Vol 13, No 1 (2016)

Obesity: the modern approach to the problem
Razina A.O., Achkasov E.E., Runenko S.D.

The review presents epidemiological observations of recent years about the prevalence of overweight and obesity in different countries among people of different gender, age and social groups, and ethnicity. It also presents and analyses health risks and comorbidities leading to disability and death according to national and foreign researchers. It was found that the pathogenesis of obesity was multifactorial and also it was noted the importance of energy balance, consumed and expended calories. It was emphasized the need of a multidisciplinary approach to the treatment and prevention of the disease. The significant influence of the environment and increasing urbanization on the development of the pathology as well as the role of government support in relation to increasing physical activity of the population, including integrated interdisciplinary programs with environmental changes to increase physical activity and control over the quality of food was investigated. The priority areas for correction of overweight including optimization motion activity and correction of the diet were identified.

Obesity and metabolism. 2016;13(1):3-8
The role of neurotransmitters in regulation of energy homeostasis and possibility of drug correction of its disturbances in obesity
Dedov I.I., Troshina E.A., Mazurina N.V., Galieva M.O., Logvinova O.V.

In today's world the problem of obesity is discussed in the context of non-communicable diseases, leading to significant encumbrances on society. This article provides information about the basics of the regulation of energy balance and eating behavior. Particular attention is paid to the role of neurotransmitters, including serotonin, a metabolic disorder that is one of the suspected causes of eating disorders. Demonstrated experience in the use of sibutramine in the world, and in the Russian practice, taking into account the impact on the development of comorbid conditions and their complications.

Obesity and metabolism. 2016;13(1):9-15
Original paper
Functional activity of intestinal microbiota with metabolic syndrome
Kurmangulov A.A., Dorodneva E.F., Isakova D.N.

Actuality: The metabolic syndrome (MS) is a multifactorial disease involved in the pathogenesis of many systems and organs, including the digestive system. Accumulating evidence signify the role of microorganisms in many metabolic processes and suggest human microbiota involvement in the development of different pathologic conditions, including the MS.

The aim: To evaluate the qualitative and quantitative characteristics of the functional activity of intestinal microbiota in individuals with MS.

Materials and methods: The study involved 85 subjects with MS divided into 4 groups according to BMI. Determination of the short chain fatty acids in the feces was carried out by gas-liquid chromatographic studies.

Results: Chromatographic examination of feces revealed changes in both qualitative and quantitative characteristics of the functional activity of the intestinal microbiota in people with MS. The severity of disturbances in microbiota correlated with BMI. In all groups with excess body weight the overall metabolic activity of microorganisms was decreased. In grade 2 obesity there was an increases in the activity of aerobic microorganisms populations, mostly of optional and residual strains. The grade 3 obesity is accompanied by the most significant changes in coprologic profile with the activation of proteolytic microorganisms.

Conclusions: These data suggest the presence of pathogenic correlations between obesity, MS, and intestinal microbiota. In this regard, it is necessary to search for causal relationships oin onset and progression of metabolic disorders involving the bowel microbiota in MS..

Obesity and metabolism. 2016;13(1):16-19
Adipokines and metabolic parameters in patients with type 2 diabetes mellitus in combination with gout
Verbovoy A.F., Tsanava I.A., Verbovaya N.I.

Aim. To study the impact of type 2 diabetes and its combination with gout on the level of adipokines, hormonal and metabolic parameters.

Materials and methods. The study included 18 men with type 2 diabetes with a mean age 57,83 ± 1,67 years, and 21 subjects with a combination of type 2 diabetes and gout, whose average age was 57,57 ± 1,44 years. The controls were 40 healthy men: 20 subjects with an average age of 21,03 ± 0,15 years and 20 men with average age 51,31 ± 1,34 years. All patients had anthropometric measurements, evaluation of parameters of lipid and carbohydrate metabolism, uric acid, levels of adiponectin, leptin and resistin.

Results. Patients of both groups had elevated concentrations of leptin, resistin and reduced level of adiponectin. Men with type 2 diabetes, and its combination with gout had increased levels of total cholesterol, triglycerides, glucose and insulin.

Conclusion. In patients with type 2 diabetes, and its combination with gout are characterized by hyperleptinemia, hypererresistinemia, hypooadiponectinemia. Insulin resistance with compensatory hyperinsulinemia and atherogenic dyslipidemia was found in all patient groups.

Obesity and metabolism. 2016;13(1):20-24
Relationship of body mass index and abdominal obesity in rural population of Krasnodarsky kray taken
Bolotova E.V., Samorodskaya I.V., Komissarova I.M.

The aim was to study the relationship of body mass index (BMI) and abdominal obesity with the frequency of comorbid pathology in rural population of Krasnodarsky kray.

Materials and methods. The study included 700 rural workers (18 years of age and older) who underwent a preventive medical examination (57,2% of women and 42,8% of men, mean age 49,11±16,57 years).

Results. In rural population of Krasnodarsky kray the proportion of the individuals with BMI 25.0–29.9 kg/m2 was 34.7% (statistically more significant in men than in women, р<0.0001), the proportion of the individuals with BMI ≥ 30.0 kg/m2 was 39.7% (statistically more significant in women than in men, р<0.0001). Abdominal obesity was found in 70.1% of individuals (77.3% of women and 60.5% of men, p=0.0001). In the group of patients with increased BMI, abdominal obesity was more common in women than in men (p=0.0001). In the group of patients with BMI ≥ 30.0 kg/m2 abdominal obesity was revealed in 100% of cases. Risk factors for chronic non-infectious diseases such as hypercholesterolemia (26.7%), hyperglycemia (16.4%), and arterial hypertension (26.1%) were statistically more frequent in the individuals with BMI ≥ 30.0 kg/m2 than in those with normal and increased BMI. The diseases that can be enhanced by the presence of abdominal obesity were registered more often in patients with BMI ≥ 30.0 kg/m2 (97.8%) in comparison with patients with elevated BMI (23.5%; р<0,0001) and with normal BMI (4%; р<0,0001).

Conclusions. Elevated BMI, abdominal obesity and high frequency of comorbid pathology is prevalent in Krasnodarsky kray.

Obesity and metabolism. 2016;13(1):25-29
Heart rate features among men of working age with obesity and hypertension
Tsyplenkova N.S., Panova E.I.

Aim. To study features of heart rate of men with arterial hypertension and obesity, to identify factors associated with arrhythmia evolution.

Materials and methods. The study included 3 groups of men (with obesity – 98 men, with excessive body weight – 46 men, with normal body weight – 40 men). The comparative analysis of heart rhythm was performed with Resting ECG and Holter ECG monitoring, blood pressure from daily monitoring, echocardiography, blood lipid spectrum, glycaemia. The adiponectin level was analyzed only for group with obesity.

Results. Obesity in men with arterial hypertension increases the frequency of arrhythmias of atrial fibrillation (AF) type (15.3% vs. 0% in group with normal body weight, p=0.004) and increases the frequency of ventricular premature beats (VPB) (26.5% in group with obesity vs. 10% in group with normal body weight). We were also able to show the relation between arrhythmia and the severity of obesity. Obesity with arterial hypertension significantly increases the risk of various arrhythmias (more than 6 times for AF risk – p=0.004 and more than 5.31 times for frequent VPB – p=0.026. Risk factors for AF are statistically significant with the presence of obesity: left ventricular (LV) and left atrium (LA) dilation, II–III stage of hypertension and low level of high-density lipoprotein (p<0.05). AF risk factors are significant without relation to obesity: left ventricular hypertrophy, dilatation LA, IHD (p<0.05). But there is no relation between ischemic heart disease (IHD) and an increased risk of AF evolution. Also no relation was found between sleep apnea syndrome and arrhythmias.

Conclusion. Men with excessive body weight or obesity in contrast to men with normal body weight have an increased risk of AF and VPB. Factors directly associated with arrhythmias: heart remodeling (hypertrophy and dilatation of the left ventricular, dilatation of the left atrium), advanced stages of arterial hypertension, dyslipidemia; IHD with obesity associated with risk of VPB and doesn’t affect the AF frequency.


Obesity and metabolism. 2016;13(1):30-35
The strategy of obesity management: the results of All-Russian observational program “Primavera”
Dedov I.I., Mel'nichenko G.A., Romantsova T.I.

Introduction. The prevalence of obesity and associated comorbidities is comparable to the scale of the epidemic. Along with the change in lifestyle, pharmacotherapy is necessary to lead obesity patients to a healthier state.

Aim. The evaluation of efficacy and safety of Reduxin® (sibutramine + microcrystalline cellulose) application among patients with alimentary obesity and comorbidities in routine clinical practice. Analysis of results of Primavera program.

Materials and methods. The observation program Primavera was conducted since November 2012 to July 2015 under the auspices of

Endocrinology Research Centre and the Russian Association of Endocrinologists. The program "Primavera" was attended by 3095 doctors of various specialties and 98.774 patients being treated in 1272 hospitals in 142 Russian cities. The average age of the patients was 39.4 ± 10.4 years, the ratio of male / female – 17.7%/82,3%, the average body mass – 99.1±14.28 kg, the average BMI – 35.7±4.41 kg/m2, the average waist circumstance – 105.7±13.7 cm. The Duration of Reduxine® treatment was determined by the attending physician and ranged from 3 months to 1 year.

Results. The duration of therapy was 3 months for 3% of patients, 6 months for 59.3% of patients, 12 months for 37.7% of patients. The BMI reducing dynamics during 3, 6, 12 months was 3.4±1.53 kg/m2 (average 9.5±4.28 kg), 5.4±2.22 kg/m2 (15.0±6.22 kg), 7.2±3.07 kg/m2 (20.0±8.62 kg) respectively. The average waist circumference reduction for 3, 6 and 12 months was 6.3±4.31 sm, 10.6±6.30 sm, 16.0±8.94 sm, respectively. It was shown that the weight loss during prolonged (more than six months) Reduxine therapy under the supervision of a physician was associated with decreased levels of systolic and diastolic blood pressure and had no affect on heart rate. Adverse events were reported for 4.1% of patients, according to doctors, the cause-effect relationship with the use of Reduxine can be estimated as probable or definite for 1.9% of patients, possible – for 1.7%.

Conclusions. Observation programs allow to implement the principles of active monitoring of the efficacy and safety of the drug in the current clinical practice and to develop a skill of reasonable prescribing. In Primavera program it was shown that the use of Reduxine® (sibutramine+ microcrystalline cellulose) leads to loss of body weight and doesn’t lead to serious adverse effects.

Obesity and metabolism. 2016;13(1):36-44
The study of clinical bioequivalence drug Nativa (generic desmopressin acetate tablets) in patients with central diabetes insipidus
Pigarova E.A., Dzeranova L.K.

Materials and methods. The study included 15 patients (9 women and 6 men) with central diabetes insipidus (CDI), compensated by therapy with a tablet formulation Minirin (diuresis up to 3000 ml). The average age of the patients was 44 ± 8 years. For 3 days during treatment Minirin we evaluated the clinical manifestations of the CDI. On the fourth day, Minirin was replaced by Nativa in the equivalent dose, with further correction whennecessary. From the 4th to the 6th day of treatment with Nativawe assessed the same parameters as on the initial therapy.

Results. The vast majority of patients did not require dose adjustment and, if necessary, dose adjustment was small and accounted for about 20% of the original dose. Average dose did not differ in patients receiving Minirin or Nativa, 0.43 ± 0.26 vs. 0.45 ± 0.32 (p> 0.05).

Conclusions. Nativa is characterized by therapeutic equivalence to Minirin in patients with a central form of diabetes insipidus.

Obesity and metabolism. 2016;13(1):46-48
Use of bariatric surgery in patients with type 2 diabetes: help to the practitioner
Ershova E.V., Troshina E.A.

The use of bariatric surgery in patients with obesity and type 2 diabetes mellitus (T2DM) has its own features. In this lecture we discuss indications and contraindications for bariatric surgery, including specific, e.g. presence of type 2 diabetes. Various types of bariatric surgery and the mechanisms of their effects on glucose and lipid metabolism. We show the results of the restrictive and bypass bariatric surgery in patients with obesity and type 2 diabetes, we present requirements for bariatric surgery and parameters of assessment of its effectiveness, including remission of type 2 diabetes after bariatric surgery. The reasons postsurgical hypoglycemia, as well as predictors of effectiveness of bariatric surgery for the metabolic control in patients with obesity and type 2 diabetes.

Obesity and metabolism. 2016;13(1):50-56
Case Report
Endogenous hypercortisolism in the patient with obesity: the cause or a competing disorder
Belaya Z.E., Vorontsov A.V., Il'in A.V., Grigor'ev A.Y., Rozhinskaya L.Y.

Endogenous hypercortisolism (EH) is a rare endocrine disorder, one of the most frequent manifestations of which is obesity. Due to the high prevalence of the metabolic syndrome and the similarity of the clinical manifestations, EH may remain undiagnosed. However, prompt diagnosis and treatment can effectively promote complete cure of the patient. We describe the clinical case of a patient К., 58 years old, who suffered from morbid obesity, diabetes, uncontrolled hypertension and dyslipidemia. The CT examination revealed bilateral adrenal incidentalomas. The further follow-up let us to establish Cushing's disease. The adrenal tumors in this case may be the results of a long-term stimulation of the adrenal glands by ACTH. There is a possibility that the first manifestation of the disease began at the age of 30 years after the second pregnancy, when she observed weight gain and poorly controlled hypertension. When remission was achieved after neurosurgical treatment, we could observe significant improvements (reduction in body weight of 10 kg, improved glucose levels), but without the full normalization of all complications and symptoms.

Conclusion: EH may cause the development of obesity and metabolic syndrome or significantly exacerbate its course. In cases of doubt, weight gain and poorly controlled manifestations of metabolic syndrome screening is justified to exclude EH.

Obesity and metabolism. 2016;13(1):57-61

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