Vol 14, No 4 (2017)

Review
Resistin – a marker of cardiovascular diseases
Verbovoy A.F., Tsanava I.A., Verbovaya N.I., Rudolf G.A.

Abstract

Adipose tissue is an active endocrine organ secreting a number of hormones – adipokines. One of them is resistin, which is produced not only by adipocytes, but also by monocytes, macrophages, cardiomyocytes. Since the beginning of its discovery in 2001 the effect of this adipokine on insulin resistance has been studied. However, later his role in the initiation of inflammatory reactions, activation of the endothelium, proliferation of smooth muscle cells of the blood vessels have been researched, and therefore resistin began to be considered as a possible marker of cardiovascular pathology. This review article presents data on resistin in terms of its effect on the development and progress of cardiovascular diseases.

Obesity and metabolism. 2017;14(4):5-9
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Social and medical aspects of elderly age: obesity and professional longevity
Leskova I.V., Mazurina N.V., Troshina E.A., Ermakov D.N., Didenko E.A., Adamskaya L.V.

Abstract

The article raises the problem of the population aging and the expected significant increase in the proportion of the elderly population in Russian in the next 10–15 years. Population aging will cause the need to attract additional financial resources for pensions to 12–14% of GDP, which is approximately 1.5 – 1.6 times more than is provided for by the program of the Government of Russia aimed at improving the pension System in the period until 2025. The existing pension system and social security system only partially takes into account the aging process. Mechanisms for adapting the elderly to work have not yet been created, a well-thought-out state policy in this area has yet to be developed. In addition, the aging of the population leads to an increase in the older age groups of the risks of diseases with severe and catastrophic consequences, to prevent and reduce which is the number one task before the social policy of the state for this population group. The costs of medical care and care help are exorbitant in scope for the vast majority of retirees, so the elderly remain virtually defenseless against the risks of old age. It is emphasized that before medicine the task is not simply to increase life expectancy, but to prolong the labor activity of a citizen. The article suggests measures to improve the policy of interaction between state institutions and civil society in overcoming the negative consequences of aging and social adaptation of older persons.

Obesity and metabolism. 2017;14(4):10-15
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Obesity, reproduction and oxidative stress
Zhuk T.V., Yavorskaya S.D., Vostrikov V.V.

Abstract

The prevalence of obesity and overweight is one of the most pressing problems nowadays. Obesity as a comorbid condition affects all body systems. Obesity has been reported to be a risk factor not only for cardiovascular diseases and oncopathology, but also for fertility problems, many obstetric and perinatal complications worsening the maternal and infant health. The balance between the oxidative and antioxidant system is one of the indicators of the state of human homeostasis. Today it is proved that obesity is associated with an increase in oxidative stress and a decrease in antioxidant protection. This review reveals a close relationship between obesity, oxidative stress and reproductive problems.

Obesity and metabolism. 2017;14(4):16-22
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Selection of desmopressin preparations for the treatment of central diabetes insipidus
Biryukova E.V.

Abstract

Central diabetes insipidus (CDI) is a severe pathology of the hypothalamic-pituitary system, based on a deficit of antidiuretic hormone (ADH). The disease is a life threating condition for patients without adequate replacement therapy by various preparations of arginine vasopressin. This review presents the current concepts on etiology, pathogenesis, diagnostic proсedures, and treatment of CDI. The article gives comparative pharmacological characteristics of various desmopressin forms for the treatment of the central form of disease. When choosing a therapy for the treatment of CDI, the article highlights the long-term high efficiency and safety of the original sublingual form of desmopressin (Mininin Melt), which is confirmed by real clinical practice and clinical trials, including the comparison with other forms of desmopressin.

Obesity and metabolism. 2017;14(4):23-30
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Original paper
The structure of pathozoospermia in young men with post-pubertal visceral obesity and a non-aggravated andrologic anamnesis
Rozhivanov R.V., Kurbatov D.G.

Abstract

Introduction. Given the frequent development of visceral obesity in men, it is important to study its effect on spermatogenesis.

Aim. Assessment of the structure of pathozoospermia in young men with post-pubertal visceral obesity and a non-aggravated andrologic anamnesis.

Materials and Methods. In a single, one-stage study, 80 men with post-pubertal alimentary visceral obesity aged up to 30 years were included. The length of the circumference of the waist, the level of gonadotropins and total testosterone, the antioxidant activity of the ejaculate, its electron microscopic examination were estimated. Statistically significant differences were considered between groups at p <0.05.

Results. 24% of men did not have pathosoospermia. The main pathogenetic phenomenon, revealed in patients with pathozoospermia, was astenozoospermia - 100%. There was also a high prevalence of teratozoospermia - 36%. The prevalence of oligozoospermia was 11% of cases. An increase in the content of spermatozoa with insufficiently condensed chromatin and a decrease in the antioxidant activity of the ejaculate were characteristic of all types of pathozoospermia in obese men. A decrease in testosterone levels was characteristic of oligozoospermia. At the same time, statistically significant negative correlations between waist circumference and testosterone level, quantitative indicators of ejaculate, its antioxidant activity, as well as a positive correlation between the waist circumference and the content of spermatozoa with insufficiently condensed chromatin were established.

Conclusions. In young men with post-pubertal visceral obesity and a non-aggravated andrologic anamnesis, the prevalence of pathozoospermia in our study was 76%. The most common was oligozoospermia, which was characterized by the presence of the syndrome of normogonadotropic hypogonadism, which developed in patients with the most pronounced visceral obesity. An increase in the content of spermatozoa with insufficiently condensed chromatin and a decrease in the antioxidant activity of the ejaculate is characteristic of all types of pathozoospermia in obese men, which is due to oxidative stress.

Obesity and metabolism. 2017;14(4):32-37
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Adipokine-cytokine profile of adipocytes of epicardial adipose tissue in ischemic heart disease complicated by visceral obesity
Gruzdeva O.V., Borodkina D.A., Akbasheva O.E., Dileva J.A., Antonova L.V., Matveeva V.G., Ivanov S.V., Uchasova E.G., Belik E.V., Fanaskova E.V., Karetnikova V.N., Kokov A.N., Barbarash O.L.

Abstract

Introduction. To date, cardiovascular diseases (CVD) remain the main cause of disability and mortality in population. The majority of ectopic fat deposits demonstrated a reliable association with cardiometabolic risks and clinical manifestations of most CVD. The elucidation of the metabolic features of adipocytes of epicardial adipose tissue localized in the immediate vicinity of the lesion in ischemic heart disease (IHD) can have both theoretical and practical significance for pathophysiology and cardiology.

Aim. To study the adipokine-cytokine profile of epicardial adipocytes (EA) and subcutaneous adipose tissue (SCAT), blood serum in relation to the area of visceral adipose tissue (AVAT), biochemical and rhelinic characteristics of IHD patients.

Methods. 84 patients (70 men and 14 women) with IHD were examined. In the presence of visceral obesity (VO), patients were divided into two groups. In patients with VO, adipocyte EA and SCAT were sampled, followed by cultivation and evaluation of adipokine and proinflammatory activity. The parameters of carbohydrate and lipid metabolism, adipokine and proinflammatory status in blood serum were determined.

Results. It has been established that the adipokine-cytokine profile of the adipocytes EA and SCAT differ. Adipocytes of EA in IHD on the background of VO are characterized by an increase in IL-1, TNF-α, leptin-adiponectin ratio and a decrease in the protective factors: adiponectin and anti-inflammatory cytokine IL-10. While adipocytes of SCAT were characterized by a decrease in the concentration of the soluble receptor to leptin and a more pronounced leptin resistance, and the increase in inflammatory cytokines was compensated by an increase in the concentration of IL-10, the presence of VO was associated with multivessel coronary disease, multifocal atherosclerosis, insulin resistance, atherogenic dyslipidemia, adipokine imbalance, and markers of inflammation. Thus, the value of the area of VO determined higher values of leptin concentration, TNF-α in adipocytes and serum, lipid and carbohydrate metabolism and a lower soluble receptor for leptin content.

The conclusion. Thus, in IHD with VO the state of adipocytes, EA is characterized as "metabolic inflammation" and may indicate the direct involvement of adipocytes in the pathogenesis of IHD due to the formation of adipokine imbalance and the activation of proinflammatory reactions.

Obesity and metabolism. 2017;14(4):38-45
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The evaluation of the effectiveness of diet therapy for obese patients basing on studying of the polymorphism rs9939609 of the FTO gene
Lapik I.A., Gapparova K.M., Sorokina E.Y., Grigorian O.N.

Abstract

The Aim. The aim of the study was to develop and evaluate the effectiveness of dietary therapy in obese patients on the basis of studying the polymorphism rs9939609 of the FTO gene.

Materials and methods. 100 patients with obesity of I-III degree aged from 18 to 55 years were examined. All patients underwent genotyping using allele-specific amplification with real-time detection of results. Depending on the genotypes of the FTO gene, obese patients received different diet therapy and were divided into 3 groups: patients with the TT and AT genotype received a standard low-calorie diet, and with the AA genotype a personalized diet.

Results. It was found that a decrease in the caloric content of the diet contributed to a decrease in body weight in obese patients, mainly due to muscle mass in carriers of the genotype AT, and in carriers of genotypes TT and AA - mainly due to the fat component.

Conclusions. Thus, the carriers of the mutant allele A in the homozygous and heterozygous variant require the selection of only a personalized diet. Therefore, in the appointment of dietary therapy to obese patients, it is recommended to carry out molecular genetic studies that will not only identify individuals with increased need for personalization of dietary therapy, but also increase the effectiveness of treatment for obesity and prevent the development of its complications.

Obesity and metabolism. 2017;14(4):46-50
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The prevalence of metabolically healthy obesity according to the sample of the Moscow region
Ostrovskaya E.V., Romantsova T.I., Gerasimov A.N., Novoselova T.E.

Abstract

Introduction. Obesity is a major factor for cardiometabolic risk. However, there is a category of obese patients without disorders of lipid, carbohydrate metabolism and cardiovascular disease – metabolically healthy obese (MHO).

Aim. Our goal was to investigate the prevalence and characteristics of this phenotype compared to patients with metabolic syndrome (MS).

Materials and methods. To evaluate the prevalence of the MHO phenotype we analyzed 389 medical records of females aged 18–60 years with obesity. Three types of MHO criteria were used: 1) HOMA index (<2.7); 2) IDF-criteria of metabolic syndrome, 2005; 3) the BioSHaRE-EU 2013 criteria (obese patients without any symptoms of MS). We conducted a comparative analysis of anthropometry, status of lipid and carbohydrate metabolism, the functional state of the liver.

Results. The MHO prevalence was: 34.5% according to HOMA index, according to the definitions of MS 2005 – 38.6%, in BioSHaRE-EU – 9.6%. In groups of MHO and MS dyslipidemia was observed in 27.3 and 49.5% (p<0.05), hypertension in 25% and 71.6% (p<0.05), steatogepatosis in 47.7% vs 51.3% (p<0.05) of observations, respectively. Among comorbidities the gynecological pathology was most prevalent - 50.8 and 61.4% (p<0.05), disorders of carbohydrate metabolism differed significantly in frequency- 6.82 and 39.1% of patients (p<0.05). Patients with MHO had a shorter duration of the existence of obesity than MS (18.7 vs. 24 years) (p=0.0004) and less likely to have attempted to reduce weight – 85.8% and 91.6%. Average BMI, waist circumference, hip circumference, fasting glucose, total cholesterol, insulin basal, basal C-peptide, HOMA index in groups of MHO and MS differed significantly (p<0.05). Median ALT was 20 and 23.2 U/l, AST – 20 and 23 U/l, triglycerides – 1.1 and 1.8 mmol/l, high-density lipoprotein – 1.4 and 1.1 mmol/l, respectively.

Conclusions. The MHO prevalence was maximal according to the MS definitions from 2005, and minimal with BioSHaRE-EU criteria. The main analyzed indicators differed significantly in groups MHO and MS. Longer obesity existence in the MS group may suggest an instability of MHO phenotype over time.

Obesity and metabolism. 2017;14(4):51-56
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Characteristics of early pregnancy and prevention of gestational and perinatal complications in women with metabolic syndrome
Lipatov I.S., Tezikov Y.V., Protasov A.D., Martynova N.V., Bukreeva A.A., Kutuzova O.A., Zhernakova E.V., Dobroditskaya A.D.

Abstract

Introduction. Based on the knowledge of early gestational disorders related to metabolic syndrome (MS), pathogenetically relevant preventive treatment meeting the requirements of perinatal pharmacology can be developed.

Aim. To reveal clinical and laboratory characteristics of early pregnancy and develop pathogenetically relevant preventive monotherapy for unfavorable gestational and perinatal outcomes in women with metabolic syndrome.

Material and methods. A total of 230 women were investigated and divided into four groups: Group I consisted of 68 pregnant women with MS who refused any preventive measures; Group II comprised 97 women with MS who received periconceptional preventive monotherapy with dydrogesterone, a progestagen; Group III consisted of 35 healthy primigravidas women with physiological course of gestation; Group IV comprised 30 healthy non-pregnant women. Laboratory testing during I–III trimesters allowed to assess the dynamics demonstrated by markers of lipid spectrum, endothelial dysfunction, apoptosis, decidualization, energy metabolism, and immunomodulation.

Results. A balance between factors of physiological damage and gestational adaptation in the course of physiological pregnancy has been shown to be of primary significance. In women with MS, embryo-placental dysfunction develops during early pregnancy, and this stage is preceding for major obstetric syndromes. Preventive administration of dydrogesterone in women with MS appeared highly effective: NNT (number needed to treat) was 1.33 (95% CI 0.9–1.8); OR 5.2 (95% CI 4.6–5.7).

Conclusion. Pregestational changes and atherogenic profile of gestational process determine the course of early pregnancy in women with MS with the development of embryo-placental dysfunction and major obstetric syndromes. High efficacy in the prevention of unfavorable gestational and perinatal outcomes was shown by preventive dydrogesterone monotherapy.

Obesity and metabolism. 2017;14(4):57-66
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The assessment of Trabecular bone score to improve the sensitivity of FRAX in patients with type 2 diabetes mellitus
Yalochkina T.O., Belaya Z.E., Chernova T.O., Sazonova N.I., Tarbaeva N.V., Tsoriev T.T., Rozhinskaya L.Y., Mel'nichenko G.A.

Abstract

Aim. To estimate the trabecular bone score (TBS) for evaluation of fracture probability in order to make decisions about starting osteoporosis treatment in patients with type 2 diabetes mellitus (T2DM).

Materials and methods. We obtained the bone mineral density (BMD) and trabecular bone score (TBS) using dual energy X-ray absorptiometry (iDXA) in patients with T2DM (with and without a history of osteoporotic fractures) versus the control group. Before and after TBS measurements we assessed the ten-year probability of fracture using the Fracture Risk Assessment Tool (FRAX).

Results. We enrolled 48 patients with T2DM, including 17 with a history of low-traumatic fracture, 31 patients without fractures and 29 subjects of a control group. BMD was higher in patients with T2DM compared to the control group at L1–L4 (mean T-score 0.44, 95% CI -3.2 – 4.9 vs mean T-score 0.33, 95% CI -2.9 – 3.0 in a control group p=0.052) and Total Hip (mean T-score 0.51, 95% CI -2.1 – 3.0 vs mean T-score -0.03, 95% CI -1.4 – 1.2 in a control group p=0,025). The TBS and 10-year probability of fracture (FRAX) was not different in patients with T2DM versus the control group. However, when the TBS was entered as an additional risk factor, the 10-year probability of fracture became higher in patients with T2DM (10-year probability of fracture in T2DM- 8.68, 95% CI 0.3-25.0 versus 6.68, 95% CI 0.4–15.0 in control group, p=0.04). Among patients with diabetes with and without fractures the FRAX score was higher in subjects with fractures, but no difference was found in regards to BMD or TBS. Entering BMD and TBS values into the FRAX tool in subjects with diabetes and fractures decreased the FRAX score. However, patients with low-traumatic fractures should be treated for osteoporosis without a BMD, TBS or FRAX assessment.

Conclusion. TBS improves the results of FRAX assessment in patients with T2DM and should be entered while evaluating FRAX in patients with T2DM. However, additional research is needed to develop a more sensitive tool to evaluate fracture risk in patients with T2DM.

Obesity and metabolism. 2017;14(4):67-72
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Lecture
Metabolic mechanisms of development and compensation of osmotic stress in the brain
Pigarova E.A., Dzeranova L.K.

Abstract

Extracellular fluid of the brain, consisting of cerebrospinal fluid and interstitial fluid, is normally isotonic to blood plasma. Problems arise with a rapid change in osmolality of circulating blood or interstitial brain fluid. The permeability of the blood-brain barrier is lower than in the peripheral capillaries, but this permeability is still several times greater than the passive permeability for electrolytes or glucose. Because of this difference, it is believed that the brain is like an osmometer: it swells with reduced plasma osmolality and contracts (dehydrated) when the plasma becomes hypertonic. Osmotic stress has a direct effect on the functioning of the brain and triggers physiological compensatory mechanisms, in the absence of which due to the intensity or duration of stress, irreversible serious complications may develop. Knowledge and understanding of these processes are the basis for preventing their development and treatment.

Obesity and metabolism. 2017;14(4):73-76
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Case Report
Osteogenesis imperfecta in combination with Graves disease
Sheremeta M.S., Pigarova E.A., Kulikova K.S., Belovalova I.M., Tyulpakov A.N., Rumiantsev P.O.

Abstract

Osteogenesis imperfecta (OI) – is a group of genetically disorders, which are charaterized by a disturbed bone formation. In turn, the excess of thyroid hormones in Graves' disease (GD) also posses a negative effect on bone tissue, thereby aggravating OI. That requires from the endocrinologist the most careful management of patients with the combination of these pathologies. In this article, we present a unique clinical case of a combination of GD and OI.

Obesity and metabolism. 2017;14(4):77-82
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News
Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus
Dedov I.I., Mel'nichenko G.A., Shestakova M.V., Rozhivanov R.V., Terehova A.L., Zilov A.V., Ladygina D.O., Kurbatov D.G.

Abstract

Hypogonadism in men, defined as a reduction in serum testosterone in combination with characteristic symptoms and/or signs (described in detail later), is common in diabetes mellitus (DM). These recommendations do not cover the whole range of pathologies that cause the development of testosterone deficiency (hypogonadism), but focus on its clinical variants and characteristic for men with diabetes. The recommendations provide data on the prevalence of hypogonadism in diabetes, its etiology. In the section "diagnostics" the features of anamnesis of patients with hypogonadism with diabetes, the necessary methods of physical and laboratory examination are presented in detail. The risk factors and clinical consequences of hypogonadism are separately examined. In the section "choice of treatment methods", there are possible treatment options for such patients using various androgenic therapies, taking into account the needs of the man, maintaining his reproductive function and risk factors. Particular attention is paid to indications, contraindications and risk factors for androgen therapy in men with diabetes, especially in old age. With this in mind, principles for monitoring the treatment are developed. Based on a large number of studies, favorable effects of androgen replacement therapy in men with hypogonadism and diabetes have been demonstrated.

Obesity and metabolism. 2017;14(4):83-92
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