Obesity is a complex multifactorial pathology associated with a complex of metabolic, cellular, cardiovascular factors leading to extremely negative health consequences, which determines the high social significance of this nosology. Telemedicine technologies are being widely implemented in practical healthcare, including can be used for many obese patients. Currently, the true prevalence of obesity is not reflected in the forms of statistical registration of diseases and, often, is not considered by doctors as the main cause of the development of cardiovascular diseases, carbohydrate metabolism disorders and diseases of the musculoskeletal system. The underestimation of the problem of obesity is also reflected in the structure of telemedicine consultations with a specialized endocrinological research center

Morbid obesity is a pathology associated with a complex of metabolic disorders, type 2 diabetes mellitus, and cardiovascular diseases, leading to extremely negative health consequences, which necessitates a multidisciplinary approach. The presented clinical case is an example of a combination of primary (exogenous-constitutional) obesity with two other endocrine diseases, and it demonstrates the importance of determining the optimal treatment tactic for a patient with morbid obesity, taking into account his concomitant diseases. Step-by-step patient treatment was carried out by a team of therapeutic and surgical specialists

Currently, increasing evidence shows the mutual influence of aldosterone and adipose tissue. Aldosterone excess has been reported in patients with obesity and metabolic syndrome. Aldosterone has a direct effect on adipose tissue increasing anabolic activity and expression of mineralocorticoid receptors. In turn, excessive activation of MCR leads to stimulation of adipogenesis and an increase in the volume of adipose tissue. Aldosterone excess can be considered an independent cardiovascular risk factor that affects such processes as cardiac fibrosis, nephrosclerosis, and arteriosclerosis. There is convincing evidence of higher prevalence and severity of impaired glucose homeostasis and lipid metabolism disorders among patients with primary hyperaldosteronism. Similar pathological changes are also observed in patients with obesity and metabolic syndrome. This review presents scientific data on the metabolic effects of aldosterone, in particular its effect on adipose tissue function, glucose and lipid metabolism. Treatment with mineralocorticoid receptor antagonists may provide substantial benefit in the management of metabolic syndrome, contribute to the stabilisation of glucose and lipid metabolism, improve clinical status of patients with cardiovascular diseases and reduce the risk of complications. However, available evidence from the conducted studies is not sufficient to justify introduction of such therapy into clinical practice.

BACKGROUND: Overweight and obesity have a significant impact on the course and results of treatment of many diseases, including cancer. One of the modern types of antitumor therapy is immune checkpoint inhibitors. Taking into account the high effectiveness of immune checkpoint inhibitors for various types of tumors, it seems interesting to study the initial anthropometric data of patients and assess the possible influence of nutritional status on the development of endocrine immune-mediated adverse events.AIM: To compare groups of patients with different starting body mass index (BMI) before the first administration of the immune checkpoint inhibitors drug and analyze the risk of developing endocrine immune-mediated adverse events in the future.MATERIALS AND METHODS: The single-center study included 172 patients who were recommended antitumor therapy immune checkpoint inhibitors at the N.N. Blokhin National Medical Research Center of Oncology and Moscow City Oncology Hospital №62 in 2020–2022. Measurement of height and body weight with further calculation of BMI was carried out before the first administration of the drug immune checkpoint inhibitors.Depending on the subsequent occurrence of immune-mediated adverse events, patients were divided into groups: those with developed immune-mediated adverse events (any, cutaneous, thyroid) and those without immune-mediated adverse events (any, cutaneous, thyroid).RESULTS: According to the results of our study, in 38 patients (37.3%) out of 102, for whom data on the presence/absence of any immune-mediated adverse events were obtained, the following were recorded: thyropathies (n=13, 12.7%), skin lesions (n=13, 12.7%), gastrointestinal toxicity (n=7, 6.9%), hepatotoxicity (n=4, 3.9%), hypophysitis (n=2, 2%), nephritis (n=2, 2%), diabetes mellitus (DM) (n=1, 1%), hematological toxicity (n=1, 1%), pneumonitis (n=1, 1%), Guillain-Barré syndrome (n=1, 1%). At the same time, in most patients only one immune-mediated adverse event was encountered (n=31, 81.6%), two immune-mediated adverse events were detected significantly less frequently (n=7, 18.4%).When conducting a comparative analysis of groups of patients with developed immune-mediated adverse events, including dermatological ones, or their absence, a statistical trend in differences in BMI was obtained. Using ROC analysis, a BMI cut-off point was determined equal to 28.16 kg/m² for all immune-mediated adverse events and 25.39 kg/m² for skin immune-mediated adverse events, below which, contrary to the available data, the risk of developing immune-mediated adverse events increased, but the diagnostic sensitivity (DS) and diagnostic specificity (DS) turned out to be low.CONCLUSION: We identified a statistical trend in the risk of developing immune-mediated adverse events (primarily dermatological) with a lower BMI before the start of antitumor immunotherapy immune checkpoint inhibitors. More research is required to find a more reliable relationship.

The prevalence of obesity and type 2 diabetes continues to grow, which determines the need to develop new methods of prevention in order to reduce the population risks of developing these diseases. The current direction is to limit the consumption of easily digestible carbohydrates and use low-calorie or non-calorie sweeteners instead. Currently, there is an increase in the use of non-calorie sweeteners in the manufacture of food. In this regard, the study of their possible effects on metabolic processes is of great importance.This review presents studies that have shown different effects of non-calorie sweeteners on carbohydrate and fat metabolism, body weight, the composition of intestinal microbiota, as well as the regulation of eating behavior. Some studies show that low-calorie sugar substitutes can be used in obese people as part of a comprehensive weight loss program, as well as in patients with type 2 diabetes mellitus with the aim of reducing postprandial hyperglycemia. Other studies demonstrate the negative effect of a number of low-calorie sweeteners on carbohydrate metabolism.The main search for materials was carried out in Pubmed databases, eLIBRARY.ru, Google Scholar. Temporary search criteria 2012–2023 The relevant additional literature was included after a manual search in the literature lists of the included articles.

AIM. To study the effect of the non-calorie sweetener erythritol and the combination of erythritol and sucrose on postprandial secretion of insulin and peptide-YY (PYY).MATERIALS AND METHODS. A comparative study was conducted to assess the effect of erythritol, sucrose and a combination of erythritol and sucrose on postprandial glucose, IRI and PYY levels. The participants were selected from among healthy volunteers, aged 18 to 35 years. If the participants met the selection criteria, further stages of the study were carried out. During the study, each participant took a solution of sucrose 75 g, erythritol 75 g or a mixture of sucrose and erythritol (75 g and 25 g, respectively). Further determination of glucose and insulin was carried out every 30 minutes, so glucose, insulin and PYY values were determined initially and at the 30th, 60th, 90th and 120th minutes.RESULTS. Data were obtained confirming the absence of the effect of erythritol on postprandial secretion of insulin and glucose. In our work, we also demonstrated a decrease in postprandial glycemia when taking sucrose and erythritol together. Sucrose and erythritol equally stimulated PYY secretion.CONCLUSION. Our data show that erythritol can be considered as an optimal sugar substitute in people with impaired carbohydrate metabolism and obesity.

Non-alcoholic fatty liver disease (NAFLD) is a liver disease with a characteristic accumulation of fatty inclusions in hepatocytes and includes a spectrum of liver lesions from steatosis to cirrhosis. In view of the increasing incidence of obesity and associated NAFLD, a search is underway for optimal treatments. The authors analyzed published clinical studies on the effect of bariatric surgery on morphological changes in the liver. The literature was searched for the keywords «non-alcoholic fatty liver disease», «obesity», «bariatric surgery» in Pubmed databases and еLibrary.ru for the period from 1990 to 2022 . Both the positive effects of surgical treatment of obesity in the form of a decrease in steatosis, steatohepatitis of the liver, and adverse effects in the form of aggravation of cirrhosis in patients after surgery are considered. Despite the obvious effectiveness of bariatric surgery in relation to the components of the metabolic syndrome associated with obesity, there is still no unambiguous opinion about their effectiveness in relation to NAFLD.

Surgical treatment in the scope of laparoscopic gastric bypass for morbid obesity and type 2 diabetes mellitus (DM 2) with careful preoperative preparation, a gradual expansion of the diet with the obligatory observance of the recommendations of a nutritionist on the balance of micro- and macronutrients, a gradual increase in the amount of available physical activity in the postoperative period allows not only significantly reduce body weight, but also achieve compensation for obesity-related diseases. The expected development of micro- and macronutrient deficiencies requires an active search for and compensation for these conditions both at the pre- and postoperative stages. The development of postbariatric hypoglycemia confirms the need to comply with dietary recommendations not only at the stage of conservative treatment of obesity and DM 2, but also, no less important, after bariatric surgery.

BACKGROUND : The steadily increasing number of people with obesity requires the development of simple and accurate methodological approaches to assess the absolute and relative amount of body fat mass. The body adiposity index (BAI) is one of the indices proposed to assess the body fat percentage. However, the comparison analysis of common methods, i.e., of bio-electrical impedance analysis and ultrasound scanning, and BAI was not performed for the Russian population. AIM : Comparison analysis of the body fat percentage estimates by bio-electrical impedance analysis, ultrasound scanning, and body adiposity index in the group of adult male and females. MATERIALS AND METHODS : An examination of healthy males and females from Moscow was conducted. Height, weight, waist and hip circumferences were measured. The body fat percentage was obtained by bio-electrical impedance analysis — BIA (ABC-02 Medas), ultrasound scanning — US (BodyMetrixTM, IntelaMetrix), and body adiposity index. RESULTS : 263 females and 134 males aged 18 to 73 years participated in the study. Correlation coefficients between BAI values and the body fat percentage obtained by BIA and US were 0.749 and 0.763 (p<0.000), respectively. Comparison of body fat percentage measurements obtained by BAI, BIA and US showed the low agreement ( ССС <0.90) between BAI and other methods in pooled sample as well as in the female and male groups. Comparison of the US and BAI methods revealed higher level of agreement ( ССС = 0.84 [0.80–0.86]) and no systematic bias. Lower level of agreement was obtained in the group of males. CONCLUSION : Conducted study allows to conclude that, at the individual level, BAI is not an appropriate method for estimating the body fat percentage relatively to other indirect methods. However, all three methods can be used in the group of pooled males and females when testing at the population level.

ВЛИЯНИЕ ЛАПАРОСКОПИЧЕСКОГО МИНИ-ШУНТИРОВАНИЯ НА КОМПЕНСАЦИЮ УГЛЕВОДНОГО ОБМЕНА У БОЛЬНЫХ С МОРБИДНЫМ ОЖИРЕНИЕМ И САХАРНЫМ ДИАБЕТОМ 2 ТИПАКим Е .И

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guide-lines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

The obesity epidemic has led to the growing number of bariatric operations and the expansion of indications for this operation as the most effective method of treatment, that’s why endocrinologists are increasingly faced the challenge of late complications, including postbariatric hypoglycemia. Postbariatric hypoglycemia is a rare but severe metabolic disorder that occurs months or years after upper gastrointestinal surgery. Postbariatric hypoglycemia can be accompanied by severe clinical symptoms and lead to disability and decreasing of the life’s quality. It is difficult to assess the prevalence of hypoglycemia after bariatric surgery due to the lack of clear diagnostic criteria, often a hidden clinical picture and ignorance of doctors and patients about this complication. Hypoglycemia in this case has postprandial and hyperinsulinemic nature. The mechanisms of development of this complication have recently been actively discussed. The exchange of incretins and dysregulation of insulin secretion are the subject of constant research in this area. Understanding the mechanisms of development of this condition makes it possible to develop optimal methods of diagnosis and treatment. The issues of pathophysiology, basic principles of diagnosis and treatment of post-bariatric hypoglycemia will be considered in this review.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года БАРИАТРИЧЕСКИЙ ПАЦИЕНТ: ПОСЛЕОПЕРАЦИОННЫЙ МОНИТОРИНГ Ершова Е .В ., Комшилова К

Background : The Republic of Tyva is a region with a proven severe natural iodine deficiency and a high prevalence of IDD (iodine deficiency disorders). However, in the region in certain periods of time, measures were taken to eliminate iodine deficiency in the diet of the population. The article presents the results of the October 2020. by specialists of the Endocrinology Research Centre, a control and epidemiological study aimed at assessing the current state of iodine supply in the population of the Republic of Tyva. The study was carried out on behalf of the Ministry of Health of Russia within the framework of the state task «Scientific assessment of the need to take additional regulatory legal and other measures to eliminate iodine deficiency in pilot regions with severe iodine deficiency». Aim : Assessment of iodine supply of the population of the Republic of Tuva. Materials and methods : The research was carried out in three settlements of the republic — years. Kyzyl, Shagonar, Saryg-Sep settlement. A total of 227 pre-pubertal schoolchildren (8–10 years old) were examined with anamnesis collection, examination by an endocrinologist, palpation of the thyroid gland, collection of single urine samples into disposable eppendorfs, followed by freezing to minus 20–25 degrees to further determine the concentration of iodine in urine with using the cerium-arsenitic method in the laboratory (clinical diagnostic laboratory of the Federal State Budgetary Institution «National Medical Research Center of Endocrinology» of the Ministry of Health of Russia). In addition, all schoolchildren underwent an ultrasound examination of the thyroid gland (using a portable ultrasound machine LOGIQe (China) with a multifrequency linear transducer 10–15 MHz, in the supine position). The height and weight of children was determined according to the standard method at the time of the examination. A collection of samples of edible salt, which is used in families of schoolchildren, was carried out and the presence of iodine in it was determined by an express method for the qualitative determination of potassium iodate. Parents of schoolchildren signed informed consent for the examination of children. Permission of the local ethical committee of the Endocrinology Research Centre — received, date: March 25, 2020, N 5. Results : 227 schoolchildren of 8–10 years old were examined. The median concentration of iodine in urine was determined, the presence of iodine in food salt was investigated, and an ultrasound examination of the thyroid gland was carried out in order to clarify the iodine supply, the coverage of the use of iodized salt in nutrition and the prevalence of goiter. The median concentration of iodine in urine was 153 μg/l, the frequency of goiter was 7.7%, and the proportion of households using iodized salt was 95.2%. Conclusion : Results of assessment (median urinary iodine concentration) confirm that population of Tuva, Russian Federation, has optimum iodine nutrition. The prevalence of goiter in schoolchildren significantly decreased compared to earlier assessments. The proportion of households using iodized salt indicates the effectiveness of preventive measures in the ­region.

The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ДИСФУНКЦИЯ ЩИТОВИДНОЙ ЖЕЛЕЗЫ НА ФОНЕ ТЕРАПИИ ИНГИБИТОРАМИ КОНТРОЛЬНЫХ ТОЧЕК ИММУННОГО ОТВЕТА 1 Мазурина Н .В ., 1 Глибка А .А ., 1 Трошина Е .А ., 2 Локтионов К .К ., 2 Харкевич Г