of adult obesity. Maternal obesity or fat diet exposure predisposes the onset and development of obesity, insulin resistance, cardiac hypertrophy and myocardial contractile anomalies in the offspring. A number of mechanisms including elevated hormones (leptin, insulin), nutrients (fatty acids, triglycerides and glucose) and inflammatory cytokines have been postulated to play a key role in maternal obesity-induced postnatal cardiovascular sequelae. In addition, lipotoxicity (accumulation of lipid metabolites) resulting from maternal obesity is capable of activating a number of stress signaling cascades including pro-inflammatory cytokines and oxidative stress to exacerbate maternal obesity-induced cardiovascular complications later on in adult life. This mini-review summarizes the recent knowledge with regard to the role of lipotoxicity in maternal obesity-induced change in cardiovascular function in the offspring. This article is part of a Special Issue entitled "Focus on Cardiac Metabolism".