Vol 16, No 1 (2019)

Features of the eye pathology in primary hyperparathyroidism
Mokrysheva N.G., Lipatov D.V., Dobreva E.A., Bibik E.E.

The pathology of vision occurs in various endocrine diseases, but information about the state of the eyes in patients with primary hyperparathyroidism (PHPT) has been limited yet. Large systematic studies on this problem are absent, mainly the data of foreign literature are based on descriptions of several clinical cases that report about non-specific changes of eyes in people with significant hypercalcemia. The most common manifestations of hyperparathyroid ophthalmopathy are the cornea and conjunctiva calcification, disfunction of the eye muscles. Taking into account the prevalence of mild PHPT caused by early diagnosis and timely pathogenetic treatment of the disease, nowadays these ophthalmic disorders are rare. However, specific eye pathology in this category of patients requires detailed study and further research.

Obesity and metabolism. 2019;16(1):3-6
Neurocognitive aspects of hyperparathyroidism
Poyarkova V.O., Runova G.E., Fadeev V.V.

The clinical features of primary hyperparathyroidism (PHPT) are characterized not only by typical end organ damage, including osteopenia/osteoporosis, nephrocalcinosis/renal calculi, pancreatitis, but also by neurocognitive changes, including weakness, easy fatigability, depression, inability to concentrate, memory impairment or subtle deficits, dementia, anxiety, irritability and sleep disturbances. The indications for the surgical treatment of PHPT are markedly elevated serum calcium, end organ damage, younger patients (less than 50 years). Cardiovascular and neurocognitive complications of PHPT are not currently an indication for surgical treatment. The results of the surgical treatment of PHTP are contradictory for neurocognitive symptoms. Some studies have demonstrated an improvement in neurocognitive symptoms after parathyroidectomy (PTE), including patients with mild PHPT. However, randomized trials have not demonstrated the benefits of PTE in patients with mild PHPT for neurocognitive symptoms. There are certain difficulties at evaluation of neurocognitive manifestations of PHPT, and therefore, it is actual to use a specific quality of life questionnaire, assessing cognitive function and memory deficit of the patient. Considering the prevalence of patients with asymptomatic course of PHPT and the absence of typical clinical manifestations of the disease, but with the presence of neurocognitive symptoms, the question of the appropriateness of surgical intervention in such cases remains relevant.

Obesity and metabolism. 2019;16(1):7-11
Inflammation of adipose tissue. Is there a place for statins to correct adiposopathy?
Borodkina D.A., Gruzdeva O.V., Palicheva E.V., Barbarash O.L.

This review is devoted to the analysis of data on the effect of inhibitors of 3-hydroxy-3-methylglutaryl coenzymate-reductase on the endocrine function of adipose tissue in obesity. Violation of metabolism of adipose tissue, as well as the amount of fat, are a a key factor in the pathophysiology of obesity and the development of concomitant diseases. Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl-kofermenta reductase (HMG-COA reductase) that catalyze the initial stage of cholesterol biosynthesis in the liver. Therefore, traditionally, the liver is considered as the main target organ for statins. The results of studies of molecular mechanisms of action of statins on carbohydrate and lipid metabolism, adipokine and inflammatory balance in adipose tissue on the example of isolated adipocytes (in vivo) and in living organism (in vitro) are presented. Effect of statins on the action of insulin, as well as the possibility of developing pathological conditions associated with insulin resistance and the development of type 2 diabetes mellitus (DM 2). The proven clinical effects of cholesterol-lowering action of statins, allow new insights and to further explore their possible impact on other links in the development of obesity, and potentially to use them as therapeutic agents for pharmacological correction of obesity and the fight against cardiovascular diseases.

Obesity and metabolism. 2019;16(1):12-19
Obesity in Russia: modern view in the light of a social problems
Leskova I.V., Ershova E.V., Nikitina E.A., Krasnikovsky V.Y., Ershova Y.A., Adamskaya L.V.

The purpose of the article is to highlight the social aspects of stress as a syndrome of adaptation to the current situation in Russian society in order to justify the consideration of society as a factor contributing to the development and spread of overweight and obesity among the Russian population.

The problem of the conditions and quality of everyday life of a significant part of the population of our country is raised, which are accompanied by an increased stress level of everyday life events. A modern Russian society, possessing an immanently inherent systemic quality - a stressful property, combined with the specificity of a hypodynamic lifestyle, is a powerful and systemically active factor that provokes the development and spread of obesity and overweight. The stress factors of modern society, generated by the disorder and non-complementarity of the work of social institutions, instability in the economic and political spheres are analyzed. Food family traditions, food paradigm, leisure activity of Russians are studied. The irrationality of the use of food by mankind is discussed. The proposed measures to combat and prevent obesity.

Obesity and metabolism. 2019;16(1):20-26
Opportunities and options for surrogate assessment of insulin resistance
Ruyatkina L.A., Ruyatkin D.S., Iskhakova I.S.

The high prevalence of type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular diseases (CVD) determines the need for early detection and correction of key markers of cardio-metabolic risk (CMR). This prophylactic direction is closely related to metabolic syndrome (MS) based on the concept of insulin resistance (IR). At the same time, IR is the first link in the pathogenesis of T2DM and is a recognized risk factor for atherothrombosis. Therefore, early diagnosis of IR is of practical importance both for the detection of early disorders of carbohydrate metabolism (DCM) and prognosis of T2DM, and cardiological risk. Alternative indicators have been proposed for evaluating IR with the inclusion of lipid and anthropometric parameters, the diagnostic and prognostic significance of which in terms of CMR (DCM and CVD) has been evaluated in randomized clinical trials in comparison with the HOMA-IR index and clamp. The TyG index (calculated on the basis of plasma glucose and triglycerides) is consistent with the phenomenon of glucolipotoxicity with subsequent metabolic disorders in target organs. Its derivatives are proposed: TyG-WC (TyG / waist circumference) and TYG-BMI (TyG / BMI). Apply LAP indices (lipid accumulation index) and VAI (visceral obesity index), as well as TG / HDL (TG / HDL). Their ethnic and gender differences were revealed, attempts were made to calculate the cut-off points for these indices.

Obesity and metabolism. 2019;16(1):27-33
Original paper
Dynamics of frequency of overweight and obesity children of young school age in the Tyumen region
Suplotova L.A., Smetanina S.A., Makarova O.B., Rebrova O.Y., Sudnicina A.S.

BACKGROUND: Over the past decades, the growth of overweight and obesity among the population, especially significant in children, is registered everywhere. To assess the dynamics of the obesity epidemic and to monitor the effectiveness of preventive interventions in the regions, it is recommended that monitoring be carried out in the regions to ensure regular measurement of body weight.

AIMSto assess the dynamics of the frequency of overweight and obesity in children of primary school age in the Tyumen region.

METHODSa survey of children aged 8–11 years old residing in the Tyumen region in 2008 (n=390) and in 2017 (n=468) was conducted. The choice of territories in 2008 was carried out by the cluster method in 2008 and in 2017. The studies were conducted by expeditionary method with the departure of a team of doctors in the territory with the measurement of height and body weight and determination of the body mass index (BMI). The results were evaluated according to the SDS BMI guidelines. To compare the frequency of occurrence of qualitative features, the chi-square test (χ²) was used, to compare samples by quantitative characteristics, Student's t-criterion was used. The critical level of significance (p) was checked for statistical hypotheses to be 0.05.

RESULTSIn 2017, in the Tyumen region, an increase in the frequency of obesity in children of primary school age is 2.4 times higher than in 2008 (6.7% in 2008, 15.8% in 2017), in boys as in girls. Overweight and obesity are more often diagnosed in boys in 2017 (40.0%). Girls 8–11 years in 2017 compared with 2008 increased the frequency of both obesity and overweight.

CONCLUSIONIn 2017, in the Tyumen region, an increase in the frequency of obesity in children of primary school age is 2.4 times higher than in 2008 (6.7% in 2008, 15.8% in 2017), as in boys, and for girls. Overweight and obesity are more often diagnosed in boys in 2017 (40.0%). Girls 8–11 years in 2017 compared with 2008 increased the frequency of both obesity and overweight.

Obesity and metabolism. 2019;16(1):34-38
Genetic predictors of chronic heart failure in obese patients
Bogdanov A.R., Derbeneva S.A., Cherniak O.O., Bogdanova A.A., Gapparova K.M., Grigorian O.N.

BACKGROUND: the study of molecular genetic markers and pathogenetic mechanisms of neurohormonal activation, as well as their importance in the formation of heart failure in obesity, is an urgent problem of modern medicine, the solution of which will allow effective prevention of cardiovascular complications, optimize treatment and improve the prognosis of obese patients.

AIMS: search for genetic markers presumably involved in the pathogenesis of secondary diastolic heart failure in patients with obesity.

MATERIALS AND METHODS: PCR-diagnostics of whole blood of 104 patients with obesity was carried out, which were divided into 2 groups, depending on the presence of diastolic heart failure. The following candidate genes were analyzed: angiotensinogen AGT gene (C521T and T704C), angiotensin II receptor gene of the first type AGTR1 (A1166C), angiotensin II receptor gene of the second type AGTR2 (G1675A), aldosterone synthase gene CYP11B2 (C (-344) T).

RESULTS: It is shown that the development of secondary diastolic heart failure in obese individuals of both sexes is associated with the mutation of the aldosterone synthase gene CYP11B2, namely, with the replacement of the C allele at the -344 position by the T allele and the presence of the T / T genotype. The relative risk of developing the disease with the T / T genotype was 5.93 times higher in men (p = 0.008) and 4.57 times in women (p = 0.014). For men, the mutation of the angiotensinogen AGT gene, namely the replacement of the allele C at position 521 by the T allele, is important. At the same time, the relative risk of development of SDS in the T / T genotype is increased by 4.26 times (p = 0.039). Mutations of the genes of the angiotensin II receptor of the first type AGTR1 (A1166C) and the angiotensin II receptor of the second type AGTR2 (G1675A) are not associated with the development of diastolic heart failure in obese patients.

CONCLUSIONS: The data presented can be used to stratify the risk of secondary heart failure in obese individuals.

Obesity and metabolism. 2019;16(1):39-46
Epidemiological features of obesity in children and adolescents in the Udmurt Republic
Larionova M.A., Kovalenko T.V.

BACKGROUND: Obesity is one of the most frequent chronic diseases in the world. The true prevalence of obesity in the Russia significantly exceeds the data of official statistics and remains at the moment insufficiently studied.

AIM: to study the main epidemiological features of obesity in children and adolescents in the Udmurt Republic (UR).

MATERIALS AND METHODS: The data of official statistics for the period from 2005 to 2016 were analyzed. A total of 9662 children aged 1–17 years living in large cities and rural areas of the UR were examined (the ratio of urban and rural residents was 1:1), of which 4795 boys (49.6%), girls 4867 (50.4%). Age features of the disease were analyzed in groups of 1–3 years, 3–7 years, 7–12 years, 12–15 years, over 15 years. At the standard deviation (SD) values of the body mass index (BMI) from +1 to +2 SD, excess body weight was diagnosed, with an excess of +2 SD – obesity. The degree of obesity was assessed according to the classification of V.A. Peterkova et al. (2014) Epidemiological data were calculated for 1000 surveyed.

RESULTS: Official statistics showed a steady increase in the prevalence of obesity: in the 0–14 age group, the indicator (per 1000 children's population) increased from 5.4 (2005) to 16.2 (2016), among adolescents 15–17 years – from 7,5 to 45,4 respectively. In the epidemiological survey, overweight was recorded in 166,5 children, obesity in 67.1 (per 1000 surveyed). Data on a higher incidence of obesity in rural residents compared to urban residents (7.3% and 6.1%, respectively, p <0.05) were obtained. The disease was more often registered in boys (8,7%, in girls 4.7%, p <0.05). Thehighest prevalence of overweight was registered is 1–3 years (217.4 per 1000 people surveyed), of obesity – 7–12 years (93.1 per 1000 people surveyed). The lowest prevalence rates of both overweight and obesity are registered in the age group over 15 years.

СONCLUSIONS: The study showed the importance of the problem of obesity in children and adolescents in the region.

Obesity and metabolism. 2019;16(1):47-54
Influence of mass and distribution of adipose tissue on the content of leptin in pregnant women at different periods gestations
Chabanova N.B., Vasilkova T.N., Polyakova V.A., Mataev S.I.

BACKGROUND: Currently, obesity is one of the most global problem in the world. Redundant accumulation of adipose tissue accompanied by metabolic disorders including high secretion of leptin may lead to an increased risk of gestational complications.

AIMS: To assess the level of leptin in pregnant women’s blood serum depending on their body weight and the character of content of adipose tissue in different terms of gestation.

MATERIALS AND METHODS: We investigated 211 women with single pregnancies, which came in natural cycles and finished with urgent parturitions. All of them got anthropometric study, assessment of adipose tissue’s weight by bioimpedanceometry, character of fat deposition by ultrasound investigation of adipose tissue, determination of the level of whey leptin at 10–14, 24–28, 36–38 weeks of pregnancy.

RESULTS: Established, that the level of leptin increases in proportion to pregestational body mass index from the first trimester. Women with excess body mass and with obesity had higher concentrations of leptin all over gestation, than women with normal body mass (р<0.001). The higher term of pregnancy was, the higher the level of whey leptin was in all groups, independently of character of fat deposition. In the end of third trimester, women with normal body mass had the largest value of absolute and relative increase of body mass and fatty mass, what accompanied by enlargement of the concentration of leptin more than in 3 times for the pregestational level.

CONCLUSIONS: In this way, high content of leptin in pregnant women’s (with excess body mass and obesity) blood serum in the first trimester is explained by redundant accumulation of the adipose tissue. The largest value of gestational increase of body mass and fat mass in group where women had normal initial weight is accompanied by the great increase of the level of leptin on the body weight unit and fat mass. These data indicate, that control and limitation of excessive weight gain while pregnancy can be a measure of prevention of the redundant leptin’s secretion and different gestational complications related with it.

Obesity and metabolism. 2019;16(1):55-61
The significance of circulating progenitor cells with osteogenic activity in the of atherosclerosis development in patients with type 2 diabetes mellitus
Michurova M.S., Kalashnikov V.Y., Smirnova O.M., Stepanova S.M., Zakharov A.S., Shestakova M.V., Dedov I.I.

BACKGROUND: There is an interaction between cell-mediated pathway of the vessel calcification and atherosclerosis processes. In some studies the relation beeen circulating osteogenic progenitor cells and cardiovascular diseases was shown. Though its role in the development of cerebrovascular diseases (CVD) in Type 2 diabetes mellitus (T2DM) remains unknown.

AIM: To study the level of circulating endothelial (CD34 + VEGFR2 +) and osteogenic (CD34 + OCN +) progenitor cells in patients with CVD and T2DM.

METHODS: We observed patients with CVD (coronary artery disease and / or chronic limb threatening ischemia) with T2DM and without T2DM. Patients with CVD and T2DM were included in group 1 patients with CVD and without T2D were included in group 2. The level of CD34 + VEGFR2 cells and CD34 + OCN+ cells was determined by flow cytometry.There were no differences in the age, gender, lipid profile, body mass index, creatinine clearance, myocardial revascularization and lower limb revascularization between the 2 groups.The level of CD34 + VEGFR2 cells and CD34 + OCN+ cells was determined by flow cytometry. The number of cells was determined by a percentage of the number of CD34+ cells.

RESULTS: We observed 71 patients (38 women, mean age 67 years [62, 74]). Forty six patients were included in group 1 (28 women, mean age 68 years [63;75], 25 patients (10 women, 66 years [55;72]) were included in group 2. We found that in patients with CVD and T2DM demonstrated higher amounts of CD34+OCN+ cells than CD34+VEGFR2+ cells. (29.7% [26.2;36.1] and 11.8% [9.57;17.2], p<0.001). In the 1st group observed higher amounts of CD34+OCN+ cells, than in the 2d group (29.7 [26.2;36.1] и 25.6 [17.3;30.7] соответственно; p=0.035). Positive correlation was established between amount of CD34+OCN+ cells and atherogenic lipid fraction, LDL (r=0.4; р=0.032) and total cholesterol (r=0.27; р=0.05) in patients of group 1.While SYNTAX score tertiles and amount of CD34+OCN+ cells (r = 0.50, p=0.021) were the positive correlation. Between coronary artery calcium score and amount of CD34+OCN+ cells (r = 0.49, p=0.034) was the positive correlation.

CONCLUSIONS: Acquired results may indicate the active role of CD34+OCN+ endothelial progenitor cells in atherosclerosis and vascular calcification in patients with T2DM.

Obesity and metabolism. 2019;16(1):62-69
Obesity in children and adolescents: diagnosis criteria
Vasyukova O.V.

Currently in the world the main diagnostic parameter for assessing obesity is the magnitude of body mass index. In children, taking into account the growth and body weight indicators that dynamically change as the child grows up, it is common to use not absolute, but relative values of body mass index — percentiles or standard deviations. The lecture examined various systems and methods for assessing the physical development of children in the world and in Russia — domestic ones, R.N. Dorokhova and I.I. Bakhraha, World Health Organization (WHO), International Group for the Study of Obesity. A comparative analysis of the existing systems and the validity of the currently adopted Federal recommendations on the diagnosis of obesity in children based on the recommendations of WHO has been carried out.

Obesity and metabolism. 2019;16(1):70-73
Case Report
Case of insulinoma detected in a patient after bariatric operation for morbid obesity
Maloletkina E.S., Gurova O.Y., Fadeyev V.V., Egorov V.I., Petrov R.V., Beltsevich D.G., Vorob'ev A.V.

The prevalence of insulinomas is 1–3 cases per million population per year of which 4–14% tumor is malignant. Weight gain is one of the symptoms of the disease, often resulting in morbid obesity with indications for surgical treatment. The presented clinical case demonstrates the successful treatment of malignant insulinoma with the manifestation of hypoglycemic syndrome after carrying out biliopancreatic bypass with longitudinal gastrectomy for morbid obesity.

Obesity and metabolism. 2019;16(1):74-80
Materials of scientific and practical conference «Dietoogy In Practice Of Endocrinologist» at the VIII (XXV) Russian Diabetology Congress With International Participation «Diabetes Mellitus – XXIth Century Pandemia»
Shestakova M.V., Ruyatkina L.A., Suplotova L.A., Smetanina S.A., Khramova E.B., Arbatskaya N.Y., Ibragimova L.I., Iskhakova I.S., Pavlova Z.S., Shilina A.V., Dzgoeva F.H., Shamkhalova M.S.

The scientific-practical conference Dietoogy In Practice Of Endocrinologist was held during the VIII Russian diabetology congress with international participation “Diabetes Mellitus – XXIth Century Pandemia”. It was chaired by Academician of RAS M.V. Shestakova (Moscow), Professors L.A. Ruyatkina (Novosibirsk ) and L.A. Suplotova (Tyumen).

The expediency of this event was dictated by the necessity to create a unified national regulated guidelines for the diet therapy of obesity and associated diseases for the medical community and patients. The program of the meeting included a discussion about the formation of a healthy diet and its effect on the body, starting from the pregnant women, fetal development, the breastfeeding period, in the period of perimenopause and postmenopause, in the presence of concomitant pathology of heart and kidneys.

Obesity and metabolism. 2019;16(1):82-93

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