BACKGROUND: Bariatric surgery is the most effective treatment for morbid obesity and type 2 diabetes. Hypercortisolism in patients undergoing bariatric surgery may reduce the effectiveness of surgery and increase the risk of complications. AIM: To assess the prevalence and clinical forms of hypercortisolism in patients with morbid obesity and type 2 diabetes mellitus undergoing examination before bariatric interventions.MATERIALS AND METHODS: Screening for Cushing's syndrome was performed in patients with morbid obesity and type 2 diabetes mellitus referred to the clinic for examination before bariatric surgery. The overnight dexamethasone suppressive test with 1 mg dexamethasone (1-mg DST) was used as a first-line test. Additional tests included 24-hour urinary free cortisol excretion and evening cortisol level in saliva or blood serum. In case of pathological results of the second-line tests, the ACTH level was measured, and suppressive test with 8 mg dexamethasone was performed.RESULTS: The study included 91 patients, 21 men and 70 women, aged 27 to 66 years. A decrease in the cortisol level <50 nmol/l in the 1-mg DST was recorded in 75 patients. In the remaining subjects, the cortisol concentration exceeded the cutoff point, which required further tests. In 14 patients (15.4%) with functional hypercortisolism (pseudo-Cushing`s syndrome), the cortisol level in 1-mg DST ranged from 50 to 140 nmol/l (median 67.7). In three women, the cortisol level in the 1-mg DST demonstrated very high values (593, 461 and 425 nmol/l). During further examination, pituitary adenomas were verified in two of them, and the third woman was diagnosed with adenomas in both adrenal glands.CONCLUSION: The obtained results confirm the need for screening for hypercortisolism in all patients with morbid obesity and type 2 diabetes scheduled for bariatric surgery.
BACKGROUND: Binge eating disorder (BED) is the most prevalent eating disorder manifesting as episodes with higher than usual food intake uncontrolled by patients. Nutritional specifics, their associations with biological and psychological parameters in Type 2 diabetes mellitus (T2DM) with BED have not been studied.AIM: To identify specific characteristics of nutrition (food choices, food planning, diet barriers [DB]) in T2DM patients with and without BED, their associations with clinical, laboratory, and psychological parameters and their changes over time under treatment of BED.MATERIAL AND METHODS: T2DM patients with and without BED participated in this cross-sectional study. In those with and without BED, we compared the characteristics of nutritional style, clinical, laboratory and psychological parameters (depression, anxiety/anxiousness, some personality characteristics, including alexithymia, and diabetes-dependent quality of life (Qol). In subsequent prospective open-label interventional part of the study, we evaluated changes of the nutrition characteristics in T2DM patients with BED under treatment with glucagon-like peptide I receptor agonists (GLP1-RA) versus no BED treatment. The univariate analysis was performed at α=0,05, logistic regression at α=0,10.RESULTS: The study recruited 273 T2DM patients (176 with and 97 without BED). The BED patients ate less frequently than those without: minimal number of daily food intakes 2,6±1,1 and 2,9±0,8, respectively (р=0,010), food intake skipped 1,5±1,8 and 0,8±1,5 weekly (р=0,001). Compared to no-BED patients, those with BED consumed more sweets (р=0,003), “hidden” fats (eggs, р=0,015; nuts, р=0,027), and alcoholic drinks (р=0,004). In the BED group, there were 23 associations between various foods and clinical and laboratory parameters (9 of them indicated favorable and 14 unfavorable food effects). In the non-BED group, 6 associations were found, all them indicating favorable food effects. In both groups, the most significant DB was “difficult to withdraw sweets”. The BED-specific weighted DB were: “difficult to stick to a diet in unexpected situations”, “when I eat more than allowed, I feel bad”, “sometimes I am not allowed to eat being hungry”, and “I would like to eat foods that I should not eat”. Only in the BED group, there were weak but significant correlations between DB numbers/patient and metabolic parameters: НbA1c (r=0,210, р<0,010), serum insulin level (r=0,171, р<0,05), HOMA insulin resistance index (r=0,286, р<0,010), and triglyceride levels (r=0,183, р=0,026). In both groups, DB numbers correlated to higher scores of somatic complaints, alexithymia, depression, psychopathic deviate, paranoia, autism, social introversion, and poorer diabetes-dependent QoL. Logistic regression showed associations of BED to alcoholic intake (odds ratio [OR] 1,03, 95% CI 1,001–1,058, р=0,044), DB domain “limited food diversity” (OR 1,51; 1,172–1,946, р=0,001), food planning (OR 0,154, 0,054–0,442, р=0,001), DB domain “additional food-related costs” (OR 0,49, 0,304–0,792, р=0,004), and high-fiber foods consumption (OR 0,58, 0,324–1,026, р=0,061).In the second 6-month study period with 66/176 BED patients, 33 of them were prescribed GLP1-RAs and 33 continued their previous therapy. In both groups, food choices remained unchanged qualitatively. Under treatment with GLP1-RA, there was statistically significant (but not clinically meaningful) decrease in DB domains “limited foods choices” and “limited foods diversity”, while in the control group, a decrease in “limited foods choices” score and an increase in “additional food-related costs” were found.CONCLUSION: Specific characteristics of nutrition in T2DM patients with BED (less regular food intake, higher intake of unhealthy products and higher numbers of DB, compared to those in T2DM without BED) may negatively affect clinical, laboratory and psychological parameters. Three factors related to nutrition style are associated with increased BED risk and three, with lower risk. The results necessitate a personalized dietary approach to T2DM patients with BED, which requires its timely diagnosis made in primary and secondary care. GLP1-RAs exert no clinically valuable effects on the studied nutrition characteristics in BED patients with T2DM.
BACKGROUND: Adipose tissue (AT) is an active endocrine organ that produces biologically active molecules — adipokines, which participate in lipid and glucose metabolism. The imbalance of adipokine secretion in obesity is a consequence of AT dysfunction, which at the molecular genetic level is manifested as changes in the expression of the key genes, and can be complicated by the development of metabolic disorders, in particular type 2 diabetes mellitus (T2DM).AIM: The aim of this study was to investigate the expression level of PPARG, ADIPOQ, LEP, SLC2A4 genes in subcutaneous and visceral adipose tissue (SAT and VAT) in bariatric patients with obesity and T2DM, as well as to assess the correlation of adiponectin and leptin serum concentrations with the expression of corresponding genes.MATERIALS AND METHODS: The single-center, cross-sectional, two-sample, comparative, observational case-control study included patients with grade II, III, IV obesity with/without T2DM, as well as non-obese individuals who applied to the Pavlov First Saint Petersburg State Medical University for bariatric (patients) and planned abdominal surgeries (control group), SAT and VAT samples, as well as blood serum, were collected. Real-time polymerase chain reaction was used to determine the mRNA levels of target genes in AT. Adiponectin and leptin serum concentrations were assesed by enzyme immunoassay.RESULTS: The group of bariatric patients included 53 patients (mean age 44.1±11.2 years; body mass index (BMI) over 35 kg/m2), including 26 patients with a diagnosis of T2DM and 27 without T2DM. The control group included 15 individuals without obesity, metabolic disorders and T2DM (mean age 46.7±12.8; BMI less than 30 kg/m2). In patients with obesity and T2DM, a decrease in the level of PPARG, ADIPOQ and SLC2A4 gene expression in SAT was observed compared to the control group. The level of PPARG and ADIPOQ gene expression was also reduced in VAT in patients with obesity and T2DM compared to the control group. The observed changes in gene expression in obesity were associated with a decrease in adiponectin and an increase in leptin serum concentrations, with the most pronounced decrease in adiponectin concentration in patients with obesity and T2DM. Unidirectional positive correlations were observed in the expression levels of PPARG, ADIPOQ, LEP, SLC2A4 genes in SAT and VAT in the total cohort.CONCLUSION: The development of T2DM on the basis of obesity and BMI of more than 35 kg/m2 is associated with reduced expression levels of the PPARG, ADIPOQ and SLC2A4 genes in SAT, a marked decrease in the concentration of adiponectin and an increase in the concentration of leptin in the blood serum.
Diabetes mellitus is one of the most pressing problems of modern medicine, characterized by high morbidity (with continuous growth), a decrease in the duration and quality of life, numerous and severe complications. Among the disorders observed in diabetes mellitus, the insufficiency of angiogenesis, the process of formation of new vessels from existing ones, is noted. This process plays an important role in reparative regeneration, ensuring the formation of granulation tissue. The insufficiency of angiogenesis in diabetes mellitus causes a decrease in the rate and quality of wound healing in such patients. We conducted a literature review with the following objectives: to collect up-to-date data on the mechanisms of angiogenesis and its regulation, to identify the links of angiogenesis that are subject to the pathological influence of diabetes mellitus; and to identify potential targets of pharmacological therapy that can compensate for this effect. The results of this work will allow us to apply the data obtained in studies aimed at developing a personalized approach to the management of patients with diabetes mellitus.
Prader–Willi–like syndromes (PWLS) represent a heterogeneous group of disorders characterized by a set of key clinical features, including muscular hypotonia, obesity, psychomotor and speech developmental delay, and behavioral problems, in the absence of methylation abnormalities within the chromosomal region 15q11.2q13. The phenotypic manifestations of PWLS show substantial overlap with the classical Prader–Willi syndrome (PWS), a disorder belonging to the group of imprinting disorders. PWLS include certain chromosomal syndromes (deletions of 1p36, 2pter, 3p26.3, 6q, 10q26, 19p, subtelomeric deletion of 12q, paracentric inversion Xq26q28, Xq27–qter disomy, duplications of 6q, 15q, Xq21.1q21.31, Xq23q25), imprinting disorders (Angelman syndrome, Temple syndrome, pseudohypoparathyroidism types 1A and 1C, pseudopseudohypoparathyroidism, Schaaf–Yang syndrome), and monogenic syndromic forms of obesity (Fragile X syndrome, Bardet–Biedl syndrome, Alström syndrome, Cohen syndrome, Börjeson–Forssman–Lehmann syndrome, MYT1L-related syndrome, SIM1-associated PWS-like obesity, GNAI1-associated neurodevelopmental disorder). The combination of the genetic heterogeneity of PWLS and the absence of the specific genetic defect observed in PWS creates significant challenges for differential diagnosis in clinical practice. This literature review systematizes current research data aimed at refining the phenotypic characterization, management approaches, and treatment strategies for syndromes within the Prader–Willi–like spectrum.
BACKGROUND: Lifestyle influences the risk of childhood obesity. Long-term use of glucocorticoids (GCS) for treatment of chronic autoimmune and inflammatory diseases in children leads to development of obesity with Cushing redistribution of subcutaneous fat; spontaneous weight normalization is expected after dose reduction or discontinuation of GCS. However, in some cases obesity persists.AIM: To study the lifestyle characteristics of children with weight gain during GCS therapy compared to children with simple obesity (SO)MATERIALS AND METHODS: We compared the results of a questionnaire-based survey of children treated with GCS in 09.2017-03.2018 and the previous survey of patients with SO in 2015. We analyzed the follow-up of patients treated with GCS.RESULTS: 25 patients (14 girls, 11 boys; 12.1 (9.4; 15.3) years) taking GCS at a maximum dose of 1.00 (0.50; 1.00) mg/kg/day, compared with 100 patients (43 girls, 57 boys; 13.4 (10.5; 15.7) years) with SO were characterized by significantly more sedentary lifestyle, adherence to breakfast and snacks. BMI SDS after 7.8 (3.2; 9.6) years of therapy correlated with BMI SDS before treatment and while maximum GCS dose treatment (p<0.01), but not with the value of maintenance dose of GCS (0.09 (0.00; 0.16) mg/kg/day). Persistence of obesity after reduction of the GCS dose was associated with the absence of any physical activity — OR 3.5 (95% CI 0.460–26.617).CONCLUSION: Most children with chronic autoimmune and inflammatory diseases treated with GCS have a sedentary lifestyle, which is a risk factor for the persistence of obesity after reducing the dose of GCS.
BACKGROUND: Being an indication for androgen replacement therapy, male hypogonadism is often associated with obesity. Therefore, assessing the impact of testosterone replacement therapy (TRT) on obesity is relevant. AIMS: To evaluate the impact of transdermal TRT on obesity and quality of life (QOL) in males with hypogonadism. MATERIALS AND METHODS: A comparative, randomized, prospective study enrolled 156 hypogonadal and obese males aged 39 [34; 44] years (the comparison group had no concurrent intervention). Study participants were randomly assigned 1 of the 2 groups by matching appropriate pairs. Group 1 consisted of males receiving transdermal TRT, while Group 2 consisted of patients not receiving androgen therapy but undergoing obesity treatment through diet and lifestyle modification. The observation period was 12 months. A retrospective comparison was also performed on patient subgroups within Group 2, based on whether their hypogonadism was eliminated or persisted. The procedures included collecting patient anamnesis, conducting a physical examination to determine body mass index, administering a questionnaire regarding androgen deficiency symptoms, and assessing total testosterone levels. The Mann–Whitney U-test, Wilcoxon test, and χ² with Yates' correction were employed for group comparisons. A p-value below 0.05 was deemed statistically significant. Multiple comparisons were adjusted using the Bonferroni correction.RESULTS: The groups were comparable regarding the parameters examined at the study's outset. Most of the parameters observed showed statistically significant alterations in both groups 1 and 2, except for hematocrit and hemoglobin levels in group 2. Patients receiving TRT after 12 months from their inclusion into the study had a statistically significantly higher level of total testosterone and lesser severity of androgen deficiency symptoms. When assessing the magnitude of changes in the studied parameters, it was found that patients receiving TRT were characterized by a statistically significantly more pronounced decrease in body weight (mean difference -4.0% (95% CI -5.2; -2.7, р<0,001), a decrease in waist circumference, as well as the severity of androgen deficiency symptoms. In the group of males not receiving TRT, but undergoing obesity treatment through diet and lifestyle modification, 12 months following the commencement of the study, 31 men showed resolution of hypogonadism. Hematocrit elevations above the reference value (>50%) were observed in 23% of men on TRT and 12% of patients without hypogonadism therapy, p=0.098 (χ² with Yates' correction). Hemoglobin elevations above the reference value (>160 g/L) were detected in 37% and 15% of males on TRT and without hypogonadism therapy, respectively (p=0.003; χ² with Yates' correction). No increases in hematocrit or hemoglobin levels requiring discontinuation of TRT were observed.CONCLUSIONS: Treatment of hypogonadism using TRT has a positive effect on weight loss in obese males. Furthermore, normalization of testosterone levels leads to a reduction in androgen deficiency symptoms, accompanied by an improvement in quality of life (QOL). Hypogonadism cessation with obesity treatment alone (without the use of TRT) is possible in 41% (95% CI 30.1-53.3) of cases, provided clinically significant weight loss is achieved. Since most respondents achieved normalization of total testosterone levels within the first 6 months, this allows timely initiation of TRT to those patients who have not achieved stable normalization of total testosterone levels within a specified time.
Vitamin D supplementation has a significant positive effect on the skeletal system (prevention of rickets/osteomalacia; in severe deficiency, reduction in the risk of certain fractures and falls). However, for extraskeletal effects, which include acute respiratory infections, cardiovascular diseases, cancer, type 2 diabetes, and obesity, the data are mixed. Large randomized clinical trials in non-selected populations have generally failed to confirm a significant clinical benefit from vitamin D supplementation, while meta-analytic and subgroup data indicate a significant benefit in individuals with corrected baseline deficiency. Dosage regimen and baseline 25(OH)D status are key effect modifiers. Therefore, experts currently recommend a targeted approach screening and correcting deficiency and insufficiency in at-risk groups, achieving and maintaining target vitamin D levels. This literature review focuses on the effects of vitamin D supplementation in patients with obesity and carbohydrate metabolism disorders.
BACKGROUND. Insulin resistance (IR) is considered the main mechanism of type 2 diabetes (T2DM). Diabetic vascular complications (DVC) are main causes of morbidity and mortality. Urinary c-peptide to creatinine ratio (UCPCR) is a novel promising biomarker that may be of value in assessment of IR and DVC.AIM. The present work aimed at studying the relation between UCPCR, IR and DVC in subjects with T2DM.MATERIALS AND METHODS. This was a cross-sectional study performed on a group of subjects with T2DM. Insulin resistance was assessed by measuring homeostasis model assessment for insulin resistance (HOMA-IR). Laboratory investigations included glycemic parameters and renal functions. Human C-peptide ELISA kit was used to asses c-peptide level in a spot urine sample after processing.RESULTS. The study included 90 subjects with T2DM. There was highly statistically significant positive correlations between UCPCR and HOMA-IR, FPG and HbA1c with P values of <0.001, 0.006 and 0.005 respectively. FPG, HbA1c, and UCPCR were the independent risk factors for IR in the univariate regression analysis. However, UCPCR was the only independent risk factor for IR in multivariate analysis (OR 16.431(1.401–192.706). UCPCR cut-off value (>0.19) nmol/mmol was able to differentiate significantly (p<0.001) between patients with IR and those without IR with good sensitivity, specificity and AUC (85.11%, 60.47% and 0.716 respectively).CONCLUSION. In patients with T2DM, UCPCR could be used as a simple, noninvasive and available biomarker for IR. It also could be used as a marker of glycemic control. However, UCPCR is not related to DVC.
Arterial hypertension is the leading modifiable risk factor for cardiovascular morbidity, and lifestyle and diet play an important role both in the pathogenesis of hypertension and in the development of concomitant metabolic disorders, including atherosclerosis, obesity, and type 2 diabetes mellitus. The nature of nutrition and the development of hypertension with metabolic disorders are largely related to the intestinal microbiota, the products of its metabolism and low-intensity non-septic endotoxemia, which can develop as a background condition. Conscious manipulation of the composition and metabolites of the intestinal microbiota and intestinal wall permeability through dietary strategies can be considered as one of the approaches in the prevention and treatment of hypertension and metabolic disorders. The aim of the review was to search, summarize and discuss real literature data on the role of intestinal microbiota and endotoxemia in the pathogenesis of the development of arterial hypertension and the atherosclerotic process, as well as to systematize data on the effect of diet on intestinal microbiota in individuals of this category. Materials and methods: the search and selection of literary sources was carried out in systemic studies in the scientific databases cyberleninka.ru, elibrary.ru, link.springer.com, frontiersin. org, pubmed.ncbi.nlm.nih.gov, Web of Science, Google Scholar and others.
Metabolic syndrome is a common pathophysiological complex of metabolic disorder, which is characterized by a central type of obesity, arterial hypertension, hyperglycemia, hyperinsulinemia, decreased sensitivity of peripheral tissues to insulin. This symptom complex is also associated with atherogenic dyslipidemia, which is characterized by increased triglyceride levels, decreased high-density lipoprotein (HDL) levels, and increased cholesterol levels. It should be noted that metabolic syndrome has become one of the main public health problems around the world and attracts the interesting of researchers in this area. There are a large number of directions for studying this pathophysiological complex, one of which is the dependence of metabolic syndrome development on the length of chromosome telomeres. Analysis of scientific literature over the past 6 years showed that most authors agree that there is a positive correlation between the development of metabolic syndrome and its components, including oxidative stress as a key pathogenic factor, and changes in the length of chromosome telomeres, suggesting that this parameter could be used as a potential biomarker for the development of metabolic syndrome.
BACKGROUND: Dyslipidemias occupy one of the leading places among modified risk factors for cardiovascular pathologies. AIM: Evaluation of the blood lipid spectrum in men under unfavorable working conditions in various climatic zones of the Krasnoyarsk Territory.MATERIALS AND METHODS: Blood parameters were assessed in the Arctic (n=60), Subarctic (n=60), and temperate zones (n=60): triglycerides, total cholesterol, and highand low-density lipoproteins. Dyslipidemia types were determined: predominant triglyceridemia and hypercholesterolemia, mixed hyperlipidemia, and atherogenic hyperlipidemia. Age, total work experience, length of service in the North, nutritional status, and working conditions based on hazards were assessed. RESULTS: Conditions in the Arctic are of an organized team, in the Subarctic and temperate zone they are normal. Age is 35.7±3.4, 34.2±5.5 and 32.9±3.3 years without statistically significant differences, as well as the length of work experience: up to 40 years, 65.0%, 79.6% and 70.7%, respectively. Work experience in the North is 7.1±0.8 and 6.4±3.5 (p=0.450) years. The work is harmful: 3.3 (Arctic severity and intensity of work), 3.2 (Subarctic, temperate zone intensity of work). In the Arctic, hypercholesterolemia is in 43.1%, mixed in 41.2%, atherogenic dyslipidemia in 11.8%; In the Subarctic, hypercholesterolemia is found in 36.7%, mixed in 10.0%, atherogenic in 43.3%; in the temperate zone, hypercholesterolemia is found in 58.5%, mixed in 18.9%, atherogenic in 17.0%, and triglyceridemia in 1.9%.CONCLUSION: Dyslipidemia is more pronounced with the combined effect of living conditions, low physical activity and intense mental work in the Subarctic. With mental work and physical exertion in the Arctic, the adaptive capabilities of the body are higher, which is confirmed by high high-density lipoproteins in 58.9%, as well as a smaller proportion of people with atherogenic dyslipidemia. The need to assess the lipid spectrum of the blood under unfavorable living and working conditions, regardless of age, and differentiated measures to prevent dyslipidemia has been established.
BACKGROUND. Eating foods with a high sugar content causes changes in the functioning of the cerebral systems, involving hedonic and homeostatic mechanisms, which may be one of the mechanisms for the formation of increased cravings for sweet foods, weight gain and the development of metabolic disorders. Low-calorie sweeteners are widely used as an alternative to sucrose. Changes in the activity of brain areas when using various low-calorie sweeteners that stimulate sweet taste receptors are poorly understood.AIM. To study the features of functional activity of various brain regions in healthy volunteers using functional magnetic resonance imaging (fMRI) when consuming sugar and the low-calorie sweetener Erythritol (E968).MATERIALS AND METHODS. The study included 12 volunteers with a normal body weight (BMI) <25 kg/m2). The study was performed on a Siemens Magnetom Prisma 3.0T MR tomograph. The MRI examination protocol included sequences for obtaining T2-weighted images and three-dimensional T1-weighted images to exclude structural pathology of the brain and obtain anatomical data, as well as a sequence for obtaining resting fMRI data.RESULTS. The median age of the subjects was 25 years [24; 26]; the median BMI was 22.5 [20; 24.8]. According to fMRI data, when taking sugar, connections between the temporal zones and the visual cortex are activated, which may reflect enhanced sensory integration and motivational processing of food reward. The sweetener has an effect on functional connectivity; the connection between the structures of the cerebellum, parietal cortex and insular cortex is specifically weakened, which can be interpreted as a decrease in the involvement of integrative sensory-motivational networks active on an empty stomach.CONCLUSION. A dynamic study of brain activity using fMRI showed a different pattern of activation of brain areas when consuming sugar and sweetener.
OBJECTIVE. To investigate postprandial secretion of insulin, peptide YY (PYY), and glucagon-like peptide-1 (GLP-1) following erythritol ingestion in patients with obesity, and to compare these responses with hormonal changes after sucrose intake and combined erythritol–sucrose administration.MATERIALS AND METHODS. Adults aged 18–35 years with class I–II obesity (BMI 30–40 kg/m²) and without carbohydrate metabolism disorders were enrolled. Each participant completed three oral tests on separate days, receiving solutions containing either 75 g sucrose, 75 g erythritol, or 75 g sucrose plus 25 g erythritol, with washout intervals ≥48 hours. Plasma glucose, insulin, PYY, and GLP-1 were measured at baseline and at 30-, 60-, 90-, and 120-minutes post-ingestion. The protocol duplicated our prior study in healthy volunteers, enabling direct comparison of metabolic and incretin responses between the two populations.RESULTS. Erythritol ingestion did not increase plasma glucose or insulin concentrations. Peak glucose after sucrose intake reached 7.55 [6.59; 8.07] mmol/L, compared with 7.20 [7.05; 7.66] mmol/L after the erythritol–sucrose mixture (p = 0.598). No increase in PYY was observed under any test condition. GLP-1 levels at 120 minutes were significantly higher after erythritol ingestion compared with sucrose (p=0.0017).CONCLUSION. In patients with obesity, erythritol does not elevate plasma glucose or insulin levels but enhances GLP-1 secretion, which may contribute to improved satiety signaling and delayed gastric emptying. These data support erythritol as a safe and physiologically appropriate sugar substitute for individuals with obesity.
ВACKGROUND. Obesity and overweight occupy one of the leading places in the structure of morbidity in the population around the world. Of particular relevance is the task of developing effective methods for treating this pathology, including diet therapy using biologically active substances with antioxidant and anti-inflammatory properties.AIM was to study the effect of capsaicinoids on the immune status in a model of nutritional obesity in rats.MATERIALS AND METHODS. The study was carried out on male Wistar rats, which were randomized by body weight into 3 groups (10 animals each, initial body weight 350±10 g). The rats received a semisynthetic standard diet (group 1) and a high-calorie choline-deficient diet (HCChDD) (groups 2 and 3). Animals were intragastrically administered (3.33 ml/kg body weight) 3 times a week sunflower oil (groups 1 and 2) or hot pepper extract (capsaicin — 59%, dihydrocapsaicin — 31%, nordihydrocapsaicin — 4%) in sunflower oil (group 3) in a single dose of 15 mg capsaicinoids/kg body weight. Hematological studies were performed on a Coulter ACT TM 5 diff OV hematological analyzer (Beckman Coulter, USA). The study of the subpopulation composition of lymphocytes was carried out using a flow cytometer FC-500 (Beckman Coulter, USA). The content of cytokines in the blood plasma of rats was determined by multiplex immunoassay using a Luminex 200 analyzer (Luminex Corporation, USA).RESULTS. In rats of the 2nd group, compared with the control, the presence of neutrophilic leukocytosis (1.20±0.13 vs 0.72±0.07 x109/l; p < 0.05). A study of the subpopulation composition of lymphocytes in rats of the 2nd group revealed an increase in the relative content of T-helpers (61.41±1.31 vs 53.30±3.25%; p < 0.05) and the value of the immunoregulatory index (IRI): (1.94±0.15 vs 1.55±0.14; 0.05<p < 0.10) compared to the control group. Administration of capsaicinoids to rats of the 3rd group led to the normalization of these indicators. In animals of the 2nd group, a significant increase in the blood plasma levels of cytokines was found: IFN-γ, IL-1β, IL-5, IL-10, IL-17A, and MCP-1 and a decrease in the content of IL-2 and TNF-α according to compared with the control group. Capsaicinoids administered to rats of group 3 provided an increase (p < 0.05) in the levels of: IL-2, IL-4, IL-5, IL-6, IL-10, IL-17A, MIP-1α and TNF-α and a decrease (p < 0.05) in the content of IL-12(p70) and MIP-2 compared to groups 2 and 1. Due to this influence, the median ratio of the level of IL-10 to IL-12(p70) increased significantly (1.52 vs 0.29 and 0. 23), but the median IL-10/17A remained significantly lower than the control value (1.54 vs 3.07).CONCLUSION. The anti-inflammatory effect of capsaicinoids in the extract of hot capsicum on nutritional obesity in rats has been established.
BACKGROUND: Obesity and hyperuricemia (HU) as metabolically and genetically similar conditions with a single list of comorbid diseases are of serious concern to the global scientific community.AIM: to assess the incidence of GU and the severity of insulin resistance with different levels of fat content in comparison with BMI levels and obesity stages in working patients.MATERIALS AND METHODS: A cross-sectional, single-center study included 458 working patients observed in the private healthcare institution "KB "RZhD-Medicine" in Yaroslavl. BMI, laboratory blood test results (glucose, uric acid, triglycerides, cholesterol, high-density lipoproteins), data on existing chronic diseases, and a photoplethysmographic marker of insulin resistance were recorded. The obesity stage was determined based on the presence/absence of fasting hyperglycemia, hypertriglyceridemia, decreased HDL-C, and comorbidity data. Statistical processing of the results was performed using the Statistica13 program.RESULTS: Assessment of obesity by ABCD stages demonstrated the prevalence of metabolically unhealthy obesity (OB stages 1 and 2) in 64.8% of patients (OB1 — in 40.8% of subjects and OB 2 — 24.0%). HU occurs in metabolically unhealthy obesity more often at the second stage than at the first in men by 2.2 times, in women by 2.7 times, and relative to individuals with normal body weight, this ratio is 5.6 and 9.04 times. Photoplethysmographic marker of insulin resistance increased from the group with normal body weight to OB stage 2. Pathological level of photoplethysmographic marker of insulin resistance in men with OB stage 2 was detected more often by 1.4 times compared to OB 0 and by 2.25 times relative to OB stage 1, in women — by 2.2 and 2.1 times, respectively.CONCLUSION: Metabolically neutral accumulation of fat mass (overweight and obesity stage 0) is very rare in the modern population of outpatient working patients (5.4–3.35%, respectively). Surrogate markers of insulin resistance are determined even with metabolically neutral variants of excess adipose tissue accumulation and reach a prevalence of more than 50% in stage 2 obesity. Hyperuricemia is practically not found in metabolically neutral variants of excess body fat and can act as a cheap routine marker of metabolic distress and a criterion for the effectiveness of preventive interventions.
BACKGROUND: Diseases, which pathogenesis is based on iron overload - hereditary hemochromatosis, β-thalassemia, porphyria cutanea tarda - are associated with type 2 diabetes mellitus; this suggests the role of excess iron in the formation of carbohydrate metabolism disorders (CMD). The question of the possibility and informative content of using traditional ferrokinetics parameters as predictors and markers for diagnosing various CMD remains debatable.AIM: To establish relationships between ferrokinetics markers and indicators of carbohydrate metabolism in overweight and obese individuals. The scientific hypothesis is that disturbances in ferrokinetics, such as dysmetabolic iron overload, influence the risk of induction and progression of CMD, regardless of body mass index.MATERIALS AND METHODS: Patients underwent anthropometry, blood sampling with the determination of a detailed biochemical analysis, lipid spectrum analysis, a detailed general blood test and biochemical indicators of iron metabolism. Taking into account the technical capabilities of the device, a number of patients included in the study underwent T2*-magnetic resonance relaxometry of the liver.RESULTS: The study included 108 patients, stratified into groups depending on the presence of CMD (without CMD, with impaired glucose tolerance (IGT) and with T2DM), as well as depending on the iron metabolism (with relatively high and relatively low ferritin levels). Ferritin levels were significantly higher in patients with T2DM than in patients with IGT (298.10 [145.80–336.95] and 124.00 [58.30–170.55] ng/ml, respectively, p=0.029) and persons without CMD (59.80 [24.10–108.85] ng/ml, p=0.002), and significantly higher in persons with IGT compared to patients without CMD (p=0.035). Patients with ferritin levels above the 75th percentile had higher glycated hemoglobin levels (HbA1c) (5.8 [5.3–6.6] and 5.4 [5.2–5.7]%, respectively, p=0.016). Ferritin was highly informative in the diagnosis of T2DM: sensitivity 77.8%, specificity 91% with a diagnostic threshold of 208.1 ng/ml (area under the curve = 0.813; p=0.002). In diagnosing IGT ferritin had a high sensitivity of 75% and specificity of 84.4%, but with a lower diagnostic threshold of 126.65 ng/ml (area under the curve = 0.738; p=0.016).CONCLUSION: The level of hyperferritinemia increases as dysglycemia progresses. Ferritin is a promising marker that is highly informative in the diagnosis of various carbohydrate metabolism disorders.
In the history and current status of Russian endocrinology, the personality of Academician Ivan Ivanovich Dedov occupies a special place. This article presents the unique contribution of the founder and President of the State Research Centre of the Russian Federation, the National Medical Research Centre for Endocrinology of the Ministry of Health of the Russian Federation (hereinafter referred to as the Endocrinology Research Center, ERC, Centre), the Chief External Endocrinologist of the USSR and the Russian Federation, Academician of the Russian Academy of Sciences I.I. Dedov, to the development of fundamental and clinical endocrinology, primarily in terms of providing high-quality specialized care to citizens with metabolic disorders of the endocrine glands (obesity and diabetes mellitus). The article was prepared as part of a historical and scientific research project dedicated to the 100th anniversary of the Endocrinology Research Centre, with a focus on the contributions of Academician I.I. Dedov as a world-class theoretical scientist, talented clinician, and effective healthcare organizer and manager.
BACKGROUND: Androgen deficiency associated with type 2 diabetes mellitus (T2DM) is one of the components of the metabolic syndrome, which is followed by visceral obesity. The pathogenetic features of the functioning of adipose tissue in patients with a combination of pathologies such as T2DM and hypogonadism have been studied extremely little.AIMS: To measure the effect of testosterone (T) deficiency on metabolic parameters and secretory activity of adipose tissue in men suffering from T2DM.MATERIALS AND METHODS: Patients with T2DM and hypogonadism were subjected to a series of general clinical studies, studied the degree of disturbance of carbohydrate and lipid metabolism, as well as the lipid accumulation index LAP, and also the level of hormones produced by adipose tissue (resistin, adiponectin and leptin) and sex hormones.RESULTS: The study involved 276 male patients with T2DM (aged 54.0 (8.0) years), divided into 2 groups: group 1 consisted of patients with hypogonadism (n=124); 2nd — eugonadal patients (n=152).Along with insulin resistance, men suffering from T2DM in combination with hypogonadism have hyperinsulinemia and dyslipidemia, more significant disturbances in the secretory activity of adipose tissue: an increase in leptin concentration by 18.4% (p=0.03), resistin by 2 times (p < 0.001), and a 1.7-fold decrease in the level adiponectin (p=0.006). This pattern clearly demonstrates the fundamental importance T deficiency in men with T2DM in the formation of metabolic disorders, as well as dysfunction of adipose tissue.CONCLUSIONS: Decreased T production in patients with T2DM worsens the disturbance of carbohydrate and lipid metabolism, and also the dysfunction of adipose tissue, the main pathophysiologic basis for cardiometabolic diseases.
BACKGROUND. Cushing disease (CD) is a severe neuroendocrine disorder caused by excessive secretion of adrenocorticotropic hormone by a pituitary adenoma. This disorder leads to hypercortisolism and systemic complications (obesity, hypertension, osteoporosis, etc.), which significantly increase mortality and reduce quality of life. Epidemiological data on CD vary depending on the assessment methods, making it difficult to determine the true prevalence.AIM. To analyze the epidemiological and clinical characteristics of CD using data from the Russian database of hypothalamic and pituitary tumors (OGGO).MATERIALS AND METHODS. The study was conducted using the OGGO clinical and epidemiological monitoring database in Russian Federation, which includes 84 regions, with date of analysis January 1, 2025. The OGGO database has been created in 2006, and has been available as online resource since 2013.RESULTS. As of January 1, 2025, the OGGO database included 986 patients with CD. The average prevalence of CD in the Russian Federation was 0.7 per 100,000 population: the highest prevalence was observed in the Republic of Karelia (2.5/100,000), Chukotka Autonomous Okrug (2.1/100,000), and Tver Oblast (1.8/100,000). The sex ratio (m:f) was 152 (15.4%):834 (84.6%). The median age was 52 years [42.1; 63.6]. The median time from symptom onset to diagnosis was 22.2 months [4.1; 57.0]. At the time of the last visit, remission was achieved in 58.6% of patients.CONCLUSIONS. The OGGO database is a valuable tool for monitoring and studying CD in Russia. The results confirm significant variability in the prevalence of CD in Russian Federation and the need for training and awareness-raising among physicians, which will contribute to improved diagnostics, reduced time to diagnosis, and optimized treatment.
