Nonalcoholic fatty liver disease (NAFLD) is a term describing excessive accumulation of fat in hepatocytes, and is associated with metabolic syndrome and insulin resistance. NAFLD prevalence is on increase and goes in parallel with the increasing prevalence of metabolic syndrome and its components. That is why Croatian guidelines have been developed, which cover the screening protocol for patients with NAFLD risk factors, and the recommended diagnostic work-up and treatment of NAFLD patients. NAFLD screening should be done in patients with type 2 diabetes mellitus, or persons with two or more risk factors as part of metabolic screening, and is carried out by noninvasive laboratory and imaging methods used to detect fibrosis. Patient work-up should exclude the existence of other causes of liver injury and determine the stage of fibrosis as the most important factor in disease prognosis. Patients with initial stages of fibrosis continue to be monitored at the primary healthcare level with the management of metabolic risk factors, dietary measures, and increased physical activity. Patients with advanced fibrosis should be referred to a gastroenterologist/ hepatologist for further treatment, monitoring, and detection and management of complications.

Colorectal cancer is a malignant neoplasm which has an increasing incidence and represents a global public health problem. The majority of patients are diagnosed after the age of 50, and the risk of developing it over lifetime is 5%. Development of preventive, diagnostic and treatment methods has resulted in a significant reduction in mortality and other negative clinical outcomes. Precisely because of the efficient method of prevention and early detection of this disease, numerous countries, including Croatia, have organized national colorectal cancer screening and monitoring programs. However, these programs are primarily organized for the population with the usual, i.e. average risk of developing colorectal cancer. High-risk groups include persons with endoscopically detected and removed colon polyps, persons surgically treated for colon cancer, persons with a positive family history of colorectal cancer, persons with inflammatory bowel diseases, individuals and families with hereditary disorders or genetic mutations that increase the risk of this disease several fold, persons with acromegaly, and patients who have undergone ureterosigmoidostomy. Recommendations for the detection and monitoring of high-risk groups are often not defined clearly, and some of the existing ones are based mostly on scarce scientific evidence. It is commonly accepted that screening in high-risk groups should start at an earlier age, with shorter intervals between follow-ups. The basic diagnostic method for screening and monitoring in these patient groups is endoscopic monitoring, or colonoscopy. The aim of this review paper is to present the characteristics of the abovementioned risk groups and provide clear screening recommendations.

Nealkoholna bolest masne jetre (engl. nonalcoholic fatty liver disease, NAFLD) označava prekomjerno nakupljanje masti unutar hepatocita, a povezana je s metaboličkim sindromom i inzulinskom rezistencijom. Učestalost NAFLD-a je u porastu i prati rastuću učestalost metaboličkog sindroma i njegovih komponenata. Stoga su izrađene hrvatske smjernice koje obuhvaćaju postupnik probira bolesnika s rizičnim čimbenicima za NAFLD te preporučenu dijagnostičku obradu i liječenje bolesnika s NAFLD-om. Probir na NAFLD potrebno je raditi bolesnicima s dijabetesom tipa 2 ili osobama s dva ili više rizičnih čimbenika u sklopu metaboličkog sindroma, a probir se izvodi neinvazivnim laboratorijskim i slikovnim metodama za otkrivanje fibroze. Obradom bolesnika potrebno je isključiti postojanje drugih uzroka oštećenja jetre te utvrditi stadij fibroze kao najvažnijeg čimbenika u prognozi bolesti. Bolesnici s početnim stadijima fibroze nastavljaju se pratiti na razini primarne zdravstvene zaštite uz liječenje metaboličkih rizičnih čimbenika, dijetetske mjere i pojačanu tjelesnu aktivnost. Bolesnike sa značajnom fibrozom preporuča se uputiti gastroenterologu/hepatologu radi daljnjeg liječenja, praćenja te prepoznavanja i zbrinjavanja komplikacija bolesti.

Kolorektalni karcinom zloćudna je novotvorina incidencija kojega je u stalnom porastu i koja predstavlja globalni javnozdravstveni problem. U većine bolesnika ova se bolest dijagnosticira nakon 50. godine života, a rizik od njenog razvoja tijekom životnog vijeka iznosi oko 5%. Razvoj preventivnih, dijagnostičkih i terapijskih metoda rezultirao je značajnim smanjenjem smrtnosti i drugih negativnih kliničkih ishoda. Upravo zbog učinkovite metode prevencije i ranog otkrivanja ove bolesti u brojnim državama pa tako i u Republici Hrvatskoj organizirani su nacionalni programi probira i praćenja kolorektalnog karcinoma. Međutim, navedeni su programi prvenstveno organizirani za populaciju s uobičajenim, odnosno prosječnim rizikom obolijevanja od kolorektalnog karcinoma. Visokorizične skupine obuhvaćaju osobe u kojih su endoskopski otkriveni, odnosno uklonjeni polipi debelog crijeva, osobe kirurški liječene zbog karcinoma debelog crijeva, osobe s pozitivnom obiteljskom anamnezom za kolorektalni karcinom, osobe oboljele od upalnih bolesti crijeva, pojedinci i obitelji s nasljednim poremećajima, odnosno genetskim mutacijama koje višestruko povećavaju rizik za razvoj ove bolesti, osobe oboljele od akromegalije te bolesnici u kojih je učinjen zahvat ureterosigmoidostomije. Preporuke za otkrivanje i praćenje visokorizičnih skupina često nisu jasno definirane, a neke od postojećih se temelje na uglavnom oskudnim znanstvenim dokazima. Opće je prihvaćeno mišljenje da bi probir u visokorizičnih skupina trebao započeti u ranijoj životnoj dobi uz kraće vremenske intervale između pojedinih pregleda. Osnovna dijagnostička metoda probira i praćenja u ovih skupina bolesnika je endoskopsko praćenje, odnosno kolonoskopija. Cilj ovoga preglednog rada je prikazati značajke navedenih rizičnih skupina i dati jasne preporuke za probir.

Purpose The present study investigates the differences in physical health-related quality of life (HRQoL) among overweight and obese people, as well as the correlates of HRQoL in this population and the association between BMI, depression, anxiety, and potential mediating effects of HRQoL.Methods The research was conducted on a sample of overweight and obese adults who visited their primary care physician. A total of 143 women and 130 men were enrolled in the study, 43 % of the subjects were overweight, and 57 % of the subjects were obese. The subjects ranged in age between 21 and 60 years. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, and HRQoL was evaluated using the Medical Outcome Study Short-Form 36.Results The analysis of variance results showed that women in comparison to men have lower physical HRQoL (e.g. worst physical functioning, more bodily pain), and that severely obese patients have lower physical HRQoL in comparison to overweight ones. The regression analysis results indicated that some of the aspects of physical HRQoL (e.g. physical functioning, role limitations) mediate the relationship between BMI and depression only in women. The higher level of body mass decreased the physical HRQoL, which became a potential risk factor for the development of depressive symptoms.Conclusions The results from the present study show that a different pattern of functioning exists between men and women. It is important to identify the factors that can effectively motivate and stimulate obese people to change their lifestyle and to consider the differences in psychological functioning between women and men.

The aim of the study was to analyse psychological characteristics and medical parameters in obese and overweight to identify the possible psychosocial consequences of obesity that may occur along with the numerous medical problems associated with excess body weight. Analysis was made on 296 patients (103 males and 193 females, median age 50, range 16-81) divided in three groups, depending on their Body mass index (BMI). Group I included 41 patients with BMI ranging from 25 to 29.9, group II included 170 patients with BMI from 30 to 34.9, and group III 85 patients with BM > or =35. We compared medical (glucose, cholesterol, triglycerides, HDL-cholesterol, systolic and diastolic blood pressure, body fat percentage) and psychological parameters (anxiety, depression, pros and cons of losing weight, self efficacy and four stages of change) in the patients included in the study. Univariate analysis has shown statistically significant difference among obese and overweight patients in goal weight, systolic and diastolic blood pressure, body fat percentage, glucose and cholesterol serum level. People with higher BMI (>30) found more advantages (pros) over disadvantages (cons) of weight loss but the level of anxiety and depression did not differ significantly among those 3 groups of patients. The results have shown that overweight and obese people have serious medical problems. They also differ in some psychological characteristics which have to be taken into consideration. Therefore, approach to these patients should be multidisciplinary, including dietary care, physical activity, psychological and medical care.

Povisena razina homocisteina u plazmi (Hcy) povezana je s fizioloskim i prehrambenimcimbenicima, kao i genetskim defektom enzima koji su ukljucen

Because of the increasing number of patients, chronic kidney disease (CKD) has become a signifi cant public health problem. As kidney function decreases, it is necessary to introduce certain dietary modifi cations. The aim was to investigate what is the appropriate approach to diet of CKD patients, which could contribute to slowing down progression of the disease. Dietary recommendations are individual for each patient, but also vary in the same patient depending on the stage of disease progression because special attention must be paid to appropriate intake of macronutrients (protein, carbohydrates and fats), micronutrients (sodium, potassium, calcium, phosphorus, zinc, selenium, various vitamins), and water. In newly diagnosed patients, it is necessary to assess their nutritional status and energy requirements. It has been shown that protein-energy malnutrition, muscle loss and cachexia are strong predictors of mortality in CKD. Comparing different dietary approaches in everyday life of patients suffering from CKD, it was found that the most effective diet is Mediterranean food style. Studies confi rm that Mediterranean diet has a preventive effect on renal function and reduces progression of the disease. Preventive measures, correct identifi cation and early intervention can increase survival of patients and improve their quality of life. Mediterranean diet tailored to individual stages of CKD has been confi rmed as the best choice in CKD patients.

During last several decades, epidemiologists have described prevalence of obesity in different parts of the world from 1.5-3.9% (Thailand) to 12%(USA). The prevalence of obesitiy is usually greater among women than men, and is greater today than in past decades.The psychosocial consequences of obesity are not the inevitable consequences of obesity but derive from culture-bound values by wich people view body fat as ugly and unhealthy. Obese persons must also contend with discrimination, the behavioral enactment of prejudice. Many obese persons suffer from psychological problems specific to obesity, including disparagement of the body image and binge eating. This study assesed whether a model of the stages of change could distinguish which patients, male or female, with different level of BMI are most likely to persist in dieting and predict those who will lose weight.The present data showed that contemplation can be critical for the therapy and for the process of change. Contemplation is paradoxical stage of change, since the patient is open to the possibility of change, but is stopped by ambivalence. The characteristic style of the contemplator is yes, but.... For this reason contemplation generates anxiety and it is present in greater measure in patients with higher BMI. Sometime the long time spent in the treatment can cause anxiety and lowered mood.